HIV Drug Resistance among Pre-treatment Cases in Thailand: Four Rounds of Surveys during 2006-2013.

In Thailand, antiretroviral therapy (ART) was initiated to treat human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) cases using the empirical regimen with no prior genotypic test to determine drug resistance. In order to assess prevalence rate of HIV drug resistance (HIVDR) among pre-treatment cases, four rounds of survey were carried out in ART clinics, including six, eight, 33 and four ART clinics in each round during 2006-2013. For which, HIVDR testing results were available in 310, 350, 797, and 413 cases in four rounds. It was revealed that HIVDR rates among naive cases were 2.0%, 2.8%, 4.0% and 4.8%, while in experienced cases, the rates were 0, 3.3%, 11.4% and 13.9%. The rates among all cases were 1.9%, 2.9%, 4.4% and 5.6%. Resistant drugs with the highest rates among all cases in the survey round 4 were nevirapine (3.6%) and efavirenz (3.1%). The results indicated the need to continue surveillance for pre-treatment HIVDR, and posed challenges to implement activities for protecting efficacy and prolong the use of empirical first-line regimen. A strategy to apply genotyping test, in a cost-effective approach, should be considered to prepare for situation when HIVDR increases beyond a critical level.

Cytokine profiles in HIV-1 subtype CRF01_AE infected individuals with different rates of diseases progression: a multiplex immunoassay.

OBJECTIVE: Cytokines play an important role in controlling the homeostasis of the immune system and contribute to the pathogenesis of HIV infection. The measurement soluble cytokines in plasma of HIV-1 infected individuals with different rates of disease progression may provide additional information to complement prognostic markers and understand disease process. The aim of the present study was to determine the cytokine profiles in plasma of Thai HIV-1 CRFO1_AE infected individuals with different rates of disease progression by using a multiplex system for simultaneous detection of 7 cytokines. MATERIAL AND METHOD: The authors used a multiplex immunoassay method to measure 7 cytokines (IL-2, IL-4, IL-6, IL-7, IL-10, IL-15 and IFN-gamma) in plasma of 23 progressors (PRs; symptomatic or AIDS within 5 years and CD4+ < 200/mm3), 23 slower progressors (SPs; asymptomatic more than 5 years and CD4+ > 350/mm3) and 23 normal healthy individuals. RESULTS: Both PRs and SPs demonstrated significantly higher levels of IL-7, IL-10 and IFN-gamma than healthy controls (p < 0.05). No significant difference in IL-6 between SPs and healthy controls but significant difference between RPs and controls were found. Furthermore, PRs showed significantly higher levels of plasma IL-6 (p = 0.001), IL-7 (p = 0.016), IL-10 (p < 0.001) and IFN-gamma (p = 0.026) than SPs. No significant difference in IL-2, IL-4 and IL-15 was found among 3 groups (PRs, SPs and healthy control). CONCLUSION: These results suggested that a Th1 to Th2 cytokine switch did not occur. However, the measurements of plasma levels of cytokines could be used for predicting disease progression.

National program scale-up and patient outcomes in a pediatric antiretroviral treatment program, Thailand, 2000-2007.

BACKGROUND: There are limited reports of public sector scale-up of antiretroviral treatment (ART) for HIV-infected children. We describe patient outcomes for HIV-infected children initiating ART in Thailand from 2000 to 2005. METHODS: ART-naive patients <15 years old initiating ART from January 2000 to December 2005 were included; follow-up was through March 2007. Survival probabilities were estimated with Kaplan-Meier and hazard ratios for death and loss to follow-up (LTFU) with Cox proportional hazards models. RESULTS: Analysis included 3409 children. Median follow-up time was 1.7 years (interquartile range = 1.0-2.5). Median age at ART initiation was 7.3 years, weight-for-age z score was -2.0, CD4% was 5.0%. ART was initiated in 1428 (41.9%) children at regional/university hospitals and in 689 (20.2%) at district/community hospitals. At last visit, 346 (10.1%) were LTFU and 305 (9.0%) had died. Age <1 (P = 0.008), weight-for-age z score <-2.0 (P < 0.001), CD4% <5% (P < 0.001), and clinical stage C (P < 0.001) were associated with death; district/community hospital patients had a lower hazard of death (P = 0.011). Clinical stage C (P = 0.052) and regional/university hospital (P < 0.001) were associated with increased LTFU. CONCLUSIONS: Pediatric ART has been successfully scaled-up in Thailand, including to district/community hospitals. Late entry to care is associated with poorer outcomes, and earlier ART initiation should be prioritized.