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Ounchanum P, Aurpibul L, Teeraananchai S, Lumbiganon P, Songtaweesin WN, Sudjaritruk T, Chokephaibulkit K, Rungmaitree S, Kosalaraksa P, Suwanlerk T, Ross JL, Sohn AH, Puthanakit T. High mortality in adolescents and young adults with perinatally-acquired HIV in Thailand during the transition to adulthood. AIDS Care 2024:1-10. [PMID: 38447043 DOI: 10.1080/09540121.2024.2325100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/22/2024] [Indexed: 03/08/2024]
Abstract
Transitioning from pediatric to adult care remains a challenge for adolescents and young adults with perinatally-acquired HIV (AYA-PHIV). We assessed treatment outcomes and mortality among Thai AYA-PHIV. The study included AYA-PHIV who reached age 18-24 years who started antiretroviral treatment during childhood at five pediatric HIV clinics across Thailand. From November 2020-July 2021, data were gathered from a cohort database, medical records, and the Thai National AIDS Program. Of 811 eligible AYA-PHIV, 93% were alive; median age 22.3 years (IQR 20.6-23.7), treatment duration 16.1 years (IQR 13.4-18.0). Current HIV care was provided in adults (71%) and pediatric clinics (29%). Treatment regimens included non-nucleoside reverse transcriptase inhibitors (55%), protease inhibitors (36%), and integrase inhibitors (8%); 78% had HIV RNA <200 copies/ml. Of the 7.0% who died, median age at death was 20.8 years (IQR 20.6-22.1); 88% were AIDS-related death. Mortality after age 18 was 1.76 per 100-person years (95% confidence interval 1.36-2.28). Those with CD4 <200 cell/mm3 at age 15 had higher risk of mortality (adjusted hazard ratio 6.16, 95% CI 2.37-16.02). In conclusion, the high mortality among Thai AYA-PHIV indicated the need for better systems to support AYA-PHIV during the transition to adulthood.
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Affiliation(s)
- Pradthana Ounchanum
- Department of Pediatrics, Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
| | - Linda Aurpibul
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Sirinya Teeraananchai
- Department of Statistics, Faculty of Science, Kasetsart University, Bangkok, Thailand
| | - Pagakrong Lumbiganon
- Department of Pediatrics, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kean, Thailand
| | | | - Tavitiya Sudjaritruk
- Department of Pediatrics and Clinical and Molecular Epidemiology of Emerging and Re-emerging Infectious Diseases Research Cluster, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kulkanya Chokephaibulkit
- Siriraj Institute of Clinical Research and Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supattra Rungmaitree
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pope Kosalaraksa
- Department of Pediatrics, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kean, Thailand
| | | | - Jeremy L Ross
- TREAT Asia/amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | - Annette H Sohn
- TREAT Asia/amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | - Thanyawee Puthanakit
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Ounchanum P, Ounchanum P, Achalapong J, Achalapong J, Teeraananchai S, Teeraananchai S, Gatechompol S, Gatechompol S, Phongsamart W, Phongsamart W, Chokephaibulkit K, Chokephaibulkit K, Tran DNH, Tran DNH, Dang HLD, Dang HLD, Teeratakulpisarn N, Teeratakulpisarn N, Chalermchockcharoenkit A, Chalermchockcharoenkit A, Singtoroj T, Singtoroj T, Sohn AH, Sohn AH, Phanuphak N, Phanuphak N. The effects of bivalent human papillomavirus (HPV) vaccination on high-risk anogenital HPV infection among sexually active female adolescents with and without perinatally acquired HIV. Sex Health 2024; 21:NULL. [PMID: 37967583 DOI: 10.1071/sh22185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 10/26/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Females with perinatal HIV (PHIV) infection are at elevated risk for anogenital high-risk human papillomavirus (HR-HPV) infection. Limited data are available around the effect of the HPV vaccination after initiation of sexual activity among PHIV youth. This study aims to assess the impact of a bivalent HPV vaccination on the persistence of anogenital HR-HPV among sexually active female PHIV youth and matched HIV-negative controls aged 12-24years in Thailand and Vietnam. METHODS During a 3-year study, prevalent, incident, and persistent HR-HPV infection were assessed at annual visits. A subset of participants received a bivalent HPV vaccine. Samples were taken for HPV testing from the vagina, cervix, and anus. HR-HPV persistence was defined as the detection of the same genotype(s) at any anogenital compartment over≥two consecutive visits. RESULTS Of the 93 PHIV and 99 HIV-negative female youth enrolled in this study, 25 (27%) PHIV and 22 (22%) HIV-negative youth received a HPV vaccine. Persistent infection with any HR-HPV type was significantly lower among PHIV youth who received the vaccine compared to those who did not (33%vs 61%, P =0.02); a difference was not observed among HIV-negative youth (35%vs 50%, P =0.82). PHIV infection (adjusted prevalence ratio [aPR] 2.31, 95% CI 1.45-3.67) and not receiving a HPV vaccine (aPR, 1.19, 95%CI 1.06-1.33) were associated with persistent anogenital HR-HPV infection. CONCLUSIONS Bivalent HPV vaccination after initiation of sexual activity was associated with reduced persistence of anogenital HR-HPV infection in Southeast Asian PHIV female youth, which may be related to vaccine cross-protection. Primary and catch-up HPV vaccinations should be prioritised for children and youth with HIV.
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Affiliation(s)
| | | | | | | | - Sirinya Teeraananchai
- Department of Statistics, Faculty of Science, Kasetsart University, Bangkok, Thailand
| | - Sirinya Teeraananchai
- Department of Statistics, Faculty of Science, Kasetsart University, Bangkok, Thailand
| | - Sivaporn Gatechompol
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand; and Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sivaporn Gatechompol
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand; and Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | | | | | | | | | | | | | | | | | | | | | | | - Thida Singtoroj
- TREAT Asia/amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | - Thida Singtoroj
- TREAT Asia/amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | - Annette H Sohn
- TREAT Asia/amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | - Annette H Sohn
- TREAT Asia/amfAR - The Foundation for AIDS Research, Bangkok, Thailand
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Teeraananchai S, Kerr SJ, Ruxrungtham K, Khananuraksa P, Puthanakit T. Long-term outcomes of rapid antiretroviral NNRTI-based initiation among Thai youth living with HIV: a national registry database study. J Int AIDS Soc 2023; 26:e26071. [PMID: 36943729 PMCID: PMC10029993 DOI: 10.1002/jia2.26071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 02/17/2023] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION The Thai National AIDS programme (NAP) treatment guidelines have recommended rapid antiretroviral therapy (ART) initiation, regardless of CD4 count since 2014. We assessed treatment outcomes among youth living with HIV (YLHIV), initiating first-line ART and assessed the association between virological failure (VF) and timing of ART initiation. METHODS We retrospectively reviewed data for YLHIV aged 15-24 years, initiating non-nucleoside reverse transcriptase inhibitor-based ART from 2014 to 2019, through the NAP database. We classified the timing of ART into three groups based on duration from HIV-positive diagnosis or system registration to ART initiation: (1) <1 month (rapid ART); (2) 1-3 months (intermediate ART); and (3) >3 months (delayed ART). VF was defined as viral load (VL) ≥ 1000 copies/ml after at least 6 months of first-line ART. Factors associated with VF were analysed using generalized estimating equations. RESULTS Of 19,825 YLHIV who started ART, 78% were male. Median (interquartile range, IQR) age was 21 (20-23) years and CD4 count was 338 (187-498) cells/mm3 . After registration, 12,216 (62%) started rapid ART, 4272 (22%) intermediate ART and 3337 (17%) delayed ART. The proportion of YLHIV starting ART <30 days significantly increased from 43% to 57% from 2014-2016 to 2017-2019 (p < 0.001). The median duration of first-line therapy was 2 (IQR 1-3) years and 89% started with efavirenz-based regimens. Attrition outcomes showed that 325 (2%) died (0.73 [95% CI 0.65-0.81] per 100 person-years [PY]) and 1762 (9%) were loss to follow-up (3.96 [95% CI 3.78-4.15] per 100 PY). Of 17,512 (88%) who had VL checked from 6 to 12 months after starting treatment, 80% achieved VL <200 copies/ml. Overall, 2512 experienced VF 5.87 (95% CI 5.65-6.11) per 100 PY). In a multivariate model, the adjusted incidence rate ratio for VF was 1.47 (95% CI 1.33-1.63, p < 0.001) in the delayed ART group and 1.14 (95% CI 1.03-1.25, p< 0.001) in the intermediate ART group, compared to YLHIV in the rapid ART group. CONCLUSIONS Rapid ART initiation after diagnosis was associated with significantly reduced risks of VF and death in YLHIV, supporting the implementation of rapid ART for optimizing health outcomes.
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Affiliation(s)
- Sirinya Teeraananchai
- Department of Statistics, Faculty of Science, Kasetsart University, Bangkok, Thailand
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Stephen J Kerr
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Biostatistics Excellence Centre, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Kiat Ruxrungtham
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Chula Vaccine Research Center (ChulaVRC), School of Global Health, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Thanyawee Puthanakit
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand
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Wei F, Goodman MT, Xia N, Zhang J, Giuliano AR, D’Souza G, Hessol NA, Schim van der Loeff MF, Dai J, Neukam K, de Pokomandy A, Poynten IM, Geskus RB, Burgos J, Etienney I, Moscicki AB, Donà MG, Gillison ML, Nyitray AG, Nowak RG, Yunihastuti E, Zou H, Hidalgo-Tenorio C, Phanuphak N, Molina JM, Schofield AM, Kerr S, Fan S, Lu Y, Ong JJ, Chikandiwa AT, Teeraananchai S, Squillace N, Wiley DJ, Palefsky JM, Georges D, Alberts CJ, Clifford GM. Incidence and Clearance of Anal Human Papillomavirus Infection in 16 164 Individuals, According to Human Immunodeficiency Virus Status, Sex, and Male Sexuality: An International Pooled Analysis of 34 Longitudinal Studies. Clin Infect Dis 2023; 76:e692-e701. [PMID: 35869839 PMCID: PMC10226739 DOI: 10.1093/cid/ciac581] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/24/2022] [Accepted: 07/13/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Understanding the natural history of anal high-risk human papillomavirus (hrHPV) infection is key for designing anal cancer prevention programs but has not been systematically characterized. METHODS We reanalyzed data from 34 studies including 16 164 individuals in 6 risk groups defined by human immunodeficiency virus (HIV) status, sex, and male sexuality: men who have sex with men (MSM) and people with HIV (MSMWH), HIV-negative MSM, women with HIV (WWH), HIV-negative women, men who have sex with women (MSW) with HIV (MSWWH), and HIV-negative MSW. We used Markov models to estimate incidence and clearance of 13 hrHPV types and their determinants. RESULTS Human papillomavirus (HPV) 16 had the highest incidence-clearance ratio of the hrHPV types. MSMWH had the highest hrHPV incidence (eg, 15.5% newly HPV-16 infected within 2 years), followed by HIV-negative MSM (7.5%), WWH (6.6%), HIV-negative women (2.9%), MSWWH (1.7%), and HIV-negative MSW (0.7%). Determinants of HPV-16 incidence included HIV status and number of sexual partners for MSM, women, and MSW, and anal sex behavior for MSM only. HPV-16 clearance was lower for people with HIV (PWH) and lower for prevalent than incident infection. Among MSM, increasing age was associated with lower clearance of prevalent, but not incident, HPV-16 infection. CONCLUSIONS This robust and unifying analysis of anal hrHPV natural history is essential to designing and predicting the impact of HPV vaccination and HPV-based screening programs on anal cancer prevention, particularly in MSM and PWH. Importantly, it demonstrates the higher carcinogenic potential of longstanding anal prevalent hrHPV infection than more recent incident infection.
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Affiliation(s)
- Feixue Wei
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Marc T Goodman
- Cancer Prevention and Control Program, Cedars Cancer, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ningshao Xia
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Jun Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer (CIIRC), Moffitt Cancer Center, Tampa, Florida, USA
| | - Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nancy A Hessol
- Department of Clinical Pharmacy, University of CaliforniaSan Francisco, California, USA
| | | | - Jianghong Dai
- School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Karin Neukam
- Unidad Clínica de Enfermedades Infecciosas y Medicina Preventiva, UCEIMP, Instituto de Biomedicina de Sevilla, CSIC, Universidad de Sevilla, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre and Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - I Mary Poynten
- The Kirby Institute, University of New South Wales, Kensington, Sydney, New South Wales, Australia
| | - Ronald B Geskus
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Joaquin Burgos
- Infectious Diseases Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Vall d’Hebron Institut de Recerca (VHIR), Universitat Autónoma de Barcelona, Barcelona, Spain
| | | | | | - Maria Gabriella Donà
- Sexually Transmitted Infections (STI)/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Maura L Gillison
- Thoracic Head and Neck Medical Oncology Department, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alan G Nyitray
- Center for AIDS Intervention Research and Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Rebecca G Nowak
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Evy Yunihastuti
- Faculty of Medicine Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Carmen Hidalgo-Tenorio
- Early Clinical Trial Unit. Biosanitary Institute (IBS.Granada). Infectious Diseases Unit. University Hospital Virgen de las Nieves, Granada, Spain
| | | | - Jean-Michel Molina
- Department of Infectious diseases, University of Paris Cité, St-Louis Hospital, Paris, France
| | - Alice M Schofield
- Institute of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Stephen Kerr
- HIV-NAT, Thai Red Cross AIDS Research Centre, and Research Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Song Fan
- School of Public Health, Southwest Medical University, Luzhou, China
| | - Yong Lu
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
| | - Jason J Ong
- Central Clinical School, Monash University, Melbourne, Australia
| | - Admire T Chikandiwa
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sirinya Teeraananchai
- Department of Statistics, Faculty of Science, Kasetsart University, Bangkok, Thailand
| | - Nicola Squillace
- Infectious Diseases Unit ASST-Monza, San Gerardo Hospital-University of Milano-Bicocca, Monza, Italy
| | - Dorothy J Wiley
- School of Nursing, University of California, Los Angeles, California, USA
| | - Joel M Palefsky
- Department of Medicine, University of California, San Francisco, California, USA
| | - Damien Georges
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Catharina J Alberts
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Gary M Clifford
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
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Singtoroj T, Teeraananchai S, Chokephaibulkit K, Phanuphak N, Gatechompol S, Hansudewechakul R, Dang HLD, Tran DNH, Kerr S, Sohn AH. Factors Associated with Morbidity and Mortality Among Sexually Active Asian Adolescents and Young Adults with Perinatally Acquired HIV. AIDS Res Hum Retroviruses 2023. [PMID: 36515173 PMCID: PMC10278009 DOI: 10.1089/aid.2021.0169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
We assessed morbidity and mortality among Thai and Vietnamese adolescents and young adults with perinatally acquired human immunodeficiency virus (PHIV) compared with matched HIV-negative peers, 12-24 years of age. Data on serious adverse events (SAEs) were prospectively collected between 2013 and 2018 according to U.S. NIH Division of AIDS criteria. Of 288 youth, 142 had PHIV and 146 were HIV negative. At enrollment, the overall median age was 19 (interquartile range [IQR] 17-20) years, 67% were female, and 95% were Thai. Almost all PHIV youth (99%) were receiving antiretroviral therapy; 50% self-reported adherence ≥95%. Median CD4 was 579 (IQR 404-800) cells/mm3, and 24% had HIV-RNA ≥1,000 copies/mL. During follow-up, 31 (22%) PHIV youth and 9 (6%) HIV-negative youth had at least one SAE. The overall crude SAE rate was 4.66 (3.42-6.35) per 100 person-years (PY); 7.22 (5.08-10.26) per 100 PY among youth with PHIV and 2.10 (1.09-4.03) per 100 PY in HIV-negative youth (p < .001). All seven deaths that occurred were among those with PHIV and primarily due to opportunistic infections (e.g., pneumocystis pneumonia, tuberculous meningitis). In multivariate analyses, having PHIV, being <20 years of age, and having anogenital high-risk human papillomavirus (HPV) infection with types 16 and/or 18 increased risk of SAEs. Among PHIV youth, CD4 count <350 cells/mm3, HIV-RNA ≥1,000 copies/mL, advanced WHO stages, and having anogenital HPV 16 and/or 18 infection predicted higher incidence of SAEs; no prior use of alcohol was protective. These data emphasize the need for tailored interventions for adolescents with PHIV to prevent long-term morbidity and mortality.
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Affiliation(s)
- Thida Singtoroj
- TREAT Asia/amfAR-The Foundation for AIDS Research, Bangkok, Thailand
| | - Sirinya Teeraananchai
- HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,Department of Statistics, Faculty of Science, Kasetsart University, Bangkok, Thailand
| | - Kulkanya Chokephaibulkit
- Siriraj Institute of Clinical Research, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Sivaporn Gatechompol
- HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | | | | | - Stephen Kerr
- HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,Biostatistics Excellence Centre, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Annette H Sohn
- TREAT Asia/amfAR-The Foundation for AIDS Research, Bangkok, Thailand
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Sudsila P, Teeraananchai S, Kiertiburanakul S, Lertpiriyasuwat C, Triamwichanon R, Gatechompol S, Putcharoen O, Chetchotisakd P, Avihingsanon A, Kerr SJ, Ruxrungtham K. Treatment Outcomes After Switching to Second-Line Anti-Retroviral Therapy: Results From the Thai National Treatment Program. J Int Assoc Provid AIDS Care 2023; 22:23259582231220513. [PMID: 38115729 PMCID: PMC10734336 DOI: 10.1177/23259582231220513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 11/23/2023] [Accepted: 11/25/2023] [Indexed: 12/21/2023] Open
Abstract
This study aimed to assess second-line antiretroviral therapy (ART) outcomes in a National HIV Treatment program. People living with HIV aged ≥18 years initiating first-line ART who switched to second-line protease inhibitor-based regimens from January 2008 to May 2019, with a minimum of 1-year follow-up were studied. The primary outcome was second-line treatment failure (two consecutive virological failure episodes (viral load ≥1000 copies/mL)). Of 318,506 PLH initiating ART, 29,015 (9.1%) switched to second-line regimens after a median (IQR) ART duration of 1.63 (0.60-3.59) years. Lost to follow-up (LTFU) occurred in 5316 (18.3%) of whom 1376 (5%) remained LTFU and alive; 4606 (15.9%) died. Cumulative second-line failure incidence was 9.8% at 6 years, more common in females, younger PLH those with lower switch CD4 cell counts. Multidisciplinary, innovative support systems are needed to improve second-line treatment outcomes, particularly those relating to modifiable risk factors.
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Affiliation(s)
- Pupe Sudsila
- Biostatistics Excellence Centre, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sirinya Teeraananchai
- Department of Statistics, Faculty of Science, Kasetsart University, Bangkok, Thailand
| | | | - Cheewanan Lertpiriyasuwat
- Division of AIDS and STIs, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | | | - Sivaporn Gatechompol
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Centre of Excellence in Tuberculosis, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Opass Putcharoen
- Division of Infectious Disease, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ploenchan Chetchotisakd
- Division of Infectious Disease, Department of Medicine, Faculty of Medicine, Khon Kaen University, Srinagarind Hospital, Khon Kaen, Thailand
| | - Anchalee Avihingsanon
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Centre of Excellence in Tuberculosis, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Stephen J Kerr
- Biostatistics Excellence Centre, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Kiat Ruxrungtham
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Centre of Excellence in Vaccine Research and Development (Chula VRC), and School of Global Health, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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7
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Teeraananchai S, Law M, Boettiger D, Mata NDL, Gupte N, Chan YTL, Pham TN, Chaiwarith R, Ly PS, Chan YJ, Kiertiburanakul S, Khusuwan S, Zhang F, Yunihastuti E, Kumarasamy N, Pujari S, Azwa I, Somia IKA, Tanuma J, Ditangco R, Choi JY, Ng OT, Do CD, Gani Y, Ross J, Jiamsakul A. Virological failure and treatment switch after ART initiation among people living with HIV with and without routine viral load monitoring in Asia. J Int AIDS Soc 2022; 25:e25989. [PMID: 36028921 PMCID: PMC9418417 DOI: 10.1002/jia2.25989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 08/01/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Viral load (VL) testing is still challenging to monitor treatment responses of antiretroviral therapy (ART) for HIV treatment programme in Asia. We assessed the association between routine VL testing and virological failure (VF) and determine factors associated with switching to second‐line regimen. Methods Among 21 sites from the TREAT Asia HIV Observational Database (TAHOD), people living with HIV (PLHIV) aged ≥18 years initiating ART from 2003 to 2021 were included. We calculated the average number of VL tests per patient per year between the date of ART initiation and the most recent visit. If the median average number of VL tests was ≥ 0.80 per patient per year, the site was classified as a routine VL site. A site with a median < 0.80 was classified into the non‐routine VL sites. VF was defined as VL ≥1000 copies/ml during first‐line therapy. Factors associated with VF were analysed using generalized estimating equations with Poisson distribution. Results Of 6277 PLHIV starting ART after 2003, 3030 (48%) were from 11 routine VL testing sites and 3247 (52%) were from 10 non‐routine VL testing sites. The median follow‐up was 9 years (IQR 5–13). The median age was 35 (30–42) years; 68% were male and 5729 (91%) started non‐nucleoside reverse‐transcriptase inhibitor‐based regimen. The median pre‐ART CD4 count in PLHIV from routine VL sites was lower compared to non‐routine VL sites (144 vs. 156 cells/mm3, p <0.001). Overall, 1021 subsequent VF at a rate of 2.15 (95% CI 2.02–2.29) per 100 person‐years (PY). VF was more frequent at non‐routine VL sites (adjusted incidence rate ratio 2.85 [95% CI 2.27–3.59]) compared to routine VL sites. Other factors associated with an increased rate of VF were age <50 years and CD4 count <350 cells/mm3. A total of 817 (13%) patients switched to second‐line regimen at a rate of 1.44 (95% CI 1.35–1.54) per 100 PY. PLHIV at routine VL monitoring sites were at higher risk of switching than those at non‐routine VL sites (adjusted sub‐hazard ratio 1.78 95% CI [1.17–2.71]). Conclusions PLHIV from non‐routine VL sites had a higher incidence of persistent VF and a low switching regimen rate, reflecting possible under‐utilized VL testing.
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Affiliation(s)
- Sirinya Teeraananchai
- Department of Statistics, Faculty of Science, Kasetsart University, Bangkok, Thailand.,HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Matthew Law
- The Kirby Institute, UNSW, Sydney, New South Wales, Australia
| | - David Boettiger
- The Kirby Institute, UNSW, Sydney, New South Wales, Australia
| | - Nicole De La Mata
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Nikhil Gupte
- BJ Government Medical College and Sassoon General Hospital, Pune, India
| | | | | | - Romanee Chaiwarith
- Chiang Mai University - Research Institute for Health Sciences, Chiang Mai, Thailand.,Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Penh Sun Ly
- National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia
| | - Yu-Jiun Chan
- Taipei Veterans General Hospital, Taipei, Taiwan
| | | | | | - Fujie Zhang
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Evy Yunihastuti
- Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Nagalingeswaran Kumarasamy
- Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), VHS-Infectious Diseases Medical Centre, VHS, Chennai, India
| | | | - Iskandar Azwa
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - I Ketut Agus Somia
- Faculty of Medicine, Udayana University & Sanglah Hospital, Bali, Indonesia
| | - Junko Tanuma
- National Center for Global Health and Medicine, Tokyo, Japan
| | - Rossana Ditangco
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Jun Yong Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | | | | | - Yasmin Gani
- Hospital Sungai Buloh, Sungai Buloh, Malaysia
| | - Jeremy Ross
- TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
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- Department of Statistics, Faculty of Science, Kasetsart University, Bangkok, Thailand
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8
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Anugulruengkitt S, Teeraananchai S, Chantasrisawad N, Promsena P, Jantarabenjakul W, Puthanakit T. Clinical outcomes of pediatric COVID-19 in a tertiary care center in Bangkok, Thailand. IJID Reg 2021; 1:159-162. [PMID: 35721777 PMCID: PMC8600753 DOI: 10.1016/j.ijregi.2021.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 11/22/2022]
Abstract
Limited reports of pediatric COVID-19 clinical characteristics and outcomes in Asia Children usually have milder COVID-19 disease than adults Severe cases are more likely at a younger age, and with obesity or comorbidities Increased symptomatic pediatric COVID-19 infection coincided with Delta variant Off-label use of favipiravir in a pediatric COVID-19 patient cohort is reported
Objective To describe the clinical characteristics and outcomes of pediatric COVID-19 in Thailand, where favipiravir is the mainstay of antiviral treatment. Methods We conducted a hospital based observational cohort study of COVID-19 among children. The study included children (age <15 years) with confirmed positive reverse transcriptase-polymerase chain reaction for SARS-CoV-2 from nasopharyngeal swab. Results From April to July 2021, 416 cases with a median age of 7.1 (interquartile range 2.7–11.6) years were included in the study. The spectrum of disease included 82 (20%) asymptomatic, 232 (56%) mild and 102 (24%) with pneumonia. Abnormal chest x-ray findings included ground-glass opacities (46%), focal infiltrations (27%), perihilar opacities (19%), reticular infiltrations (15%) and other non-specific findings (4%). Only 12 children (3%) required oxygen support. Favipiravir was prescribed to 129 children (31%); 102 patients with pneumonia and 27 patients at risk for disease progression. Pneumonia was more common in age <3 years compared with those aged 3–<12 years (adjusted odds ratio (aOR) 0.30, 95% CI 0.17–0.52), 12–15 years (aOR 0.40, 95% CI 0.21–0.77) and in patients with comorbidities (aOR 2.36, 95% CI 1.09–5.12). Conclusions One-fourth of pediatric COVID-19 patients had pneumonia, but few required oxygen support. Off-label use of Favipiravir in pediatric COVID-19 patients in a recent outbreak in Bangkok is reported.
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Affiliation(s)
- Suvaporn Anugulruengkitt
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand
- Corresponding author: Suvaporn Anugulruengkitt, MD, PhD. Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Bangkok 10330, Thailand. Phone (Fax) +662 256 4930.
| | - Sirinya Teeraananchai
- Department of Statistics, Faculty of Science, Kasetsart University, Bangkok, Thailand
| | - Napaporn Chantasrisawad
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand
- Thai Red Cross Emerging Infectious Diseases Clinical Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Pathariya Promsena
- Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand
| | - Watsamon Jantarabenjakul
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand
- Thai Red Cross Emerging Infectious Diseases Clinical Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Thanyawee Puthanakit
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand
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9
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Phanuphak N, Teeraananchai S, Hansudewechakul R, Gatechompol S, Chokephaibulkit K, Dang HLD, Tran DNH, Achalapong J, Teeratakulpisarn N, Chalermchockcharoenkit A, Thamkhantho M, Pankam T, Singtoroj T, Termrungruanglert W, Chaithongwongwatthana S, Kerr SJ, Sohn AH. Incidence and Persistence of High-risk Anogenital Human Papillomavirus Infection Among Female Youth With and Without Perinatally Acquired Human Immunodefiency Virus Infection: A 3-year Observational Cohort Study. Clin Infect Dis 2021; 71:e270-e280. [PMID: 31768522 DOI: 10.1093/cid/ciz1143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 11/25/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Female youth with perinatally acquired human immunodeficiency virus (PHIV) may be at higher risk than uninfected youth for persistent anogenital human papillomavirus (HPV) infection, due to prolonged immunodeficiency. METHODS A 3-year cohort study was conducted between 2013 and 2017 among Thai and Vietnamese PHIV and HIV-uninfected females 12-24 years, matched by age group and number of lifetime sexual partners. For HPV genotyping, cervical and anal samples were obtained at baseline and annually. Vaginal samples were collected at baseline and every 6 months. Factors associated with high-risk HPV (HR-HPV) persistence and incidence were assessed. RESULTS We enrolled 93 PHIV and 99 HIV-uninfected females. Median age was 19 (interquartile range [IQR] 18-20) years. For the 7 HR-HPV types (16, 18, 31, 33, 45, 52, 58) in the nonavalent HPV vaccine, PHIV had significantly higher incidence (P = .03) and persistence (P = .01) than HIV-uninfected youth over a 3-year period. Having HIV (adjusted hazard ratio [aHR] 2.1, 95% confidence interval [CI] 1.1-3.9) and ever using illegal substances (aHR 4.8, 95% CI 1.8-13.0) were associated with incident 7 HR-HPV infections. HIV-positive status (adjusted prevalence ratio [aPR] 2.2, 95% CI 1.5-3.2), recent alcohol use (aPR 1.75, 95% CI 1.2-2.5), and higher number of lifetime partners (aPR 2.0, 95% CI 1.4-3.1, for 3-5 partners; aPR 1.93, 95% CI 1.2-3.2, for ≥6 partners) were significantly associated with persistent 7 HR-HPV infections. CONCLUSIONS Female PHIV were at higher risk of having anogenital HR-HPV acquisition and persistence. Primary and secondary prevention programs for HPV infection and HPV-related diseases should be prioritized for PHIV children and youth.
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Affiliation(s)
| | - Sirinya Teeraananchai
- HIV-NAT, The Thai Red Cross AIDS Research Centre Bangkok, Thailand.,Department of Statistics, Faculty of Science, Kasetsart University Bangkok, Thailand
| | | | | | | | | | | | | | | | | | | | | | - Thida Singtoroj
- TREAT Asia/amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | | | | | - Stephen J Kerr
- HIV-NAT, The Thai Red Cross AIDS Research Centre Bangkok, Thailand.,The Kirby Institute, University of New South Wales Sydney, New South Wales, Australia
| | - Annette H Sohn
- TREAT Asia/amfAR - The Foundation for AIDS Research, Bangkok, Thailand
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10
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Sohn AH, Chalermchockcharoenkit A, Teeraananchai S, Hansudewechakul R, Gatechompol S, Chokephaibulkit K, Dang HLD, Tran DNH, Achalapong J, Teeratakulpisarn N, Thamkhantho M, Phanuphak N, Ananworanich J, Reiss P, Kerr SJ. Increased Burden of Concordant and Sequential Anogenital Human Papillomavirus Infections Among Asian Young Adult Women With Perinatally Acquired HIV Compared With HIV-Negative Peers. Sex Transm Dis 2021; 48:200-205. [PMID: 32976361 PMCID: PMC7867588 DOI: 10.1097/olq.0000000000001294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Youth with perinatally acquired HIV (YPHIV) are at higher risk for anogenital human papillomavirus (HPV) infection. METHODS We enrolled a cohort of YPHIV and HIV-negative youth in Thailand and Vietnam, matched by age and lifetime sex partners, and followed them up for 144 weeks (to 2017). Participants had annual pelvic examinations with samples taken for HPV genotyping. Concordant infection was simultaneous HPV detection in multiple anogenital compartments (cervical, vaginal, anal); sequential infection was when the same type was found in successive compartments (cervicovaginal to/from anal). Generalized estimating equations were used to assess factors associated with concordant infection, and Cox regression was used to assess factors associated with sequential infection. RESULTS A total of 93 YPHIV and 99 HIV-negative women were enrolled, with a median age of 19 years (interquartile range, 18-20 years). High-risk anogenital HPV infection was ever detected in 76 (82%) YPHIV and 66 (67%) HIV-negative youth during follow-up. Concordant anogenital high-risk HPV infection was found in 62 (66%) YPHIV versus 44 (34%) HIV-negative youth. Sequential cervicovaginal to anal high-risk HPV infection occurred in 20 YPHIV versus 5 HIV-negative youth, with an incidence rate of 9.76 (6.30-15.13) versus 2.24 (0.93-5.38) per 100 person-years. Anal to cervicovaginal infection occurred in 4 YPHIV versus 0 HIV-negative women, with an incidence rate of 1.78 (0.67-4.75) per 100 person-years. Perinatally acquired HIV was the one factor independently associated with both concordant and sequential high-risk HPV infection. CONCLUSIONS Children and adolescents with perinatally acquired HIV should be prioritized for HPV vaccination, and cervical cancer screening should be part of routine HIV care for sexually active YPHIV.
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Affiliation(s)
- Annette H. Sohn
- TREAT Asia/amfAR - The Foundation for AIDS Research,
Bangkok, Thailand
| | | | - Sirinya Teeraananchai
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok,
Thailand
- Department of Statistics, Faculty of Science, Kasetsart
University, Bangkok, Thailand
| | | | - Sivaporn Gatechompol
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok,
Thailand
- Tuberculosis research unit, Faculty of Medicine,
Chulalongkorn University, Bangkok, Thailand
| | | | | | | | | | | | | | | | - Jintanat Ananworanich
- Department of Global Health, Amsterdam University Medical
Centers, University of Amsterdam, and Amsterdam Institute for Global Health and
Development, Amsterdam, The Netherlands
| | - Peter Reiss
- Department of Global Health, Amsterdam University Medical
Centers, University of Amsterdam, and Amsterdam Institute for Global Health and
Development, Amsterdam, The Netherlands
- HIV Monitoring Foundation, Amsterdam, The
Netherlands
| | - Stephen J. Kerr
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok,
Thailand
- Biostatistics Excellence Centre, Faculty of Medicine,
Chulalongkorn University, Bangkok, Thailand
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11
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Teeraananchai S, Kerr SJ, Khananuraksa P, Ruxrungtham K, Puthanakit T. Rapid antiretroviral initiation among Thai youth living with HIV in the National AIDS programme in the era of treatment at any CD4 cell count: a national registry database study. J Int AIDS Soc 2020; 23 Suppl 5:e25574. [PMID: 32869537 PMCID: PMC7459169 DOI: 10.1002/jia2.25574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/24/2020] [Accepted: 06/19/2020] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The process indicators of ending the HIV epidemic include 90% of people living with HIV receiving antiretroviral therapy (ART). The population of youth, however, has less access to healthcare. We assessed ART initiation and attrition outcomes of the HIV continuum from HIV diagnosis to ART initiation in youth living with HIV (YLHIV) and factors associated with ART initiation. METHODS We studied YLHIV aged 15 to 24 years who were registered on the National AIDS Program (NAP) from January 2008 to May 2019. The study period was divided into 2008 to 2013 (initiated ART by CD4-guided criteria) and 2014 to 2018 (initiate ART at any CD4). Date of registration was used as a surrogate for the diagnosis date and defined as the baseline. The database included ART prescription and laboratory results, and the vital status was linked daily with the National Death Registry. Competing risk methods were used to assess factors associated with accessing ART, with loss to follow-up (LTFU) and death considered as competing events. Logistic regression was used to assess factors associated with rapid ART initiation, defined as initiation ≤1 month after registration. RESULTS Overall, 51,607 youth registered on the NAP (42% between 2008 and 2013). Median age was 21 (IQR 20 to 23) years; 64% were male. Overall ART initiation was 80% in the first period and 83% in the second. The ART initiation rate was higher among YLHIV aged 15 to 19 years (86%) than 20 to 24 years (82%) (p < 0.001) in the second period. The proportion of youth starting rapid ART increased significantly from 27% to 52% between the two periods (p < 0.001). Factors associated with ART initiation were age 15 to 19 years (aSHR 1.09, 95% CI 1.06 to 1.11), female (aSHR 1.26, 95% CI 1.23 to 1.29) and registration year 2014 to 2018 (aSHR 1.73, 95% CI 1.69 to 1.76). The cumulative incidence of LTFU/death prior to ART initiation at 12 months was 3.8% (95% CI 3.6% to 4.1%) in the first period and 1.9% (95% CI 1.8% to 2.1%) in the second period. CONCLUSIONS In the era of universal treatment of all at any CD4 level, 83% of YLHIV registered on the Thai National AIDS Program initiated ART. The majority initiated within one month of registration.
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Affiliation(s)
- Sirinya Teeraananchai
- HIV‐NATThai Red Cross AIDS Research CentreBangkokThailand
- Department of StatisticsFaculty of ScienceKasetsart UniversityBangkokThailand
| | - Stephen J Kerr
- HIV‐NATThai Red Cross AIDS Research CentreBangkokThailand
- Biostatistics Excellence CentreFaculty of MedicineChulalongkorn UniversityBangkokThailand
- Kirby InstituteUniversity of New South WalesSydneyAustralia
| | | | - Kiat Ruxrungtham
- HIV‐NATThai Red Cross AIDS Research CentreBangkokThailand
- Department of MedicineFaculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Thanyawee Puthanakit
- HIV‐NATThai Red Cross AIDS Research CentreBangkokThailand
- Division of Infectious DiseasesDepartment of PediatricsFaculty of MedicineChulalongkorn UniversityBangkokThailand
- Center of Excellence in Pediatric Infectious Diseases and VaccinesChulalongkorn UniversityBangkokThailand
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12
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Sudjaritruk T, Teeraananchai S, Kariminia A, Lapphra K, Kumarasamy N, Fong MS, Hansudewechakul R, Bunupuradah T, Ly PS, Nallusamy RA, Sohn AH, Sirisanthana V. Impact of low-level viraemia on virological failure among Asian children with perinatally acquired HIV on first-line combination antiretroviral treatment: a multicentre, retrospective cohort study. J Int AIDS Soc 2020; 23:e25550. [PMID: 32628816 PMCID: PMC7338042 DOI: 10.1002/jia2.25550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 05/13/2020] [Accepted: 05/28/2020] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION The clinical relevance of low-level viraemia (LLV) and virological outcomes among children living with HIV (CLHIV) remains controversial. This study aimed to determine the impact of LLV on virological failure (VF) among Asian CLHIV on first-line combination antiretroviral therapy (cART). METHODS CLHIV aged <18 years, who were on first-line cART for ≥12 months, and had virological suppression (two consecutive plasma viral load [pVL] <50 copies/mL) were included. Those who started treatment with mono/dual antiretroviral therapy, had a history of treatment interruption >14 days, or received treatment and care at sites with a pVL lower limit of detection >50 copies/mL were excluded. LLV was defined as a pVL 50 to 1000 copies/mL, and VF as a single pVL >1000 copies/mL. Baseline was the time of the second pVL < 50 copies/mL. Cox proportional hazards models were performed to assess the association between LLV and VF. RESULTS From January 2008 to September 2016, 508 CLHIV (55% female) were eligible for the study. At baseline, the median age was 9.6 (IQR: 7.0 to 12.3) years, cART duration was 1.4 (IQR: 1.3 to 1.8) years, 97% of CLHIV were on non-nucleoside reverse transcriptase inhibitor-based regimens, and the median CD4 was 25% (IQR: 20% to 30%). Over a median follow-up time of 6.0 (IQR: 3.1 to 8.9) years from baseline, 86 CLHIV (17%) had ever experienced LLV, of whom 32 (37%) had multiple LLV episodes. Female sex, living in Malaysia (compared to Cambodia), having family members other than biological parents/grandparents as a primary caregiver, and baseline CD4 < 25% increased risk of LLV. Overall, 115 children (23%) developed VF, corresponding to a rate of 4.0 (95%CI: 3.4 to 4.9) per 100 person-years of follow-up (PYFU). VF was greater among children who had ever experienced LLV compared with those who maintained virological suppression throughout the study period (8.9 vs. 3.3 per 100 PYFU; p < 0.001). In multivariable analyses, ever experiencing LLV was associated with increased risk of subsequent VF (adjusted hazard ratio: 3.01; 95%CI: 1.97 to 4.60). CONCLUSIONS LLV increased the risk of subsequent VF among Asian CLHIV who had previously been suppressed on first-line cART. Adherence interventions and additional targeted pVL monitoring may be warranted among children with LLV to facilitate early detection of VF.
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Affiliation(s)
- Tavitiya Sudjaritruk
- Department of Pediatrics, Faculty of MedicineChiang Mai UniversityChiang MaiThailand
- Research Institute for Health SciencesChiang Mai UniversityChiang MaiThailand
| | - Sirinya Teeraananchai
- The HIV Netherlands Australia Thailand Research CollaborationThe Thai Red Cross AIDS Research CentreBangkokThailand
- Department of Statistics, Faculty of ScienceKasetsart UniversityBangkokThailand
| | | | - Keswadee Lapphra
- Department of Pediatrics, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
| | - Nagalingeswaran Kumarasamy
- Chennai Antiviral Research and Treatment Clinical Research SiteVHS‐Infectious Diseases Medical CentreVHSChennaiIndia
| | | | | | - Torsak Bunupuradah
- The HIV Netherlands Australia Thailand Research CollaborationThe Thai Red Cross AIDS Research CentreBangkokThailand
| | - Penh Sun Ly
- National Centre for HIV/AIDS, Dermatology and STDsPhnom PenhCambodia
| | | | - Annette H Sohn
- TREAT Asia/amfAR – The Foundation for AIDS ResearchBangkokThailand
| | - Virat Sirisanthana
- Research Institute for Health SciencesChiang Mai UniversityChiang MaiThailand
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13
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Teeraananchai S, Kerr SJ, Gandhi M, Do VC, Van Nguyen L, Tran DNH, Kosalaraksa P, Singtoroj T, Thammajaruk N, Jupimai T, Sohn AH. Determinants of Viral Resuppression or Persistent Virologic Failure After Initial Failure With Second-Line Antiretroviral Treatment Among Asian Children and Adolescents With HIV. J Pediatric Infect Dis Soc 2020; 9:253-256. [PMID: 31125411 PMCID: PMC7368343 DOI: 10.1093/jpids/piz034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 05/03/2019] [Indexed: 11/12/2022]
Abstract
Of 56 children with perinatally acquired human immunodeficiency virus (HIV) who had been prescribed second-line protease inhibitor-based antiretroviral therapy and had ≥1 previous episode of viral failure (HIV RNA, ≥1000 copies/mL), 46% had ≥1, 34% had ≥2, and 23% had ≥3 consecutive episodes of viral failure during the 2 years of follow-up. Two of these children experienced a major protease inhibitor mutation.
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Affiliation(s)
- Sirinya Teeraananchai
- HIV Netherlands Australia Thailand Research Collaboration, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Stephen J Kerr
- HIV Netherlands Australia Thailand Research Collaboration, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Monica Gandhi
- Division of HIV, Infectious Diseases, and Global Medicine, San Francisco General Hospital, University of California San Francisco
| | - Viet Chau Do
- Children’s Hospital 2, Ho Chi Minh City, Vietnam
| | | | | | - Pope Kosalaraksa
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Thailand
| | - Thida Singtoroj
- TREAT Asia/amfAR-Foundation for AIDS Research, Bangkok, Thailand
| | - Narukjaporn Thammajaruk
- HIV Netherlands Australia Thailand Research Collaboration, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Thidarat Jupimai
- HIV Netherlands Australia Thailand Research Collaboration, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Annette H Sohn
- TREAT Asia/amfAR-Foundation for AIDS Research, Bangkok, Thailand
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14
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Sohn AH, Chokephaibulkit K, Lumbiganon P, Hansudewechakul R, Gani YM, Van Nguyen L, Mohamed TJ, Teeraananchai S, Sethaputra C, Singtoroj T, Ananworanich J, Reiss P, Kerr SJ. Peritransition Outcomes of Southeast Asian Adolescents and Young Adults With HIV Transferring From Pediatric to Adult Care. J Adolesc Health 2020; 66:92-99. [PMID: 31627925 PMCID: PMC6928413 DOI: 10.1016/j.jadohealth.2019.07.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/17/2019] [Accepted: 07/30/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of this article was to study the clinical and social outcomes of health care transition among Asian adolescents and young adults with HIV (AYHIV). METHODS AYHIV who transferred from a pediatric to an adult clinic within the past year across five sites in Malaysia, Thailand, and Vietnam had clinical and laboratory evaluations and completed questionnaires about their health, socioeconomic factors, and transition experiences. Multiple logistic regression was used to assess associations with HIV viremia. RESULTS Of 93 AYHIV enrolled between June 2016 and April 2017, 56% were female, 87% acquired HIV through perinatal exposure, median age was 20 years (interquartile range [IQR] 18.5-21). Two-thirds were in a formal education program, 43% were employed, 43% of females and 35% of males were sexually active. Median lifetime antiretroviral therapy duration was 6.2 years (IQR 3.3-10.7); 45% had received second-line therapy. Median CD4 was 601 cells/mm3 (IQR 477-800); 82% had HIV-RNA <40 copies/mL. Being in a relationship, a shorter posttransition duration, self-reported adherence of ≥95%, and higher CD4 were inversely associated with HIV viremia. Half felt very prepared for the transfer to adult care, and 20% frequently and 43% sometimes still met with pediatric providers. Two-thirds reported needing to keep their HIV a secret, and 23%-38% reported never or rarely having someone to discuss problems with. CONCLUSIONS Asian AYHIV in our cohort were concerned about the negative social impact of having and disclosing HIV, and one-third lacked people they could trust with their personal problems, which could have negative implications for their ability to navigate adult life.
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Affiliation(s)
- Annette H. Sohn
- TREAT Asia/amfAR - The Foundation for AIDS Research, 388 Sukhumvit Road, Suite 2104, Klongtoey, Bangkok, Thailand, 10110
| | - Kulkanya Chokephaibulkit
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkoknoi, Bangkok, Thailand, 10700
| | - Pagakrong Lumbiganon
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Khon Kaen University, 123 Mitrapharb Road, Muang Khon Kaen, Khon Kaen, Thailand, 40002
| | - Rawiwan Hansudewechakul
- Chiangrai Prachanukroh Hospital, 1039 Satanpayaban Road, Muang Chiangrai, Chiang Rai, Thailand, 57000
| | - Yasmin Mohamed Gani
- Hospital Sungai Buloh/Jalan Hospital, Sungai Buloh, Selangor, Malaysia, 47000
| | - Lam Van Nguyen
- National Hospital of Pediatrics, 18/879 La Thanh Road, Dong Da District, Hanoi, Vietnam
| | - Thahira Jamal Mohamed
- Pediatric Institute, Hospital Kuala Lumpur, 23 Jalan Pahang, Kuala Lumpur, Malaysia, 50586
| | - Sirinya Teeraananchai
- HIV-NAT, The Thai Red Cross AIDS Research Centre, 104 Rajchadamri Road, Patumwan, Bangkok, Thailand, 10330
| | - Chuenkamol Sethaputra
- TREAT Asia/amfAR - The Foundation for AIDS Research, 388 Sukhumvit Road, Suite 2104, Klongtoey, Bangkok, Thailand, 10110
| | - Thida Singtoroj
- TREAT Asia/amfAR - The Foundation for AIDS Research, 388 Sukhumvit Road, Suite 2104, Klongtoey, Bangkok, Thailand, 10110
| | - Jintanat Ananworanich
- Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive, Suite 400, Bethesda, Maryland, USA, 20817,Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam, and Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Peter Reiss
- Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam, and Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands,HIV Monitoring Foundation, Amsterdam, The Netherlands
| | - Stephen J. Kerr
- HIV-NAT, The Thai Red Cross AIDS Research Centre, 104 Rajchadamri Road, Patumwan, Bangkok, Thailand, 10330,Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Patumwan, Bangkok, Thailand, 10330
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15
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Emmanuel S, Nadel J, Fagan D, Teeraananchai S, Law M, Holloway CJ. Patients with HIV and coronary disease: are we meeting national guidelines? Sex Health 2019; 15:83-85. [PMID: 28724498 DOI: 10.1071/sh17035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 05/22/2017] [Indexed: 11/23/2022]
Abstract
Cardiovascular disease (CVD) has a higher incidence in patients with HIV infection. This study sought to determine whether HIV-infected patients with established CVD were being managed according to national guidelines. Data were collected from Australian general practitioners for 77 HIV-infected patients with a median age of 59 (range 54-64). There was good adherence to guidelines with regards to anti-platelet (84%; n=65; 95% confidence interval (CI) 74-92%) and statin therapy (97%; n=75; 95% CI 91-100%), despite a failure to meet cholesterol targets, with only 31% (n=24; 95% CI 21-42%) of the cohort meeting low-density lipoprotein target values. Similarly, there was limited adherence to guidelines regarding the prescriptions of medications for those with established hypertension (66%; n=51; 95% CI 55-77%), body mass index targets met (40%; n=31; 95% CI 29-52%), and depression screening (32%; n=25; 95% CI 22-44%). This Australian audit provides insight into adherence to guidelines for individuals with CVD and HIV, suggesting that current screening and management practices for these patients falls short of guidelines, particularly in relation to cholesterol management.
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Affiliation(s)
- Sam Emmanuel
- St Vincent's Hospital, 390 Victoria Street, Darlinghurst, NSW 2010, Australia
| | - James Nadel
- St Vincent's Hospital, 390 Victoria Street, Darlinghurst, NSW 2010, Australia
| | - Damien Fagan
- Gilead Sciences, 417St Kilda Road, Melbourne, Vic. 3004, Australia
| | - Sirinya Teeraananchai
- Kirby Institute, University of New South Wales, High Street, Kensington, NSW 2052, Australia
| | - Matthew Law
- Kirby Institute, University of New South Wales, High Street, Kensington, NSW 2052, Australia
| | - Cameron J Holloway
- St Vincent's Hospital, 390 Victoria Street, Darlinghurst, NSW 2010, Australia
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16
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Teeraananchai S, Kerr SJ, Ruxrungtham K, Avihingsanon A, Chaivooth S, Teeraratkul A, Bhakeecheep S, Ongwandee S, Thanprasertsuk S, Law MG. Loss to follow-up and associated factors of patients in the National AIDS Program in Thailand. Antivir Ther 2019; 23:529-538. [PMID: 29583122 DOI: 10.3851/imp3233] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Loss to follow-up (LTFU) is a crucial indicator to evaluate the effectiveness of HIV care and treatment programmes. We assessed the LTFU rate and associated factors of Thai HIV-infected patients who enrolled in the National AIDS Program (NAP) for two periods: prior to (pre-ART) and after starting ART (ART-patients). METHODS Thai HIV patients aged ≥15 years enrolled in NAP from 2008 to 2014. Vital status was ascertained by linkage with the National Death Registry. Competing risk models were used to calculate the adjusted sub-distribution hazards (aSHR) for LTFU for pre-ART and ART-patients, with death considered as a competing risk. RESULTS A total of 157,026 patients registered in care and were included in analyses. The cumulative incidence of LTFU in pre-ART patients at 1 year was 10.2%, whereas in ART-patients it was 12.8%. Among pre-ART patients, younger age (<30 versus ≥45 years, aSHR 1.60, 95% CI 1.49, 1.72), less advanced HIV stage (aSHR 1.29, 95% CI 1.21, 1.37) and higher CD4+ T-cell count (≥350 versus <100, aSHR 6.31, 95% CI 5.74, 6.95) had a higher chance of LTFU. ART-patients with high baseline CD4+ T-cell count (CD4 ≥350 versus CD4 <50, aSHR 2.06, 95% CI 1.97, 2.15) and non-advanced HIV stage had increased risk of LTFU. CONCLUSIONS Our findings provide new evidence of the LTFU rate in Thai HIV-infected patients in NAP. Emphasis needs to be placed on improving follow-up in all patients with higher CD4+ T-cell counts. LTFU will be important to monitor as programmes move to commence ART regardless of CD4+ T-cell count.
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Affiliation(s)
- Sirinya Teeraananchai
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,Kirby Institute, University of New South Wales, Sydney, Australia
| | - Stephen J Kerr
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,Kirby Institute, University of New South Wales, Sydney, Australia
| | - Kiat Ruxrungtham
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Anchalee Avihingsanon
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Suchada Chaivooth
- The HIV/AIDS, Tuberculosis and Infectious Diseases Program, National Health Security Office (NHSO), Bangkok, Thailand
| | | | - Sorakij Bhakeecheep
- The HIV/AIDS, Tuberculosis and Infectious Diseases Program, National Health Security Office (NHSO), Bangkok, Thailand
| | | | | | - Matthew G Law
- Kirby Institute, University of New South Wales, Sydney, Australia
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17
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Teeraananchai S, Puthanakit T, Kerr SJ, Chaivooth S, Kiertiburanakul S, Chokephaibulkit K, Bhakeecheep S, Teeraratkul A, Law M, Ruxrungtham K. Attrition and treatment outcomes among adolescents and youths living with HIV in the Thai National AIDS Program. J Virus Erad 2019; 5:33-40. [PMID: 30800424 PMCID: PMC6362904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND There are limited data describing the care outcome of youth living with HIV in Asia. We assessed attrition and treatment outcomes among youths with behaviourly acquired HIV (BIY) and adolescents with perinatally acquired HIV (PIY) who initiated antiretroviral treatment (ART) through the National AIDS Program (NAP) in Thailand. METHODS People living with HIV aged 10-24 years who initiated antiretroviral therapy (ART) from 2008 to 2013 through the Thai NAP and who were followed up until 2014 were included in the analysis. We assessed youths initiating ART: BIY aged 15-19 years (BIY1) and BIY aged 20-24 (BIY2) compared against PIY aged 10-14 years. Attrition rates (mortality and loss to follow-up [LTFU]) were calculated and potential associations were assessed using Cox regression. Logistic regression was used to assess associations with treatment failure. RESULTS Of 11,954 individuals, 9909 (83%) were BIY with a median follow-up of 2.1 years and 17% were PIY with 4.2 years of follow-up. The median baseline CD4 cell count in BIY was higher (190 vs 154 cells/mm3) compared to PIY. Mortality rates were not significantly different among PIY (2.5 per 100 person years [PY], BIY1 3.1/100 PY and BIY2 2.9/100 PY, P=0.46). Compared to PIY with a crude LTFU rate of 2.9/100 PY, LTFU was higher in BIY1 (13.9/100 PY) and BIY2 (9.5/100 PY), P<0.001 and P<0.001, respectively. At 1 year after initiating ART, 16% experienced virological failure (viral load above 1000 copies/mL). Combined treatment failure and LTFU rates at 1 year after ART were higher among BIY1 (45.0%) and BIY2 (34.4%) compared to PIY (29.9%), P<0.001 and 0.001, respectively. CONCLUSION Youth with behaviourally acquired HIV aged 15-19 years had poorer retention rates than older BIY and PIY. Targeted interventions for youth are urgently needed to improve overall treatment outcomes.
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Affiliation(s)
- Sirinya Teeraananchai
- HIV-NAT,
Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand,Kirby Institute,
University of New South Wales,
Sydney,
Australia
| | - Thanyawee Puthanakit
- HIV-NAT,
Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand,Department of Pediatrics, Faculty of Medicine,
Chulalongkorn University,
Bangkok,
Thailand,Center of Excellence in Pediatric Infectious Diseases and Vaccines,
Chulalongkorn University,
Bangkok,
Thailand
| | - Stephen J Kerr
- HIV-NAT,
Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand,Kirby Institute,
University of New South Wales,
Sydney,
Australia,Faculty of Medicine,
Chulalongkorn University,
Bangkok,
Thailand
| | - Suchada Chaivooth
- HIV/AIDS,
Tuberculosis and Infectious Diseases Program,
National Health Security Office (NHSO),
Thailand
| | | | | | - Sorakij Bhakeecheep
- HIV/AIDS,
Tuberculosis and Infectious Diseases Program,
National Health Security Office (NHSO),
Thailand
| | | | - Matthew Law
- Kirby Institute,
University of New South Wales,
Sydney,
Australia
| | - Kiat Ruxrungtham
- HIV-NAT,
Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand,Faculty of Medicine,
Chulalongkorn University,
Bangkok,
Thailand
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18
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Teeraananchai S, Puthanakit T, Kerr SJ, Chaivooth S, Kiertiburanakul S, Chokephaibulkit K, Bhakeecheep S, Teeraratkul A, Law M, Ruxrungtham K. Attrition and treatment outcomes among adolescents and youths living with HIV in the Thai National AIDS Program. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30276-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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19
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Prasitsuebsai W, Sethaputra C, Lumbiganon P, Hansudewechakul R, Chokephaibulkit K, Truong KH, Nguyen LV, Mohd Razali KA, Nik Yusoff NK, Fong MS, Teeraananchai S, Ananworanich J, Durier N. Adherence to antiretroviral therapy, stigma and behavioral risk factors in HIV-infected adolescents in Asia. AIDS Care 2018; 30:727-733. [PMID: 29336591 DOI: 10.1080/09540121.2018.1425363] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We studied behavioral risks among HIV-infected and uninfected adolescents using an audio computer-assisted self-interview. A prospective cohort study was initiated between 2013 and 2014 in Malaysia, Thailand, and Vietnam. HIV-infected adolescents were matched to uninfected adolescents (4:1) by sex and age group (12-14 and 15-18 years). We enrolled 250 HIV-infected (48% male; median age 14.5 years; 93% perinatally infected) and 59 uninfected (51% male; median age 14.1 years) adolescents. At enrollment, HIV-infected adolescents were on antiretroviral therapy (ART) for a median (IQR) of 7.5 (4.7-10.2) years, and 14% had HIV-RNA >1000 copies/mL; 19% reported adherence <80%. Eighty-four (34%) HIV-infected and 26 (44%) uninfected adolescents reported having ever smoked cigarettes or drunk alcohol (p = 0.13); 10% of HIV-infected and 17% of uninfected adolescents reported having initiated sexual activity; 6 of the HIV-infected adolescents had HIV-RNA >1000 copies/mL. Risk behaviors were common among adolescents, with few differences between those with and without HIV.
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Affiliation(s)
- Wasana Prasitsuebsai
- a The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT) , The Thai Red Cross AIDS Research Centre , Bangkok , Thailand
| | | | - Pagakrong Lumbiganon
- c Faculty of Medicine , Srinagarind Hospital, Khon Kaen University , Khon Kaen , Thailand
| | | | | | | | | | | | | | | | - Sirinya Teeraananchai
- a The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT) , The Thai Red Cross AIDS Research Centre , Bangkok , Thailand
| | - Jintanat Ananworanich
- k US Military HIV Research Program , Walter Reed Army Institute of Research , Silver Spring , USA.,l Henry M. Jackson Foundation for the Advancement of Military Medicine , Bethesda , USA.,m SEARCH, The Thai Red Cross AIDS Research Centre , Bangkok , Thailand.,n University of Amsterdam , Amsterdam , the Netherlands
| | - Nicolas Durier
- b TREAT Asia/amfAR-The Foundation for AIDS Research , Bangkok , Thailand.,o Dreamlopments LTD , Bangkok , Thailand
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20
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Chaivooth S, Bhakeecheep S, Ruxrungtham K, Teeraananchai S, Kerr SJ, Teeraratkul A, Sirinirund P, Ongwandee S, Avihingsanon A, Benjarattanaporn P, Phanuphak N, Sungkanuparph S, Mekthon S, Phanuphak P. The challenges of ending AIDS in Asia: outcomes of the Thai National AIDS Universal Coverage Programme, 2000-2014. J Virus Erad 2017; 3:192-199. [PMID: 29057081 PMCID: PMC5632544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES We sought to determine Thai National AIDS Program (NAP) outcomes and gaps, and success in reaching the WHO 90:90:90 goals. METHODS Retrospective study of treatment outcomes, mortality and loss to follow-up (LTFU), of all individuals aged >15 years who registered to the NAP from 2000 to 2014. We focused outcomes on data from 2008 when the NAP was linked to the death registry. RESULTS A total of 429,294 patients registered to the NAP up to November 2014, and 309,313 patients aged >15 years started ART. Median (IQR) age was 37 (31-43) years; 51% were male. From 2008 to 2014, long-term follow-up rates per 100 person-years were 3.2 in those who started ART vs 3.5 in those who did not (P<0.001) and mortality rates per 100 person-years were 3.5 in those who started ART vs 4.9 in those who did not (P<0.001). Mortality reduced from 16% in 2008 to 3% in 2014 for those who started ART. For patients starting treatment since 2000, 87% of those alive and with a recent viral load (VL) result had <50 copies/mL, and 6% had VL ≥1000 copies/mL. In a continuum-of-care analysis from 2008 to 2014, 68% were living and retained on ART, and 46% of diagnosed individuals were virally suppressed at <50 copies/mL. CONCLUSIONS In the Thai NAP, death and LTFU are major factors disrupting the care-continuum, and many patients initiate ART with low CD4 cell counts. Rolling out systems for early detection and treatment for all, regardless of CD4 cell count, are essential and under way.
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Affiliation(s)
- Suchada Chaivooth
- HIV/AIDS, Tuberculosis and Infectious Diseases Program, National Health Security Office (NHSO),
Thailand
| | - Sorakij Bhakeecheep
- HIV/AIDS, Tuberculosis and Infectious Diseases Program, National Health Security Office (NHSO),
Thailand
| | - Kiat Ruxrungtham
- Corresponding author: Kiat Ruxrungtham.
Faculty of Medicine,
Chulalongkorn University; and
HIV-NAT, Thai Red Cross AIDS Research Centre,
Rama 4 Road,
Bangkok,
Thailand
| | | | - Stephen J Kerr
- HIV-NAT, Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand
| | | | | | | | | | | | | | - Somnuek Sungkanuparph
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University,
Bangkok,
Thailand
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21
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Teeraananchai S, Kerr SJ, Puthanakit T, Bunupuradah T, Ruxrungtham K, Chaivooth S, Law MG, Chokephaibulkit K. Attrition and Mortality of Children Receiving Antiretroviral Treatment through the Universal Coverage Health Program in Thailand. J Pediatr 2017; 188:210-216.e1. [PMID: 28606372 DOI: 10.1016/j.jpeds.2017.05.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 03/30/2017] [Accepted: 05/12/2017] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To assess mortality and loss to follow-up of children with HIV infection who started antiretroviral therapy (ART) through the Universal Coverage Health Program (UC) in Thailand. STUDY DESIGN Children with HIV infection who initiated ART at age <15 years through the UC between 2008 and 2013 were included in the analysis. Death was ascertained through linkage with the National Death Registry. A competing-risks method was used to calculate subdistribution hazard ratios (SHRs) of predictors for loss to follow-up. Death was considered a competing risk. Cox proportional hazards models were used to assess predictors of mortality. RESULTS A total of 4618 children from 497 hospitals in Thailand were included in the study. Median age at ART initiation was 9 years (IQR, 6-12 years), and the median duration of tracking was 4.1 years (a total of 18 817 person-years). Three hundred and ninety-five children (9%) died, for a mortality rate of 2.1 (95% CI, 1.9-2.3) per 100 person-years, and 525 children (11%) were lost to follow-up, for a lost to follow-up rate of 2.9 (95% CI, 2.7-3.2) per 100 person-years. The cumulative incidence of loss to follow-up increased from 4% at 1 year to 8.8% at 3 years. Children who started ART at age ≥12 years were at the greatest risk of loss to follow-up. The probability of death was 3.2% at 6 months and 6.4% at 3 years. Age ≥12 years at ART initiation, lower baseline CD4%, advanced HIV staging, and loss to follow-up were associated with mortality. CONCLUSION The Thai national HIV treatment program has been very effective in treating children with HIV infection, with low mortality and modest rates of loss to follow-up.
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Affiliation(s)
- Sirinya Teeraananchai
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand; Kirby Institute, University of New South Wales, Sydney, Australia.
| | - Stephen J Kerr
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand; Kirby Institute, University of New South Wales, Sydney, Australia
| | - Thanyawee Puthanakit
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand; Department of Pediatrics, Faculty of Medicine, Chulalongkorn University
| | | | - Kiat Ruxrungtham
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand; Department of Medicine, Faculty of Medicine, Chulalongkorn University
| | - Suchada Chaivooth
- The HIV/AIDS, Tuberculosis and Infectious Diseases Program, National Health Security Office (NHSO)
| | - Matthew G Law
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Kulkanya Chokephaibulkit
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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22
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Jamal Mohamed T, Teeraananchai S, Kerr S, Phongsamart W, Nik Yusoff NK, Hansudewechakul R, Ly PS, Nguyen LV, Sudjaritruk T, Lumbiganon P, Do VC, Kurniati N, Kumarasamy N, Wati DK, Fong MS, Nallusamy R, Kariminia A, Sohn AH. Short Communication: Impact of Viral Load Use on Treatment Switch in Perinatally HIV-Infected Children in Asia. AIDS Res Hum Retroviruses 2017; 33:230-233. [PMID: 27758114 DOI: 10.1089/aid.2016.0039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We sought to assess the impact of routine HIV viral load (VL) monitoring on the incidence of switching from a first- to a second-line antiretroviral therapy (ART) regimen, and to describe factors associated with switch. Data from a regional cohort of 16 clinical programs in six Asian countries were analyzed. Second-line switch was defined as a change from a non-nucleoside reverse transcriptase inhibitor (NNRTI) to a protease inhibitor (PI) or vice versa, and ≥1 of the following: (1) reported treatment failure by local criteria, (2) switch of ≥1 additional drug, or (3) a preceding HIV VL ≥1,000 copies/ml. Routine VL was having ≥1 test after ≥24 weeks of ART and ≥1 time/year thereafter. Factors associated with time to switch were evaluated with death and loss to follow-up as competing risks. A total of 2,398 children were included in this analysis. At ART initiation, the median (interquartile range) age was 6.0 (3.3-8.9) years, more than half had WHO stage 3 or 4, the median CD4 was 189 (47-456) cells/mm3, 93% were on NNRTI-based first-line ART, and 34% had routine VL monitoring. Treatment switch occurred in 17.6% of patients, at a median of 35 (22-49) months. After adjusting for country, sex, first ART regimen, and CD4% at ART initiation, children with routine VL monitoring were 1.46 (95% confidence interval 1.11-1.93) times more likely to be switched (p = .007). Scale-up of VL testing will lead to earlier identification of treatment failure, and it can help guide earlier switches to prevent resistance.
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Affiliation(s)
| | | | - Stephen Kerr
- HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | | | | | | | - Penh Sun Ly
- National Centre for HIV/AIDS, Dermatology and STDs, Phnom Penh, Cambodia
| | | | - Tavitiya Sudjaritruk
- Department of Pediatrics, Faculty of Medicine, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | | | - Viet Chau Do
- Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Nia Kurniati
- Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | | | | | | | | | | | - Annette H. Sohn
- TREAT Asia/amfAR-The Foundation for AIDS Research, Bangkok, Thailand
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23
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Teeraananchai S, Chaivooth S, Kerr SJ, Bhakeecheep S, Avihingsanon A, Teeraratkul A, Sirinirund P, Law MG, Ruxrungtham K. Life expectancy after initiation of combination antiretroviral therapy in Thailand. Antivir Ther 2017; 22:393-402. [PMID: 28054931 DOI: 10.3851/imp3121] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Access to combination antiretroviral therapy (cART) has decreased mortality in HIV-positive people. We aimed to estimate the expected additional years of life in HIV-positive Thai people after starting cART through the National AIDS Program (NAP), administered by the Thai National Health Security Office (NHSO). METHODS The NHSO database collects characteristics of all Thai HIV-infected patients through the National AIDS Program, including linkage with the National Death Registry for vital status. This study included patients aged ≥15 years at cART initiation between 2008 and 2014. The abridged life table method was used to construct life tables stratified by sex and baseline CD4+ T-cell count. Life expectancy was defined as the additional years of life from age at starting cART. RESULTS 201,688 eligible patients were included in analyses, contributing 618,837 person-years of follow-up. Median CD4+ T-cell count was 109 cells/mm3 and median age 37 years. The overall life expectancy after cART initiation at age 20 was 25.4 (95% CI, 25.3, 25.6) years and 20.6 (95% CI, 20.5, 20.7) at age 35 years. Life expectancy at baseline CD4+ T-cell count ≥350 cells/mm3 was 51.9 (95% CI, 51.0, 52.9) years for age 20 years and 43.2 (95% CI, 42.4, 44.1) years for age 35 years, close to life expectancy in the general Thai population. CONCLUSIONS Increasing life expectancy with higher baseline CD4+ T-cell counts supports the guideline recommendations to start cART irrespective of CD4+ T-cell count. These results are beneficial to forecast the treatment cost and develop health policies for people living with HIV in Thailand and Asia.
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Affiliation(s)
- Sirinya Teeraananchai
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,Kirby Institute, University of New South Wales, Sydney, Australia
| | - Suchada Chaivooth
- The HIV/AIDS, Tuberculosis and Infectious Diseases Program, National Health Security Office (NHSO), Bangkok, Thailand
| | - Stephen J Kerr
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,Kirby Institute, University of New South Wales, Sydney, Australia.,Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute of Global Health and Development, Amsterdam, the Netherlands
| | - Sorakij Bhakeecheep
- The HIV/AIDS, Tuberculosis and Infectious Diseases Program, National Health Security Office (NHSO), Bangkok, Thailand
| | - Anchalee Avihingsanon
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | | | - Matthew G Law
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Kiat Ruxrungtham
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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24
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Huy BV, Teeraananchai S, Oanh LN, Tucker J, Kurniati N, Hansudewechakul R, Truong KH, Khol V, Nguyen LV, Chau Do V, Lumbiganon P, Kongstan N, Bunupuradah T, Sudjaritruk T, Kumarasamy N, Yusoff NKN, Mohd Razali KA, Wati DK, Fong MS, Nallusamy R, Kariminia A, Sohn AH. Impact of orphan status on HIV treatment outcomes and retention in care of children and adolescents in Asia. J Virus Erad 2016; 2:227-231. [PMID: 27781105 PMCID: PMC5075350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
An analysis of the impact of orphanhood at antiretroviral therapy (ART) initiation on HIV outcomes in Asia included 4300 children; 51% were male. At ART initiation, 1805 (42%) were non-orphans (median age: 3 years), 1437 (33%) were single orphans (6 years) and 1058 (25%) were double orphans (7 years). Ten-year post-ART survival was 93.4-95.2% across orphan categories. Clinic transfers were higher among single and double orphans than non-orphans (41% vs 11%, P<0.001). On multivariate analysis, children ≥3 years at ART initiation (hazard ratio 1.58 vs <3 years, 95% confidence interval: 1.11-2.24) were more likely to be lost to follow-up. Although post-ART mortality and retention did not differ by orphan status, orphans were at greater risk of starting ART at older ages, and with more severe immunosuppression and poorer growth.
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Affiliation(s)
- Bui Vu Huy
- Hanoi Medical University,
Hanoi,
Vietnam;
| | | | - Le Ngoc Oanh
- Worldwide Orphans Foundation,
Ho Chi Minh City,
Vietnam;
| | - John Tucker
- New Hope for Cambodian Children,
Phnom Penh,
Cambodia;
| | - Nia Kurniati
- Cipto Mangunkusumo – Faculty of Medicine Universitas Indonesia,
Jakarta,
Indonesia;
| | | | | | - Vohith Khol
- National Centre for HIV/AIDS Dermatology and STDs and University of Health Sciences,
Phnom Penh,
Cambodia;
| | | | - Viet Chau Do
- Children's Hospital 2,
Ho Chi Minh City,
Vietnam;
| | - Pagakrong Lumbiganon
- Department of Pediatrics, Faculty of Medicine,
Khon Kaen University,
Khon Kaen,
Thailand;
| | - Nantaka Kongstan
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital,
Mahidol University,
Bangkok,
Thailand;
| | | | - Tavitiya Sudjaritruk
- Department of Pediatrics, Faculty of Medicine,
Chiang Mai University and Research Institute for Health Sciences,
Chiang Mai,
Thailand;
| | | | | | | | | | | | | | | | - Annette H Sohn
- TREAT Asia/amfAR – The Foundation for AIDS Research,
Bangkok,
Thailand.,Corresponding author: Annette H Sohn,
TREAT Asia/amfAR,
388 Sukhumvit Road, 2104 Klongtoey,
Bangkok10110,
Thailand
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Teeraananchai S, Kerr SJ, Amin J, Ruxrungtham K, Law MG. Life expectancy of HIV-positive people after starting combination antiretroviral therapy: a meta-analysis. HIV Med 2016; 18:256-266. [PMID: 27578404 DOI: 10.1111/hiv.12421] [Citation(s) in RCA: 265] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Life expectancy is an important indicator informing decision making in policies relating to HIV-infected people. Studies estimating life expectancy after starting combination antiretroviral therapy (cART) have noted differences between income regions. The objective of our study was to perform a meta-analysis to assess life expectancy of HIV-positive people after starting cART, and to quantify differences between low/middle- and high-income countries. METHODS Eight cohort studies estimating life expectancy in HIV-positive people initiating cART aged ≥ 14 years using the abridged life table method were identified. Random effects meta-analysis was used to pool estimated outcomes, overall and by income region. Heterogeneity between studies was assessed with the I2 statistic. We estimated additional years of life expected after starting cART at ages 20 and 35 years. RESULTS Overall life expectancy in high-income countries was an additional 43.3 years [95% confidence interval (CI) 42.5-44.2 years] and 32.2 years (95% CI 30.9-33.5 years) at ages 20 and 35 years, respectively, and 28.3 (95% CI 23.3-33.3) and 25.6 (95% CI 22.1-29.2) additional years, respectively, in low/middle-income countries. In low/middle-income countries, life expectancy after starting cART at age 20 years was an additional 22.9 years (95% CI 18.4-27.5 years) for men and 33.0 years (95% CI 30.4-35.6 years) for women, but was similar in the two sexes in high-income countries. In all income regions, life expectancy after starting cART increased over calendar time. CONCLUSIONS Our results suggest that the life expectancy of HIV-positive people after starting cART has improved over time. Monitoring life expectancy into the future is important to assess how changes to cART guidelines will affect patient long-term outcomes.
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Affiliation(s)
- S Teeraananchai
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia.,HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - S J Kerr
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia.,HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,Department of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands
| | - J Amin
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - K Ruxrungtham
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - M G Law
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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Jiamsakul A, Kerr SJ, Chandrasekaran E, Huelgas A, Taecharoenkul S, Teeraananchai S, Wan G, Ly PS, Kiertiburanakul S, Law M. The occurrence of Simpson's paradox if site-level effect was ignored in the TREAT Asia HIV Observational Database. J Clin Epidemiol 2016; 76:183-92. [PMID: 26854260 DOI: 10.1016/j.jclinepi.2016.01.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 01/20/2016] [Accepted: 01/29/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVES In multisite human immunodeficiency virus (HIV) observational cohorts, clustering of observations often occurs within sites. Ignoring clustering may lead to "Simpson's paradox" (SP) where the trend observed in the aggregated data is reversed when the groups are separated. This study aimed to investigate the SP in an Asian HIV cohort and the effects of site-level adjustment through various Cox regression models. STUDY DESIGN AND SETTING Survival time from combination antiretroviral therapy (cART) initiation was analyzed using four Cox models: (1) no site adjustment; (2) site as a fixed effect; (3) stratification through site; and (4) shared frailty on site. RESULTS A total of 6,454 patients were included from 23 sites in Asia. SP was evident in the year of cART initiation variable. Model (1) shows the hazard ratio (HR) for years 2010-2014 was higher than the HR for 2006-2009, compared to 2003-2005 (HR = 0.68 vs. 0.61). Models (2)-(4) consistently implied greater improvement in survival for those who initiated in 2010-2014 than 2006-2009 contrasting findings from model (1). The effects of other significant covariates on survival were similar across four models. CONCLUSIONS Ignoring site can lead to SP causing reversal of treatment effects. Greater emphasis should be made to include site in survival models when possible.
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Affiliation(s)
| | - Stephen J Kerr
- HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand; Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | | | | | | | | | - Gang Wan
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Penh Sun Ly
- National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia
| | | | - Matthew Law
- The Kirby Institute, UNSW Australia, Sydney, NSW 2052, Australia
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Prasitsuebsai W, Kerr SJ, Truong KH, Ananworanich J, Do VC, Nguyen LV, Kurniati N, Kosalaraksa P, Sudjaritruk T, Chokephaibulkit K, Thammajaruk N, Singtoroj T, Teeraananchai S, Horng H, Bacchetti P, Gandhi M, Sohn AH. Using Lopinavir Concentrations in Hair Samples to Assess Treatment Outcomes on Second-Line Regimens Among Asian Children. AIDS Res Hum Retroviruses 2015; 31:1009-14. [PMID: 26200586 PMCID: PMC4576945 DOI: 10.1089/aid.2015.0111] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
We conducted a prospective monitoring study to determine whether antiretroviral (ARV) levels in hair of Asian children on second-line protease inhibitor-based ARV therapy (ART) are associated with virologic failure (VF), compared to plasma drug levels and self-reported adherence. HIV-infected Asian children on second-line ART regimens were enrolled into a longitudinal cohort. Traditional adherence measures, plasma, and hair samples were collected 24 weeks after study enrollment. Hair ARV levels were determined via liquid chromatography/tandem mass spectrometry. Among 149 children on lopinavir/ritonavir-based regimens, 47% were female; the median [interquartile range (IQR)] age was 10.3 (7.9-13.3) years. The median CD4% was 26% (IQR 21.7-32.1%) and the median CD4 cell count 754 (IQR 596-1,013) cells/mm(3). The median duration of lopinavir-based ART prior to week 24 of the study was 2.9 (IQR 1.6-4.2) years. Adherence was >95% in 91% (135/148) by visual analogue scale and 89% (129/145) by pill count. The median lopinavir hair concentrations were 5.43 (IQR 3.21-9.01) ng/mg in children with HIV RNA >1,000 copies/ml and 9.96 (IQR 6.51-12.31) ng/mg in children with HIV RNA <1,000 copies/ml (p = 0.003). Plasma trough and lopinavir hair concentrations were not statistically significantly correlated (Pearson's correlation coefficient 0.20; p = 0.13). Increasing lopinavir hair concentrations in quartiles were strongly associated with virologic success (odds ratios ≥4.0, overall p = 0.02), while self-reported adherence, pill count, and plasma lopinavir levels were not. Based on this first report of hair ARV concentrations and virologic outcomes in children, ARV hair concentrations, representing longer-term adherence, may be useful to identify children at risk for VF.
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Affiliation(s)
- Wasana Prasitsuebsai
- The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Stephen J. Kerr
- The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | | | - Jintanat Ananworanich
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland and the Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Viet Chau Do
- Children's Hospital 2, Ho Chi Minh City, Vietnam
| | | | - Nia Kurniati
- Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Pope Kosalaraksa
- Division of Infectious Diseases, Department of Pediatrics, Khon Kaen University, Khon Kaen, Thailand
| | - Tavitiya Sudjaritruk
- Research Institute for Health Sciences and Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Narukjaporn Thammajaruk
- The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Thida Singtoroj
- TREAT Asia/amfAR—The Foundation for AIDS Research, Bangkok, Thailand
| | - Sirinya Teeraananchai
- The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Howard Horng
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, California
| | - Peter Bacchetti
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Monica Gandhi
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Annette H. Sohn
- TREAT Asia/amfAR—The Foundation for AIDS Research, Bangkok, Thailand
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Phongsamart W, Hansudewechakul R, Bunupuradah T, Klinbuayaem V, Teeraananchai S, Prasithsirikul W, Kerr SJ, Akarathum N, Denjunta S, Ananworanich J, Chokephaibulkit K. Long-term outcomes of HIV-infected children in Thailand: the Thailand Pediatric HIV Observational Database. Int J Infect Dis 2014; 22:19-24. [PMID: 24576843 DOI: 10.1016/j.ijid.2013.12.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 12/09/2013] [Accepted: 12/09/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To describe the outcomes of antiretroviral therapy (ART) in a large cohort of HIV-infected children in Thailand. METHODS The data were obtained from four collaborative referral sites around the country. Data from 2008 to March 2011 were collected prospectively, and data before 2008 were collected retrospectively. RESULTS Of the 1139 children, 599 (52.6%) were female, and the duration of ART was a median 2.9 years (interquartile range (IQR) 3.3-5.5 years). At ART initiation, the median age was 7.1 years (IQR 3.4-10.0 years), CD4 percentage was 9.0% (IQR 3.0-17.0%), and 61.3% were in World Health Organization (WHO) stage 3 or 4. Seventy-four percent were initiated on an NNRTI-based regimen. The death and lost to follow-up rates were 1.3 (95% confidence interval (CI) 1.1-1.6) and 2.2 (95% CI 1.6-2.6)/100 patient-years of follow-up, respectively. At the last clinic visit of 919 children, the median CD4 percentage was 27.0% (IQR 23.0-32.0%) and 80.2% had HIV-RNA <40 copies/ml. WHO stage 1 or 2 at ART initiation was associated with having a viral load <40 copies/ml (p < 0.002), and baseline CD4 ≥15% and starting with a three-drug regimen were associated with achieving CD4 ≥25% (p<0.001). CONCLUSIONS Although most children initiated ART at low CD4 levels, the majority achieved immune reconstitution and long-term virological control. Earlier treatment may improve these outcomes.
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Affiliation(s)
| | | | - Torsak Bunupuradah
- The HIV Netherlands Australia Thailand Research Collaboration, the Thai Red Cross AIDS Research Center, Bangkok, Thailand
| | | | - Sirinya Teeraananchai
- The HIV Netherlands Australia Thailand Research Collaboration, the Thai Red Cross AIDS Research Center, Bangkok, Thailand
| | | | - Stephen J Kerr
- The HIV Netherlands Australia Thailand Research Collaboration, the Thai Red Cross AIDS Research Center, Bangkok, Thailand; Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia
| | | | | | - Jintanat Ananworanich
- The HIV Netherlands Australia Thailand Research Collaboration, the Thai Red Cross AIDS Research Center, Bangkok, Thailand; Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia; Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; SEARCH, The Thai Red Cross AIDS Research Center, Bangkok, Thailand
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