Hepatitis: Ratanasuwan W

Sungkanuparph S, Anekthananon T, Hiransuthikul N, Bowonwatanuwong C, Supparatpinyo K, Mootsikapun P, Chetchotisakd P, Kiertiburanakul S, Tansuphaswadikul S, Buppanharun W, Manosuthi W, Techasathit W, Ratanasuwan W, Tantisiriwat W, Suwanagool S, Leechawengwongs M, Ruxrungtham K, Anonymous00067. · Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand. · J Med Assoc Thai. · Pubmed #19133532 No free full text.

Abstract: BACKGROUND: More than 100,000 patients have been treated, since the implementation of the National Universal Coverage for antiretroviral therapy (ART) in Thailand Although there are several comprehensive guidelines available internationally, there is a need to have guidelines that can be implemented in Thailand. MATERIAL AND METHOD: The guidelines were developed by a panel of 17 members who are the experts on HIV research and/or HIV patient care and appointed without incentive by the Thai AIDS Society (TAS). The recommendations were based on evidences from the published studies and availability of antiretroviral agents. Published studies that are relevant and applicable to Thailand in particular have been taken into consideration. RESULTS: The recommendations include: when to start ART; what to start; how to monitor the therapy; adverse effects and its management; diagnosis of treatment failure; and antiretroviral treatment options in patients with treatment failure. ART in special circumstances, i.e., patients with co-infection of tuberculosis or hepatitis B virus, is also included Appropriate level of CD4+ T-cell count to start ART among Thai patients has been considered carefully. The authors recommend to start ART at CD4+ T-cell count < 200 cells/mm3. CONCLUSION: ART should be initiated in adults and adolescents HIV-1 infected patients with a history of HIV-related illness or AIDS or with a CD4+ T-cell count <200 cells/mm3. For treatment-naive patients, the preferred initial therapy is a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen. CD4' T-cell count and viral load should be monitored for at least twice and once a year, respectively. Proper management of antiretroviral-related toxicity and enhancement of adherence are crucial for the long-term success of ART.

Techasathit W, Ratanasuwan W, Sonjai A, Sangsiriwut K, Anekthananon T, Suwanagool S. · Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand. · J Med Assoc Thai. · Pubmed #15962639 No free full text.

Abstract: Medical students are frequently at risk of being infected by hepatitis B virus (HBV) via occupational exposure to infected blood or body fluids. In 2002, the Faculty of Medicine, Siriraj Hospital provided screening tests for HBV serology to all medical students for a vaccination campaign against the infection. There were 1,165 medical students tested. Eight hundred and eleven (69.6%) students had immunity by previous vaccination, but more importantly 212 (18.2%) had no immunity and required vaccination. Most of the students who needed to be vaccinated were in the pre-clinical year (82.5%). Moreover, the students in the pre-clinical year who had previous vaccination had a 2.2 times greater risk of having negative anti-HBs than the students in the clinical year (OR = 2.2, 95% CI = 1.4-3.5). This is because they might have been vaccinated when they were young and the antibody waned overtime.

Ratanasuwan W, Sonji A, Tiengrim S, Techasathit W, Suwanagool S. · Department of Preventive and Social Medicine, Faculty of Medicine at Siriraj Hospital, Mahidol University, Bangkok, Thailand. · Southeast Asian J Trop Med Public Health. · Pubmed #15691148 No free full text.

Abstract: Hepatitis A, B, and C are important viral hepatitis infections in the Thai population. Hepatitis B vaccination was included in the Thai Expanded Program on Immunization (EPI) 10 years ago. In addition, the seroprevalence of hepatitis A has significantly changed in the last two decades. This study was done to evaluate current risk groups for hepatitis A and B infections and identify the magnitude of hepatitis C infection in the general population of Bangkok and six provinces in the Central Region of Thailand, during the period October 2000 to January 2002. This study revealed that the prevalence of anti-HAV in people younger than 25 years was low but very high in people older than 25 years. The prevalence of anti-HAV was 1.95% in Bangkok and 12.7% in other provinces in people younger than 25 years (p<0.001) while 90.9% in Bangkok and 88.2% in other provinces among people older than 25 years. Therefore, people who are older than 25 years should have a blood test for anti-HAV before getting a hepatitis A vaccination. Approximately 80% of people who are not covered by hepatitis B vaccination from EPI are at risk of hepatitis B infection and its complications. This group of people should receive hepatitis B vaccination. For hepatitis C, the prevalence is lower than 2% across age groups and areas. Therefore, current good primary prevention via blood donor screening and health education must be maintained.