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News Article | February 28, 2017
Site: www.eurekalert.org

Teens and young adults with type 2 diabetes develop kidney, nerve, and eye diseases - as well as some risk factors for heart disease - more often than their peers with type 1 diabetes in the years shortly after diagnosis. The results are the latest findings of the SEARCH for Diabetes in Youth study, published Feb. 28 in the Journal of the American Medical Association. Funded by the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC), SEARCH researchers examined how quickly and often youth developed signs of kidney, nerve and eye diseases, among the most common complications of diabetes. They also measured several risk factors for heart disease. Participants had diabetes an average of under eight years at the end of the study. Though youth with type 2 diabetes showed signs of complications more often in nearly every measure than their peers with type 1, many youth in both groups developed complications. "There's often the assumption that young people don't develop complications from diabetes, but that's just not true. We saw that young people with diabetes are developing signs of major complications in the prime of their lives," said Dr. Barbara Linder, a study author and senior advisor for childhood diabetes research within the NIH's National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). "Particularly for youth with type 2, this research demonstrates the clear need to learn how to reduce or delay the debilitating complications of diabetes, itself a huge challenge for young people to manage." SEARCH examined 1,746 youth with type 1 diabetes (averaging about 18 years old) and 272 with type 2 diabetes (average age about 22) between 2002-2015. All were diagnosed before age 20. Youth were identified at five clinical centers - Kaiser Permanente Southern California in Pasadena, University of Colorado in Denver, Cincinnati Children's Hospital Medical Center, University of North Carolina at Chapel Hill, and Seattle Children's Hospital. Wake Forest University in Winston-Salem, North Carolina, served as coordinating center. The researchers looked at factors including glucose control, body mass index, waist-to-height ratio and blood pressure, but no factor could explain why people with type 2 developed more complications than counterparts with type 1. By about age 21, about 1/3 of participants with type 1 diabetes and about 3/4 of participants with type 2 had at least one complication from diabetes or were at high risk for a complication. "This study highlights the need for early monitoring for development of complications among young people with diabetes," said Dr. Sharon Saydah, senior scientist at CDC and an author on the paper. "If young people can delay onset of these complications from diabetes by even a few years, that can ease their burden and lengthen their lives." Type 1 diabetes typically develops in young people. In type 1, the body does not make insulin, a hormone needed to live. In type 2 diabetes, the body does not make enough insulin or does not use insulin well. In the past, type 2 diabetes was extremely rare in youth, but occurrences have risen alongside the obesity epidemic. Find health information on diabetes at https:/ . About the CDC: CDC works 24/7 saving lives and protecting people from health threats to have a more secure nation. Whether these threats are chronic or acute, manmade or natural, human error or deliberate attack, global or domestic, CDC is the U.S. health protection agency. The NIDDK, part of the NIH, conducts and supports basic and clinical research and research training on some of the most common, severe, and disabling conditions affecting Americans. The Institute's research interests include: diabetes and other endocrine and metabolic diseases; digestive diseases, nutrition, and obesity; and kidney, urologic, and hematologic diseases. For more information, visit http://www. . About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www. .


Schuetz A.,Armed Forces Research Institute of Medical science United States Component | Schuetz A.,Foundation Medicine | Deleage C.,Frederick National Laboratory for Cancer Research | Sereti I.,National Institute of Allergy and Infectious Diseases | And 37 more authors.
PLoS Pathogens | Year: 2014

Mucosal Th17 cells play an important role in maintaining gut epithelium integrity and thus prevent microbial translocation. Chronic HIV infection is characterized by mucosal Th17 cell depletion, microbial translocation and subsequent immune-activation, which remain elevated despite antiretroviral therapy (ART) correlating with increased mortality. However, when Th17 depletion occurs following HIV infection is unknown. We analyzed mucosal Th17 cells in 42 acute HIV infection (AHI) subjects (Fiebig (F) stage I-V) with a median duration of infection of 16 days and the short-term impact of early initiation of ART. Th17 cells were defined as IL-17+ CD4+ T cells and their function was assessed by the co-expression of IL-22, IL-2 and IFNγ. While intact during FI/II, depletion of mucosal Th17 cell numbers and function was observed during FIII correlating with local and systemic markers of immune-activation. ART initiated at FI/II prevented loss of Th17 cell numbers and function, while initiation at FIII restored Th17 cell numbers but not their polyfunctionality. Furthermore, early initiation of ART in FI/II fully reversed the initially observed mucosal and systemic immune-activation. In contrast, patients treated later during AHI maintained elevated mucosal and systemic CD8+ T-cell activation post initiation of ART. These data support a loss of Th17 cells at early stages of acute HIV infection, and highlight that studies of ART initiation during early AHI should be further explored to assess the underlying mechanism of mucosal Th17 function preservation. © 2014.


Phanuphak N.,Red Cross | Teeratakulpisarn N.,Red Cross | Pankam T.,Red Cross | Kerr S.J.,HIV National | And 12 more authors.
Journal of Acquired Immune Deficiency Syndromes | Year: 2013

Background:: HIV-positive men who have sex with men (MSM) have a higher prevalence of anal human papillomavirus (HPV) infection and anal cancer incidence than HIV-negative MSM. High-risk HPV persistence is an important risk factor for the development of anal cancer. METHODS:: A total of 123 HIV-positive and 123 HIV-negative MSM were enrolled from the Thai Red Cross AIDS Research Centre in Bangkok, Thailand, and followed for 12 months. Anal sample collection for HPV genotyping was performed at every visit. HPV prevalence, incidence, clearance, and persistence were calculated. A logistic regression model was used to study factors associated with high-risk HPV persistence. RESULTS:: The prevalence of any anal HPV infection was 85% in HIV-positive and 58.5% in HIV-negative MSM (P < 0.0001). The prevalence of high-risk HPV infection was 57.5% in HIV-positive and 36.6% in HIV-negative MSM (P = 0.001). HPV 16 was the most common high-risk HPV type. HIV-positive MSM had a higher prevalence (22.5% vs. 9.8%, P = 0.008) and persistence (16.7% vs. 1.3%, P < 0.001) of HPV 16 than HIV-negative MSM and a trend for higher incidence (16.1 vs. 6.1 episodes/1000 person-months, incidence rate ratio 2.6, P = 0.058). HIV infection (odds ratio: 4.45, 95% confidence interval: 2.11 to 9.4, P < 0.001) and smoking in HIV-positive MSM (odds ratio: 2.3, 95% confidence interval: 1.17 to 4.5, P = 0.015) were independently associated with high-risk HPV persistence in multivariate models. CONCLUSIONS:: In addition to targeting HIV-positive MSM who are at higher risk for anal, high-risk HPV persistence, anal cancer prevention programs should also integrate behavioral interventions such as smoking cessation to modify risk for high-risk HPV persistence. © 2013 by Lippincott Williams & Wilkins.


PubMed | Red Cross, SEARCH, Armed Forces Research Institute of Medical science United States Component, U.S. Army and 5 more.
Type: Clinical Trial | Journal: PLoS pathogens | Year: 2014

Mucosal Th17 cells play an important role in maintaining gut epithelium integrity and thus prevent microbial translocation. Chronic HIV infection is characterized by mucosal Th17 cell depletion, microbial translocation and subsequent immune-activation, which remain elevated despite antiretroviral therapy (ART) correlating with increased mortality. However, when Th17 depletion occurs following HIV infection is unknown. We analyzed mucosal Th17 cells in 42 acute HIV infection (AHI) subjects (Fiebig (F) stage I-V) with a median duration of infection of 16 days and the short-term impact of early initiation of ART. Th17 cells were defined as IL-17+ CD4+ T cells and their function was assessed by the co-expression of IL-22, IL-2 and IFN. While intact during FI/II, depletion of mucosal Th17 cell numbers and function was observed during FIII correlating with local and systemic markers of immune-activation. ART initiated at FI/II prevented loss of Th17 cell numbers and function, while initiation at FIII restored Th17 cell numbers but not their polyfunctionality. Furthermore, early initiation of ART in FI/II fully reversed the initially observed mucosal and systemic immune-activation. In contrast, patients treated later during AHI maintained elevated mucosal and systemic CD8+ T-cell activation post initiation of ART. These data support a loss of Th17 cells at early stages of acute HIV infection, and highlight that studies of ART initiation during early AHI should be further explored to assess the underlying mechanism of mucosal Th17 function preservation.


Ananworanich J.,SEARCH | Ananworanich J.,Red Cross | Ananworanich J.,Chulalongkorn University | Fletcher J.L.K.,SEARCH | And 20 more authors.
Retrovirology | Year: 2013

Background: Fourth generation (4thG) immunoassay (IA) is becoming the standard HIV screening method but was not available when the Fiebig acute HIV infection (AHI) staging system was proposed. Here we evaluated AHI staging based on a 4thG IA (4thG staging).Findings: Screening for AHI was performed in real-time by pooled nucleic acid testing (NAT, n=48,828 samples) and sequential enzyme immunoassay (EIA, n=3,939 samples) identifying 63 subjects with non-reactive 2nd generation EIA (Fiebig stages I (n=25), II (n=7), III (n=29), IV (n=2)). The majority of samples tested (n=53) were subtype CRF_01AE (77%). NAT+ subjects were re-staged into three 4thG stages: stage 1 (n=20; 4th gen EIA-, 3rd gen EIA-), stage 2 (n=12; 4th gen EIA+, 3rd gen EIA-), stage 3 (n=31; 4th gen EIA+, 3rd gen EIA+, Western blot-/indeterminate). 4thG staging distinguishes groups of AHI subjects by time since presumed HIV exposure, pattern of CD8+ T, B and natural killer cell absolute numbers, and HIV RNA and DNA levels. This staging system further stratified Fiebig I subjects: 18 subjects in 4thG stage 1 had lower HIV RNA and DNA levels than 7 subjects in 4thG stage 2.Conclusions: Using 4th generation IA as part of AHI staging distinguishes groups of patients by time since exposure to HIV, lymphocyte numbers and HIV viral burden. It identifies two groups of Fiebig stage I subjects who display different levels of HIV RNA and DNA, which may have implication for HIV cure. 4th generation IA should be incorporated into AHI staging systems. © 2013 Ananworanich et al.; licensee BioMed Central Ltd.


Daulaire N.,Norwegian Institute of Public Health | Bang A.,SEARCH | Tomson G.,Karolinska Institutet | Kalyango J.N.,Makerere University | Cars O.,Uppsala University
Journal of Law, Medicine and Ethics | Year: 2015

Universal access to effective antimicrobials is essential to the realization of the right to health. At present, 5.7 million people die from treatable infections each year because they lack this access. Yet, community-based diagnosis and appropriate treatment for many of the leading causes of avoidable infectious deaths has been shown to be feasible and effective, demonstrating that strategies to reach the under-served need to receive high priority. This is a necessary part of a broad strategy to assure the long-term benefits of antimicrobials and to combat antimicrobial resistance, both because the lack of systematic and rigorous efforts to assure effective coverage increases the likelihood of antimicrobial resistance, and because global efforts aimed at antimicrobial stewardship and innovation cannot succeed without explicitly addressing the needs of the under-served. Elements of this strategy will include clear evidence-based treatment protocols, a robust international framework and locally tailored regulations, active engagement with communities and local health providers, strong attention to program management and cost considerations, a focus on the end user, and robust surveillance and response to emerging resistance patterns. Only by balancing the needs of universal access with stewardship and innovation, and assuring that they are mutually reinforcing can a global strategy hope to effectively address antimicrobial resistance. © 2015 American Society of Law, Medicine & Ethics, Inc.


Rungsiyanont S.,Srinakharinwirot University | Vacharotayangul P.,Srinakharinwirot University | Lam-Ubol A.,Srinakharinwirot University | Ananworanich J.,SEARCH | And 7 more authors.
AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV | Year: 2012

Despite the advancement in highly active antiretroviral therapy and improved health status of HIV-infected individuals, dental problems are still affecting their life and well-beings. We aimed to establish the prevalence of oral and dental complaints among HIV-infected patients, the prevalence of delayed access to dental service, and factors related with delayed access to dental service. A cross-sectional study using self-report questionnaire completed by the HIV-positive subjects was conducted at the largest HIV research clinic in Thailand during 2009-2010. Of all 299 subjects (28.6% males, 71% females, and 0.4% sex change from male to female: ages ranged from 22 to 59 years [mean 36.7±5.53)]), 84.3% reported of having past or present illnesses or problems related to the dental or oral conditions. The most reported problems were dental hypersensitivity (93.3%), bleeding from the gum (92.1%), and having dental caries (65.9%). Two-hundred and forty-two subjects (80.9%) would not disclose their HIV status when seeing a dentist. The most cited reasons of such behavior were their personal right whether to reveal or not, and being afraid of not receiving dental treatment from the dentists or staffs (51.7 and 40.9%, respectively). It is important to note that HIV-subjects admitted to having fear of being discriminated by the dental staffs even if they trusted their dentists as having high morality. In conclusion, our HIV-subjects had good basic knowledge of oral health with regard to HIV infection, experienced common dental problems, and wished to have accesses to HIV-dental specialist services, if possible. © 2012 Copyright Taylor and Francis Group, LLC.


Kancheva Landolt N.T.,Red Cross | Lakhonphon S.,SEARCH | Ananworanich J.,Red Cross | Ananworanich J.,Chulalongkorn University
AIDS Research and Therapy | Year: 2011

Sexual behavior of HIV-positive youths, whether infected perinatally, through risky behavior or other ways, is not substantially different from that of HIV-uninfected peers. Because of highly active antiretroviral therapy, increasing number of children, infected perinatally, are surviving into adolescence and are becoming sexually active and need reproductive health services. The objective of this article is to review the methods of contraception appropriate for HIV-positive adolescents with a special focus on hormonal contraceptives. Delaying the start of sexual life and the use of two methods thereafter, one of which is the male condom and the other a highly effective contraceptive method such as hormonal contraception or an intrauterine device, is currently the most effective option for those who desire simultaneous protection from both pregnancy and sexually transmitted diseases. Health care providers should be aware of the possible pharmacokinetic interactions between hormonal contraception and antiretrovirals. There is an urgent need for more information regarding metabolic outcomes of hormonal contraceptives, especially the effect of injectable progestins on bone metabolism, in HIV-positive adolescent girls. © 2011 Kancheva Landolt et al; licensee BioMed Central Ltd.

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