Human immunodeficiency virus-related tuberculosis and primary drug resistance in Bangkok, Thailand.

SETTING: Central Chest Hospital, a 500-bed referral hospital near Bangkok with a large out-patient department. OBJECTIVES: To determine human immunodeficiency virus (HIV) seroprevalence among patients with pulmonary tuberculosis (TB), and compare HIV-positive and HIV-negative TB patients. DESIGN: From July 1995 through June 1996, a cross-sectional study was conducted of newly registered adults (> or =16 years old) with suspected pulmonary TB. RESULTS: Of 2587 newly registered patients with suspected pulmonary TB, 2019 (78%) received HIV pretest counseling and 1816 (90%) consented to testing. Of these, 364 (20%) were HIV-seropositive. Among 1091 patients with bacteriologically confirmed TB, HIV seroprevalence was 22%. HIV-positive patients were more likely to be young, unemployed, single men and to have a history of injection drug use. HIV-positive patients with first-episode TB were more likely to have Mycobacterium tuberculosis strains resistant to isoniazid (10.9% vs 3.5%; P < 0.001), rifampicin (9.4% vs 2.9%; P < 0.001), and at least isoniazid and rifampicin (multidrug-resistant TB [MDR-TB]; 5.2% vs 0.4%; P < 0.001). CONCLUSIONS: HIV prevalence is high among TB patients at this Bangkok hospital and is associated with drug resistance, including a 12 times higher risk of MDR-TB. These findings underscore the urgent need to assure adherence to complete, effective TB treatment regimens for all patients, including persons who are potentially difficult to manage such as injection drug users.

Resistance of Mycobacterium tuberculosis to antituberculosis drugs in the Central Region of Thailand, 1996.

OBJECTIVE: To determine the proportion and profile of antituberculosis drug resistance among Mycobacterium tuberculosis isolates in Thailand. SETTING: A 500-bed cardiothoracic centre. DESIGN: From January to December 1996, isolates of M. tuberculosis from consecutive patients with pulmonary tuberculosis underwent susceptibility testing to isoniazid (H), rifampicin (R), ethambutol (E), streptomycin (S), kanamycin (K), and ofloxacin (O). RESULTS: In all, 1861 strains were tested, 1738 from new cases and 123 from previously treated cases. Overall initial and acquired resistance were 20.9% and 53.6%, respectively. The percentages of initial resistance to R, H, S, O, K and E were 12.6, 8.3, 6.6, 1.8, 1.1 and 0.8, respectively, whereas those of acquired resistance were 43.0, 29.2, 21.1, 9.7, 8.1 and 4.8, respectively. Multidrug resistance was observed in 4.2% of new patients and 25.2% of previously treated patients. CONCLUSION: The overall drug resistance of M. tuberculosis in the central region of Thailand is high, and acquired multidrug resistance has reached an ominous level. The results have serious implications for tuberculosis control in Thailand. Urgent measures are needed to control the spread of drug resistance, and supervised treatment of standard protocol should be adhered to more strictly.

Clinical field site evaluation of the FACSCount for absolute CD3+, CD3+ CD4+, and CD3+ CD8+ cell count determinations in Thailand.

The FACSCount flow cytometer absolute CD3+, CD3+ CD4+, and CD3+ CD8+ cell counts measured at a field site hospital laboratory in Thailand were compared to FACScan absolute counts obtained at a nearby research laboratory. Correlation coefficients for 208 samples were > or = 0.95. The FACSCount was accurate, and it was easier and less expensive to operate than the FACScan. Additionally, the FACScan-generated lymphocyte percentage value was accurate for use with the FACScan SimulSET software.

A comparison of two short course tuberculosis chemotherapy regimens, both using Rifater during an intensive phase, with a 3 year follow-up.

Tuberculosis is still a major public health threat in Thailand. The introduction of a short course of chemotherapy at national level might help reduce the magnitude of the problem. In order to assess the efficacy and toleration of two different regimens of chemotherapy under field conditions, a comparative clinically controlled trial was conducted at the Central Chest Hospital in Nonthaburi, Thailand. From January 1988 to August 1990, 199, newly diagnosed, untreated, sputum positive tuberculosis patients were allocated randomly to two treatment groups; in Group A, 97 patients received Rifater daily for the first 2 months, followed by Rifinah daily for 4 months (2 Rifater/4 Rifinah). In Group B, 102 patients received Rifater supplemented by ethambutol daily for the first 2 months followed by thiacetazone and isoniazid daily for 6 months (2 Rifater EMB/6 HT.) Treatment results were very satisfactory in both groups. At the end of treatment conversion rates were 100 per cent in Group A, and 99 per cent in Group B. After a period of 36 months following completion of treatment, relapse rates of 3 per cent for Group A and 4 per cent for Group B were observed. Adverse reactions were minimal in both groups, but acne formation and gastrointestinal symptoms were noticed more in Group B, suggestive of thiacetazone side effects. This study shows that, the 6-months regimen is as effective as the 8-months regimen. Although the 8-months regimen is cheaper, it causes more gastrointestinal disturbance and skin reaction which might led to less patient compliance and result in a lower cure rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Smoking cessation through the use of nicotine chewing gum: a double-blind trial in Thailand.

Two hundred cigarette smokers in Thailand were randomly assigned to receive a chewing gum containing nicotine or placebo. After six months, significantly more of the group receiving the active gum than those receiving the placebo had given up smoking. The results suggested that this treatment was more effective in highly dependent smokers than in those who were less dependent. Few side effects were reported.