Journal of acquired immune deficiency syndromes (1999), 2006
... Sydney, Australia †Thai Red Cross AIDS Research Centre Bangkok, Thailand ‡Ramathibodi Hospita... more ... Sydney, Australia †Thai Red Cross AIDS Research Centre Bangkok, Thailand ‡Ramathibodi Hospital Bangkok, Thailand §Research Institute for Tropical Medicine Manila, Philippines ¶University Malaya Medical Centre Kuala Lumpur, Malaysia ∥Ruby Hall Clinic, Pune, India. ...
Using data from TREAT Asia HIV Observational Database (TAHOD), this paper aims to assess the rate... more Using data from TREAT Asia HIV Observational Database (TAHOD), this paper aims to assess the rate of, and factors associated with the diagnosis of new AIDS-defining illness (ADI) within 90 days after antiretroviral treatment. Patients starting three or more antiretroviral combinations and having subsequent follow-up were included. New ADI cases were checked for evidence of immune reconstitution syndrome (IRS). Among the 1185 patients included, 75 (6.3%) were diagnosed with a new ADI within 90 days, giving a rate of 26.8/100 person-years, compared with a further 3.6% cumulative incidence of new ADI between 90 days to one year (4.2/100 person-years). Of the 75 patients, 21 were judged as definitive or presumptive IRS, giving a rate of 7.3/100 person-years. Patients with new ADI generally had lower CD4 counts before treatment started (median, 43 cells/microL). Lower CD4 count, lower body mass index and starting treatment in the same year as the first HIV-positive test done were associated with developing a new ADI. The higher rate of new ADI within 90 days may be partly explained by IRS occurring shortly after treatment. Although it is difficult to identify IRS from observational data, it appears that in TAHOD setting IRS was relatively uncommon.
ObjectiveWe investigated the use of antiretroviral therapy regimens containing zidovudine or stav... more ObjectiveWe investigated the use of antiretroviral therapy regimens containing zidovudine or stavudine, using data from the TREAT Asia HIV Observational Database (TAHOD), a multicentre, prospective, observational study of an HIV-infected cohort in the Asia-Pacific Region.We investigated the use of antiretroviral therapy regimens containing zidovudine or stavudine, using data from the TREAT Asia HIV Observational Database (TAHOD), a multicentre, prospective, observational study of an HIV-infected cohort in the Asia-Pacific Region.MethodsA proportional hazards regression analysis of factors associated with the time to discontinuation of initial regimens containing zidovudine or stavudine and a logistic regression analysis to identify factors associated with a diagnosis of anaemia within 6 months of commencement of zidovudine in initial or subsequent regimens were performed.A proportional hazards regression analysis of factors associated with the time to discontinuation of initial regimens containing zidovudine or stavudine and a logistic regression analysis to identify factors associated with a diagnosis of anaemia within 6 months of commencement of zidovudine in initial or subsequent regimens were performed.ResultsPatients who started zidovudine were more likely to stop within the first 9 months of treatment than those who started on stavudine; the reverse was true after 9 months. Anaemia (haemoglobin≤10 g/dL) occurred in the first 6 months in 57 of 433 patients (13%) on zidovudine. Baseline anaemia was the strongest predictive factor for subsequent anaemia, and prior antiretroviral therapy (ART) experience was protective for development of anaemia.Patients who started zidovudine were more likely to stop within the first 9 months of treatment than those who started on stavudine; the reverse was true after 9 months. Anaemia (haemoglobin≤10 g/dL) occurred in the first 6 months in 57 of 433 patients (13%) on zidovudine. Baseline anaemia was the strongest predictive factor for subsequent anaemia, and prior antiretroviral therapy (ART) experience was protective for development of anaemia.ConclusionsThese data support baseline haemoglobin testing and avoidance of zidovudine if the patient is anaemic. The protective effect of prior ART for development of anaemia on zidovudine supports the short-term safety of a stavudine to zidovudine switch with routine haemoglobin monitoring in this cohort. Further studies in resource-poor settings of longer term efficacy and toxicities of ART switch strategies are needed.These data support baseline haemoglobin testing and avoidance of zidovudine if the patient is anaemic. The protective effect of prior ART for development of anaemia on zidovudine supports the short-term safety of a stavudine to zidovudine switch with routine haemoglobin monitoring in this cohort. Further studies in resource-poor settings of longer term efficacy and toxicities of ART switch strategies are needed.
ABSTRACT Background: Current treatment guidelines for HIV infection recommend CD4+ T lymphocyte (... more ABSTRACT Background: Current treatment guidelines for HIV infection recommend CD4+ T lymphocyte (CD4) count monitoring every 6 to 12 months in patients with viral suppression. As clinically meaningful CD4 decline rarely occurs during viral suppression, routine CD4 monitoring may have a limited role in influencing care. Methods: Among patients in a regional HIV observational cohort in the Asia-Pacific, those with viral suppression (2 consecutive viral loads <400 copies/mL) and a baseline CD4 count ≥200 cells/µL within 390 days of viral suppression who had CD4 testing every 6 months during viral suppression were analyzed. Study endpoints were occurrence of one CD4 count <200 cells/µL (single CD4 <200), confirmed CD4 count <200 cells/µL (confirmed CD4 <200; 2 results <200 cells/µL within a 6-month period), and clinical failure (a new or recurrent WHO stage 3 or 4 illness). A comparison of time to single CD4 <200 and confirmed CD4<200 at 6- and 12- month intervals was performed. Results: Among 1538 patients who met the inclusion criteria, the rate of single CD4<200 was 3.45 per 100 patient-years, of confirmed CD4<200 was 0.77 per 100 patient-years, and of clinical failure was 0.57 per 100 patient-years. After 5 years of viral suppression, the cumulative probability of single CD4 <200 was 10%. The 5-year cumulative probabilities of confirmed CD4 <200 and clinical failure were lower than 10% (see Figure 1). Patients with baseline CD4 between 200-249 cells/µL were significantly more likely to experience confirmed CD4 <200 compared with patients with higher baseline CD4 (hazard ratio 55.47 [95% confidence interval (CI) 7.36 – 418.20], p<0.001 versus baseline CD4 ≥500). There was no significant difference in the time to confirmed CD4 <200 between the 6- and 12-month testing intervals (log rank = 0.335). Conclusion: Patients in our cohort with baseline CD4 <250 cells/µL were at greater risk of confirmed CD4 <200 during viral suppression compared with patients with higher baseline CD4. CD4 testing at 6-month intervals offered no benefit over annual testing in detecting confirmed CD4 <200. Annual CD4 monitoring in virally suppressed HIV patients with a baseline CD4 ≥250 cells/µL may be sufficient for clinical management.
Adherence to antiretroviral therapy (ART) plays an important role in treatment outcomes. It is cr... more Adherence to antiretroviral therapy (ART) plays an important role in treatment outcomes. It is crucial to identify factors influencing adherence in order to optimize treatment responses. The aim of this study was to assess the rates of, and factors associated with, suboptimal adherence (SubAdh) in the first 24 months of ART in an Asian HIV cohort. As part of a prospective resistance monitoring study, the TREAT Asia Studies to Evaluate Resistance Monitoring Study (TASER-M) collected patients' adherence based on the World Health Organization-validated Adherence Visual Analogue Scale. SubAdh was defined in two ways: (i) <100% and (ii) <95%. Follow-up time started from ART initiation and was censored at 24 months, loss to follow-up, death, treatment switch, or treatment cessation for >14 days. Time was divided into four intervals: 0-6, 6-12, 12-18 and 18-24 months. Factors associated with SubAdh were analysed using generalized estimating equations. Out of 1316 patients, 32% ever reported <100% adherence and 17% ever reported <95%. Defining the outcome as SubAdh <100%, the rates of SubAdh for the four time intervals were 26%, 17%, 12% and 10%. Sites with an average of >2 assessments per patient per year had an odds ratio (OR)=0.7 (95% confidence interval (CI) (0.55 to 0.90), p=0.006), compared to sites with ≤2 assessments per patient per year. Compared to heterosexual exposure, SubAdh was higher in injecting drug users (IDUs) (OR=1.92, 95% CI (1.23 to 3.00), p=0.004) and lower in homosexual exposure (OR=0.52, 95% CI (0.38 to 0.71), p<0.001). Patients taking a nucleoside transcriptase inhibitor and protease inhibitor (NRTI+PI) combination were less likely to report adherence…
Since 1957 Japan has successfully eradicated human and animal rabies through registration, confin... more Since 1957 Japan has successfully eradicated human and animal rabies through registration, confinement and compulsory vaccination of family dogs, and elimination of stray dogs. However, in November 2006, two cases of human rabies infections were reported in the country. These patients were bitten by dogs during travel in the Philippines, and did not receive pre- and post-exposure prophylaxes. With the mounting numbers of Japanese travelers every year, the risk of infection increases especially to those who visit regions where the disease is endemic. In this paper, we shall discuss the two recent human deaths from rabies, review the current situation and control measures in Japan and surrounding countries where the disease is prevalent, summarize precautionary measures for travelers, and suggest public health strategies to prevent the re-introduction of rabies in the country.
Journal of acquired immune deficiency syndromes (1999), 2006
... Sydney, Australia †Thai Red Cross AIDS Research Centre Bangkok, Thailand ‡Ramathibodi Hospita... more ... Sydney, Australia †Thai Red Cross AIDS Research Centre Bangkok, Thailand ‡Ramathibodi Hospital Bangkok, Thailand §Research Institute for Tropical Medicine Manila, Philippines ¶University Malaya Medical Centre Kuala Lumpur, Malaysia ∥Ruby Hall Clinic, Pune, India. ...
Using data from TREAT Asia HIV Observational Database (TAHOD), this paper aims to assess the rate... more Using data from TREAT Asia HIV Observational Database (TAHOD), this paper aims to assess the rate of, and factors associated with the diagnosis of new AIDS-defining illness (ADI) within 90 days after antiretroviral treatment. Patients starting three or more antiretroviral combinations and having subsequent follow-up were included. New ADI cases were checked for evidence of immune reconstitution syndrome (IRS). Among the 1185 patients included, 75 (6.3%) were diagnosed with a new ADI within 90 days, giving a rate of 26.8/100 person-years, compared with a further 3.6% cumulative incidence of new ADI between 90 days to one year (4.2/100 person-years). Of the 75 patients, 21 were judged as definitive or presumptive IRS, giving a rate of 7.3/100 person-years. Patients with new ADI generally had lower CD4 counts before treatment started (median, 43 cells/microL). Lower CD4 count, lower body mass index and starting treatment in the same year as the first HIV-positive test done were associated with developing a new ADI. The higher rate of new ADI within 90 days may be partly explained by IRS occurring shortly after treatment. Although it is difficult to identify IRS from observational data, it appears that in TAHOD setting IRS was relatively uncommon.
ObjectiveWe investigated the use of antiretroviral therapy regimens containing zidovudine or stav... more ObjectiveWe investigated the use of antiretroviral therapy regimens containing zidovudine or stavudine, using data from the TREAT Asia HIV Observational Database (TAHOD), a multicentre, prospective, observational study of an HIV-infected cohort in the Asia-Pacific Region.We investigated the use of antiretroviral therapy regimens containing zidovudine or stavudine, using data from the TREAT Asia HIV Observational Database (TAHOD), a multicentre, prospective, observational study of an HIV-infected cohort in the Asia-Pacific Region.MethodsA proportional hazards regression analysis of factors associated with the time to discontinuation of initial regimens containing zidovudine or stavudine and a logistic regression analysis to identify factors associated with a diagnosis of anaemia within 6 months of commencement of zidovudine in initial or subsequent regimens were performed.A proportional hazards regression analysis of factors associated with the time to discontinuation of initial regimens containing zidovudine or stavudine and a logistic regression analysis to identify factors associated with a diagnosis of anaemia within 6 months of commencement of zidovudine in initial or subsequent regimens were performed.ResultsPatients who started zidovudine were more likely to stop within the first 9 months of treatment than those who started on stavudine; the reverse was true after 9 months. Anaemia (haemoglobin≤10 g/dL) occurred in the first 6 months in 57 of 433 patients (13%) on zidovudine. Baseline anaemia was the strongest predictive factor for subsequent anaemia, and prior antiretroviral therapy (ART) experience was protective for development of anaemia.Patients who started zidovudine were more likely to stop within the first 9 months of treatment than those who started on stavudine; the reverse was true after 9 months. Anaemia (haemoglobin≤10 g/dL) occurred in the first 6 months in 57 of 433 patients (13%) on zidovudine. Baseline anaemia was the strongest predictive factor for subsequent anaemia, and prior antiretroviral therapy (ART) experience was protective for development of anaemia.ConclusionsThese data support baseline haemoglobin testing and avoidance of zidovudine if the patient is anaemic. The protective effect of prior ART for development of anaemia on zidovudine supports the short-term safety of a stavudine to zidovudine switch with routine haemoglobin monitoring in this cohort. Further studies in resource-poor settings of longer term efficacy and toxicities of ART switch strategies are needed.These data support baseline haemoglobin testing and avoidance of zidovudine if the patient is anaemic. The protective effect of prior ART for development of anaemia on zidovudine supports the short-term safety of a stavudine to zidovudine switch with routine haemoglobin monitoring in this cohort. Further studies in resource-poor settings of longer term efficacy and toxicities of ART switch strategies are needed.
ABSTRACT Background: Current treatment guidelines for HIV infection recommend CD4+ T lymphocyte (... more ABSTRACT Background: Current treatment guidelines for HIV infection recommend CD4+ T lymphocyte (CD4) count monitoring every 6 to 12 months in patients with viral suppression. As clinically meaningful CD4 decline rarely occurs during viral suppression, routine CD4 monitoring may have a limited role in influencing care. Methods: Among patients in a regional HIV observational cohort in the Asia-Pacific, those with viral suppression (2 consecutive viral loads <400 copies/mL) and a baseline CD4 count ≥200 cells/µL within 390 days of viral suppression who had CD4 testing every 6 months during viral suppression were analyzed. Study endpoints were occurrence of one CD4 count <200 cells/µL (single CD4 <200), confirmed CD4 count <200 cells/µL (confirmed CD4 <200; 2 results <200 cells/µL within a 6-month period), and clinical failure (a new or recurrent WHO stage 3 or 4 illness). A comparison of time to single CD4 <200 and confirmed CD4<200 at 6- and 12- month intervals was performed. Results: Among 1538 patients who met the inclusion criteria, the rate of single CD4<200 was 3.45 per 100 patient-years, of confirmed CD4<200 was 0.77 per 100 patient-years, and of clinical failure was 0.57 per 100 patient-years. After 5 years of viral suppression, the cumulative probability of single CD4 <200 was 10%. The 5-year cumulative probabilities of confirmed CD4 <200 and clinical failure were lower than 10% (see Figure 1). Patients with baseline CD4 between 200-249 cells/µL were significantly more likely to experience confirmed CD4 <200 compared with patients with higher baseline CD4 (hazard ratio 55.47 [95% confidence interval (CI) 7.36 – 418.20], p<0.001 versus baseline CD4 ≥500). There was no significant difference in the time to confirmed CD4 <200 between the 6- and 12-month testing intervals (log rank = 0.335). Conclusion: Patients in our cohort with baseline CD4 <250 cells/µL were at greater risk of confirmed CD4 <200 during viral suppression compared with patients with higher baseline CD4. CD4 testing at 6-month intervals offered no benefit over annual testing in detecting confirmed CD4 <200. Annual CD4 monitoring in virally suppressed HIV patients with a baseline CD4 ≥250 cells/µL may be sufficient for clinical management.
Adherence to antiretroviral therapy (ART) plays an important role in treatment outcomes. It is cr... more Adherence to antiretroviral therapy (ART) plays an important role in treatment outcomes. It is crucial to identify factors influencing adherence in order to optimize treatment responses. The aim of this study was to assess the rates of, and factors associated with, suboptimal adherence (SubAdh) in the first 24 months of ART in an Asian HIV cohort. As part of a prospective resistance monitoring study, the TREAT Asia Studies to Evaluate Resistance Monitoring Study (TASER-M) collected patients' adherence based on the World Health Organization-validated Adherence Visual Analogue Scale. SubAdh was defined in two ways: (i) <100% and (ii) <95%. Follow-up time started from ART initiation and was censored at 24 months, loss to follow-up, death, treatment switch, or treatment cessation for >14 days. Time was divided into four intervals: 0-6, 6-12, 12-18 and 18-24 months. Factors associated with SubAdh were analysed using generalized estimating equations. Out of 1316 patients, 32% ever reported <100% adherence and 17% ever reported <95%. Defining the outcome as SubAdh <100%, the rates of SubAdh for the four time intervals were 26%, 17%, 12% and 10%. Sites with an average of >2 assessments per patient per year had an odds ratio (OR)=0.7 (95% confidence interval (CI) (0.55 to 0.90), p=0.006), compared to sites with ≤2 assessments per patient per year. Compared to heterosexual exposure, SubAdh was higher in injecting drug users (IDUs) (OR=1.92, 95% CI (1.23 to 3.00), p=0.004) and lower in homosexual exposure (OR=0.52, 95% CI (0.38 to 0.71), p<0.001). Patients taking a nucleoside transcriptase inhibitor and protease inhibitor (NRTI+PI) combination were less likely to report adherence…
Since 1957 Japan has successfully eradicated human and animal rabies through registration, confin... more Since 1957 Japan has successfully eradicated human and animal rabies through registration, confinement and compulsory vaccination of family dogs, and elimination of stray dogs. However, in November 2006, two cases of human rabies infections were reported in the country. These patients were bitten by dogs during travel in the Philippines, and did not receive pre- and post-exposure prophylaxes. With the mounting numbers of Japanese travelers every year, the risk of infection increases especially to those who visit regions where the disease is endemic. In this paper, we shall discuss the two recent human deaths from rabies, review the current situation and control measures in Japan and surrounding countries where the disease is prevalent, summarize precautionary measures for travelers, and suggest public health strategies to prevent the re-introduction of rabies in the country.
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