Warangkana Munsakul - Academia.edu (original) (raw)

Papers by Warangkana Munsakul

Antiviral Therapy, 2014

Background: HIV-1 shedding in genital secretions is associated with HIV transmission risk. Limite... more Background: HIV-1 shedding in genital secretions is associated with HIV transmission risk. Limited data exist on the effect of second-line lopinavir/ritonavir monotherapy (mLPV/r) on genital secretion of HIV RNA. Methods: We measured HIV-1 in genital secretions of HIV-infected adults at time of failure from non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens and at 48 weeks after being randomized to second-line mLPV/r versus tenofovir/lamivudine/LPV/r (TDF/3TC/LPV/r). Plasma and genital secretion (semen, vaginal swab) HIV RNA was quantified by the CobasAmpliprep/TaqMan assay. Results: Forty enrolled (15 on mLPV/r and 25 on TDF/3TC/LPV/r). Median age was 37.8 years and 35% were male. Median baseline CD4 + T-cell count was 222 cells/mm 3 , plasma HIV RNA was 4.1 log 10 copies/ml and genital secretion HIV RNA was 2.3 log 10 copies/ml. At

Effectiveness and Side Effects of Therapy Using a 3-drug Antiretroviral Tablet: Nevirapine/Stavu... more Effectiveness and Side Effects of Therapy Using a 3-drug Antiretroviral Tablet: Nevirapine/Stavudine/Lamivudine (GPOvir) in HIV-infected Patients Warangkana Munsakul MD Petch Rawdaree MD, MSc Epidermiology, DLSHTM Natee Munsakuo MD * Department of Medicine, BMA Medical College and Vajira Hospital Objective: To determine the effectiveness and side effects of the 3 drug antiretroviral tablet: nevirapine/stavudine/lamivudine (GPOvir) in treatment of HIV- infected patients. Study design: Analytic longitudinal study Subjects: Eighty-seven HIV -infected patients who were treated with GPOvir from April 2002 to November 2002 in Infectious Diseases Clinic, Department of Medicine, BMA Medical College and Vajira Hospital. Methods: Sex, body weight, history of taking antiretroviral agent and CD4+cell count were recorded when starting GPOvir. After following up for 3 months, body weight and CD4+cell count were recorded again. Side effects were also re...

BACKGROUND Meropenem plays a significant role in the current antimicrobial treatment of serious i... more BACKGROUND Meropenem plays a significant role in the current antimicrobial treatment of serious infections. Recently, generic meropenems have become widely available in Thailand. OBJECTIVE Compare the effectiveness and safety ofa generic meropenem (Mapenem) with the original meropenem (Meronem) in clinical practice. MATERIAL AND METHOD A retrospective cohort study was conducted in hospitalized patients with serious infections that had been treated with either the generic or the original meropenem in nine secondary- and tertiary-care hospitals nationwide. The treatment outcomes at days 3, 7, and 14 after the use ofmeropenem between the two groups were compared. RESULTS Three hundred ninety seven patients with a mean (SD) age of 66.4 +/- 16.9 years were included. There were 228 (57.4%) males and 169 (42.6%) females. Two hundred and seven (52.1%) and 190 (47.9%) cases fell into the generic and original groups respectively. There were no significant differences regarding age, gender his...

Vajira Medical Journal, Mar 29, 2010

PloS one, 2017

We implemented a hospital-based prevention with positives (PwP) intervention among people living ... more We implemented a hospital-based prevention with positives (PwP) intervention among people living with HIV (PLHIV) that included HIV transmission risk screening, short HIV prevention messages, family planning, HIV disclosure counseling, and partner HIV testing at five hospitals in Thailand. We assessed changes in sexual risk behaviors among PLHIV who received the PwP services at the hospitals. From January 2008-March 2009, we systematically selected a subset of PLHIV receiving care at the five hospitals to offer participation in the PwP intervention. We collected demographic, risk behavior, and laboratory data using a standardized questionnaire. We analyzed data from PLHIV who completed at least four visits, using generalized estimating equations to identify baseline participant characteristics that were associated with adopting sexual practices less likely to be associated with HIV transmission during follow-up. A total of 830 PLHIV were interviewed and 756 (91.1%) completed four vi...

Journal of the Medical Association of Thailand Chotmaihet Thangphaet, Feb 1, 2011

Background: Meropenem plays a significant role in the current antimicrobial treatment of serious ... more Background: Meropenem plays a significant role in the current antimicrobial treatment of serious infections. Recently, generic meropenems have become widely available in Thailand. Objective: Compare the effectiveness and safety ofa generic meropenem (Mapenem) with the original meropenem (Meronem) in clinical practice. Material and method: A retrospective cohort study was conducted in hospitalized patients with serious infections that had been treated with either the generic or the original meropenem in nine secondary- and tertiary-care hospitals nationwide. The treatment outcomes at days 3, 7, and 14 after the use ofmeropenem between the two groups were compared. Results: Three hundred ninety seven patients with a mean (SD) age of 66.4 +/- 16.9 years were included. There were 228 (57.4%) males and 169 (42.6%) females. Two hundred and seven (52.1%) and 190 (47.9%) cases fell into the generic and original groups respectively. There were no significant differences regarding age, gender history of underlying disease, body weight, and ward of admission between the two groups. The majority ofpatients had presented with the respiratory tract (48.6%) and bloodstream infections (29.5%). The three most common causative bacteria were Pseudomonas aeruginosa, Acinetobacter baumannii, and extended-spectrum beta-lactamase (ESBL) producing Escherichia coli. The distribution ofthe sites of infection, causative microorganisms, the dosage ofmeropenem, and duration oftreatment were similar between the two groups. The distribution of patients with complete resolution, improvement, stable, worse, diedfrom infection, and died from other causes were similar between the two groups at day 3, 7, and 14 ofmeropenem use (p > 0.05). The drugs were well-tolerated, and less than 2% of patients in both groups discontinued meropenem due to the adverse drug effects. Conclusion: The generic meropenem has a similar effectiveness in the treatment of serious bacterial infections when compared with original meropenem. Both formulations are well tolerated among patients with substantial comorbidities. Adverse drug effects that lead to drug discontinuation are uncommon.

Antiviral Therapy, Feb 1, 2008

Background: The aim of this study was to assess the long-term efficacy and safety of first-line t... more Background: The aim of this study was to assess the long-term efficacy and safety of first-line treatment with once-daily saquinavir/ritonavir plus two nucleoside reverse transcriptase inhibitors (NRTIs). Methods: A total of 272 antiretroviral-naive patients with a CD4 + T-cell count of 200-350 cells/mm 3 were treated with two NRTIs and saquinavir/ritonavir 1,600/100 mg per day for ≥24 weeks. Patients were followed up every 12 weeks for CD4 + T-cell counts, HIV RNA levels, clinical and laboratory toxicities. Intentionto-treat analyses were used for the first 24 weeks of treatment and as-treated analysis after week 24. Results: The median baseline CD4 + T-cell count was 269 cells/mm 3 and HIV RNA was 4.7 log 10 copies/ml. At a median follow-up time of 56 (interquartile range [IQR] 25-113) weeks, 262/272 (96.3%) had HIV RNA <400 copies/ml, with a median HIV RNA decline of-2.89 (IQR 3.31-2.37) log 10 copies/ml (P<0.001) and a median rise in CD4 + T-cell count of 192 (IQR 117-317) cells (P<0.001). At weeks 24, 48, 72 and 96, 249/272 (91.5%), 157/164 (95.7%), 113/126 (89.7%) and 84/90 (93.3%) had HIV RNA <400 copies/ml, respectively; at the same time points, 83.8%, 92.7%, 85.7% and 85.6% had HIV RNA <50 copies/ml. Drug-related adverse events were reported in 6.3%. Significant rises in total cholesterol, triglyceride, low-density lipoprotein and high-density lipoprotein were seen. Conclusion: First-line highly active antiretroviral therapy with once-daily saquinavir/ritonavir plus two NRTIs showed strong antiviral efficacy.

The Lancet HIV, 2016

Thai patients with HIV have higher exposure to HIV protease inhibitors than do white people and d... more Thai patients with HIV have higher exposure to HIV protease inhibitors than do white people and dose reduction might be possible. We compared the efficacy of low-dose with standard-dose ritonavir-boosted atazanavir in virologically suppressed Thai patients with HIV. In this randomised, open-label, non-inferiority trial, we recruited patients aged 18 years or older who were receiving ritonavir-boosted protease-inhibitor-based antiretroviral therapy (ART) with HIV plasma viral loads of less than 50 copies per mL, an alanine aminotransferase concentration of less than 200 IU/L, and a creatinine clearance of at least 60 mL/min from 14 hospitals in Thailand. We excluded patients who had active AIDS-defining disease or opportunistic infections, had a history of an HIV viral load of 1000 copies per mL or more after 24 weeks of any ritonavir-boosted protease-inhibitor-based ART, used concomitant medications that could interact with the study drugs, were pregnant or lactating, had illnesses that might change the effect of the study drugs, or had a history of sensitivity to the study drugs. A biostatistician at the study coordinating centre randomly allocated patients (1:1) to switch the protease inhibitor for oral atazanavir 200 mg and ritonavir 100 mg or for atazanavir 300 mg and ritonavir 100 mg once daily, both with two nucleoside or nucleotide reverse transcriptase inhibitors at recommended doses. Randomisation was done with a minimisation schedule, stratified by recruiting centre, use of tenofovir, and use of indinavir as a component of the preswitch regimen. The primary endpoint was the proportion of patients with viral loads of less than 200 copies per mL at week 48, and we followed up patients every 12 weeks. Treatments were open label, the non-inferiority margin was -10%, and all patients who received at least one dose of study medication were analysed. This trial is registered with ClinicalTrials.gov, number NCT01159223. Between July 6, 2011, and Dec 23, 2013, we randomly assigned 559 patients: 279 to receive atazanavir 200 mg and ritonavir 100 mg (low dose) and 280 to atazanavir 300 mg and ritonavir 100 mg (standard dose). At week 48, 265 (97·1%) of 273 in the low-dose group and 267 (96·4%) of 277 in the standard-dose group had viral loads of less than 200 copies per mL (difference 0·68; 95% CI -2·29 to 3·65). Seven (3%) of 273 in the low-dose group and 21 (8%) of 277 in the standard-dose group discontinued their assigned treatment (p=0·01). 46 (17%) of 273 participants in the low-dose group and 97 (35%) of 277 in the standard-dose group had total bilirubin grade 3 or higher toxicity (≥3·12 mg/dL; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0·0001). A switch to low-dose atazanavir should be recommended for Thai patients with well controlled HIV viraemia while on regimens based on boosted protease inhibitors. The National Health Security Office and Kirby Institute for Infection and Immunity in Society.

F1000posters, Oct 7, 2011

In patients who develop NNRTI-based treatment failure, genotypic-guided 2 NRTIs+ boosted protease... more In patients who develop NNRTI-based treatment failure, genotypic-guided 2 NRTIs+ boosted protease inhibitor (bPI)-based HAART is recommended as the second-line therapy[1, 2]. In settings where viral load monitoring is not easily accessible and patients develop late virologic failure, it is not known whether recycling NRTIs plus a bPI is beneficial, compared to treating with bPI alone.

Reproductive health, Jan 3, 2016

Describe dual contraceptive method use and the intention to become pregnant of people living with... more Describe dual contraceptive method use and the intention to become pregnant of people living with HIV (PLHIV) and their partners in Thailand. From January 2008-March 2009, we systematically selected a cohort of PLHIV from PLHIV seeking care at five tertiary care hospitals and one community hospital to complete a questionnaire assessing sexual activity, intention to become pregnant, and contraceptive practices at baseline and 12 months after enrollment. Participants received short family planning messages every 2-3 months to promote the use of dual contraceptives and were offered family planning services. A total of 1,388 PLHIV enrolled, their median age was 37 years (IQR 33-43), 898 (64.7 %) had a steady partner, and 737 (53.1 %) were male. Among those with a steady partner, 862 (96.0 %) did not intend to become pregnant; 709 (82.3 %) had sex during the previous 3 months, 683 (96.3 %) used at least one contraceptive method, and 202 (29.6 %) used dual contraceptive methods. Of the 31...

Vajira Medical Journal, Sep 21, 2011

Vajira Medical Journal, Sep 22, 2011

Antiviral therapy, 2006

There are few data on the selection of resistance by ritonavir-boosted saquinavir (SQV/r), partic... more There are few data on the selection of resistance by ritonavir-boosted saquinavir (SQV/r), particularly in antiretroviral (ARV)-naive patients. To assess the incidence of virological failure and evolution of resistance in ARV-naive individuals receiving SQV/r in the induction phase of the Staccato trial. ARV-naive subjects (n = 272) received SQV/r 1,600/100 mg once daily with two nucleoside reverse transcriptase inhibitors (NRTIs) for at least 24 weeks. Patients were defined as having virological failure (VF) when there were two consecutive HIV-1 RNA measurements > 500 copies/ml after week 12. Viral genotypes (reverse transcriptase [RT] and protease [PRO]) were determined at baseline in all patients and as close as possible to the time of initial failure in patients experiencing VF. VF was observed in 9/272 patients receiving SQV/r 1,600/100 mg once daily with two NRTIs (3.3%) and occurred 19-48 weeks after treatment initiation. Eight of these patients were evaluable at failure. ...

F1000posters, Oct 7, 2011

In patients who develop NNRTI-based treatment failure, genotypic-guided 2 NRTIs+ boosted protease... more In patients who develop NNRTI-based treatment failure, genotypic-guided 2 NRTIs+ boosted protease inhibitor (bPI)-based HAART is recommended as the second-line therapy[1, 2]. In settings where viral load monitoring is not easily accessible and patients develop late virologic failure, it is not known whether recycling NRTIs plus a bPI is beneficial, compared to treating with bPI alone.

F1000posters, Oct 7, 2011

In patients who develop NNRTI-based treatment failure, genotypic-guided 2 NRTIs+ boosted protease... more In patients who develop NNRTI-based treatment failure, genotypic-guided 2 NRTIs+ boosted protease inhibitor (bPI)-based HAART is recommended as the second-line therapy[1, 2]. In settings where viral load monitoring is not easily accessible and patients develop late virologic failure, it is not known whether recycling NRTIs plus a bPI is beneficial, compared to treating with bPI alone.

Antiviral Therapy, 2012

Running head: LPV/r monotherapy or with TDF/3TC in NNRTI-based failure Abstract Background Data i... more Running head: LPV/r monotherapy or with TDF/3TC in NNRTI-based failure Abstract Background Data informing the use of boosted-protease inhibitor monotherapy as second-line treatment are limited. There are also no randomized trials addressing treatment options after failing first-line non-nucleoside reverse transcriptase inhibitor (NNRTI)regimens.

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2011

Meropenem plays a significant role in the current antimicrobial treatment of serious infections. ... more Meropenem plays a significant role in the current antimicrobial treatment of serious infections. Recently, generic meropenems have become widely available in Thailand. Compare the effectiveness and safety ofa generic meropenem (Mapenem) with the original meropenem (Meronem) in clinical practice. A retrospective cohort study was conducted in hospitalized patients with serious infections that had been treated with either the generic or the original meropenem in nine secondary- and tertiary-care hospitals nationwide. The treatment outcomes at days 3, 7, and 14 after the use ofmeropenem between the two groups were compared. Three hundred ninety seven patients with a mean (SD) age of 66.4 +/- 16.9 years were included. There were 228 (57.4%) males and 169 (42.6%) females. Two hundred and seven (52.1%) and 190 (47.9%) cases fell into the generic and original groups respectively. There were no significant differences regarding age, gender history of underlying disease, body weight, and ward...

Antiviral therapy, 2008

The aim of this study was to assess the long-term efficacy and safety of first-line treatment wit... more The aim of this study was to assess the long-term efficacy and safety of first-line treatment with once-daily saquinavir/ritonavir plus two nucleoside reverse transcriptase inhibitors (NRTIs). A total of 272 antiretroviral-naive patients with a CD4+ T-cell count of 200-350 cells/mm3 were treated with two NRTIs and saquinavir/ritonavir 1,600/100 mg per day for > 24 weeks. Patients were followed up every 12 weeks for CD4+ T-cell counts, HIV RNA levels, clinical and laboratory toxicities. Intention-to-treat analyses were used for the first 24 weeks of treatment and as-treated analysis after week 24. The median baseline CD4+ T-cell count was 269 cells/mm3 and HIV RNA was 4.7 log10 copies/ml. At a median follow-up time of 56 (interquartile range [IQR] 25-113) weeks, 262/272 (96.3%) had HIV RNA < 400 copies/ml, with a median HIV RNA decline of -2.89 (IQR 3.31--2.37) log10 copies/ml (P < 0.001) and a median rise in CD4+ T-cell count of 192 (IQR 117-317) cells (P < 0.001). At we...

Antiviral Therapy, 2014

Background: HIV-1 shedding in genital secretions is associated with HIV transmission risk. Limite... more Background: HIV-1 shedding in genital secretions is associated with HIV transmission risk. Limited data exist on the effect of second-line lopinavir/ritonavir monotherapy (mLPV/r) on genital secretion of HIV RNA. Methods: We measured HIV-1 in genital secretions of HIV-infected adults at time of failure from non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens and at 48 weeks after being randomized to second-line mLPV/r versus tenofovir/lamivudine/LPV/r (TDF/3TC/LPV/r). Plasma and genital secretion (semen, vaginal swab) HIV RNA was quantified by the CobasAmpliprep/TaqMan assay. Results: Forty enrolled (15 on mLPV/r and 25 on TDF/3TC/LPV/r). Median age was 37.8 years and 35% were male. Median baseline CD4 + T-cell count was 222 cells/mm 3 , plasma HIV RNA was 4.1 log 10 copies/ml and genital secretion HIV RNA was 2.3 log 10 copies/ml. At

Effectiveness and Side Effects of Therapy Using a 3-drug Antiretroviral Tablet: Nevirapine/Stavu... more Effectiveness and Side Effects of Therapy Using a 3-drug Antiretroviral Tablet: Nevirapine/Stavudine/Lamivudine (GPOvir) in HIV-infected Patients Warangkana Munsakul MD Petch Rawdaree MD, MSc Epidermiology, DLSHTM Natee Munsakuo MD * Department of Medicine, BMA Medical College and Vajira Hospital Objective: To determine the effectiveness and side effects of the 3 drug antiretroviral tablet: nevirapine/stavudine/lamivudine (GPOvir) in treatment of HIV- infected patients. Study design: Analytic longitudinal study Subjects: Eighty-seven HIV -infected patients who were treated with GPOvir from April 2002 to November 2002 in Infectious Diseases Clinic, Department of Medicine, BMA Medical College and Vajira Hospital. Methods: Sex, body weight, history of taking antiretroviral agent and CD4+cell count were recorded when starting GPOvir. After following up for 3 months, body weight and CD4+cell count were recorded again. Side effects were also re...

BACKGROUND Meropenem plays a significant role in the current antimicrobial treatment of serious i... more BACKGROUND Meropenem plays a significant role in the current antimicrobial treatment of serious infections. Recently, generic meropenems have become widely available in Thailand. OBJECTIVE Compare the effectiveness and safety ofa generic meropenem (Mapenem) with the original meropenem (Meronem) in clinical practice. MATERIAL AND METHOD A retrospective cohort study was conducted in hospitalized patients with serious infections that had been treated with either the generic or the original meropenem in nine secondary- and tertiary-care hospitals nationwide. The treatment outcomes at days 3, 7, and 14 after the use ofmeropenem between the two groups were compared. RESULTS Three hundred ninety seven patients with a mean (SD) age of 66.4 +/- 16.9 years were included. There were 228 (57.4%) males and 169 (42.6%) females. Two hundred and seven (52.1%) and 190 (47.9%) cases fell into the generic and original groups respectively. There were no significant differences regarding age, gender his...

Vajira Medical Journal, Mar 29, 2010

PloS one, 2017

We implemented a hospital-based prevention with positives (PwP) intervention among people living ... more We implemented a hospital-based prevention with positives (PwP) intervention among people living with HIV (PLHIV) that included HIV transmission risk screening, short HIV prevention messages, family planning, HIV disclosure counseling, and partner HIV testing at five hospitals in Thailand. We assessed changes in sexual risk behaviors among PLHIV who received the PwP services at the hospitals. From January 2008-March 2009, we systematically selected a subset of PLHIV receiving care at the five hospitals to offer participation in the PwP intervention. We collected demographic, risk behavior, and laboratory data using a standardized questionnaire. We analyzed data from PLHIV who completed at least four visits, using generalized estimating equations to identify baseline participant characteristics that were associated with adopting sexual practices less likely to be associated with HIV transmission during follow-up. A total of 830 PLHIV were interviewed and 756 (91.1%) completed four vi...

Journal of the Medical Association of Thailand Chotmaihet Thangphaet, Feb 1, 2011

Background: Meropenem plays a significant role in the current antimicrobial treatment of serious ... more Background: Meropenem plays a significant role in the current antimicrobial treatment of serious infections. Recently, generic meropenems have become widely available in Thailand. Objective: Compare the effectiveness and safety ofa generic meropenem (Mapenem) with the original meropenem (Meronem) in clinical practice. Material and method: A retrospective cohort study was conducted in hospitalized patients with serious infections that had been treated with either the generic or the original meropenem in nine secondary- and tertiary-care hospitals nationwide. The treatment outcomes at days 3, 7, and 14 after the use ofmeropenem between the two groups were compared. Results: Three hundred ninety seven patients with a mean (SD) age of 66.4 +/- 16.9 years were included. There were 228 (57.4%) males and 169 (42.6%) females. Two hundred and seven (52.1%) and 190 (47.9%) cases fell into the generic and original groups respectively. There were no significant differences regarding age, gender history of underlying disease, body weight, and ward of admission between the two groups. The majority ofpatients had presented with the respiratory tract (48.6%) and bloodstream infections (29.5%). The three most common causative bacteria were Pseudomonas aeruginosa, Acinetobacter baumannii, and extended-spectrum beta-lactamase (ESBL) producing Escherichia coli. The distribution ofthe sites of infection, causative microorganisms, the dosage ofmeropenem, and duration oftreatment were similar between the two groups. The distribution of patients with complete resolution, improvement, stable, worse, diedfrom infection, and died from other causes were similar between the two groups at day 3, 7, and 14 ofmeropenem use (p > 0.05). The drugs were well-tolerated, and less than 2% of patients in both groups discontinued meropenem due to the adverse drug effects. Conclusion: The generic meropenem has a similar effectiveness in the treatment of serious bacterial infections when compared with original meropenem. Both formulations are well tolerated among patients with substantial comorbidities. Adverse drug effects that lead to drug discontinuation are uncommon.

Antiviral Therapy, Feb 1, 2008

Background: The aim of this study was to assess the long-term efficacy and safety of first-line t... more Background: The aim of this study was to assess the long-term efficacy and safety of first-line treatment with once-daily saquinavir/ritonavir plus two nucleoside reverse transcriptase inhibitors (NRTIs). Methods: A total of 272 antiretroviral-naive patients with a CD4 + T-cell count of 200-350 cells/mm 3 were treated with two NRTIs and saquinavir/ritonavir 1,600/100 mg per day for ≥24 weeks. Patients were followed up every 12 weeks for CD4 + T-cell counts, HIV RNA levels, clinical and laboratory toxicities. Intentionto-treat analyses were used for the first 24 weeks of treatment and as-treated analysis after week 24. Results: The median baseline CD4 + T-cell count was 269 cells/mm 3 and HIV RNA was 4.7 log 10 copies/ml. At a median follow-up time of 56 (interquartile range [IQR] 25-113) weeks, 262/272 (96.3%) had HIV RNA <400 copies/ml, with a median HIV RNA decline of-2.89 (IQR 3.31-2.37) log 10 copies/ml (P<0.001) and a median rise in CD4 + T-cell count of 192 (IQR 117-317) cells (P<0.001). At weeks 24, 48, 72 and 96, 249/272 (91.5%), 157/164 (95.7%), 113/126 (89.7%) and 84/90 (93.3%) had HIV RNA <400 copies/ml, respectively; at the same time points, 83.8%, 92.7%, 85.7% and 85.6% had HIV RNA <50 copies/ml. Drug-related adverse events were reported in 6.3%. Significant rises in total cholesterol, triglyceride, low-density lipoprotein and high-density lipoprotein were seen. Conclusion: First-line highly active antiretroviral therapy with once-daily saquinavir/ritonavir plus two NRTIs showed strong antiviral efficacy.

The Lancet HIV, 2016

Thai patients with HIV have higher exposure to HIV protease inhibitors than do white people and d... more Thai patients with HIV have higher exposure to HIV protease inhibitors than do white people and dose reduction might be possible. We compared the efficacy of low-dose with standard-dose ritonavir-boosted atazanavir in virologically suppressed Thai patients with HIV. In this randomised, open-label, non-inferiority trial, we recruited patients aged 18 years or older who were receiving ritonavir-boosted protease-inhibitor-based antiretroviral therapy (ART) with HIV plasma viral loads of less than 50 copies per mL, an alanine aminotransferase concentration of less than 200 IU/L, and a creatinine clearance of at least 60 mL/min from 14 hospitals in Thailand. We excluded patients who had active AIDS-defining disease or opportunistic infections, had a history of an HIV viral load of 1000 copies per mL or more after 24 weeks of any ritonavir-boosted protease-inhibitor-based ART, used concomitant medications that could interact with the study drugs, were pregnant or lactating, had illnesses that might change the effect of the study drugs, or had a history of sensitivity to the study drugs. A biostatistician at the study coordinating centre randomly allocated patients (1:1) to switch the protease inhibitor for oral atazanavir 200 mg and ritonavir 100 mg or for atazanavir 300 mg and ritonavir 100 mg once daily, both with two nucleoside or nucleotide reverse transcriptase inhibitors at recommended doses. Randomisation was done with a minimisation schedule, stratified by recruiting centre, use of tenofovir, and use of indinavir as a component of the preswitch regimen. The primary endpoint was the proportion of patients with viral loads of less than 200 copies per mL at week 48, and we followed up patients every 12 weeks. Treatments were open label, the non-inferiority margin was -10%, and all patients who received at least one dose of study medication were analysed. This trial is registered with ClinicalTrials.gov, number NCT01159223. Between July 6, 2011, and Dec 23, 2013, we randomly assigned 559 patients: 279 to receive atazanavir 200 mg and ritonavir 100 mg (low dose) and 280 to atazanavir 300 mg and ritonavir 100 mg (standard dose). At week 48, 265 (97·1%) of 273 in the low-dose group and 267 (96·4%) of 277 in the standard-dose group had viral loads of less than 200 copies per mL (difference 0·68; 95% CI -2·29 to 3·65). Seven (3%) of 273 in the low-dose group and 21 (8%) of 277 in the standard-dose group discontinued their assigned treatment (p=0·01). 46 (17%) of 273 participants in the low-dose group and 97 (35%) of 277 in the standard-dose group had total bilirubin grade 3 or higher toxicity (≥3·12 mg/dL; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0·0001). A switch to low-dose atazanavir should be recommended for Thai patients with well controlled HIV viraemia while on regimens based on boosted protease inhibitors. The National Health Security Office and Kirby Institute for Infection and Immunity in Society.

F1000posters, Oct 7, 2011

In patients who develop NNRTI-based treatment failure, genotypic-guided 2 NRTIs+ boosted protease... more In patients who develop NNRTI-based treatment failure, genotypic-guided 2 NRTIs+ boosted protease inhibitor (bPI)-based HAART is recommended as the second-line therapy[1, 2]. In settings where viral load monitoring is not easily accessible and patients develop late virologic failure, it is not known whether recycling NRTIs plus a bPI is beneficial, compared to treating with bPI alone.

Reproductive health, Jan 3, 2016

Describe dual contraceptive method use and the intention to become pregnant of people living with... more Describe dual contraceptive method use and the intention to become pregnant of people living with HIV (PLHIV) and their partners in Thailand. From January 2008-March 2009, we systematically selected a cohort of PLHIV from PLHIV seeking care at five tertiary care hospitals and one community hospital to complete a questionnaire assessing sexual activity, intention to become pregnant, and contraceptive practices at baseline and 12 months after enrollment. Participants received short family planning messages every 2-3 months to promote the use of dual contraceptives and were offered family planning services. A total of 1,388 PLHIV enrolled, their median age was 37 years (IQR 33-43), 898 (64.7 %) had a steady partner, and 737 (53.1 %) were male. Among those with a steady partner, 862 (96.0 %) did not intend to become pregnant; 709 (82.3 %) had sex during the previous 3 months, 683 (96.3 %) used at least one contraceptive method, and 202 (29.6 %) used dual contraceptive methods. Of the 31...

Vajira Medical Journal, Sep 21, 2011

Vajira Medical Journal, Sep 22, 2011

Antiviral therapy, 2006

There are few data on the selection of resistance by ritonavir-boosted saquinavir (SQV/r), partic... more There are few data on the selection of resistance by ritonavir-boosted saquinavir (SQV/r), particularly in antiretroviral (ARV)-naive patients. To assess the incidence of virological failure and evolution of resistance in ARV-naive individuals receiving SQV/r in the induction phase of the Staccato trial. ARV-naive subjects (n = 272) received SQV/r 1,600/100 mg once daily with two nucleoside reverse transcriptase inhibitors (NRTIs) for at least 24 weeks. Patients were defined as having virological failure (VF) when there were two consecutive HIV-1 RNA measurements > 500 copies/ml after week 12. Viral genotypes (reverse transcriptase [RT] and protease [PRO]) were determined at baseline in all patients and as close as possible to the time of initial failure in patients experiencing VF. VF was observed in 9/272 patients receiving SQV/r 1,600/100 mg once daily with two NRTIs (3.3%) and occurred 19-48 weeks after treatment initiation. Eight of these patients were evaluable at failure. ...

F1000posters, Oct 7, 2011

In patients who develop NNRTI-based treatment failure, genotypic-guided 2 NRTIs+ boosted protease... more In patients who develop NNRTI-based treatment failure, genotypic-guided 2 NRTIs+ boosted protease inhibitor (bPI)-based HAART is recommended as the second-line therapy[1, 2]. In settings where viral load monitoring is not easily accessible and patients develop late virologic failure, it is not known whether recycling NRTIs plus a bPI is beneficial, compared to treating with bPI alone.

F1000posters, Oct 7, 2011

In patients who develop NNRTI-based treatment failure, genotypic-guided 2 NRTIs+ boosted protease... more In patients who develop NNRTI-based treatment failure, genotypic-guided 2 NRTIs+ boosted protease inhibitor (bPI)-based HAART is recommended as the second-line therapy[1, 2]. In settings where viral load monitoring is not easily accessible and patients develop late virologic failure, it is not known whether recycling NRTIs plus a bPI is beneficial, compared to treating with bPI alone.

Antiviral Therapy, 2012

Running head: LPV/r monotherapy or with TDF/3TC in NNRTI-based failure Abstract Background Data i... more Running head: LPV/r monotherapy or with TDF/3TC in NNRTI-based failure Abstract Background Data informing the use of boosted-protease inhibitor monotherapy as second-line treatment are limited. There are also no randomized trials addressing treatment options after failing first-line non-nucleoside reverse transcriptase inhibitor (NNRTI)regimens.

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2011

Meropenem plays a significant role in the current antimicrobial treatment of serious infections. ... more Meropenem plays a significant role in the current antimicrobial treatment of serious infections. Recently, generic meropenems have become widely available in Thailand. Compare the effectiveness and safety ofa generic meropenem (Mapenem) with the original meropenem (Meronem) in clinical practice. A retrospective cohort study was conducted in hospitalized patients with serious infections that had been treated with either the generic or the original meropenem in nine secondary- and tertiary-care hospitals nationwide. The treatment outcomes at days 3, 7, and 14 after the use ofmeropenem between the two groups were compared. Three hundred ninety seven patients with a mean (SD) age of 66.4 +/- 16.9 years were included. There were 228 (57.4%) males and 169 (42.6%) females. Two hundred and seven (52.1%) and 190 (47.9%) cases fell into the generic and original groups respectively. There were no significant differences regarding age, gender history of underlying disease, body weight, and ward...

Antiviral therapy, 2008

The aim of this study was to assess the long-term efficacy and safety of first-line treatment wit... more The aim of this study was to assess the long-term efficacy and safety of first-line treatment with once-daily saquinavir/ritonavir plus two nucleoside reverse transcriptase inhibitors (NRTIs). A total of 272 antiretroviral-naive patients with a CD4+ T-cell count of 200-350 cells/mm3 were treated with two NRTIs and saquinavir/ritonavir 1,600/100 mg per day for > 24 weeks. Patients were followed up every 12 weeks for CD4+ T-cell counts, HIV RNA levels, clinical and laboratory toxicities. Intention-to-treat analyses were used for the first 24 weeks of treatment and as-treated analysis after week 24. The median baseline CD4+ T-cell count was 269 cells/mm3 and HIV RNA was 4.7 log10 copies/ml. At a median follow-up time of 56 (interquartile range [IQR] 25-113) weeks, 262/272 (96.3%) had HIV RNA < 400 copies/ml, with a median HIV RNA decline of -2.89 (IQR 3.31--2.37) log10 copies/ml (P < 0.001) and a median rise in CD4+ T-cell count of 192 (IQR 117-317) cells (P < 0.001). At we...