Estimated economic losses of hospitalized AIDS patients at Siriraj Hospital from January 2003 to December 2003: time for aggressive voluntary counseling and HIV testing.

This retrospective study was performed to explore the pattern of adult HIV-infected patients admitted to Siriraj Hospital from January 2003 to December 2003 and estimated the economic losses of these patients. Two hundred and forty four medical records were available for review. The proportion of male to female was 2 to 1. Mean age of patients was 36.64 +/- 9.72 years. The mean CD4 count among 112 patients was 82.79 +/- 96.49 cell/mm3. One hundred and twenty four (50.82%) were newly diagnosed of HIV infection. The three most common opportunistic infections were Tuberculosis (42.62%), Pneumocystis carinii pneumonia (14.75%), and cryptococcosis (13.11%). The mean duration of admission was 15.72 +/- 15.11 days. The mean expense per admission was 38,194.58 +/- 32,354.86 Baht. Fifty four patients (22.13%) died during admission. The mean income of these patients was 3,903.5 +/- 3,841.42 baht per month. The estimated economic losses of 54 patients who died during admission including medical care expense and income losses due to premature death was 69,769,739.32 baht. However, the expected medical expense of antiretroviral medications in these 54 patients if they had been diagnosed earlier and their lives had been saved would have been 42,214,608 baht. Therefore, vigorous voluntary counseling and HIV testing in patients aged 13-70 years when they have any risk factors for HIV infection regardless of symptoms might be more cost effective than diagnosis when they get sick.

Vaccination against hepatitis B virus: are Thai medical students sufficiently protected?

Medical students are frequently at risk of being infected by hepatitis B virus (HBV) via occupational exposure to infected blood or body fluids. In 2002, the Faculty of Medicine, Siriraj Hospital provided screening tests for HBV serology to all medical students for a vaccination campaign against the infection. There were 1,165 medical students tested. Eight hundred and eleven (69.6%) students had immunity by previous vaccination, but more importantly 212 (18.2%) had no immunity and required vaccination. Most of the students who needed to be vaccinated were in the pre-clinical year (82.5%). Moreover, the students in the pre-clinical year who had previous vaccination had a 2.2 times greater risk of having negative anti-HBs than the students in the clinical year (OR = 2.2, 95% CI = 1.4-3.5). This is because they might have been vaccinated when they were young and the antibody waned overtime.

Safety and efficacy of a simplified fixed-dose combination of stavudine, lamivudine and nevirapine (GPO-VIR) for the treatment of advanced HIV-infected patients: a 24-week study.

OBJECTIVE: To determine the efficacy and safety of the fixed-dose combination of stavudine (d4T), lamivudine (3TC) and nevirapine (NVP) in the treatment of antiretroviral naive HIV-infected Thai adults. PATIENTS AND METHOD: An open-label, single arm trial was conducted Baseline clinical assessment and blood test was done on 10, antiretroviral naive HIV-infected patients, who then received a fixed dose combination of d4T, 3TC and NVP (GPO- VIR, Thai Government Pharmaceutical Organization, Bangkok, Thailand). Nevirapine was given as 200 mg once daily for the first 2 weeks. The patients were followed up at 2, 4, 8, 12 and 24 weeks. A CD4 cell count and HIV-RNA assay were done at 12 and 24 weeks. RESULTS: One hundred and one patients were enrolled The mean baseline CD4 cell count and mean HIV RNA were 58.7 (57.7) cells/mm3 and 5.3 (0.5) log10, copies/mL respectively. At week 24th, the mean decrease in log HIV RNA was 3.6 (0.7) log10 copies/mL [P < 0.001; 95% confidence interval (CI), 2.70-3.03]. Eighty one (80.2%) patients had HIV RNA < 400 copies/mL by intention-to-treat analysis (ITT) and 97.6% had HIV RNA < 400 copies/mL by on-treatment analysis (OT). Sixteen (84.2%) patients with baseline HIV RNA < or = 100,000 copies/mL and 65 (82.3%) patients with baseline HIV RNA > 100,000 copies/mL had viral load < 400 copies/mL by ITT (P = 0.842; 95% CI, -20.9%-16.2%). Sixteen (94.1%) patients with baseline HIV RNA < or = 100,000 copies/mL and 65 (98.5%) patients with baseline HIV RNA > 100,000 copies/mL had viral load < 400 copies/mL by OT (P = 0.295; 95% CI, -25.5%-3.8%). The mean CD4 cell count at week 24 was 155.1 (89.0) cells/mm3 (range 13-402). The mean increase in CD4 cell count from baseline was 96.5 (63.5) cells/ mm3 (P < 0.001). A total of 12% of the patients receiving d4T + 3TC + NVP developed skin rashes. Grade 3 or 4 hepatotoxicity was recognized in 7% of the patients. CONCLUSION: Fixed-dose combination of d4T + 3 TC + NVP (GPO- VIR) is safe, well tolerated and effective in increasing CD4 cell counts and suppression of HIV RNA at 24 weeks in advanced HIV-infected patients in Thailand.

Occupational exposure to HIV among healthcare workers: Experience at Siriraj Hospital.

Objective : To evaluate the incidence and epidemiological data concerning occupational exposure to HIV among healthcare workers (HCWs) at Siriraj Hospital. Methods : We prospectively collected data concerning occupational exposure among HCWs at Siriraj Hospital using a self-reporting system from 1994 to 2001. All exposed individuals were followed up for at least 6 months after exposure. Results : During the years 1994-2001, there were 691 incident reports from 670 individuals, 180 males and 490 females. The groups of HCWs exposed to blood and other body fluids consisted of : - 152 (22.0%) nurses, 147 (21.3%) medical students, and 119 (17.2%) externs. Needlestick or sharps injuries accounted for 538 (77.9%) cases, while the number exposed to mucous membranes was 93 (13.5%). The remaining 28 (4.1%) cases were of broken skin and 32 (4.6%) cases of intact skin exposure. Venepuncture was the procedure with highest risk of producing injury (20.7%). The incidents mostly occurred on medical wards 156 (22.6%) cases, operating rooms 121 (17.5%) cases, and in the emergency room 111 (16.1%) cases. The HIV status of the sources was positive in 230 (33.3%) cases, negative in 315 (45.6%) cases, and unknown in 146 (21.1%) cases. Postexposure prophylaxis was given in 206 (29.8%) cases. In terms of HIV seroconversion, only 172 (27.3%) out of 629 cases reported back negative results for anti-HIV at the 6 month follow-up. Conclusion : Occupational exposure to HIV at Siriraj Hospital occurred most frequently among nurses, medical students, and externs as needlestick or sharps injuries on medical wards. According to our data up to this time, no one seroconverted or claimed compensation for work-related HIV infection.

Health status of Siriraj Hospital's nurses: Uncover the underlying health problems.

Health care providers' exposure to the hospital environment including infectious diseases and lack of self-awareness of illnesses may lead to critical health problems. The present cross sectional study was conducted to survey the magnitude of health problems in nurses at Siriraj Hospital. The study population included 1,435 nurses, 1,366 female and 69 male, with an average age of 44 ฑ 6 (range 30-60) years. Results of the study showed that 5.7 % of subjects had high fasting plasma glucose (FPG), 59.4 % had hypercholesterolemia (cholesterol > 200 mg/dl) and 6.0 % had hypertriglyceridemia (triglyceride > 200 mg/dl). Isolated hypercholesterolemia and isolated hypertriglyceridemia were found in 54.4 % and 1.0 % respectively. Combined hypercholesterolemia with hypertriglyceridemia was found in 5.0 %. Hyperuricemia was found in 8.2 % of subjects. Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels of more than 2 times the upper normal limit were found in 0.4 % and 1.5 % respectively. Serum alkaline phosphatase of more than the upper normal limit was found in 4.2 %. Anemia was found in 24.9% of cases. Abnormal chest x-ray findings including nodules, calcification, infiltration, fibrosis and effusion were found in 4.5 %. This study uncovered underlying health problems in the majority of the population of health care providers at Siriraj Hospital, who were presumed to be healthy. The most frequent finding was dyslipidemia, which was found in more than half of the study population. This abnormality may lead to more serious illnesses especially cardiovascular diseases. More intensive study is required to determine the associated factors and to find the appropriate strategy in managing this problem on the basis.