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Landolt N.K.,HIV Netherlands Australia Thailand Research Collaboration HIV National | Phanuphak N.,HIV Netherlands Australia Thailand Research Collaboration HIV National | Phanuphak N.,Chulalongkorn University | Chaithongwongwatthana S.,Chulalongkorn University | And 4 more authors.
Asian Biomedicine | Year: 2010

As people living with HIV (PLH) are living longer and healthier lives in the era of highly active antiretroviral therapy, common reproductive health issues are becoming more important. According to WHO, PLH should be offered routine counselling on sexual and reproductive health, so that they can implement informed, healthy, and appropriate decisions. PLH need special attention with regard to the use of contraceptive methods that provide dual protection against HIV/sexually transmitted infection transmission and unintended pregnancies. This article includes literature review on sexual life and contraception in the context of HIV infection including barrier methods, natural methods, sterilization, hormonal contraception, intrauterine device, spermicides/microbicides and emergency contraception. To date, there is no perfect method that provides both protection against HIV transmission and unintended pregnancy. Although male condom remains the principal contraceptive method, its male-controlled usage is its most important obstacle. This article describes the pros and cons of each method for PLH as well as the interaction between hormonal contraceptives and antiretroviral drugs. Many questions remain to be answered. It is therefore important that studies of different methods of contraception in PLH continue.

Edwards-Jackson N.,Columbia University | Kerr S.J.,Red Cross | Kerr S.J.,University of New South Wales | Tieu H.V.,Columbia University | And 11 more authors.
HIV Medicine | Year: 2011

Objective: There is growing concern regarding cardiovascular disease in HIV-infected individuals in developing countries such as Thailand. We evaluated the 10-year risk of coronary heart disease (CHD) in a Thai HIV-infected cohort using three cardiovascular risk equations, and assessed the level of agreement among their predictions. Methods: We carried out a cross-sectional analysis of data on 785 Thai subjects followed prospectively in the HIV Netherlands Australia Thailand Collaboration (HIV-NAT) cohort study from 1996 to 2009. Cardiovascular risk factor history, along with relevant laboratory and clinical data, was collected at follow-up clinic visits. Ten-year risks of CHD were calculated using the Framingham, Ramathibodi-Electricity Generating Authority of Thailand (Rama-EGAT) and Data Collection on Adverse Effects of Anti-HIV Drugs (D:A:D) risk equations. Results: The mean age of the patients was 41.0 years; 55% of the subjects were male. The mean duration of antiretroviral therapy was 7.7 years. The prevalence of cardiovascular risk factors was low, with the most common risk factor being low high-density lipoprotein (HDL) (36.3%). The prevalence of high cardiovascular risk scores (defined as 10-year risk of CHD≥10%) was also low: 9.9, 2.1 and 0.8%, by the Framingham, Rama-EGAT and D:A:D scoring systems, respectively. Only eight subjects (1.0%) had a history of CHD. Bland-Altman plots showed that the Framingham equation predicted a higher risk of CVD compared with the Rama-EGAT and D:A:D equations, which agreed relatively well. Conclusion: The predicted cardiovascular risk in this HIV-infected Thai cohort was relatively low. The agreement among the Rama-EGAT and D:A:D risk scores suggests that both equations may be appropriate estimators of cardiovascular risk in this population. © 2011 British HIV Association.

Puthanakit T.,Thailand Research Collaboration HIV National | Puthanakit T.,Chulalongkorn University | Puthanakit T.,Chiang Mai University | Jourdain G.,Chiang Mai University | And 13 more authors.
HIV Medicine | Year: 2010

Objectives: The aim of the study was to assess the prevalence, predictors and patterns of genotypic resistance mutations in children after failure of World Health Organization-recommended initial nonnucleoside reverse transcriptase inhibitor (NNRTI)-based treatment regimens. Methods: We carried out a multicentre retrospective study of genotyping tests performed for all HIV-infected children at eight paediatric centres in Thailand who experienced failure of NNRTI therapy at a time when virological monitoring was not routinely available. Results: One hundred and twenty children were included in the study. Their median age (interquartile range) was 9.1 (6.8-11.0) years, the median duration of their NNRTI regimens was 23.7 (15.7-32.6) months, their median CD4 percentage was 12% (4-20%), and their median plasma HIV RNA at the time of genotype testing was 4.8 (4.3-5.2) log10 HIV-1 RNA copies/mL. The nucleoside reverse transcriptase inhibitor (NRTI) resistance mutations found were as follows: 85% of the children had M184V/I, 23% had at least four thymidine analogue mutations, 12% had the Q151M complex, 5% had K65R, and 1% had the 69 insertion. Ninety-eight per cent of the children had at least one NNRTI resistance mutation, and 48% had etravirine mutation-weighted scores ≥4. CD4 percentage <15% prior to switching regimens [odds ratio (OR) 5.49; 95% confidence interval (CI) 2.02-14.93] and plasma HIV RNA>5 log10 copies/mL (OR 2.46; 95% CI 1.04-5.82) were independent predictors of at least four thymidine analogue mutations, the Q151M complex or the 69 insertion. Conclusions: In settings without routine viral load monitoring, second-line antiretroviral therapy regimens should be designed assuming that clinical or immunological failure is associated with high rates of multi-NRTI resistance and NNRTI resistance, including resistance to etravirine. © 2010 British HIV Association.

Shikuma C.M.,University of Hawaii at Manoa | Gerschenson M.,University of Hawaii at Manoa | Ananworanich J.,South East Asia Research Collaboration with Hawaii | Valcour V.G.,University of California at San Francisco | And 11 more authors.
HIV Medicine | Year: 2012

Objectives: Distal leg epidermal nerve fibre density (ENFD) is a validated predictor of small unmyelinated nerve fibre damage and neuropathy risk in HIV infection. As pre-existing damage may increase the risk of neuropathy following antiretroviral (ARV) therapy, particularly when the regimen contains stavudine (d4T), we assessed the relationship between ENFD and various parameters including mitochondrial factors in HIV-infected Thai individuals naïve to ARV therapy. Methods: Distal leg and proximal thigh ENFDs were quantified in HIV-infected Thai individuals without neuropathy prior to randomization to a HIV clinical trial that focused on mitochondrial toxicity issues. We assessed their association with various clinical and immunovirological parameters as well as with peripheral blood mononuclear cell (PBMC) mitochondrial (mt) DNA copies/cell, oxidative phosphorylation (OXPHOS) complex I (CI) and complex IV (CIV) enzyme activities, and mt 8-oxo-deoxyguanine (8-oxo-dG) break frequencies. Results: In 132 subjects, the median (interquartile range) ENFD (fibres/mm) values were 21.0 (16.2-26.6) for the distal leg and 31.7 (26.2-40.0) for the proximal thigh. By linear regression, lower CD4 count (P<0.01), older age (P<0.01), increased body mass index (BMI) (P=0.04), increased height (P=0.02), and higher PBMC OXPHOS activity as measured by CIV activity (P=0.02) were associated with lower distal leg ENFD. Conclusions: Older age, increased height, higher BMI, poorer immunological status and higher PBMC OXPHOS activity are associated with lower distal leg ENFD in HIV-infected subjects free of neuropathy prior to initiation of first-time ARV therapy. © 2012 British HIV Association.

Schneider K.,University of New South Wales | Puthanakit T.,Red Cross | Puthanakit T.,Chulalongkorn University | Kerr S.,University of New South Wales | And 13 more authors.
AIDS | Year: 2011

Objective: Antiretroviral therapy (ART) management for HIV-infected children is critical in many resource-constrained countries. We investigated the cost-effectiveness and cost-utility of different frequencies of monitoring plasma viral load among HIV-positive children initiating ART in a resource-limited setting. Design/Methods: A stochastic agent-based simulation model was built and directly informed by a cohort of 304 HIV-infected children starting ART in Thailand between 2001 and 2009. The model simulated the expected costs and clinical outcomes over time according to different viral load monitoring frequencies and initiation of second-line therapies when appropriate. Results: The optimal frequency of viral load monitoring was found to be annual, after a single screening at 6 months. Associated costs of viral load monitoring and appropriate ART would approximately triple current treatment costs. Compared with current conditions, a single screening during the first year of ART led to a 58.4% reduction in the total person-years of virological failure with annual monitoring leading to a 76.6% reduction. The incremental cost per quality adjusted life year gained from the optimal monitoring frequency was estimated as US$ 68 084 when including costs of ART and US$ 7224 without ART costs. The estimated cost attributed to preventing 1 year of virological failure was US$ 3393 with ART costs and US$ 359 without ART costs. Conclusion: Even infrequent viral load monitoring is likely to provide substantial clinical benefit to HIV-infected children on ART. Viral load monitoring can be considered cost-effective in many resource-limited settings. However, the costs associated with second-line therapies could be a barrier to its economic feasibility. © 2011 Wolters Kluwer Health - Lippincott Williams & Wilkins.

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