Thai national guidelines for antiretroviral therapy in HIV-1 infected adults and adolescents 2010.

In Thailand, more than 150,000 patients are currently treated with antiretroviral drugs under the support of the National AIDS Program (NAP). The appointed Adults and Adolescents Committee consisted of 28 members who are experts in HIV research, patient care or health care policy. Relevant published literature, guidelines, and the most recent relevant clinical trials presented internationally were reviewed. Several peer review and clinical studies conducted in Thailand were included in the review process. Special considerations for patients with co-infection of tuberculosis or hepatitis B were incorporated. Appropriate cut-off of CD4+ T-cell counts when to commence ART among Thai patients have been considered. It is now recommended to start ART at CD4+ T-cell count <350 cells/mm3. For treatment-naive patients, the preferred initial therapy is a nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimen containing lamivudine plus zidovudine or tenofovir. Stavudine will be phased out in a two-year plan at the national program level. Viral load and CD4+ T-cell counts should be monitored at least once and twice a year. To achieve long-term treatment success, enhancing adherence together with the proper management of antiretroviral-related toxicity is critical. In summary, the major changes from the Thai 2008 guidelines include commencing ART earlier. ART is recommended regardless of CD4+ T cell count if patients have an indication to treat their HBV co-infection. Preferred first regimen uses AZT or TDF, not d4T as the NRTI-backbone. Furthermore, efavirenz is now considered a preferred NNRTI, along with nevirapine.

Guidelines for antiretroviral therapy in HIV-1 infected adults and adolescents: the recommendations of the Thai AIDS Society (TAS) 2008.

BACKGROUND: More than 100,000 patients have been treated, since the implementation of the National Universal Coverage for antiretroviral therapy (ART) in Thailand Although there are several comprehensive guidelines available internationally, there is a need to have guidelines that can be implemented in Thailand. MATERIAL AND METHOD: The guidelines were developed by a panel of 17 members who are the experts on HIV research and/or HIV patient care and appointed without incentive by the Thai AIDS Society (TAS). The recommendations were based on evidences from the published studies and availability of antiretroviral agents. Published studies that are relevant and applicable to Thailand in particular have been taken into consideration. RESULTS: The recommendations include: when to start ART; what to start; how to monitor the therapy; adverse effects and its management; diagnosis of treatment failure; and antiretroviral treatment options in patients with treatment failure. ART in special circumstances, i.e., patients with co-infection of tuberculosis or hepatitis B virus, is also included Appropriate level of CD4+ T-cell count to start ART among Thai patients has been considered carefully. The authors recommend to start ART at CD4+ T-cell count < 200 cells/mm3. CONCLUSION: ART should be initiated in adults and adolescents HIV-1 infected patients with a history of HIV-related illness or AIDS or with a CD4+ T-cell count <200 cells/mm3. For treatment-naive patients, the preferred initial therapy is a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen. CD4' T-cell count and viral load should be monitored for at least twice and once a year, respectively. Proper management of antiretroviral-related toxicity and enhancement of adherence are crucial for the long-term success of ART.

Role of drowsy driving in traffic accidents: a questionnaire survey of Thai commercial bus/truck drivers.

OBJECTIVE: The authors assessed the relationship between traffic accidents and drowsiness. MATERIAL AND METHOD: A self-answered questionnaire survey of 4331 commercial bus/truck drivers was done. RESULT: Sixty-nine percent of the drivers reported accidents and one third of these accidents was attributable to drowsiness. Drowsy driving and microsleeps were experienced by 75% and 28% of drivers respectively. Forty-five percent of drivers had excessive daytime sleepiness based on the Epworth Sleepiness Scale (ESS score > or =11). This excessive daytime sleepiness was strongly associated with feeling drowsy, microsleeps, and accidents. The major causes of drowsiness were sleep deprivation (90%), medications that caused sleepiness (78%), drinking alcohol the previous night (23%), and chronic loud snoring with or without obesity (17%). 61% of drivers worked longer than 12 hours with no days off The feeling of drowsiness at the wheel was also closely related to long hours of driving (>4 hours). Countermeasures that drivers used to keep them awake were talking to someone, drinking coffee or caffeinated-energy drinks, chewing snacks or gum and pulling over to have a nap. CONCLUSION: There is a strong relationship between accidents and drowsiness in commercial bus/truck drivers. The main cause of drowsiness was sleep deprivation. The authors hope that this information will help the public authority develop a policy to reduce the traffic accidents attributable to drowsy driving in commercial bus/truck drivers.