National Expansion of Antiretroviral Treatment in Thailand, 2000-2007: Program Scale-Up and Patient Outcomes

Chasombat, Sanchai; McConnell, Michelle S.; Siangphoe, Umaporn; Yuktanont, Porntip; Jirawattanapisal, Thidaporn; Fox, Kimberley; Thanprasertsuk, Sombat; Mock, Philip A.; Ningsanond, Peeramon; Lertpiriyasuwat, Cheewanan; S, Pinyopornpanich

doi:10.1097/qai.0b013e3181967602

Cited by 63 publications

(45 citation statements)

References 11 publications

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“…By contrast, 18 cohorts containing 39,536 patients in sub-Saharan Africa had median CD4 cell counts typically in the range of 100–150 cells/μl [70], similar to cohorts in Latin America and the Caribbean [71]. However, the median CD4 cell count among 58,000 patients starting ART in Thailand between 2000 and 2005 was just 41 cells/μl [72]. …”

Section: Prevention: Clinical Interventionsmentioning

confidence: 99%

Pathogenesis and prevention of immune reconstitution disease during antiretroviral therapy

Lawn

Meintjes

2011

Expert Review of Anti-infective Therapy

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The risks of unmasking and paradoxical forms of immune reconstitution disease in HIV-infected patients starting antiretroviral therapy (ART) are fuelled by a combination of the late presentation of patients with advanced immunodeficiency, the associated high rates of opportunistic infections (OIs) and the need for rapid initiation of ART to minimize overall mortality risk. We review the risk factors and our current knowledge of the immunopathogenesis of immune reconstitution disease, leading to a discussion of strategies for prevention. Initiation of ART at higher CD4 counts, use of OI-preventive therapies prior to ART eligibility, intensified screening for OIs prior to ART initiation and optimum therapy for OIs are all needed. In addition, use of a range of pharmacological agents with immunosuppressive and immunomodulatory activity is being explored.

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Section: Prevention: Clinical Interventionsmentioning

confidence: 99%

Pathogenesis and prevention of immune reconstitution disease during antiretroviral therapy

Lawn

Meintjes

2011

Expert Review of Anti-infective Therapy

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“…Even after stavudine for newly treated patients is being phased out according to WHO's recommendation, this combination is still widely used in these settings. In Thailand, the fixed-dose generic combination antiretroviral drug, GPOvir® (d4T,3TC and NVP), has been universally available since 2002 [2]. The efficacy of GPOvir® and survival benefit has been demonstrated [2],[3].…”

Section: Introductionmentioning

confidence: 99%

“…In Thailand, the fixed-dose generic combination antiretroviral drug, GPOvir® (d4T,3TC and NVP), has been universally available since 2002 [2]. The efficacy of GPOvir® and survival benefit has been demonstrated [2],[3]. Despite of the increased access to ART, adverse effects compelled patients to discontinue or modify the regimen more frequently than ART treatment failure.…”

Section: Introductionmentioning

confidence: 99%

Incidence and predictors of regimen-modification from first-line antiretroviral therapy in Thailand: a cohort study

et al. 2014

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BackgroundAntiretroviral therapy markedly reduced mortality in HIV-infected individuals. However, in the previous studies, up to 50% of patients are compelled to modify their regimen in middle and low-income countries where salvage drug is still limited. This cohort study aimed to investigate the incidence and predictors of regimen modification from the first-line antiretroviral regimen in northern Thailand.MethodsAll HIV-infected patients starting antiretroviral therapy (ART) with generic drug (GPOvir®; stavudine, lamivudine and nevirapine) at a governmental hospital in northern Thailand from 2002 to 2007 were recruited. Baseline characteristics and detailed information of regimen modification until the end of 2010 were ascertained from cohort database and medical charts. As a potential genetic predictor of regimen modification, HLA B allele was determined by bead-based array hybridization (WAKFlow® HLA typing kit). We investigated predictors of the regimen modification using Cox’s proportional hazard models.ResultsOf 979 patients, 914 were eligible for the analysis. The observed events of regimen modification was 377, corresponding to an incidence 13.8/100 person-year-observation (95% CI:12.5-15.3) over 2,728 person years (PY) follow up. The main reasons for regimen modification were adverse effects (73.5%), especially lipodystrophy (63.2%) followed by rash (17.7%). Sixty three patients (17.1%) changed the regimen due to treatment failure. 2% and 19% of patients had HLA-B*35:05 and B*4001, respectively. HLA-B*35:05 was independently associated with rash-related regimen modification (aHR 7.73, 95% CI:3.16-18.9) while female gender was associated with lipodystrophy (aHR 2.11, 95% CI:1.51-2.95). Female gender (aHR 0.54, 95% CI: 0.30-0.96), elder age (aHR 0.56, 95% CI: 0.32-0.99) and having HLA-B*40:01 (aHR 0.29, 95% CI: 0.10-0.82) were protective for treatment failure related modification.ConclusionHLA-B*35:05 and female gender were strong predictors of regimen modification due to rash and lipodystrophy, respectively. Female gender, elder age, and having HLA-B*40:01 had protective effects on treatment failure-related regimen modification. This study provides further information of regimen modification for future tailored ART in Asia.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0565-5) contains supplementary material, which is available to authorized users.

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“…4,5 High mortality rates early in ART have been documented in Africa, 6 the Caribbean, 7 Latin America 7 and south-eastern Asia. 8,9 Consequently, additional interventions are needed to decrease early mortality during ART in low-and middle-income countries.…”

Section: Introductionmentioning

confidence: 99%

Effect of cotrimoxazole on mortality in HIV-infected adults on antiretroviral therapy: a systematic review and meta-analysis

Suthar

Granich

Mermin

et al. 2011

Bull. World Health Organ.

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National Expansion of Antiretroviral Treatment in Thailand, 2000-2007: Program Scale-Up and Patient Outcomes

Abstract: National ARV treatment programs can be scaled up rapidly with good patient outcomes. Treatment outcomes among patients in Thailand are comparable to those reported in smaller cohorts in other countries, and survival rates have improved since 2004.

Cited by 63 publications

References 11 publications

Pathogenesis and prevention of immune reconstitution disease during antiretroviral therapy

Pathogenesis and prevention of immune reconstitution disease during antiretroviral therapy

Incidence and predictors of regimen-modification from first-line antiretroviral therapy in Thailand: a cohort study

Effect of cotrimoxazole on mortality in HIV-infected adults on antiretroviral therapy: a systematic review and meta-analysis

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