Screening Utility, Local Perceptions, and Care-seeking for Reported Jaundeesh among Respondents Lacking Signs of Icterus in Rural Bangladesh.

In rural Bangladesh, acute viral hepatitis presents a significant burden on the public-health system. As part of the formative work for a large epidemiologic study of hepatitis E in rural Bangladesh, we sought to identify local terms that could be used for population-based screening of acute viral hepatitis. Exploration of the local term jaundeesh for screening utility identified a high burden of reported jaundeesh among individuals without symptoms of icterus. Recognizing that local perceptions of illness may differ from biomedical definitions of disease, we also sought to characterize the perceived aetiology, care-seeking patterns, diagnostic symptoms, and treatments for reported jaundeesh in the absence of icteric symptoms to inform future population-based studies on reported morbidities. We conducted a cross-sectional survey among 1,441 randomly-selected subjects to identify the prevalence of reported jaundeesh and to test the validity of this local term to detect signs of icterus. To characterize the perceived aetiology and care-seeking patterns for jaundeesh among the majority of respondents, we conducted in-depth interviews with 100 respondents who self-reported jaundeesh but lacked clinical signs of icterus. To describe diagnostic symptoms and treatments, in-depth interviews were also performed with 25 kabirajs or traditional faith healers commonly visited for jaundeesh. Of the 1,441 randomly-selected participants, one-fourth (n=361) reported jaundeesh, with only a third (n=122) reporting yellow eyes or skin, representative of icterus; Jaundeesh had a positive predictive value of 34% for detection of yellow eyes or skin. Anicteric patients with reported jaundeesh perceived their illnesses to result from humoral imbalances, most commonly treated by amulets, ritual handwashing, and bathing with herbal medicines. Jaundeesh patients primarily sought folk and spiritual remedies from informal care providers, with only 19% visiting allopathic care providers. Although the local term jaundeesh appeared to have limited epidemiologic utility to screen for acute symptomatic viral hepatitis, this term described a syndrome perceived to occur frequently in this population. Future population-based studies conducting surveillance for acute hepatitis should use caution in the use and interpretation of self-reported jaundeesh. Further study of jaundeesh may provide insight into the appropriate public-health response to this syndrome.

Frequencies of IL10 SNP genotypes by multiplex PCR-SSP and their association with viral load and CD4 counts in HIV-1-infected Thais.

Background: Interleukin (IL)-10 is an immuno-regulatory cytokine, levels of which can be influenced by single nucleotide polymorphisms (SNPs) in the promoter. Some, but not all previous studies have shown associations of IL10 SNPs with HIV-1 disease progression, using markers such as viral load or CD4 count. There are few data on IL10 SNP frequencies and HIV-1 disease in regions where non-B HIV-1 subtypes predominate. Objective: To determine genotypes, haplotypes, allele frequencies and associations with markers of HIV-1 disease progression of IL10 SNPs. Methods: A new multiplexed PCR-SSP assay to detect IL10 SNPs at positions -1082, -819 and -592 was developed and used to determine genotypes and haplotypes in 244 HIV-1 CRF01_AE-infected northern Thais having a median time since HIV-1 infection of 2.7 years. Results: At position -1082 of IL10, AA genotype and A allele were the most common (87.3% and 93.2%, respectively). The -819 CT and -592 CA genotypes were the most prevalent (44.3%), and -819T and -592A were the most prevalent alleles (64.8%). The ATA/ATA was the most common genotype (42.6%) with the most prevalent haplotype of ATA (64.7%). No associations of any of the three IL10 SNPs with CD4+ or CD8+ T cell counts or with viral load were found. Conclusions: This first report of IL10-1082A, -819T and the IL10-592A allele frequencies in HIV-1-infected Thais shows the highest frequencies in HIV-1-infected persons worldwide. The lack of association of IL10 SNPs with CD4+ T cell count and viral load suggest that other genes may influence these markers in HIV-1-infected Thais.

Assessment of a self-deferral form for screening blood donors, Chiang Mai University Hospital, Thailand.

A self-deferral form has been used to screen Chiang Mai University Hospital blood donors and was improved in 2005. It has never been evaluated. The study aimed to assess the self-deferral form procedures in detecting infected donors. Sera from 5,083 donors, who passed the self-deferral screening form, were tested with the routine immuno-assays (serology) for HIV 1 and 2 antibodies, P24 antigen, HCV antibodies, HBV surface antigen, and syphilis. Antibody negative sera were also tested individually with the the Procleix Ultrio Assay for HIV-1 DNA, HCV RNA, and HBV DNA. The donors who had discrepant results between serology and NAT were evaluated with additional tests, including a more sensitive Alternative Nucleic Acid Test, AntiBcore IgM, AntiBcore IgG, HBsAg and Anti HBs. Among 5,083 donors, 331 (6.5%) had at least one positive marker. In multiple logistic regression analysis, the statistically significant factors (adjusted odds ratio and 95% CI) for infection were age 30 years or below [1.45 (1.03, 2.03)], male gender [2.73 (1.64, 4.56)], primary school or lower education [1.56 (1.09, 2.23)], first-time donation [1.82 (1.25, 2.67)], and frequent donation [0.80 (0.70, 0.92)]. The safest donors were females, older than 30 years, with an education more than primary school, and frequent donation. Because of missing responses to some sensitive questions, there remains a need for further improvement of the self-deferral form.

Physician adherence to isoniazid preventive therapy guidelines for HIV-infected patients in Thailand.

Isoniazid preventive therapy (IPT) has been shown to reduce the risk of active tuberculosis in tuberculin skin test (TST) positive human immunodeficiency virus (HIV) infected individuals. The World Health Organization has recommended IPT for HIV-infected patients since 1999. Physicians' non-adherence to the IPT guideline is one of the limitations to the wide spread use of IPT. A study of the extent to which physicians in Thailand adhere to this guideline will optimize the implementation of national IPT program. Three hundred physicians who provided medical care for HIV-infected patients were sampled by multistage cluster sampling of public hospitals according to the region and the level of health care service. Fifty-eight (19.3%) of the surveyed physicians provided IPT; 86.2% and 34.5% of physicians who provided IPT did not do the TST or screening chest radiography for active TB, respectively. Experience with HIV patient care was significantly associated with providing IPT.