Publications by authors named "Wirach Maek-a-Nantawat"

Objectives: To assess cognitive performance and psychomotor impairment in an HIV-positive cohort, well-suppressed on combination antiretroviral therapy (cART), in an Asian resource-limited setting.

Methods: Cross-sectional sociodemographic and cognitive data were collected in 329 HIV-positive and 510 HIV-negative participants. Cognitive performance was assessed using the International HIV Dementia Scale (IHDS), Montreal Cognitive Assessment (MoCA), WAIS-III Digit Symbol, Trail Making A, and Grooved Pegboard (both hands).

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Objective: To assess the efficacy and safety of a new single-tablet regimen (STR) of tenofovir disoproxil fumarate (TDF) 300mg, lamivudine (3TC) 300mg, and efavirenz (EFV) 600mg in HIV-infected Thai patients.

Methods: This was a prospective study performed for 144 weeks among 51 treatment-naïve patients and 49 experienced patients on separate tablets of TDF, 3TC, and EFV with HIV RNA<50 copies/ml. CD4, HIV RNA, liver and renal function, and lipid profiles were assessed at baseline, weeks 12, 24, and 48, and then every 24 weeks.

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This study assessed the attitudes toward, and interest in, the test-and-treat strategy, comprising regular HIV testing and immediate antiretroviral treatment (ART) among men who have sex with men (MSM) in Bangkok, Thailand. A total of 363 participants completed the questionnaires before and after learning about their HIV status. Previous HIV testing reported by 69.

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Article Synopsis
  • A new skin test for diagnosing gnathostomiasis shows promising results when compared to the standard immunoblot test, indicating its potential as an effective alternative.
  • The study analyzed 69 patients, revealing that 81% of gnathostomiasis cases had strong reactions to the skin test, which correlated highly with positive immunoblot results (p<0.001).
  • Overall, the findings suggest that this skin test could be a reliable diagnostic tool for gnathostomiasis, reinforcing its association with classic immunoblot results.
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To assess qualities and outcomes of women participating in a large, community-based HIV vaccine trial, the present study was conducted among female participants of the RV 144 prime-boost trial in Thailand from 2003 to 2009. Qualities of participation refer to complete vaccination, retention, and status change. Outcomes of participation refer to incident rate, adverse event, and participation impact event.

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Hepatitis C virus (HCV) co-infection is common among HIV-infected patients; its treatment is not affordable in resource-limited settings. This study aimed to compare the morbidity, mortality, immunological and virological outcomes of antiretroviral therapy (ART) between HIV-infected patients with and without HCV co-infection in a setting where HCV infection is rarely treated. A retrospective cohort study was conducted among HIV-infected patients attending Ramathibodi Hospital between 1998 and 2008.

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Article Synopsis
  • Hepatitis B and C infections are common among HIV-infected individuals, especially in Southeast Asia, where rates of coinfection range from 3.2-11%.
  • Most hepatitis B cases involve genotype C, while hepatitis C in Thailand is mainly genotype 3 linked to intravenous drug use, and in Vietnam, it’s mostly genotype 6.
  • Treatment options are limited, with only HBV treatment being freely available, and there's a need for better hepatitis screening and cost-effective HCV treatment incorporated into national health programs.
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Generic fixed dose combination stavudine (d4T), lamivudine (3TC) and nevirapine (NVP), named GPO-VIR is recommended in the HIV treatment guidelines for Thailand. The long term effectiveness and adverse effects of this drug combination for the treatment of HIV were evaluated in an ambispective study at Bamrasnaradura Infectious Diseases Institute, Nonthaburi Province, Thailand from March 2002 to January 2006. A total of 152 adult treatment naive HIV patients who had received at least 12 months of GPO-VIR were enrolled.

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Article Synopsis
  • The main goal of second-line therapy for HIV-1 patients is to restore effective viral suppression, particularly in settings with limited treatment options.
  • A study involving 95 patients in Thailand showed that a regimen of boosted protease inhibitor plus two nucleoside reverse transcriptase inhibitors was the most common choice for second-line treatment, leading to significant improvements in patient outcomes over time.
  • Factors such as good treatment adherence, a higher initial CD4 count, and earlier disease staging were linked to better virologic success, indicating the need for improved access to second-line ART in such environments.
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Background: Anaphylaxis, a severe systemic allergic reaction, can be fatal. However, its prevalence has been underestimated especially in biphasic phase, due to a lack of case awareness. This study aimed to determine the rate of anaphylaxis, describe clinical manifestations and management, and identify the causative agents and risk factors of biphasic anaphylactic reaction.

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This retrospective case-control study assessed the psychological burden of abnormal Pap smears, and their prevalence and characteristics among HIV-infected women attending an HIV clinic. Women with positive (n = 73) and negative Pap-smear results (n = 317) were assessed for psychosocial burden using 4 questionnaires: Psycho-Social Impact of Abnormal Pap Smears (PEAPS-Q), Hospital Anxiety and Depression Scale (HADS), Work Productivity and Impairment (WPAI) and the EURO-Qol Thermometer. The prevalence of pre-cervical cancer lesions in HIV infected woman was 17.

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Immune reconstitution inflammatory syndrome (IRIS) is an important adverse event among human immunodeficiency virus (HIV)-infected patients taking highly active antiretroviral therapy (HAART). The epidemiology of IRIS in Thailand has not been well examined, especially among adult HIV-infected patients. In the present study, we reviewed the medical records of 174 HIV-infected, antiretroviral therapy-naive patients older than 15 years (the median CD4 count at commencement of HAART was 37 cells/mm3) and compared characteristics of patients with and without IRIS.

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Article Synopsis
  • Chikungunya has re-emerged as a significant disease in Thailand, particularly in the southern region, raising concerns about its potential endemic status.
  • A case of severe muscle-related complications was reported, involving muscle weakness and limb swelling during diagnosis.
  • The detection of high levels of antinuclear antibodies suggests a link between autoimmunity and the chikungunya virus, mimicking symptoms of autoimmune diseases, which necessitates careful monitoring before starting long-term immunosuppressive treatments.
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Complementary remedies represent a potential alternative treatment for chronic diseases, including HIV/AIDS cases not meeting criteria for using highly active antiretroviral therapy (HAART). This study evaluated the safety and efficacy of CKBM-A01, a Chinese herbal medicine, and patient quality of life (QoL). Asymptomatic HIV patients with CD4 counts of 250-350 cells/microl were recruited into this open-labeled trial.

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Background: The use of antiretroviral drugs (ARV) to prevent mother-to-child HIV transmission (PMTCT) promises to be effective. However, limited data on the adverse effects of ARV among pregnant women and pregnancy outcomes have been reported in clinical practice.

Objectives: This study aimed to assess adverse effects and outcomes among pregnant HIV-infected women receiving antiretroviral drugs for either antiretroviral therapy (ART) or PMTCT.

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The objective of the study was to determine the predisposing factors and incidence of toxicity among AIDS patients treated with a nevirapine (NVP)-based regimen in clinical practice. A retrospective cohort study of representative samples of AIDS patients treated with a NVP-based regimen was performed. A total of 206 adult HIV/AIDS cases with median age (IQR) 33 years (range, 29-38 years), 51% male, treated between January 2004-December 2005, were included.

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Interleukin (IL)-17 is produced mainly by activated CD4(+) T cells, currently known as Th17. Human immunodeficiency virus (HIV) pathogenesis leads to CD4(+) T cell depletion. This is the first report of IL-17 in HIV infection.

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Background: Amphotericin B treatment in cryptococcosis requires daily hospital visits or admission. Its toxicities and hospital costs have been concerned. Short course amphotericin B regimen warrants to be evaluated.

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Article Synopsis
  • Good results from an in vitro study on JinHuang, a Chinese herbal medicine, prompted an in vivo study to assess safety and efficacy in asymptomatic HIV-infected individuals.
  • An open study involving 21 Thai volunteers (12 females, 9 males) took place, with participants taking JinHuang for 6 months, monitored closely for side effects.
  • Reported side effects included increased bowel movements (81%) and changes in taste/smell (52%), but no serious adverse events were noted; however, there were no significant changes in viral load or CD4 count, though many participants felt improvements in quality of life.
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One hundred and eight patients with severe falciparum malaria underwent a placebo controlled trial with the antioxidant, N-acetylcysteine (NAC), as an adjunctive therapy along with standard intravenous artesunate therapy. Three NAC dosage regimens were used: an intravenous loading dose of 140 mg/kg followed by 70 mg/kg every four hours intravenously for up to 18 doses (Group 1); a single intravenous loading dose followed by oral NAC in the same amount as for Group 1 (Group 2); a regimen identical to Group 1 except that oral NAC was administered after the first 24 hours (Group 3). Fifty-four patients received placebo plus artesunate.

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Article Synopsis
  • The study focused on understanding the role and commitment of volunteers in HIV vaccine trials, highlighting concerns about risk behaviors and volunteers’ expectations throughout the trial process.
  • Conducted with 164 volunteers, the study found no increase in risky behavior, and a significant decrease in risky sexual practices over time, demonstrating positive behavioral changes among participants.
  • Volunteers reported favorable outcomes from their involvement, including knowledge gain and positive social contributions, reflecting their overall beneficial expectations from participating in the vaccine trials.
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We conducted a trial of oral acetazolamide for the treatment of cryptococcal meningitis in 22 Thai adults with headache and an opening cerebrospinal fluid pressure of >/=200 mm H(2)0. The trial was terminated prematurely because patients who received acetazolamide developed significantly lower venous bicarbonate levels and higher chloride levels and had more-frequent serious adverse events than did subjects who received placebo.

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