ABSTRACT
Ebola virus was recognized in 1976 when an unrelated epidemic occurred in Zaire and Sudan. It is grouped in the Filoviridae family. It can cause hemorrhagic fever. The exact route of transmission Is unknown. Parenteral inoculation with contaminated material, skin or mucous memberne contact have probably been responsible for human infection. Ebola hemorrhagic fever has an incubation period of 4-16 days and begins with abrupt onset of fever usually accompanied by myalgia, headache, nausea, vomiting, abdominal pain, diarrhea, chest pain and cough. Around day 5-7, most patients will develop mucocutaneous hemorrhage. In the second week, the patient will defervesce and improve markedly or will die in shock with multiorgan dysfunction and disseminated intravascular coagulation. There is no specific treatment. The mortality rate is approximately 50-90% . The diagnosis made by isolation of the virus from blood or body fluids. No individual preventive measures, vaccines or antiviral chemotherapy are available.
ABSTRACT
Background: HIV-infected patients need a long-term good adherence the regimen of antiretroviral therapy to achieve the maximal response. Therefore, parents, patients and multidisciplinary team have a cooperatively essential role to maintain drug adherence. However, children become fed up with in take of drugs. This study aimed to explore the effect of duration of antiretroviral treatment with the adherence to treatment and to develop strategy in taking care of these patients in HIV-infected children in Srinagarind Hospital in the future.Methods: Demographic data of HIV- infected children and treatment information of retroviral drugs were collected retrospectively during June 01, 2005 to May 31, 2007 at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University. Adherence was calculated by standard formula. % Adherence = (initial stock + refilled amount)-final stock x 100 Number of pill/day x Number of follow-up days Data were analyzed by using mean, standard deviation and Chi square (95% confidence).Results: One hundred and twenty five HIV infected children, 71 girls and 54 boys, included in the study. There was a total of 808 visits; young age group of 395 visits and older age group of 413 visits. Young and older age group achieved good adherence by 73.1% and 77.0% respectively, p=0.21. Despite no difference in the percentage of good adherence between these 2 groups, the older age group became less adherent by the follow-up period, especially during and after 288-322 weeks and more than 322 weeks. Good adherences were 65.1% and 86.5% of medication given by self-giving in older children and parents, respectively. No other factors affected the adherence to drug therapy.Conclusion: Most of HIV-infected children in this study had good adherence. The duration of antiretroviral therapy affected the adherence in older age group. Care givers had role to improve the adherence.Key word: Drug adherence, HIV-infected children, Antiretroviral drugs, Caregiver
ABSTRACT
Background: The number of Thai children with perinatal HIV-infection receiving antiretroviral therapy has been increasing.Objectives: To describe clinical manifestations and survival of children with perinatal HIV infection.Methods: All children with perinatal HIV infection who received care at a university hospital in Northeast Thailand between January 1998 and December 2006 were included in this study. Children were assessed for their outcomes through December 31, 2007.Results: There were 322 perinatally HIV-infected children, 55.3% were female. The median age at the first clinical event was 51 months (interquartile range (IQR) =13-82). The three most common initial clinical events were pruritic papular eruption, recurrent or chronic respiratory tract infection, and persistent diarrhea. The three most common opportunistic infections were pulmonary tuberculosis, oral candidiasis, and pneumonia. Two hundred and forty three (75.5%) children received antiretroviral therapy (ARV). The initial ARV was monotherapy in 12 children (4.9%), dual therapy in 71 (29.2%), and a highly active antiretroviral therapy (HAART) regimen in 157 (64.6%). ARV was started at the median age of 76 months (IQR=47-99). As of December 31, 2007, 236 children were alive and 54 (16.8%) were known to have died. The one- and 5-year survival rates of all children were 99.4% (95%CI= 97.5-99.8%) and 93.9% (95%CI=90.6-96.0%), respectively. In children who presented with CDC clinical class C, the one-and 5-year survival rates were 96.0% (95%CI=84.9%-98.9%) and 75.7% (95%CI=60.4-85.8%), respectively.Conclusion: Survival rates among perinatally HIV-infected children in Northeast Thailand, including those who developed AIDS, increased. This might be due to the availability of ARV treatment and holistic care.