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Proceedings of: 25th Bangkok International Symposium on HIV Medicine, 18-20 January 2023, held virtually and on site at Samyan Mitrtown Hall, Bangkok, Thailand. The Bangkok International Symposium on HIV Medicine has commenced on the third Wednesday of January since 1998. The Symposium aims to provide professional healthcare workers in Thailand and the region an opportunity to receive the most up-to-date information on HIV and its related conditions if they are unable to attend other HIV conferences abroad. This year's hybrid symposium was held from 18 January to 20 January 2023. A total of six plenary sessions were held in the mornings, and four afternoon workshops held on Wednesday and Thursday. Expert speakers from Thailand, China, Malaysia, Singapore, India, Hong Kong, the Philippines, Australia, the UK, The Netherlands and the USA participated in the symposium.Copyright © 2023 Future Medicine Ltd.
ABSTRACT
The Bangkok International Symposium on HIV Medicine has commenced on the 3rd Wednesday in January since 1998. The Symposium aims to provide professional healthcare workers in Thailand and the region an opportunity to receive the most up-to-date information on HIV and its related conditions if they are unable to attend other HIV conferences abroad. This year's hybrid symposium was held from 18 January to 20 January 2023. A total of six plenary sessions were held in the mornings, and four afternoon workshops held on Wednesday and Thursday. Expert speakers from Thailand, China, Malaysia, Singapore, India, Hong Kong, Philippines, Australia, UK, The Netherlands and the USA participated in the symposium.
ABSTRACT
SARS-CoV-2 shedding in feces has been reported. We aimed to find: (1)The predictors of fecal viral shedding, (2)Incidence of post-infectious FGIDs in patients with COVID-19 infection. Methods: 188 COVID-19 patients admitted from March to July 2020 were included and prospectively collected the stool samples on admission date and then weekly until negative results. We recorded the clinical and laboratory profiles to find the predictors of fecal viral shedding. Baseline GI symptoms before COVID-19 infection were also evaluated. After discharged, patients were followed regarding their GI symptoms by telephone interviews at 3 and 9 months to evaluate the incidence of post COVID-19 irritable bowel syndrome (IBS), functional constipation (FC), and functional dyspepsia (FD) by using Rome IV criteria. Results: 127 of 188 patients completed stool collection protocol, 85 patients (66.9%) had positive stool SARS-CoV-2 with a duration of viral shedding of 79 (76-90) days. Disease severity, presence of pneumonia, fever, respiratory symptoms, vomiting, and diarrhea were not significantly different between patients with and without fecal viral shedding. Patients with stool shedding had higher prevalence of anosmia [5(83.3%) vs 0, p=0.048], lower absolute lymphocyte [1.42(0.96-1.77) x109/L vs 1.84(1.27-2.17) x109/L, p=0.004], higher ALT [27(18.25-36.75) U/L vs 19(13-28.5) U/L, p=0.02] and lower cycle threshold values [19.68 (16.35-26.40) vs 26.28 (19.34-33.31), p=0.05] (table1). Multivariate analysis including age, diabetes, diarrhea, hemoglobin, absolute lymphocyte, platelet count, ALT, and cycle threshold values demonstrated that there was no factor associated with viral shedding in the stool. 84 patients (44.7%) responsed to the follow-up phone call at 9 months. 3 patients (3.6%) had new onset of GI symptoms during 9-month post COVID-19 infection [early satiety (n=1), diarrhea (n=1), constipation (n=2) and abdominal pain (n=2) with mean severity (SD):8.5 (0.5)of 10]. One patient (1.2%) had FD, No IBS was diagnosed. Conclusions: More than a half of COVID-19 patients had viral shedding in stool for up to 3 months. Univariate analysis demonstrated that low blood lymphocyte and lower cycle threshold values were associated with fecal viral shedding but not the GI symptoms during admission. However, multivariate analysis demonstrated that these factors were not associated with fecal viral shedding. Post-infectious functional GI disorders were uncommon. (Table Presented)
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Background: Inactivated SARS-CoV-2 vaccine (CoronaVac) is commonly used in national immunization programmes. However, an immune response of CoronaVac significantly declined after 3 months, our study, thus, aimed to explore the immune response against COVID-19 following the booster dose by assessing both B-cell and T-cell activities compared to the convalescent samples. Methods: In this prospective cohort study, 98 healthcare workers with a 2-dose CoronaVac vaccination with a subsequent booster dose of ChAdOx1 nCoV-19 (n=56) or BNT162b2 (n=42) were included during March and October 2021. Immune responses were evaluated by surrogated viral neutralization test (sVNT, cPass™), anti-SARS-CoV-2 RBD total antibodies (Elecsys®) and the ELISPOT with spike (S1) peptide pools. The samples were analyzed at baseline, 4 and 12 weeks after the second CoronaVac and 4 weeks after a booster dose. In addition, convalescent sera and peripheral blood mononuclear cells (PBMCs) of the COVID-19 patients were collected at 4 weeks after diagnosis. Results: Median (interquartile range, IQR) age was 40 (31-52) years old with female predominant (80%). The median (IQR) interval after the second CoronaVac was 88 (74-92) days for ChAdOx1 nCoV-19 and 113 (112-115) days for BNT162b2. There was a significant decrease in neutralizing antibodies at the 12th week after primary CoronaVac vaccination (Figure 1). At 4 weeks after the ChAdOx1 nCoV-19 booster, median (IQR) level of sVNT and anti-RBD total antibody levels were 98.1% (97.9-98.2%) and 7768 (5349-11142), respectively, which were significantly different from the BNT162b2 booster, 98.5% (98.5-98.6%) and 25129 (17531-39434) BAU/mL, respectively (p<0.001 both). The antibody levels of the booster vaccine group were significantly higher than in the COVID-19 patients, which median (IQR) of sVNT was 80.8% (61.7-94.2%) in the mild COVID-19 and 93.8% (85.4-95.6%) in COVID-19 pneumonia, while anti-RBD total antibody levels were 94 (22-207) and 222 (130-378) BAU/mL, respectively. Using the ELISPOT with S1 peptide pools, median (IQR) of T cell response was 106 (24-256) and 196 (60-244) Spot Forming Unit (SFU)/millions of PBMCs for ChAdOx1 nCoV-19 and BNT162b2, respectively (p 0.49) which were comparable to the COVID-19 cases. Conclusion: A 2-dose CoronaVac followed by ChAdOx1 nCoV-19 or BNT162b2 effectively boosted a significantly higher antibody response than the natural COVID-19 infection. In addition, BNT162b2 booster induced significantly higher antibody levels than ChAdOx1 nCoV-19.
ABSTRACT
Thailand encountered its first coronavirus disease 2019 (COVID-19) outbreak in March 2020 and the Thailand Ministry of Public Health rapidly developed COVID-19 treatment guidelines. In this study we aimed to describe the outcomes among patients treated following those initial guidelines and determine factors significantly associated with poor outcomes in order to inform efforts to improve COVID-19 treatment guidelines for Thailand. Nine hospitals in Bangkok submitted data from their COVID-19 patients using standardized case record forms. A poor outcome was defined as death, ICU admission, requiring intubation or requiring high-flow oxygen. Factors associated with these outcomes were assessed. A total of 744 patients (48.8% male) were included in the study. The median (interquartile range) age of study subjects was 37 (27-48) years;8.4% were aged >60 years, 5.6% of subjects were obese and 16.5% had underlying conditions: obesity, immunocompromised status, diabetes, chronic conditions of lungs, kidneys, liver, cardiovascular or cerebrovascular systems or had an absolute lymphocyte count <1,000 cells/mm3. Among symptomatic patients, factors significantly independently associated with a poor outcome were: age >60 years (adjusted odds ratio (aOR): 2.50, 95% confidence interval (CI): 1.17-5.36, p = 0.018), having an underlying risk condition (aOR: 2.36, 95%CI: 1.27-4.39, p = 0.007), presenting with pneumonia (aOR: 6.60, 95%CI: 3.48-12.49,p <0.001) and azithromycin use (aOR: 2.36, 95%CI: 1.30-4.31, p = 0.005). Among symptomatic patients, the factor significantly associated with lower odds of having a poor outcome was hospital admission within 4 days of symptom onset (aOR: 0.44, 95%CI: 0.24-0.82, p = 0.009). Subgroup analysis revealed hospital admission within 4 days of symptom onset was significantly associated with a lower risk of a poor outcome only among patients who received treatment that included favipiravir (crude odds ratio (cOR): 0.320, 95%CI: 0.152-0.662, p = 0.003), but not among those who received a ritonavir boosted protease inhibitor (lopinavir or darunavir) or hydroxychloroquine (or chloroquine) without favipiravir (cOR: 0.58, 95%CI: 0.18-1.91, p = 0.372). In summary, the factors significantly associated with greater odds of having a poorer outcome were: age >60 years, having an underlying risk condition, presenting with pneumonia and azithromycin use;and with lower odds of having a poor outcome was being treated with favipiravir within 4 days of symptom onset. Thai guidelines have been updated to include early initiation of favipiravir, particularly among those with underlying risk conditions. Further studies are needed to determine if implementation of guidelines taking into account of all these factors will result in improved outcomes.