Papers by Chureeratana Bowonwatanuwong
Introduction: Tenofovir disoproxil fumarate (TDF) is associated with a risk of chronic kidney dis... more Introduction: Tenofovir disoproxil fumarate (TDF) is associated with a risk of chronic kidney disease (CKD), especially when used with protease inhibitors or in Asian populations. Data from the Thai national health insurance system were used to assess the incidence of CKD in patients receiving antiretroviral therapy (ART) in real-world practice. Materials and methods We analyzed data from patients who initiated one of the following first-line ART regimens: (i) zidovudine+lamivudine+nevirapine (AZT+3TC+NVP); (ii) zidovudine+lamivudine+efavirenz (AZT+3TC+EFV); (iii) tenofovir+lamivudine+nevirapine (TDF+3TC+NVP); (iv) tenofovir+lamivudine/emtricitabine+efavirenz (TDF+3TC/FTC+EFV); and (v) tenofovir+lamivudine+lopinavir/ritonavir (TDF+3TC+LPV/r). CKD was defined as glomerular filtration rate <60 mL/min/1.73 m2 for >3 months, or a confirmed 2010 WHO diagnosis (ICD-10 code N183, N184, or N185). Death competing risks survival regression models were used for the analysis. Results Amon...
Objective : To study the treatment outcome of HIV-patients in Sawanpracharak Hospital. Setting : ... more Objective : To study the treatment outcome of HIV-patients in Sawanpracharak Hospital. Setting : HIV-clinic, Department of medicine, Sawanpracharak Hospital Design : Retrospective descriptive study Subjects : A cohort of 425 older than 15 year-old HIV-infected patients who were cared for during July 1, 2003 and June 30, 2010 Method : Pre-antiretroviral therapy data include demographic data, Hepatitis B, Hepatitis C, positive for VDRL, opportunistic infection, and CD4 level. Post-antiretroviral therapy data include post-antiretroviral therapy opportunistic infection (IRIS syndrome), CD4 level, toxicity of antiretroviral drug, drug resistance and time to resistance. All parameter were analyzed by frequency, percentage and mean. Results : Of 310 patients (73.0%) who were on treatment continuosly, 56.5% females. 88.1% age between 15-50 year-old and 9.4% age older than 50 year-old. Hepatitis B and Hepatitis C infection were 6.1% and 4.2%. Before giving antiretrovira...
Autonome Kartierungssysteme für landwirtschaftliche Anwendungen gewinnen zunehmend an Bedeutung. ... more Autonome Kartierungssysteme für landwirtschaftliche Anwendungen gewinnen zunehmend an Bedeutung. Derzeit sind die meisten Systeme ferngesteuert oder basieren auf einer einzigen globalen Umgebungsrepräsentation. Die alleinige Verwendung fester Roboterkarten und Aktionsschemata schränkt jedoch die Flexibilität autonomer Systeme ein. Insbesondere in der Landwirtschaft kann sich die Umgebung während der Vegetationsperioden schnell ändern, weshalb es einer kontextsensitiven Navigation bedarf. Ziel der hier vorgestellten Arbeit ist es, ein autonomes System namens Autonome robotische Experimentier-Plattform (AROX) aufzubauen, das in der Lage ist, Bestandskarten über einen gesamten Vegetationszeitraum ohne Benutzereingriff zu erstellen. Dazu haben wir die Hardware-Infrastruktur zum Aufbewahren und Laden des Roboters sowie die erforderliche Software im Robot Operating System (ROS) aufgebaut, um die Kontextsensitivität zu realisieren.
Open Forum Infectious Diseases, 2019
Objective The use of some antiretroviral drugs has been associated with a higher risk of diabetes... more Objective The use of some antiretroviral drugs has been associated with a higher risk of diabetes mellitus (DM) in HIV-infected patients, but the risk associated with antiretroviral drug combinations remains unclear. We investigated the association between first-line antiretroviral therapy (ART) regimens, recommended by the World Health Organization (WHO) in 2016, and the risk of DM in adults. Method We selected all HIV-infected adults within the Thai National AIDS Program who started a first-line ART regimen consisting the following between October 2006 and September 2013: zidovudine+lamivudine+nevirapine; tenofovir disoproxil fumarate (TDF)+lamivudine+nevirapine; zidovudine+lamivudine+efavirenz; TDF+lamivudine/emtricitabine+efavirenz; zidovudine+lamivudine+ritonavir-boosted lopinavir (LPV/r); or TDF+lamivudine+LPV/r. Diagnosis of DM was defined as having at least 2 of the following characteristics: fasting plasma glucose ≥126 mg/dl, 2010 WHO ICD-10 codes E11-E14, or prescription o...
The New England journal of medicine, Mar 8, 2018
Pregnant women with an elevated viral load of hepatitis B virus (HBV) have a risk of transmitting... more Pregnant women with an elevated viral load of hepatitis B virus (HBV) have a risk of transmitting infection to their infants, despite the infants' receiving hepatitis B immune globulin. In this multicenter, double-blind clinical trial performed in Thailand, we randomly assigned hepatitis B e antigen (HBeAg)-positive pregnant women with an alanine aminotransferase level of 60 IU or less per liter to receive tenofovir disoproxil fumarate (TDF) or placebo from 28 weeks of gestation to 2 months post partum. Infants received hepatitis B immune globulin at birth and hepatitis B vaccine at birth and at 1, 2, 4, and 6 months. The primary end point was a hepatitis B surface antigen (HBsAg)-positive status in the infant, confirmed by the HBV DNA level at 6 months of age. We calculated that a sample of 328 women would provide the trial with 90% power to detect a difference of at least 9 percentage points in the transmission rate (expected rate, 3% in the TDF group vs. 12% in the placebo gr...
BMC infectious diseases, Aug 9, 2016
Chronic hepatitis B virus (HBV) infection is complicated by cirrhosis and liver cancer. In Thaila... more Chronic hepatitis B virus (HBV) infection is complicated by cirrhosis and liver cancer. In Thailand, 6-7 % of adults are chronically infected with HBV. The risk of mother-to-child transmission (MTCT) of HBV has been estimated to be about 12 % when mothers have a high hepatitis B viral load, even if infants receive passive-active prophylaxis with HBV immunoglobulin (HBIg) and initiate the hepatitis B vaccine series at birth. We designed a study to assess the efficacy and safety of a short course of maternal tenofovir disoproxil fumarate (TDF) among women with a marker of high viral load for the prevention of MTCT of HBV. The study is a phase III, multicenter (17 sites in Thailand), placebo-controlled, double-blind, randomized 1:1, two-arm clinical trial of TDF 300 mg once daily versus placebo among pregnant women from 28 weeks' gestation through 2-month post-partum. All infants receive HBIg at birth, and a hepatitis B (HB) vaccination series according to Thai guidelines: birth, a...
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2015
Use of several antiretrovirals (ARVs) has been shown associated with a higher risk of diabetes in... more Use of several antiretrovirals (ARVs) has been shown associated with a higher risk of diabetes in HIV-infected adults. We estimated the incidence of new-onset diabetes and assessed the association between individual ARVs and ARV combinations (ARVcs), and diabetes in a large cohort in Thailand. We selected all HIV-1 infected, non-diabetic antiretroviral-naïve adults, enrolled in the PHPT cohort (NCT00433030) between January 2000 and December 2011. Diabetes was defined as confirmed fasting plasma glucose ≥126 mg/dL or random plasma glucose ≥200 mg/dL. Incidence was the number of cases divided by the total number of person-years of follow-up (PYFU). Association between ARVs and ARVcs, and new-onset diabetes was assessed using Cox proportional hazards models. 1,594 HIV-infected patients, 76% female were included. Median age at antiretroviral therapy (ART) initiation was 32.5 years. The incidence rate of diabetes was 5.0 per 1,000 PYFU (95% confidence interval, 3.8-6.6) (53 cases). In analyses adjusted for potential confounders, exposure to stavudine+didanosine (adjusted Hazard Ratio [aHR]=3.9, p=0.001) and cumulative exposure ≥1 year to zidovudine (aHR=2.3 versus no exposure, p=0.009) were associated with a higher risk of diabetes. Conversely, cumulative exposure ≥1 year to tenofovir (aHR=0.4 versus no exposure, p=0.02) and emtricitabine (aHR=0.4 versus no exposure, p=0.03) were associated with a lower risk. The incidence of diabetes in this predominantly female, young, lean population was relatively low. While stavudine and didanosine have now been phased out in most ART programs, our analysis suggests a higher risk of diabetes with zidovudine, frequently prescribed today in resource-limited settings.
The Southeast Asian journal of tropical medicine and public health, 2012
This retrospective cohort study was conducted at Chon Buri Hospital, Thailand, to determine the l... more This retrospective cohort study was conducted at Chon Buri Hospital, Thailand, to determine the long term outcomes of patients taking Nevirapine (NVP) containing antiretroviral therapy (ART). Patients taken NVP at least 5 years were included. Two hundred eighty-five patients met inclusion criteria and were included in the study. The median age of patients was 35 years; the median baseline CD4 was 66 cells/mm3 and the median follow-up was 7 years. Ninety-two point four percent and 90.2% of patients achieved virological success at year 5 and year 7, respectively. The median rise in CD4 count from baseline to year 5 was 354 cells/mm3 (IQR 235.5-487 cells/mm3) and at year 7 was 387 cells/mm3 (IQR 272-557 cells/mm3). Thirty-eight point eight percent of patients had a CD4 count > or = 500 cells/mm3 at year 5 and 41.6% at year 7. Rash/hypersensitivity occurred in 2 patients after 5 years and was transient. Elevated liver enzymes occurred in 5 patients after 5 years. NVP-containing ART y...
Journal of acquired immune deficiency syndromes (1999), 2008
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 1999
Cefpirome is a fourth-generation cephalosporin with good activity against both gram-positive and ... more Cefpirome is a fourth-generation cephalosporin with good activity against both gram-positive and gram-negative bacteria. A multicentre trial was performed to study the efficacy and safety of cefpirome 2 g twice daily in the treatment of sepsis. Sixty-three cases were recruited from 10 hospitals from April 1996 to January 1998. Fifty seven cases could be evaluated according to the protocol. The APACHE II score was used to measure severity of illness, with 46.9 per cent of patients having APACHE II score more than 10 and two patients more than 20; both were cured. The most common pathogens were gram-negative bacteria with E. coli predominating 16/40 (40.0%), followed by Klebsiella 8/40 (20.0%). The overall clinical success rates were 54 out of 57 patients (94.7%). In patients with positive blood culture, the clinical cures were achieved for 20/22 (90.9%). Cefpirome showed good efficacy and safety in the empirical treatment of suspected bacteremia or sepsis.
The Southeast Asian journal of tropical medicine and public health, 2012
Histoplasmosis and penicilliosis are fungal infections with similar clinical presentation and lab... more Histoplasmosis and penicilliosis are fungal infections with similar clinical presentation and laboratory findings that were reported mainly in the era prior to highly active antiretroviral therapy. We conducted a retrospective review at two hospitals in Central Thailand of the medical records of HIV-positive patients with microbiologic evidence of histoplasmosis or penicilliosis between January 2003 to September 2007 when antiretrovirals became widely available in Thailand. Fifty patients met inclusion criteria; 36 had histoplasmosis, and 14 had penicilliosis. Symptoms and laboratory findings on presentation were similar between the two infections except for a greater incidence of tachypnea and neutropenia among patients with histoplasmosis (both p < 0.05). For histoplasmosis, blood culture had a significantly lower yield for detecting infection compared to tissue microscopic examination highlighting the importance of obtaining tissue for diagnosis (p < 0.05).
Tropical Medicine and International Health, 2004
objectives Dengue haemorrhagic fever (DHF) is an important cause of morbidity in Southeast Asia a... more objectives Dengue haemorrhagic fever (DHF) is an important cause of morbidity in Southeast Asia and used to occur almost exclusively in young children. In recent years, there has been a progressive shift in age-distribution towards older children and adults. We investigated an outbreak in 2001 in both children and adults, in an endemic area of Thailand. methods Retrospective study of 347 patients with serologically confirmed dengue infection admitted to Chonburi Hospital during an epidemic in 2001. results A total of 128 (37%) patients had dengue fever (DF) and 219 (63%) had DHF. Patients with DHF were significantly older than patients with DF (11 years vs. 8 years). Clinical bleeding was noted in 124 individuals, both with DF (n ¼ 24) and DHF (n ¼ 100), and significantly more frequently in adults. Twenty-nine (13.2%) of all DHF cases were caused by primary infection. Secondary dengue infection was associated significantly with the development of DHF in children, OR (95% CI) ¼ 3.63 (1.94-6.82), P < 0.0001, but not in adults, OR (95% CI) ¼ 0.6 (0.02-6.04), P ¼ 1. Unusual clinical manifestations were observed in 23 patients: three presented with encephalopathy and 20 with highly elevated liver-enzymes. In the latter group, four patients were icteric and nine had gastrointestinal bleeding. conclusion These results indicate that DHF in Southeast Asia is common in both children and adults. In dengue-endemic countries, dengue should be considered as a differential diagnosis in patients with clinical gastrointestinal bleeding in association with increased liver enzymes.
Therapeutic Drug Monitoring, 2011
Indinavir boosted with ritonavir (IDV/r) dosing with 400/100 mg, twice daily, is preferred in Tha... more Indinavir boosted with ritonavir (IDV/r) dosing with 400/100 mg, twice daily, is preferred in Thai adults, but this dose can lead to concentrations close to the boundaries of its therapeutic window. The objectives of this analysis were to validate a population pharmacokinetic model to describe IDV/r concentrations in HIV-infected Thai patients and to investigate the impact of patient characteristics on achieving adequate IDV concentrations. IDV/r concentration data from 513 plasma samples were available. Population means and variances of pharmacokinetic parameters were estimated using a non-linear mixed effects regression model (NONMEM Version VI). Monte Carlo simulations were performed to estimate the probability of achieving IDV concentrations within its therapeutic window. IDV/r pharmacokinetics was best described by a one compartment model coupled with a single transit compartment absorption model. Body weight influenced indinavir apparent oral clearance (CL/F) and volume of distribution (Vd/F) and allometric scaling significantly reduced the interindividual variability. Final population estimates (interindividual variability in percentage) of indinavir CL/F and Vd/F were 21.3 L/h/70kg (30%) and 90.7 L/70kg (22%), respectively. Based on model simulations, the probability of achieving an IDV trough concentration > 0.1 mg/L was >99% for 600/100 mg and >98% for 400/100 mg, twice daily, in patients 40-80 kg. However, the probability of achieving IDV concentrations associated with an increased risk of drug toxicity (>10.0 mg/L), increased from 1% to 10% with 600/100 mg, compared to <1% with 400/100 mg when body weight decreased from 80 to 40 kg. The validated model developed predicts that 400/100 mg of IDV/r, twice daily, provides indinavir concentrations within the recommended therapeutic window for the majority of patients. The risk of toxic drug concentrations increases rapidly with IDV/r dose of 600/100 mg for patients <50 kg and therapeutic drug monitoring of IDV concentrations would help to reduce the risk of IDVinduced nephrotoxicity.
PLoS Medicine, 2013
Background: Viral load (VL) is recommended for monitoring the response to highly active antiretro... more Background: Viral load (VL) is recommended for monitoring the response to highly active antiretroviral therapy (HAART) but is not routinely available in most low-and middle-income countries. The purpose of the study was to determine whether a CD4-based monitoring and switching strategy would provide a similar clinical outcome compared to the standard VL-based strategy in Thailand. Methods and Findings: The Programs for HIV Prevention and Treatment (PHPT-3) non-inferiority randomized clinical trial compared a treatment switching strategy based on CD4-only (CD4) monitoring versus viral-load (VL). Consenting participants were antiretroviral-naïve HIV-infected adults (CD4 count 50-250/mm 3) initiating non-nucleotide reverse transcriptase inhibitor (NNRTI)-based therapy. Randomization, stratified by site (21 public hospitals), was performed centrally after enrollment. Clinicians were unaware of the VL values of patients randomized to the CD4 arm. Participants switched to second-line combination with confirmed CD4 decline .30% from peak (within 200 cells from baseline) in the CD4 arm, or confirmed VL .400 copies/ml in the VL arm. Primary endpoint was clinical failure at 3 years, defined as death, new AIDS-defining event, or CD4 ,50 cells/mm 3. The 3-year Kaplan-Meier cumulative risks of clinical failure were compared for non-inferiority with a margin of 7.4%. In the intent to treat analysis, data were censored at the date of death or at last visit. The secondary endpoints were difference in future-drug-option (FDO) score, a measure of resistance profiles, virologic and immunologic responses, and the safety and tolerance of HAART. 716 participants were randomized, 356 to VL monitoring and 360 to CD4 monitoring. At 3 years, 319 participants (90%) in VL and 326 (91%) in CD4 were alive and on follow-up. The cumulative risk of clinical failure was 8.0% (95% CI 5.6-11.4) in VL versus 7.4% (5.1-10.7) in CD4, and the upper-limit of the one-sided 95% CI of the difference was 3.4%, meeting the predetermined non-inferiority criterion. Probability of switch for study criteria was 5.2% (3.2-8.4) in VL versus 7.5% (5.0-11.1) in CD4 (p = 0.097). Median time from treatment initiation to switch was 11.7 months (7.7-19.4) in VL and 24.7 months (15.9-35.0) in CD4 (p = 0.001). The median duration of viremia .400 copies/ml at switch was 7.2 months (5.8-8.0) in VL versus 15.8 months (8.5-20.4) in CD4 (p = 0.002). FDO scores were not significantly different at time of switch. No adverse events related to the monitoring strategy were reported.
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2008
Antiviral Therapy, 2012
The publisher would like to report an omission from a recently published article [1]. The title o... more The publisher would like to report an omission from a recently published article [1]. The title of Figure 3 should contain ‘(A)’ and ‘(B)’, and the correct title and corresponding figure are shown. The publisher apologizes for this omission.
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Papers by Chureeratana Bowonwatanuwong