scholarly journals Thai national guidelines for the use of antiretroviral therapy in pediatric HIV infection in 2010

2010 ◽  
Vol 4 (4) ◽  
pp. 505-513 ◽  
Author(s):  
Thanyawee Puthanakit ◽  
Auchara Tangsathapornpong ◽  
Jintanat Ananworanich ◽  
Jurai Wongsawat ◽  
Piyarat Suntrattiwong ◽  
...  
Keyword(s):  
Viral Load ◽  
Treatment Guidelines ◽  
Complete Blood Count ◽  
Clinical Stage ◽  
Liver Function Tests ◽  
Pediatric Hiv ◽  
Therapeutic Drug ◽  
National Guidelines ◽  
First Line ◽  
Function Tests

Abstract With better knowledge and availability of antiretroviral treatments, the Thai National HIV Guidelines Working Group has issued treatment guidelines for children in Thailand in March 2010. The most important aspects of these new guidelines are detailed below. ART should be initiated in infants less than 12 months of age at any CD4 level regardless of symptoms and in all children at CDC clinical stage B and C or WHO clinical stages 3 and 4. For children with no or mild symptoms consider CD4-guided thresholds of CD4 <25% (children aged one to five years) or CD4 <350 cells/mm3 (children 5 years or older). The preferred first-line regimen in children aged < 3 years is AZT+3TC+NVP. For children >3 years of age the preferred regimen is AZT+3TC+EFV. If an infant has previously been exposed to NVP perinatally, use AZT+3TC+LPV/r as empirical first regimen. In adolescents, consider TDF+3TC+EFV. The preferred ARV treatment in children who failed first line regimens of 2NRTI+NNRTI (Salvage treatment) comprises 2NRTI (guided by genotype) +LPV/r, and an alternative regimen is 2NRTI (guided by genotype) +ATV/ r (use in cases with dyslipidemia who are six years or older). In cases with extensive NRTI resistance with no effective NRTI option available, double boosted PI with LPV/r+SQV or LPV/r+IDV can be considered. Consultation with an expert is recommended. Laboratory monitoring is recommended for CD4 and every six months. Viral load at least at 6 and 12 months after initiation or change of regimen, then yearly thereafter. More frequent viral load monitoring is advised for cases with unsuccessful virologic response, infants, children with imperfect adherence, or those using of third line regimens. Toxicity monitoring depends on the drug received, at least every six months, and more often as clinically indicated. These include, but are not limited to, complete blood count, renal function tests, liver function tests, urinanalysis, and lipid profiles. Therapeutic drug monitoring is recommended in cases that have ARV-related toxicity, receiving non-standard dosing or regimens, using double boosted PI, and in those with renal or hepatic impairment.

scholarly journals Antimicrobial resistance in Neisseria gonorrhoeae isolates and gonorrhoea treatment in the Republic of Belarus, Eastern Europe, 2009–2019

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Aliaksandra Aniskevich ◽  
Iryna Shimanskaya ◽  
Iryna Boiko ◽  
Tatyana Golubovskaya ◽  
Daniel Golparian ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Neisseria Gonorrhoeae ◽  
Eastern Europe ◽  
Treatment Guidelines ◽  
Statistical Significance ◽  
Antimicrobial Treatment ◽  
National Guidelines ◽  
First Line ◽  
Exact Test ◽  
The Republic

Abstract Background Limited antimicrobial resistance (AMR) data for Neisseria gonorrhoeae are available in Eastern Europe. We investigated AMR in N. gonorrhoeae isolates in the Republic of Belarus from 2009 to 2019, antimicrobial treatment recommended nationally, and treatment given to patients with gonorrhoea. Methods N. gonorrhoeae isolates (n = 522) cultured in three regions of Belarus in 2009–2019 were examined. Determination of minimum inhibitory concentrations (MICs) of eight antimicrobials was performed using Etest. Resistance breakpoints from the European Committee on Antimicrobial Susceptibility Testing were applied where available. A Nitrocefin test identified β-lactamase production. Gonorrhoea treatment for 1652 patients was also analysed. Statistical significance was determined by the Z-test, Fisher’s exact test, or Mann-Whitney U test with p-values of < 0.05 indicating significance. Results In total, 27.8% of the N. gonorrhoeae isolates were resistant to tetracycline, 24.7% to ciprofloxacin, 7.0% to benzylpenicillin, 2.7% to cefixime, and 0.8% to azithromycin. No isolates were resistant to ceftriaxone, spectinomycin, or gentamicin. However, 14 (2.7%) isolates had a ceftriaxone MIC of 0.125 mg/L, exactly at the resistance breakpoint (MIC > 0.125 mg/L). Only one (0.2%) isolate, from 2013, produced β-lactamase. From 2009 to 2019, the levels of resistance to ciprofloxacin and tetracycline were relatively high and stable. Resistance to cefixime was not identified before 2013 but peaked at 22.2% in 2017. Only sporadic isolates with resistance to azithromycin were found in 2009 (n = 1), 2012 (n = 1), and 2018–2019 (n = 2). Overall, 862 (52.2%) patients received first-line treatment according to national guidelines (ceftriaxone 1 g). However, 154 (9.3%) patients received a nationally recommended alternative treatment (cefixime 400 mg or ofloxacin 400 mg), and 636 (38.5%) were given non-recommended treatment. Conclusions The gonococcal resistance to ciprofloxacin and tetracycline was high, however, the resistance to azithromycin was low and no resistance to ceftriaxone was identified. Ceftriaxone 1 g can continuously be recommended as empiric first-line gonorrhoea therapy in Belarus. Fluoroquinolones should not be prescribed for treatment if susceptibility has not been confirmed by testing. Timely updating and high compliance with national evidence-based gonorrhoea treatment guidelines based on quality-assured AMR data are imperative. The need for continued, improved and enhanced surveillance of gonococcal AMR in Belarus is evident.

scholarly journals Faktor Prediktor Kegagalan Virologis pada Pasien HIV yang Mendapat Terapi ARV Lini Pertama dengan Kepatuhan Berobat Baik

2017 ◽  
Vol 4 (1) ◽  
pp. 29
Author(s):  
Farid Kurniawan ◽  
Samsuridjal Djauzi ◽  
Evy Yunihastuti ◽  
Pringgodigdo Nugroho
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Virological Failure ◽  
Clinical Stage ◽  
World Health ◽  
Weight Changes ◽  
First Line ◽  
Hiv Patients ◽  
Good Adherence ◽  
Study Results

Pendahuluan. Pada negara dengan keterbatasan sumber daya, pengukuran viral load (VL) sebagai prediktor efektivitas terapi antiretroviral (ARV) tidak selalu mudah untuk diakses oleh pasien HIV yang mendapat terapi ARV. Pada penelitian-penelitian sebelumnya, kepatuhan berobat (adherens) diketahui merupakan faktor penting terhadap supresi VL HIV. Penelitian ini bertujuan untuk mengetahui faktor prediktor kegagalan virologis pada pasien HIV yang mendapat terapi ARV lini pertama sesuai paduan ARV terbaru dengan kepatuhan berobat yang baik di Indonesia.Metode. Studi kohort retrospektif dilakukan pada pasien HIV rawat jalan dewasa di Rumah Sakit dr. Cipto Mangunkusumo (RSCM), Jakarta yang memulai terapi ARV lini pertama selama periode Januari 2011-Juni 2014. Pasien HIV dengan kepatuhan berobat baik yang mempunyai data VL 6-9 bulan setelah mulai terapi ARV dimasukkan sebagai subjek penelitian. Kegagalan virologis dinyatakan sebagai nilai VL ≥400 kopi/mL setelah minimal 6 bulan terapi ARV dengan kepatuhan berobat baik. Usia awal terapi ARV, faktor risiko penularan HIV, stadium klinis HIV menurut World Health Organization (WHO), koinfeksi HIV-TB, jumlah CD4 awal terapi, peningkatan jumlah CD4, kadar hemoglobin dan indeks massa tubuh awal terapi, perubahan berat badan selama terapi, dan basis paduan terapi ARV merupakan variabel yang diteliti pada penelitian ini.  Hasil. Terdapat 197 pasien sebagai subjek penelitian ini. Kegagalan virologis ditemukan pada 21 pasien (10,7%). Peningkatan CD4 <50 sel/mm3 setelah minimal 6 bulan terapi merupakan prediktor kegagalan virologis (p = 0,003; OR 5,802, 95% CI= 1,842-18,270). Terdapat peningkatan risiko kegagalan virologis pada pasien dengan terapi ARV berbasis NVP pada saat VL diperiksa, namun tidak bermakna secara statistik (p = 0,060; OR 2,756; 95% CI= 0,958-7,924). Simpulan. Peningkatan CD4 <50 sel/mm3 setelah minimal 6 bulan terapi dapat memprediksi kegagalan virologis pada pasien yang mendapat terapi ARV lini pertama dengan kepatuhan berobat yang baik. Kata Kunci: kegagalan virologis, terapi ARV lini pertama, viral load Predictors of Virological Failure in HIV Patients Receiving First Line Antiretroviral Therapy with Good AdherenceIntroduction. Antiretroviral therapy (ART) effectively suppress HIV replication. Viral load (VL) measurement is better predictor than clinical or immunological criteria to evaluate success or failure of ART. However, in country with limited resources, viral load measurement is not easily accessible by HIV patients receiving ART. Therefore, it is necessary to know which factors that can predict virological failure. In previous studies, adherence was an  important factor for suppression of HIV viral load.  This study is aimed to know predictors of virological failure in HIV patients receiving recent first line ART regimen with good adherence in Indonesia. Methods. A retrospective cohort study was conducted among adult HIV patients in Out-patient Clinic of Cipto Mangunkusumo Hospital that started ART during periode of  January 2011-June 2014. HIV patients with good adherence that had viral load data 6-9 months after initiation of ART were included in this study. Virological failure was defined as viral load ≥ 400 copies/mL after minimum of 6 months therapy with good adherence. Age at starting ART, risk factor for HIV infection, HIV clinical stage, HIV-TB co-infection, baseline CD4 value, CD4 count increase, baseline hemoglobin level and body mass index, weight changes during therapy, and ART based regimen were analyzed in this study. Results. A total of 197 patients were included in this study. Virological failure was found in 21 patients (10,7%). CD4 increase <50 cell/mm3 after minimum 6 months of ART was predictor of virological failure (p = 0,003; OR 5,802, 95%CI 1,842-18,270). Conclusion. CD4 increase <50 cell/mm3 after minimum 6 months therapy can predict virological failure in HIV patients receiving first line ART with good adherence.  

Antimicrobial prescribing behaviour in dogs and cats by Belgian veterinarians

2017 ◽  
Vol 182 (11) ◽  
pp. 324-324 ◽  
Author(s):  
Alexia Van Cleven ◽  
Steven Sarrazin ◽  
Hilde de Rooster ◽  
Dominique Paepe ◽  
Sofie Van der Meeren ◽  
...  
Keyword(s):  
Primary Care ◽  
Online Survey ◽  
Treatment Guidelines ◽  
Current Treatment ◽  
Antimicrobial Treatment ◽  
Fourth Generation ◽  
National Guidelines ◽  
First Line ◽  
Clinical Scenarios ◽  
Prescribing Behaviour

The objective of this study is to survey general prescribing behaviour by Belgian companion animal veterinarians and to assess agreement of these practices with current treatment guidelines. Therefore an online survey was administered with five realistic and frequently occurring first-line cases to primary-care veterinary practitioners. For each case a predefined pattern of questions were asked about whether or not they would prescribe antimicrobials, if they would prescribe a non-antimicrobial treatment and if they would perform additional diagnostic steps. The responses were compared with recommendations in national guidelines and recent literature. The overall most prescribed antimicrobials were potentiated amoxicillin (43.0 per cent), fluoroquinolones (14.7 per cent), third-generation and fourth-generation cephalosporins (10.9 per cent) and tetracyclines (10.9 per cent). Only 48.3 per cent of the veterinarians complied with the guidelines in nearly all of the clinical scenarios (ie, prescribing antimicrobials when indicated, not prescribing antimicrobials when it is not indicated). Moreover, when prescribing highest priority critically important antimicrobials, susceptibility testing on bacterial cultures was performed in only 12.4 per cent of the prescriptions. The results showed that the prescribing behaviour of antimicrobial compounds by primary-care veterinary practitioners in dogs and cats is often not in agreement with national guidelines. Focus in improvement of this prescribing behaviour should be on performing the appropriate diagnostic steps and decreasing the use of highest priority critically important antimicrobials.

Voriconazole Therapeutic Drug Monitoring: Relationship between Drug Levels and Liver Function Tests.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2950-2950 ◽  
Author(s):  
S. Trifilio ◽  
M.K. Khalid ◽  
G. Pennick ◽  
J. Pi ◽  
N. Bainbridge ◽  
...  
Keyword(s):  
Liver Function ◽  
Liver Function Tests ◽  
Multivariate Regression Analysis ◽  
Hematologic Malignancies ◽  
Abnormal Liver Function ◽  
Therapeutic Drug ◽  
Data Set ◽  
Hematopoietic Stem ◽  
Drug Levels ◽  
Function Tests

Abstract Voriconazole is increasingly being used after HSCT. The hepatic cytochrome P450 isoenzyme 2C19 plays a significant role in voriconazole metabolism. As CYP2C19 exhibits significant genetic polymorphism, some patients metabolize voriconazole poorly resulting in increased plasma drug levels. However, the clinical significance of this is unknown. There is some evidence that toxicity rates are higher in patients with higher voriconazole levels (Boyd et al. Clin Infect Dis2004;39:1241–1244). In a preliminary study of 41 voriconazole levels in 25 patients, we had found that voriconazole levels correlated with aspartate aminotransferase (AST) and alkaline phosphatase (AP) levels (Trifilio et al. Bone Marrow Transplant2005;35:509–513). It was unclear if the abnormal liver function was the cause or the result of higher voriconazole levels. To further elucidate this relationship, we analyzed data on 171 steady-state plasma trough levels performed after at least 5 days of voriconazole therapy in 87 patients with hematologic malignancies. There were 1–5 levels per patient (median 2). Most patients had undergone allogeneic hematopoietic stem cell transplantation. Drug levels were monitored using HPLC (Pennick et al. Antimicrob Agents Chemother2003;47:2348–2350). Of the 201 samples assayed, 30 were below the detection limit of the assay (0.2 μg/mL), and were excluded. The daily voriconazole dose (divided into 2) was 200 mg (n=3), 400 mg (n=129), 500 mg (n=18), 600 mg (n=15), or 800 mg (n=6); corresponding to 2.0–13.3 mg/kg (median 5.3). The voriconazole levels were 0.2–12.5 μg/mL (median 1.7). The table shows the correlation between voriconazole levels, and weight, dose and biochemical parameters individually. However, in multivariate regression analysis, the parameters found to correlate significantly with voriconazole levels were ALT (P=0.0005), AST (P=0.003), and AP (P=0.027). The relationship with albumin was of borderline significance (P=0.062). Importantly, the daily dose of voriconazole in mg or in mg/kg was not predictive of drug levels. This larger data set confirms our previous observation that there is a significant relationship between elevated liver function tests and higher voriconazole levels. However, because of the relatively high frequency of abnormal liver function tests in such groups of patients, the cause-effect relationship still remains uncertain. These data suggest that pending further clarification, voriconazole levels may need to be monitored in patients with significantly abnormal liver function tests. Parameter Median (range) r P Dose (mg) 400 (200–800) 0.19 0.013 Weight (kg) 80 (39–135) 0.18 0.018 Dose (mg/kg) 5.3 (2.0–13.3) 0.23 0.002 ALT (IU/L) 25 (4–608) 0.10 0.25 AST (IU/L) 25 (6–524) 0.14 0.11 AP (IU/L) 95 (27–920) 0.27 0.002 Bilirubin (mg/dL) 1.1 (0.1–17.3) 0.01 0.89 Albumin (g/dL) 2.4 (0.8–3.9) 0.28 0.001 Creatinine (mg/dL) 1.1 (0.2–10.1) 0.01 0.92

scholarly journals Suicidal overdose of dolutegravir: A case report

2018 ◽  
Vol 19 (1) ◽  
Author(s):  
Rahul Daimari ◽  
Lawrence Kwape ◽  
Anthony A. Oyekunle
Keyword(s):  
Hiv Infection ◽  
Epigastric Pain ◽  
Clinical Stage ◽  
Integrase Inhibitor ◽  
Liver Function Tests ◽  
Progressive Increase ◽  
Full Blood Count ◽  
First Line ◽  
Treat All ◽  
Stage 1

Dolutegravir (DTG) is the most recently introduced integrase inhibitor for the treatment of HIV infection and is preferred for its superior tolerability and efficacy in both new and pre-treated patients, and infrequent drug interactions. Since January 2017, Botswana has adopted a ‘treat-all’ approach with a DTG-based antiretroviral (ARV) regimen as first-line treatment. We report a 29-year-old man with clinical stage 1 HIV infection who had been started on DTG, tenofovir and emtricitabine eight months prior, and who was admitted following a suicidal overdose of 1500 mg of DTG. He reported only minor symptoms including vomiting, epigastric pain and dizziness; which promptly resolved following supportive treatment. On admission, full blood count, liver function tests and electrocardiography were unremarkable. However, there was a non-progressive increase in serum creatinine. After a month off ARVs, he was successfully restarted on antiretroviral therapy without any serious adverse effect.

scholarly journals COMPARISON OF LIVER FUNCTION TESTS OF NORMALAND PRE-ECLAMPTIC PREGNANT FEMALES: A HOSPITAL BASED STUDY

2020 ◽  
pp. 8-9
Author(s):  
Shayista Gull
Keyword(s):  
Liver Function ◽  
Liver Function Test ◽  
Total Protein ◽  
Serum Bilirubin ◽  
Complete Blood Count ◽  
Liver Function Tests ◽  
Unknown Etiology ◽  
Serum Total Protein ◽  
Function Tests ◽  
Function Test

Background: Pre-eclampsia is a multi-system disorder of unknown etiology involving almost every organ of body including kidney, liver, brain, heart, stomach and adrenals. In liver periportal hemorrhagic necrosis, ischemic lesions and fibrin deposition occurs due to thrombosis of arterioles. Objective: To compare the liver function tests in normal pregnancy and preeclampsia Methodology: This study was conducted in the Department of Obstetrics and Gynaecology, SKIMS, Soura, Kashmir for 18 months. Participants were divided into two groups: Cases: Comprised of 200 patients with toxemia of pregnancy, Controls: comprised of 500 normal, healthy normotensive pregnant women. This group was studied to get the normal values of liver enzymes and served as controls. A complete blood count, microscopic examination of urine, liver function test, kidney function test , 24 hour urinary protein estimation was done on all participants. Results: Among the cases, 49(24.5%) patients while 76 (15.2%) controls had deranged serum bilirubin. Ninety-nine(49.5%) cases had deranged ALT while 16(3.2%) controls had so. Among the cases, 103(51.5%) had deranged AST level while it was deranged in 64(12.8%) controls. ALP and serum total protein followed similar pattern (more deranged in cases than controls). Conclusion: Liver function test impairment occurs in preeclampsia which is characterized by rise in mean level of serum transaminase levels and serum bilirubin level and fall in serum total protein and albumin level.

scholarly journals A STUDY OF SOME BLOOD PARAMETERS AMONG DENGUE PATIENTS IN LAHJ/ YEMEN

2021 ◽  
Vol 2 (1) ◽  
pp. 22-29
Author(s):  
Manal Mohamed Al-Samadi ◽  
Mohammed Mohammed Ahmed Alhaj ◽  
Khaled Saeed Ali
Keyword(s):  
Dengue Fever ◽  
Complete Blood Count ◽  
Medical Center ◽  
White Blood Cells ◽  
Elevated Serum ◽  
Good Health ◽  
Liver Function Tests ◽  
Serum Urea ◽  
Biochemical Tests ◽  
Function Tests

The present study was carried out to evaluate the effect of dengue fever on some hematological and biochemical parameters on patients, whose were infected with dengue virus at AL-Jamaheer Medical Center\ Lahj from July to September 2018.One hundred and three cases have been tested, among them 52.4% were males and 47.6% were females, the age ranged from a year to 60 years old.The tests included the evaluation of complete blood count (CBC), aminotransferase levels, glutamic-oxaloacetic transaminase (GOT), and glutamate pyruvate transaminase (GPT), in addition to serum Urea, and creatinine levels.Hematological tests revealed that approximately 56.3 % of cases showed a decrease in white blood cell (WBC) count with about 4000/μl, 19.4% cases with values between 2000 -3000/μl and 2000 /μl in 15.5 % cases, whereas 21.4% cases were with a range between 3000-4000/μl.Platelet counts (PLT) were decreased to <150000/μl in 29.2% of cases and were about 50,000- 100,000/μl in 13.6% of cases, while showed around 50000/μl in 3.9% of cases.As for the biochemical tests, liver function tests (L.F.T.) showed that an increase was observed in SGOT and SGPT of 42.7 % and 34 % of cases, respectively.Kidney function tests showed elevated serum urea and creatinine in 2.91% and 5.83% cases, respectively.In conclusion, one of the predictive markers of dengue fever is a decrease in the number of white blood cells and platelets. In contrast, it raised the levels of amine transporters (SGOT) and (SGPT), Therefore, monitoring these indicators is useful in diagnosing dengue fever in order to provide good health care to patients.

scholarly journals Prevalence of HCV-Helicobacter pylori co-infection and its effects on liver function enzymes of patients in Lahore, Pakistan

2019 ◽  
Vol 01 (03) ◽  
pp. 09-14
Author(s):  
Sohaib Bin Wahid ◽  
Muhammad Waqar ◽  
Zobaria Rehman ◽  
Muhammad Wasim ◽  
Muhammad Idrees
Keyword(s):  
Helicobacter Pylori ◽  
Liver Function ◽  
Blood Count ◽  
Liver Enzymes ◽  
Complete Blood Count ◽  
Liver Function Tests ◽  
Morbidity And Mortality ◽  
Function Tests ◽  
H Pylori ◽  
The Impact

Helicobacter pylori and HCV are the most prevalent pathogens worldwide associated with high rates of morbidity and mortality. This study aimed to determine the prevalence of H. pylori in HCV infected patients and compares changes in liver function tests (LFTs) of both HCV mono-infected and HCV/H. pylori co-infected patients. Eighty-seven participants participated in this study who were first screened for HCV using GeneXpert technology followed by H. pylori antigen stool test. A complete blood count (CBC) analysis and LFTs were performed to determine the impact of HCV and H. pylori on liver enzymes. Our findings suggested that 45% of patients had HCV mono-infection, whereas 55% were co-infected with both HCV and H. pylori. Furthermore, we also observed that ALT, AST, and ALP levels were significantly elevated in HCV/H. pylori co-infected patients as compared to HCV mono-infected patients. To the best of our knowledge, this is the first study to report the prevalence of H. pylori in HCV infected subjects of Lahori population

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