Prevalence of and Predictive Factor for Abdominal Aortic Calcification in Thai Chronic Kidney Disease Patients

Presence and severity of cardiovascular calcifications strongly predict cardiovascular morbidity and mortality in patients with CKD. This multicenter, cross‐sectional study primarily aimed to determine prevalence of abdominal aortic calcification (AAC) detected by plain lateral abdominal radiograph, and secondarily aimed to assess predictive factors for AAC. Patients (N = 1500), aged 18–70 years, with CKD stages 3–5D for ≥3 months prior to evaluation, were enrolled at 24 study centers in Thailand; 54.3% were non‐dialysis patients. The prevalence of AAC was 70.6% and 70.8% in non‐dialysis and dialysis patients, respectively. Patient's advanced age and widening pulse pressure were identified as predictive factors for AAC ≥ 5 in non‐dialysis patients, while patient's age, history of coronary heart disease or diabetes, longer dialysis vintage, and increasing corrected serum calcium or high‐sensitivity C‐reactive protein were identified as such in dialysis patients. With additional regression having covariates in binary, corrected serum calcium ≥9.5 mg/dL gave an OR 1.974 (95% CI: 1.324–2.943) for AAC ≥ 5 among the dialysis patients. AAC in diabetes subgroup (N = 692) was additionally evaluated and found that it was prevalent at 84.7% with increased phosphorus as predictive factor (OR, 1.178; 95% CI: 1.032–1.344) and 1,25 (OH)₂ vitamin D as protective factor (OR, 0.983; 95% CI, 0.970–0.996). The prevalence of AAC in the Thai CKD population is lower than that reported in the literature, and yet the burden is prominent in patients coexisting with diabetes. Variable relationships identified in this study may guide preventive measures against cardiovascular complications in CKD patients.     

Knowledge,attitudes, and practices regarding antiretroviral management,reproductive health,sexually transmitted infections,and sexual risk behavior among perinatally HIV-infected youth in Thailand

More than 30% of perinatally HIV-infected children in Thailand are 12 years and older. As these youth become sexually active, there is a risk that they will transmit HIV to their partners. Data on the knowledge, attitudes, and practices (KAP) of HIV-infected youth in Thailand are limited. Therefore, we assessed the KAP of perinatally HIV-infected youth and youth reporting sexual risk behaviors receiving care at two tertiary care hospitals in Bangkok, Thailand and living in an orphanage in Lopburi, Thailand. From October 2010 to July 2011, 197 HIV-infected youth completed an audio computer-assisted self-interview to assess their KAP regarding antiretroviral (ARV) management, reproductive health, sexual risk behaviors, and sexually transmitted infections (STIs). A majority of youth in this study correctly answered questions about HIV transmission and prevention and the importance of taking ARVs regularly. More than half of the youth in this study demonstrated a lack of family planning, reproductive health, and STI knowledge. Girls had more appropriate attitudes toward safe sex and risk behaviors than boys. Although only 5% of the youth reported that they had engaged in sexual intercourse, about a third reported sexual risk behaviors (e.g., having or kissing boy/girlfriend or consuming an alcoholic beverage). We found low condom use and other family planning practices, increasing the risk of HIV and/or STI transmission to sexual partners. Additional resources are needed to improve reproductive health knowledge and reduce risk behavior among HIV-infected youth in Thailand.     

Psychosocial needs of perinatally HIV-infected youths in Thailand: lessons learnt from instructive counseling†

Identifying psychosocial needs of perinatally HIV-infected (pHIV) youth is a key step in ensuring good mental health care. We report psychosocial needs of pHIV youth identified using the “Youth Counseling Needs Survey” (YCS) and during individual counseling (IC) sessions. pHIV youth receiving care at two tertiary-care hospitals in Bangkok or at an orphanage in Lopburi province were invited to participate IC sessions. The youths’ psychosocial needs were assessed using instructive IC sessions in four main areas: general health, reproductive health, mood, and psychosocial concerns. Prior to the IC session youth were asked to complete the YCS in which their concerns in the four areas were investigated. Issues identified from the YCS and the IC sessions were compared. During October 2010–July 2011, 150 (68.2%) of 220 eligible youths participated in the IC sessions and completed the YCS. Median age was 14 (range 11–18) years and 92 (61.3%) were female. Mean duration of the IC sessions was 36.5 minutes. One-hundred and thirty (86.7%) youths reported having at least one psychosocial problem discovered by either the IC session or the YCS. The most common problems identified during the IC session were poor health attitude and self-care (48.0%), lack of life skills (44.0%), lack of communication skills (40.0%), poor antiretroviral (ARV) adherence (38.7%), and low self-value (34.7%). The most common problems identified by the YCS were lack of communication skills (21.3%), poor health attitude and self-care (14.0%), and poor ARV adherence (12.7%). Youth were less likely to report psychosocial problems in the YCS than in the IC session. Common psychosocial needs among HIV-infected youth were issues about life skills, communication skills, knowledge on self-care, ARV adherence, and self-value. YCS can identify pHIV youths’ psychosocial needs but might underestimate issues. Regular IC sessions are useful to detect problems and provide opportunities for counseling.     

Willingness of injection drug users to participate in an HIV vaccine efficacy trial in Bangkok, Thailand.

We assessed willingness to participate in an HIV recombinant gp120 bivalent subtypes B/E candidate vaccine efficacy trial among 193 injection drug users (IDUs) attending drug treatment clinics in Bangkok, Thailand. IDUs previously enrolled in a prospective cohort study were invited to group sessions describing a potential trial, then completed questionnaires assessing comprehension and willingness to participate. A week later, they completed a follow-up questionnaire that again assessed comprehension and willingness to participate, as well as barriers to and positive motives for participation, with whom (if anyone) they talked about the information, and whether others thought participation was a good, bad, or neutral idea. At baseline, 51% were definitely willing to participate, and at follow-up 54%; only 3% were not willing to participate at either time. Comprehension was high at baseline and improved at follow-up. Participants who viewed altruism, regular HIV tests, and family support for participation as important were more willing to volunteer. Frequency of incarceration and concerns about the length of the trial, possible vaccine-induced accelerated disease progression, and lack of family support were negatively associated with willingness. Overall, IDUs comprehended the information needed to make a fully informed decision about participating in an rgp120 vaccine efficacy trial and expressed a high level of willingness to participate in such a trial.     

Human immunodeficiency virus-related tuberculosis and primary drug resistance in Bangkok, Thailand.

SETTING: Central Chest Hospital, a 500-bed referral hospital near Bangkok with a large out-patient department. OBJECTIVES: To determine human immunodeficiency virus (HIV) seroprevalence among patients with pulmonary tuberculosis (TB), and compare HIV-positive and HIV-negative TB patients. DESIGN: From July 1995 through June 1996, a cross-sectional study was conducted of newly registered adults (> or =16 years old) with suspected pulmonary TB. RESULTS: Of 2587 newly registered patients with suspected pulmonary TB, 2019 (78%) received HIV pretest counseling and 1816 (90%) consented to testing. Of these, 364 (20%) were HIV-seropositive. Among 1091 patients with bacteriologically confirmed TB, HIV seroprevalence was 22%. HIV-positive patients were more likely to be young, unemployed, single men and to have a history of injection drug use. HIV-positive patients with first-episode TB were more likely to have Mycobacterium tuberculosis strains resistant to isoniazid (10.9% vs 3.5%; P < 0.001), rifampicin (9.4% vs 2.9%; P < 0.001), and at least isoniazid and rifampicin (multidrug-resistant TB [MDR-TB]; 5.2% vs 0.4%; P < 0.001). CONCLUSIONS: HIV prevalence is high among TB patients at this Bangkok hospital and is associated with drug resistance, including a 12 times higher risk of MDR-TB. These findings underscore the urgent need to assure adherence to complete, effective TB treatment regimens for all patients, including persons who are potentially difficult to manage such as injection drug users.     

Reduction in mother-to-child transmission of HIV in Thailand, 2001-2003: Results from population-based surveillance in six provinces

BACKGROUND: In 2000, Thailand implemented a national program to prevent mother-to-child HIV transmission (PMTCT). OBJECTIVE: To describe the effectiveness of the prevention of mother-to-child HIV transmission program in Thailand. DESIGN AND METHODS: A register of HIV-exposed children at birth was created with follow-up of infection status. The register included children born to HIV-infected women between 1 January 2001 and 31 December 2003 at 84 public health hospitals in six provinces of Thailand. The main outcome measure was HIV infection in children. RESULTS: A total of 2200 children born to HIV-infected mothers were registered. Of these mother-infant pairs, 2105 (95.7%) received some antiretroviral prophylaxis, including 1358 (61.7%) who received the complete short-course zidovudine regimen during pregnancy and labor for the mother and after birth for the infant, with or without other antiretrovirals. HIV infection outcome was determined for 1667 (75.8%) children, of whom 158 [9.5%, 95% confidence interval (CI), 8.1-11.0%] were infected. Transmission risk was 6.8% (95% CI 5.2-8.9%) among 761 mother-infant pairs that received the complete zidovudine regimen alone, and 3.9% (95% CI, 2.2-6.6%) among 361 mother-infant pairs that received the complete zidovudine regimen combined with other antiretrovirals, usually nevirapine. The overall transmission risk from this cohort, including all antiretroviral prophylaxis combinations, is estimated to be 10.2%. CONCLUSIONS: The Thai national PMTCT program is effective in reducing mother-to-child transmission risk from the historical risk of 18.9-24.2%. The addition of nevirapine to short-course zidovudine beginning in 2004 may further improve program effectiveness in Thailand.     

Uptake of early infant diagnosis in Thailand’s national program for preventing mother-to-child HIV transmission and linkage to care, 2008–2011

Introduction

Early infant diagnosis (EID) has been a component of Thailand''s prevention of mother-to-child HIV transmission (PMTCT) programme since 2007. This study assessed the uptake, EID coverage, proportion of HIV-exposed infants receiving a definitive HIV diagnosis, mother-to-child transmission (MTCT) rates and linkage to HIV care and treatment.

Methods

Infant polymerase chain reaction (PCR) testing data from the National AIDS Program database were analyzed. EID coverage was calculated as the percentage of number of HIV-exposed infants receiving ≥1 HIV PCR test divided by the number of HIV-exposed infants estimated from HIV prevalence and live-birth registry data. Definitive HIV diagnosis was defined as having two concordant PCR results. MTCT rates were calculated based on infants tested with PCR and applied as a best-case scenario, and a sensitivity analysis was used to adjust these rates in average and worst scenarios. We defined linkage to HIV care as infants with at least one PCR-positive test who were registered with Thailand''s National AIDS Program. Chi-squared tests for linear trend were used to analyze changes in programme coverage.

Results

For 2008 to 2011, the average EID coverage rate increased from 54 to 76% (p<0.001), with 65% coverage (13,761/21,099) overall. The number of hospitals submitting EID samples increased from 458 to 645, and the percentage of community hospitals submitting samples increased from 75 to 78% (p=0.044). A definitive HIV diagnosis was made for 10,854 (79%) infants during this period. The adjusted MTCT rates had significantly decreasing trends in all scenarios. Overall, an estimated 53% (429/804) of HIV-infected infants were identified through the EID programme, and 80% (341/429) of infants testing positive were linked to care. The overall rate of antiretroviral treatment (ART) initiation within one year of age was 37% (157/429), with an increasing trend from 28 to 52% (p<0.001).

Conclusions

EID coverage increased and MTCT rates decreased during 2008 to 2011; however, about half of HIV-infected infants still did not receive EID. Most HIV-infected infants were linked to care but less than half initiated ART within one year of age. Active follow-up of HIV-exposed infants to increase early detection of HIV infection and early initiation of ART should be more widely implemented.     

Vancomycin‐resistant enterococci: New threat in renal patients

SUMMARY Vancomycin‐resistant enterococci (VRE) have been increasingly reported in current literature worldwide. The origin of the organisms remains speculative. Overuse of vancomycin and glycopeptide in animal feed for domestic animals may promote VRE proliferation. The contaminated food products may serve as a community reservoir for VRE. VRE could be found in virtually every environmental site as well as in the endogenous flora of the patients. Important risk factors of VRE infection comprise prolonged hospitalization and prior treatment with antibiotics including vancomycin. The modes of VRE transmission are still not clearly established but could be due to both direct: person‐to‐person and indirect transmissions. In renal patients, VRE infections have been mostly reported in continuous ambulatory peritoneal dialysis peritonitis. Some infections are also detected in haemodialysis patients as well as in renal transplantation patients. Selection of the definite antimicrobial treatment of VRE depends on the phenotypes of the resistance. Antimicrobial agents for VRE consist of the more conventional drugs, including chloramphenicol and tetracycline, and the newer ones, such as ramoplanin. Prevention and control of enteroccal infection should be emphasized in all hospitals and these could be successfully carried out by enhanced infection‐control strategies.     

Preventing mother-to-child HIV transmission: the first year of Thailand's national program

Pornsinee Amornwichet, MPH; Achara Teeraratkul, MD; R. J. Simonds, MD; Thananda Naiwatanakul, MSc; Nartlada Chantharojwong, MSc; Mary Culnane, MS,CRNP; Jordan W. Tappero, MD,MPH; Siripon Kanshana, MD,MPH

JAMA. 2002;288:245-248.

Context  Each year in Thailand, about 10 000 children are born at risk for mother-to-child human immunodeficiency virus (HIV) transmission. In 2000, Thailand implemented a national program to prevent mother-to-child HIV transmission.

Objective  To describe the results of implementation of the program.

Design  Monthly collection of summary data from hospitals.

Setting  Public health hospitals (n = 822) in all 12 regions of Thailand, representing 75 provinces, excluding Bangkok.

Participants  Women giving birth from October 2000 through September 2001, including HIV-seropositive women and their neonates.

Main Outcome Measures  Percentages of women giving birth who were tested for HIV, HIV-seropositive women giving birth who received antenatal prophylactic antiretroviral drugs, and HIV-exposed neonates who received prophylactic antiretroviral drugs and infant formula.

Results  Among 573 655 women (range, 27 344-77 806 by region) giving birth, 554 912 (96.7%) received antenatal care (range, 91.9%-98.8% by region). Of 554 912 women giving birth who had antenatal care, 517 488 (93.3%) were tested for HIV (range, 87.7%-99.4% by region) before giving birth; of 18 743 women giving birth who did not have antenatal care, 13 314 (71.0%) were tested for HIV (range, 21.7%-92.9% by region). Of 6646 HIV-seropositive women giving birth, 4659 (70.1%) received prophylactic antiretroviral drugs before delivery (range, 55.3%-81.2% by region). Of 6475 neonates of HIV-seropositive women, 5741 (88.7%) received prophylactic antiretroviral drugs (range, 67.4%-96.9% by region) and 5386 (83.2%) received infant formula (range, 65.3%-100% by region).

Conclusions  Major program components of Thailand's national program for preventing mother-to-child HIV transmission were implemented. Thailand's experience may encourage other developing countries to implement or expand similar national programs.