Publications by authors named "Patrinee Traisathit"

44 Publications

Comparison of HIV-Positive Incidence Among Transgender Women and Men Who Have Sex with Men at Stand-Alone and Mobile Voluntary Counseling and Testing Facilities in Chiang Mai Province, Thailand.

AIDS Patient Care STDS 2021 04;35(4):116-125

Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand.

Human immunodeficiency virus (HIV) infection is still a major cause of death in Thais and new cases of infection are still emerging among the key population comprising men who have sex with men (MSM), sex workers and their clients, and transgender women (TGW) and people who inject drugs. The objective of this study was to compare the incidence of HIV infection between MSM and TGW who were tested at stand-alone and mobile HIV voluntary counseling and testing (VCT) centers and to identify factors associated with HIV-positive individuals from the two services. We conducted an observational study using MSM and TGW individuals with unknown HIV status from the databases at a stand-alone center and a mobile VCT belonging to the MPlus in Chiang Mai province, Thailand. Factors associated with HIV-positive status were identified using logistic regression model. HIV VCT data were obtained for 6971 individuals at both MPlus center and mobile care unit. Among 3033 and 3938 clients tested at each facility, respectively, 168 (5.6%) and 101 (2.6%) clients were HIV positive. Individuals tested at the stand-alone centers were at a 1.91-fold higher risk of being HIV positive compared with those tested at the mobile VCT unit. Individuals who were 20-24 or >24 years old, sex workers, or sexually transmitted infection positive were more likely to be HIV positive. Our results show the beneficial effect of mobile HIV VCT facilities that enable testing of more of the at-risk population. Developing mobile VCT activities that attract a particular target population is needed to be able to reach the 90-90-90 goals. This study was approved by the Ethics Committee of the Faculty of Medicine, Chiang Mai University (0BG-2562-06418).
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http://dx.doi.org/10.1089/apc.2020.0258DOI Listing
April 2021

A Proactive Policy to Eliminate Viral Hepatitis Infection: Five-Year Results for the Subdistrict Model in Thailand.

J Community Health 2021 Mar 18. Epub 2021 Mar 18.

Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.

The objective of this study was to ascertain hepatitis B (HBV) and hepatitis C (HCV) infection rates in individuals toward the early initiation of treatment and prevention of developing hepatocellular carcinoma (HCC). This cross-sectional study was performed on 2084 participants from two subdistricts in Chiang Mai and Lampang provinces, northern Thailand. Screening for viral hepatitis in the general population was conducted at subdistrict health-promoting hospitals in Nong Pa Krang, in the suburb of Chiang Mai city, and Thoenburi, a subdistrict in the rural area of Lampang province, northern Thailand. Ninety-one (4.4%) participants tested positive for either HBV or HCV, with 3.3% of all participants infected with HBV and 1.1% infected with HCV. Treatment follow-up was 29.0% of HBV and 54.5% of HCV. A proactive approach to eliminate viral hepatitis can be carried out at the subdistrict level in Thailand. Success could increase participation in other subdistricts in a cascade-like manner by 2030. The identified factors of success are leadership by the local government supported by the Local Health Fund and Village Health Volunteers.
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http://dx.doi.org/10.1007/s10900-021-00977-2DOI Listing
March 2021

Classification of hepatocellular carcinoma and intrahepatic cholangiocarcinoma based on multi-phase CT scans.

Med Biol Eng Comput 2020 Oct 13;58(10):2497-2515. Epub 2020 Aug 13.

Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.

Liver and bile duct cancers are leading causes of worldwide cancer death. The most common ones are hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). Influencing factors and prognosis of HCC and ICC are different. Precise classification of these two liver cancers is essential for treatment and prevention plans. The aim of this study is to develop a machine-based method that differentiates between the two types of liver cancers from multi-phase abdominal computerized tomography (CT) scans. The proposed method consists of two major steps. In the first step, the liver is segmented from the original images using a convolutional neural network model, together with task-specific pre-processing and post-processing techniques. In the second step, by looking at the intensity histograms of the segmented images, we extract features from regions that are discriminating between HCC and ICC, and use them as an input for classification using support vector machine model. By testing on a dataset of labeled multi-phase CT scans provided by Maharaj Nakorn Chiang Mai Hospital, Thailand, we have obtained 88% in classification accuracy. Our proposed method has a great potential in helping radiologists diagnosing liver cancer.
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http://dx.doi.org/10.1007/s11517-020-02229-2DOI Listing
October 2020

Two-year outcome of concurrent chemoradiation with carboplatin with or without adjuvant carboplatin/fluorouracil in nasopharyngeal cancer: A multicenter randomized trial.

Curr Probl Cancer 2021 Feb 18;45(1):100620. Epub 2020 Jul 18.

Research Center in Bioresources for Agriculture, Industry, and Medicine, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand.

Background: According to the noninferiority result of chemoradiation with carboplatin in our previous nasopharyngeal carcinoma (NPC) study along with the inconclusive data on the efficacy of adjuvant chemotherapy (AC) following concurrent chemoradiotherapy (CCRT), we designed to assess the role of adjuvant carboplatin/fluorouracil following CCRT with carboplatin in locoregionally advanced NPC.

Materials And Methods: A multicenter randomized trial was conducted at 5 cancer centers in Thailand. We enrolled in stage T2N0M0-T4N2M0 (American Joint Cancer Committee 7th edition) WHO Type 2 NPC patients. N3 or metastatic disease patients were excluded. Participants were randomized into 2 groups: CCRT plus AC group vs the CCRT alone group. Patients in both groups received weekly carboplatin 100 mg/m for 6 cycles concurrently with radiotherapy 69.96-70 Gy. Patients in the AC group subsequently received 3 cycles of carboplatin area under curve-5 plus 1000 mg/m/day of fluorouracil infusion within 96 hours every 3 weeks. We report the 2-year overall survival (OS), disease-free survival (DFS), loco-regional recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS). Treatment-related toxicities and compliance were also explored.

Results: Of 175 patients, 82 (46.9%) were assigned to the AC group, and 93 (53.1%) to the CCRT group. The compliance rate during CCRT was 90% and 86% in the AC and CCRT group, whereas 81.7% during adjuvant treatment in the AC group. With a median follow-up time of 24.4 months (interquartile range 17.9-24.4), the 2-year OS rate was 89.6% in the AC group and 81.8% in the CCRT group (P= 0.167). The 2-year DFS rate was 86.8% in the AC group and 74.6% in the CCRT group (P = 0.042). The 2-year LRFS rate was 91.5% in the AC group and 88.2% in the CCRT group (P = 0.443). The 2-year DMFS rate was 85.4% in the AC group and 79.6% in the CCRT group (P = 0.294). The most frequent serious (grade 3/4) nonhematologic toxicity was acute mucositis, which occurred 5% in the AC group vs 4% in the CCRT group (P = 0.498). For hematologic toxicity, grade 3-4 leukopenia were found 10% and 5% in the adjuvant and CCRT groups, respectively (P = 0.003). Multivariate analyses determined stage N2 disease was an adverse prognostic factor associated with shorter OS, DFS, and DMFS. And the adjuvant treatment was a significant protective factor for only DFS.

Conclusions: The addition of adjuvant carboplatin/fluorouracil following CCRT with carboplatin significantly improved 2-year DFS in stage T2N0M0-T4N2M0 NPC albeit there was a nonsignificant trend in favor of a higher 2-year OS, LRFS, and DMFS. Long-term efficacy and late toxicities of AC still require exploration.
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http://dx.doi.org/10.1016/j.currproblcancer.2020.100620DOI Listing
February 2021

Incidence and risk factors of loss to follow-up among HIV-infected children in an antiretroviral treatment program.

PLoS One 2019 17;14(9):e0222082. Epub 2019 Sep 17.

Institut de recherche pour le développement (IRD, France), U174 -PHPT, Chiang Mai, Thailand.

Introduction: The success of antiretroviral treatment (ART) programs can be compromised by high rates of patient loss to follow-up (LTFU). We assessed the incidence and risk factors of LTFU in a large cohort of HIV-infected children receiving ART in Thailand.

Methods: All children participating in a multicenter cohort (NCT00433030) between 1999 and 2014 were included. The date of LTFU was 9 months after the last contact date. ART interruption was defined as ART discontinuation for more than 7 days followed by resumption of treatment. Baseline and time-dependent risk factors associated with LTFU were identified using Fine and Gray competing risk regression models with death or referral to another hospital as competing events.

Results: Of 873 children who were followed during a median of 8.6 years (interquartile range 4.5-10.6), 196 were LTFU, 73 died, and 195 referred. The cumulative incidence of LTFU was 2.9% at 1 year, 7.3% at 5 years and 22.2% at 10 years. Children aged 13 years and more had a 3-fold higher risk (95% confidence interval 2.06-4.78) of LTFU than those younger. Children who had interrupted ART within the previous year had a 2.5-fold higher risk (1.12-5.91) than those who had not. The risk of LTFU was lower in children stunted (height-for-age Z-scores <-2 SD) (0.42-0.96) or underweight (weight-for-age Z-scores <-2 SD) (0.24-0.97).

Conclusion: Adolescence, ART interruption and absence of growth deficit were associated with LTFU. These may be warnings that should draw clinicians' attention and possibly trigger specific interventions. Children with no significant growth retardation may also be at risk of LTFU.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0222082PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6748564PMC
March 2020

Impact of antiretroviral treatment on height evolution of HIV infected children.

BMC Pediatr 2019 08 17;19(1):287. Epub 2019 Aug 17.

Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France.

Background: Antiretroviral treatment (ART) has been shown to have a beneficial effect on the weight evolution but its effect on height remains unclear. We described patterns of height evolution and identified predictors of catch-up growth in HIV-infected children on ART.

Methods: To describe the height evolution from birth to adulthood, we developed a nonlinear mixed effect model using data from perinatally HIV-infected children who initiated ART from 1999 to 2013 in a prospective cohort study in Thailand. The main covariates of interest were: sex, ART regimen (dual nucleoside reverse-transcriptase inhibitor, non-nucleoside reverse transcriptase inhibitor (NNRTI)-, or protease inhibitor (PI)-based), baseline CD4 percentage, HIV-RNA load and CDC HIV Classification stage and occurrence of AIDS-defining events.

Results: A total 477 children (43% boys) contributed 18,596 height measurements over a median duration of 6.3 years on ART (interquartile range, 3.0 to 8.3). At ART initiation, median age was 6.2 years (1.8 to 9.6), 16% of children were underweight (weight-for-age z-score < - 2), 49% presented stunting (height-for-age z-score < - 2), and 7% wasting (weight-for-height z-score < - 2). The most frequent regimen at ART initiation was NNRTI-based (79%). A model with 4 components, birth length and 3 exponential functions of age accounting for the 3 growth phases was developed and show that the height-growth velocity was inversely associated with the age at ART initiation, the adult height was significantly lower in those who had experienced at least one AIDS-defining event while, as expected, the model found that adult height in females was lower than in males. Age at ART initiation, type of ART regimen, CDC stage, CD4 percentages, and HIV-RNA load were not associated with the final height.

Conclusions: The younger the children at ART initiation, the greater the effect on height-growth velocity, supporting the World Health Organization's recommendation to start ART as early as possible. However, final adult height was not linked to the age at ART initiation.
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http://dx.doi.org/10.1186/s12887-019-1663-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6697969PMC
August 2019

Arginine, glutamine, and fish oil supplementation in cancer patients treated with concurrent chemoradiotherapy: A randomized control study.

Curr Probl Cancer 2020 02 23;44(1):100482. Epub 2019 May 23.

Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Chiang Mai Cancer Registry, Faculty of Medicine, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University, Chiang Mai, Thailand.

We evaluated the effectiveness of arginine, glutamine, and fish oil supplementation in patients' ability to adhere to the planned regimen and associated toxicities in patients who received concurrent chemoradiotherapy (CCRT). Eighty-eight cancer patients were randomized into 2 groups, A; regular diet and B; regular diet plus nutritional supplementation during their CCRT course. Logistic regression was used to assess the association between toxicity and the study groups. Survival analysis was performed using the Kaplan-Meier method, and log-rank tests were used to compare between the 2 groups. Among 88 patients, 45%, 32%, and 23% were head and neck cancer, esophageal cancer, and cervical cancer patients, respectively. Significantly higher grade 3-4 hematologic toxicities were found in group A than in group B (23% vs 5%, P= 0.03). The CCRT completion rate was lower in group A than in group B (75% vs 91%), but the difference was not statistically significant (P= 0.09). Adjusted for type of cancer and age, group B patients were associated with lower hematologic toxicities of CCRT, P= 0.03. Two-year overall survival was 47% for group A, and 61% for group B, P= 0.22. In conclusion, incidence of severe hematologic toxicities were significantly lower in patients with arginine, glutamine, and fish oil supplementation during CCRT. These findings, therefore, need further studies on the isocaloric design.
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http://dx.doi.org/10.1016/j.currproblcancer.2019.05.005DOI Listing
February 2020

Associated factors for depressive disorder in patients with end-stage renal disease treated with continuous ambulatory peritoneal dialysis.

Ther Clin Risk Manag 2019 1;15:541-548. Epub 2019 Apr 1.

Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand,

Background: The aim of this study was to primarily determine factors associated with the depressive disorders in continuous ambulatory peritoneal dialysis (CAPD).

Methods: CAPD patients were recruited from the chronic kidney disease and CAPD Clinic of University Hospital. The stable CAPD patients for at least 3 months were included in the study. Sociodemographic data, renal conditions, and depressive disorder were evaluated. In addition to determining prevalence rate of depressive disorders, identification of factors associated with depressive disorders in CAPD patients were analyzed by using the multivariable logistic regression analysis with backward elimination procedure.

Results: The eligible participants were 108 patients. The study found that 11% of CAPD patients were diagnosed with depressive disorders including, minor depressive, dysthymic, and major depressive disorders. Additionally, the depressive disorders were associated with the duration between the diagnosis date of the end-stage renal disease (ESRD) and the initial treatment date (=0.043). Accordingly, the ESRD patients diagnosed in <12 months had 3.57-fold higher risk of depressive disorders than the patients diagnosed after a long time.

Conclusion: The rate of prevalence for depressive disorder is high in the CAPD patients. Additionally, the results of this study have shown the relationship between depressive disorder and time for diagnosis of ESRD. Specifically, the risk of depressive disorder increases when patients have a shorter duration between the dates of ESRD diagnosis and initial treatment. In addition to closed monitoring for those patients, the psychiatrists should be consulted for evaluation and treatment of depressive disorders for the suspected high risk patients.
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http://dx.doi.org/10.2147/TCRM.S186394DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6448535PMC
April 2019

Translation, cross-cultural adaptation and psychometric properties of the Sleep-Related Breathing Disordered-Pediatric Sleep Questionnaire for obese Thai children with obstructive sleep apnea.

Sleep Med 2019 01 4;53:45-50. Epub 2018 Oct 4.

Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand. Electronic address:

Objective: Obstructive sleep apnea (OSA) is a comorbid condition with obesity that can produce deleterious effects on children's health and well-being. Unfortunately, valid instruments for screening OSA in obese Thai children are limited. This study aimed to translate and cross-culturally adapt, from English to Thai, the Sleep-Related Breathing Disordered-Pediatric Sleep Questionnaire (SRBD-PSQ) and to determine its psychometric properties.

Methods: The SRBD-PSQ was translated into Thai and cross-culturally adapted. It was administered to 62 parents of obese children and adolescents 7-18 years of age who had polysomnographically confirmed OSA. The psychometric properties including validity, reliability, and diagnostic accuracy were examined.

Results: The Thai SRBD-PSQ possessed excellent content validity index for scale (S-CVI = 0.95). An acceptable internal consistency (cronbach's α ≥ 0.7) and good to excellent test-retest reliability (intraclass correlation coefficients [ICCs] = 0.82-0.90) of the Thai SRBD-PSQ and subdomain were observed. There was a significant correlation between the SRBD scale and polysomnography (PSG) indices: apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) (r = 0.35, p < 0.01, and r = 0.27, p < 0.05, respectively). The Thai SRBD-PSQ had an area under the curve of 0.71 (p < 0.05) with a sensitivity of 72% and a specificity of 54%.

Conclusion: The Thai SRBD-PSQ is a reliable and valid instrument for use in obese children with OSA. However, the Thai SRBD-PSQ should be used in combination with other investigations.
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http://dx.doi.org/10.1016/j.sleep.2018.08.033DOI Listing
January 2019

Risk patterns of lung cancer mortality in northern Thailand.

BMC Public Health 2018 Sep 24;18(1):1138. Epub 2018 Sep 24.

Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand.

Background: Over the past decade, lung cancers have exhibited a disproportionately high mortality and increasing mortality trend in Thailand, especially in the northern region, and prevention strategies have consequently become more important in this region. Spatial analysis studies may be helpful in guiding any strategy put in place to respond to the risk of lung cancer mortality in specific areas. The aim of our study was to identify risk patterns for lung cancer mortality within the northern region of Thailand.

Methods: In the spatial analysis, the relative risk (RR) was used as a measure of the risk of lung cancer mortality in 81 districts of northern Thailand between 2008 and 2017. The RR was estimated according to the Besag-York-Mollié autoregressive spatial model performed using the OpenBUGS routine in the R statistical software package. We presented the overall and gender specific lung cancer mortality risk patterns of the region using the Quantum Geographic Information System.

Results: The overall risk of lung cancer mortality was the highest in the west of northern Thailand, especially in the Hang Dong, Doi Lo, and San Pa Tong districts. For both genders, the risk patterns of lung cancer mortality indicated a high risk in the west of northern Thailand, with females being at a higher risk than males.

Conclusions: There was distinct geographical variation in risk patterns of lung cancer mortality in Thailand. Differences could be related to differences in risk factors such as ground-based radon and air pollution. This study provides a starting point for estimating the spatial pattern of the risk of lung cancer mortality and for examining associations between geographic risk factors and lung mortality for further studies.
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http://dx.doi.org/10.1186/s12889-018-6025-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6154807PMC
September 2018

FLT3-ITD, NPM1, and DNMT3A Gene Mutations and Risk Factors in Normal Karyotype Acute Myeloid Leukemia and Myelodysplastic Syndrome Patients in Upper Northern Thailand

Asian Pac J Cancer Prev 2017 11 26;18(11):3031-3039. Epub 2017 Nov 26.

Department of Anatomy, Faculty of Medicine, Chiang Mai University, Thailand. Email:

Objective: Approximately 40-45% of AML and MDS patients have a cytogenetically normal karyotype (CN-AML and CN-MDS). The frequency and types of gene mutations in these cases may differ among various populations. The objective of this study was to identify frequencies and types of FLT3-ITD, NPM1, and DNMT3A mutations, and associations of them with clinical data and risk factors in CN-AML and CN-MDS cases in upper Northern Thailand. Methods: Bone marrow samples of 40 CN-AML and 60 CN-MDS patients were analyzed for gene mutations by direct sequencing. In addition, data for potential risk factors were obtained for comparison. Results: Frequencies of FLT3-ITD, NPM1, and DNMT3A mutations were 25.0%, 17.5%, and 10.0%, respectively in CN-AML, but all zero in CN-MDS cases. NPM1 mutations were found at a median age older than the wild type (58 vs 47 years) while DNMT3A mutations were associated with an increase in the white blood cell count. In all patients, factors for the mutations of these three genes included age ≤ 60 years, and a history of hypertension. Conclusion: When considering mutations in only normal karyotype patients, the frequency of FLT3-ITD, NPM1, DNMT3A mutations in CN-AML patients in upper Northern Thailand were found to occur at lower rates than in Western patients and to differ from other Asian populations including parts of Thailand. No mutations were observed in CN-MDS cases. Some types of gene mutations differed from previous studies, possibly attributable to differences in geography, lifestyle and genetic backgrounds. Links with age ≤ 60 years and history of hypertension were found. Investigation of these three genes in an intermediate risk group with a normal karyotype is useful for a better understanding of molecular leukemogenetic steps in CN-AML and CN-MDS patients and may be beneficial for planning treatment and prevention in the population of upper Northern Thailand.
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http://dx.doi.org/10.22034/APJCP.2017.18.11.3031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5773788PMC
November 2017

Brief Report: AIDS-Defining Events and Deaths in HIV-Infected Children and Adolescents on Antiretrovirals: A 14-Year Study in Thailand.

J Acquir Immune Defic Syndr 2018 01;77(1):17-22

Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France.

Background: Data are scarce on the long-term clinical outcomes of perinatally HIV-infected children and adolescents receiving antiretroviral therapy (ART) in low/middle-income countries. We assessed the incidence of mortality before (early) and after (late) 6 months of ART and of the composite outcome of new/recurrent AIDS-defining event or death >6 months after ART start (late AIDS/death) and their associated factors.

Methods: Study population was perinatally HIV-infected children (≤18 years) initiating ART within the Program for HIV Prevention and Treatment observational cohort (NCT00433030). Factors associated with late AIDS/death were assessed using competing risk regression models accounting for lost to-follow-up and included baseline and time-updated variables.

Results: Among 619 children, "early" mortality incidence was 99 deaths per 1000 person-years of follow-up [95% confidence interval (CI): 69 to 142] and "late" mortality 6 per 1000 person-years of follow-up (95% CI: 4 to 9). Of the 553 children alive >6 months after ART initiation, median age at ART initiation was 6.4 years, CD4% 8.2%, and HIV-RNA load 5.1 log10 copies/mL. Thirty-eight (7%) children developed late AIDS/death after median time of 3.3 years: 24 died and 24 experienced new/recurrent AIDS-defining events (10 subsequently died). Factors independently associated with late AIDS/death were current age ≥13 years (adjusted subdistribution hazard ratio 4.9; 95% CI: 2.4 to 10.1), HIV-RNA load always ≥400 copies/mL (12.3; 95% CI: 4.0 to 37.6), BMI-z-score always <-2 SD (13.7; 95% CI: 3.4 to 55.7), and hemoglobin <8 g/dL at least once (4.6; 95% CI: 2.0 to 10.5).

Conclusions: After the initial 6 months of ART, being an adolescent, persistent viremia, poor nutritional status, and severe anemia were associated with poor clinical outcomes. This supports the need for novel interventions that target children, particularly adolescents with poor growth and uncontrolled viremia.
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http://dx.doi.org/10.1097/QAI.0000000000001571DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6047734PMC
January 2018

The Outcome of the First 100 Nasopharyngeal Cancer Patients in Thailand Treated by Helical Tomotherapy.

Radiol Oncol 2017 Sep 21;51(3):351-356. Epub 2017 Apr 21.

Department of Radiation Oncology, Institut Jules Bordet, Université libre de Bruxelles, Brussels, Belgium.

Background: The aim of the study was to analyse of two-year loco-regional failure free survival (LRFFS), distant metastasis free survival (DMFS), overall survival (OS), and toxicity outcomes of the first 100 nasopharyngeal carcinoma patients in Thailand treated by helical tomotherapy.

Patients And Methods: Between March 2012 and December 2015, 100 patients with non-metastatic nasopharyngeal carcinoma were treated by helical tomotherapy. All patients were treated by platinum-based concurrent chemoradiotherapy and adjuvant or neo-adjuvant chemotherapy.

Results: The median age was 51 years (interquartile ranges [IQR]: 42.5-57.0). The mean ± SD of D95% of planning target volume (PTV) 70, 59.4 and 54 were 70.2 ± 0.5, 59.8 ± 0.6, and 54.3 ± 0.8 Gy, respectively. The mean ± SD of conformity index, and homogeneity index were 0.89 ± 0.13 and 0.06 ± 0.07. Mean ± SD of D2 % of spinal cord and brainstem were 34.1 ± 4.4 and 53.3 ±6.3 Gy. Mean ± SD of D50 of contralateral and ipsilateral parotid gland were 28.4 ± 6.7 and 38.5 ± 11.2 Gy. At a median follow-up of 33 months (IQR: 25-41), the 2-year LRFFS, DMFS, OS were 94% (95%CI: 87-98%), 96% (95% CI: 89-98%), and 99% (95% CI: 93-100%), respectively. Acute grade 3 dermatitis, pharyngoesophagitis, and mucositis occurred in 5%, 51%, and 37%, respectively. Late pharyngoesophagitis grade 0 and 1 were found in 98% and 2% of patients. Late xerostomia grade 0, 1 and 2 were found in 17%, 78% and 5%, respectively.

Conclusions: Helical tomotherapy offers good dosimetric performance and achieves excellent treatment outcome in nasopharyngeal carcinoma patients.
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http://dx.doi.org/10.1515/raon-2017-0017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5612000PMC
September 2017

Randomized control trial of benzydamine HCl versus sodium bicarbonate for prophylaxis of concurrent chemoradiation-induced oral mucositis.

Support Care Cancer 2018 Mar 23;26(3):879-886. Epub 2017 Sep 23.

Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand.

Purpose: The purpose of the study is to compare the efficacy of benzydamine HCl with sodium bicarbonate in the prevention of concurrent chemoradiation-induced oral mucositis in head and neck cancer patients.

Methods: Sixty locally advanced head and neck cancer patients treated with high-dose radiotherapy concurrently with platinum-based chemotherapy were randomly assigned to receive either benzydamine HCl or sodium bicarbonate from the first day of treatment to 2 weeks after the completion of treatment. The total score for mucositis, based on the Oral Mucositis Assessment Scale (OMAS), was used for the assessment, conducted weekly during the treatment period and at the fourth week of the follow-up. Pain score, all prescribed medications, and tube feeding needs were also recorded and compared.

Results: The median of total OMAS score was statistically significant lower in patients who received benzydamine HCl during concurrent chemo-radiotherapy (CCRT) than in those who received sodium bicarbonate, (p value < 0.001). There was no difference in median pain score, (p value = 0.52). Nineteen percent of patients in sodium bicarbonate arm needed oral antifungal agents whereas none in the benzydamine HCl arm required such medications, (p value = 0.06). Tube feeding needs and the compliance of CCRT were not different between the two study arms.

Conclusions: For patients undergoing high-dose radiotherapy concurrently with platinum-based chemotherapy, using benzydamine HCl mouthwash as a preventive approach was superior to basic oral care using sodium bicarbonate mouthwash in terms of reducing the severity of oral mucositis and encouraging trend for the less need of oral antifungal drugs.
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http://dx.doi.org/10.1007/s00520-017-3904-4DOI Listing
March 2018

Ten-Year Outcome of Different Treatment Modalities for Squamous Cell Carcinoma of Oral Cavity

Asian Pac J Cancer Prev 2017 07 27;18(7):1919-1924. Epub 2017 Jul 27.

Chiang Mai Cancer Registry, Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.

Objective: This study reports outcomes of squamous cell carcinoma of oral cavity (SCCOC) patients with different treatment modalities. Materials and Methods: We evaluated the treatment outcomes of 775 newly diagnosed SCCOC patients treated in our hospital between 2001 and 2010. Outcome data were obtained from the medical records. Survival rates were estimated by the Kaplan-Meyer method. Cox-proportional-hazard regression models were used to compare the risk of death among all risk factors. Results: The patients were divided into group 1) surgery ± adjuvant radiotherapy (RT) (n = 323) or group 2) RT ± chemotherapy (CT) for curative intent (n = 315) or group 3) RT/CT for palliative intent (n = 137). The overall 10-year survival rate was 17%. Statistically significant difference was noted in 10-year overall survival when SCCOC was managed surgically as compared to curative RT and palliative RT/CT with 25.3 %, 12.9%, 4.7%, respectively. The hazard ratio of cancer death in group 1 was 2.0 (95% CI 1.7-2.4) as compared to group 2. Conclusion: This study suggested that surgery must be the mainstay of treatment in locally advanced stage SCCOC. Palliative RT/CT still offered long term survival in some SCCOC patients.
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http://dx.doi.org/10.22034/APJCP.2017.18.7.1919DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5648399PMC
July 2017

Relationship between Height-Weight Difference Index and Body-Fat Percentage Estimated by Bioelectrical Impedance Analysis in Thai Adults.

ScientificWorldJournal 2017 11;2017:7258607. Epub 2017 Jun 11.

Bioinformatics Research Laboratory, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand.

Introduction: The height-weight difference index (HWDI) is a new indicator for evaluating obesity status. While body-fat percentage (BF%) is considered to be the most accurate obesity evaluation tool, it is a more expensive method and more difficult to measure than the others.

Objective: Our objectives were to find the relationship between HWDI and BF% and to find a BF% prediction model from HWDI in relation to age and gender.

Method: Bioelectrical impedance analysis was used to measure BF% in 2,771 healthy adult Thais. HWDI was calculated as the difference between height and weight. Pearson's correlation coefficient was used to assess the relationship between HWDI and BF%. Multiple linear and nonlinear regression analysis were used to construct the BF% prediction model.

Results: HWDI and BF% were found to be inverse which related to a tendency toward a linear relationship. Results of a multivariate linear regression analysis, which included HWDI and age as variables in the model, predicted BF% to be 34.508 - 0.159 (HWDI) + 0.161 (age) for men and 53.35 - 0.265 (HWDI) + 0.132 (age) for women.

Conclusions: The prediction model provides an easy-to-use obesity evaluation tool that should help awareness of underweight and obesity conditions.
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http://dx.doi.org/10.1155/2017/7258607DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5485349PMC
January 2018

Delirium after a traumatic brain injury: predictors and symptom patterns.

Neuropsychiatr Dis Treat 2017 14;13:459-465. Epub 2017 Feb 14.

Department of Psychiatry.

Background: Delirium in traumatic brain injury (TBI) is common, may be predictable, and has a multifaceted symptom complex. This study aimed to examine: 1) the sum score of Glasgow Coma Scale (GCS) and if its component scores could predict delirium in TBI patients, and 2) the prominent symptoms and their courses over the first days after TBI.

Methods: TBI patients were recruited from neurosurgical ward inpatients. All participants were hospitalized within 24 hours after their TBI. Apart from the sum score of GCS, which was obtained at the emergency department (ED), the , diagnostic criteria for delirium were applied daily. The severity of delirium symptoms was assessed daily using the Delirium Rating Scale - Revised-98 (DRS-R-98).

Results: The participants were 54 TBI patients with a mean GCS score of 12.7 (standard deviation [SD] =2.9). A total of 25 patients (46.3%) met the diagnosis of delirium and had a mean age of 36.7 years (SD =14.8). Compared with 29 non-delirious patients, 25 delirious patients had a significantly lower mean GCS score (=0.04), especially a significantly lower verbal component score (=0.03). Among 18 delirious patients, four symptoms of the DRS-R-98 cognitive domain (orientation, attention, long-term memory, and visuospatial ability) were moderate symptoms (score ≥2) at the first day of admission. After follow-up, three cognitive (orientation, attention, and visuospatial ability) and two noncognitive symptoms (lability of affect and motor agitation) rapidly resolved.

Conclusion: Almost half of patients with mild to moderate head injuries may develop delirium in the first 4 days after TBI. Those having a low GCS score, especially the verbal component score, at the ED were likely to have delirium in this period. Most cognitive domains of delirium described in the DRS-R-98 were prominent within the first 4 days of TBI with delirium. Three cognitive and two noncognitive symptoms of delirium decreased significantly.
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http://dx.doi.org/10.2147/NDT.S128138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5317321PMC
February 2017

Spatial and Temporal Analyses of Cervical Cancer Patients in Upper Northern Thailand

Asian Pac J Cancer Prev 2016 11 1;17(11):5011-5017. Epub 2016 Nov 1.

Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand . Email:

Background: Cervical cancer is a major public health problem worldwide. There have been several studies indicating that risk is associated with geographic location and that the incidence of cervical cancer has changed over time. In Thailand, incidence rates have also been found to be different in each region. Methods: Participants were women living or having lived in upper Northern Thailand and subjected to cervical screening at Maharaj Nakorn Chiang Mai Hospital between January 2010 and December 2014. Generalized additive models with Loess smooth curve fitting were applied to estimate the risk of cervical cancer. For the spatial analysis, Google Maps were employed to find the geographical locations of the participants’ addresses. The Quantum Geographic Information System was used to make a map of cervical cancer risk. Two univariate smooths: x equal to the residency duration was used in the temporal analysis of residency duration, and x equal to the calendar year that participants moved to upper Northern Thailand or birth year for participants already living there, were used in the temporal analysis of the earliest year. The spatial-temporal analysis was conducted in the same way as the spatial analysis except that the data were split into overlapping calendar years. Results: In the spatial analysis, the risk of cervical cancer was shown to be highest in the Eastern sector of upper Northern Thailand (p-value <0.001). In the temporal analysis of residency duration, the risk was shown to be steadily increasing (p-value =0.008), and in the temporal analysis of the earliest year, the risk was observed to be steadily decreasing (p-value=0.016). In the spatial-temporal analysis, the risk was stably higher in Chiang Rai and Nan provinces compared to Chiang Mai province. According to the display movement over time, the odds of developing cervical cancer declined in all provinces. Conclusions: The risk of cervical cancer has decreased over time but, in some areas, there is a higher risk than in the major province of Chiang Mai. Therefore, we should promote cervical cancer screening coverage in all areas, especially where access is difficult and/or to women of lower socioeconomic status.
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http://dx.doi.org/10.22034/APJCP.2016.17.11.5011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5454712PMC
November 2016

Prevention of mother-to-child transmission of hepatitis B virus: a phase III, placebo-controlled, double-blind, randomized clinical trial to assess the efficacy and safety of a short course of tenofovir disoproxil fumarate in women with hepatitis B virus e-antigen.

BMC Infect Dis 2016 08 9;16:393. Epub 2016 Aug 9.

Chonburi Hospital, 69 M.2, Sukhumvit Rd., Ban-suan, Muang, Chonburi, 20000, Thailand.

Background: Chronic hepatitis B virus (HBV) infection is complicated by cirrhosis and liver cancer. In Thailand, 6-7 % of adults are chronically infected with HBV. The risk of mother-to-child transmission (MTCT) of HBV has been estimated to be about 12 % when mothers have a high hepatitis B viral load, even if infants receive passive-active prophylaxis with HBV immunoglobulin (HBIg) and initiate the hepatitis B vaccine series at birth. We designed a study to assess the efficacy and safety of a short course of maternal tenofovir disoproxil fumarate (TDF) among women with a marker of high viral load for the prevention of MTCT of HBV.

Methods: The study is a phase III, multicenter (17 sites in Thailand), placebo-controlled, double-blind, randomized 1:1, two-arm clinical trial of TDF 300 mg once daily versus placebo among pregnant women from 28 weeks' gestation through 2-month post-partum. All infants receive HBIg at birth, and a hepatitis B (HB) vaccination series according to Thai guidelines: birth, and age 1, 2, 4 and 6 months. Participant women at study entry must be age ≥18 years, hepatitis B surface antigen (HBsAg) and e-antigen (HBeAg) positive, have alanine aminotransferase (ALT) level < 30 IU/L at screening (confirmed < 60 IU/L pre-entry), negative hepatitis C serology, creatinine clearance >50 mL/min, and no history of anti-HBV antiviral treatment. The target sample size of 328 mother/infant pairs assumed 156 evaluable cases per arm to detect a ≥9 % difference in MTCT transmission (3 % experimental arm versus 12 % placebo arm) with 90 % power. Mothers and infants are followed until 12 months after delivery. The primary infant endpoint is detection of HBsAg, confirmed by detection of HBV DNA at six months of age. Secondary endpoints are maternal and infant adverse events, acute exacerbations of maternal hepatitis B disease (ALT >300 IU/L, defined as a "flare") following discontinuation of study treatment, infant HBV infection status and growth up to 12 months of age.

Discussion: The results of this randomized trial will clarify the efficacy and safety of a short course of antiviral treatment to prevent mother-to-child transmission of HBV and inform international guidelines.

Trial Registration: ClinicalTrials.gov Identifier NCT01745822 .
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http://dx.doi.org/10.1186/s12879-016-1734-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4977630PMC
August 2016

Contribution of different antiretroviral regimens containing zidovudine, lamivudine and ritonavir-boosted lopinavir on HIV viral load reduction during pregnancy.

Antivir Ther 2016 22;21(5):435-40. Epub 2015 Oct 22.

Department of Statistics, Faculty of Science, Kasetsart University, Bangkok, Thailand.

Background: Antiretroviral (ARV) regimens used for the prevention of mother-to-child transmission of HIV have evolved over time. We evaluated the contribution of different ARV regimens on the reduction of the plasma HIV RNA viral load (VL) during pregnancy.

Methods: A total of 1,833 VL measurements from ARV-naive pregnant women participating in perinatal prevention trials in Thailand were included. Women received either zidovudine (ZDV) monotherapy, ZDV plus lopinavir/ritonavir (LPV/r), or ZDV plus lamivudine (3TC) plus LPV/r. VL time-course during pregnancy was described as a function of pretreatment VL and treatment duration using an Emax non-linear mixed-effect model. VL reduction and median time to achieve a VL<50 copies/ml were estimated for each regimen.

Results: Among 745 women, 279 (37%), 145 (20%) and 321 (43%) received ZDV monotherapy, ZDV+LPV/r and ZDV+3TC+LPV/r, respectively. The predicted VL reduction from baseline to delivery after a median of 10 weeks of treatment were 0.5, 2.7 and 2.9 log10 copies/ml with ZDV monotherapy, ZDV+LPV/r and ZDV+3TC+LPV/r, respectively. At delivery, 1%, 57% and 63% of women receiving ZDV monotherapy, ZDV+LPV/r or ZDV+3TC+LPV/r had a VL<50 copies/ml. The addition of 3TC to ZDV+LPV/r reduced the time to achieve a VL<50 copies/ml and the higher the pretreatment VL, the larger the effect 3TC had on reducing the time to VL<50 copies/ml.

Conclusions: The addition of 3TC to ZDV+LPV/r was associated with a slight further VL reduction but the time to reach a VL<50 copies/ml was shorter. This beneficial effect of 3TC is crucial for prevention of mother-to-child transmission in women who receive ARVs late and with high pretreatment VL.
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http://dx.doi.org/10.3851/IMP3001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5440230PMC
January 2018

Randomized noninferiority trial of two maternal single-dose nevirapine-sparing regimens to prevent perinatal HIV in Thailand.

AIDS 2015 Nov;29(18):2497-507

aUnité Mixte Internationale 174, Institut de Recherche pour le Développement (IRD)-PHPT, Chiang Mai, Thailand bDepartment of Immunology and Infectious, Diseases, Harvard School of Public Health, Boston, Massachusetts, USA cDepartment of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand dUnité Mixte de Recherche 196, Centre Français de la Population et du Développement, (INED-IRD-Paris V University), Paris, France eDepartment of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai fSanpatong Hospital, Ministry of Public Health, Sanpatong gSamutprakarn Hospital, Ministry of Public Health, Samutprakarn hBanglamung Hospital, Ministry of Public Health, Chonburi, Thailand iChildren's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA jFamily Health Research Center, Mahidol University, Bangkok, Thailand.

Objectives: Perinatal single-dose nevirapine (sdNVP) selects for resistance mutations. The objective of this trial was to compare two maternal sdNVP-sparing regimens with standard zidovudine (ZDV)/sdNVP prophylaxis.

Design: PHPT-5 was a randomized, partially double-blind placebo-controlled, noninferiority trial in Thailand (NCT00409591). Study participants were women with CD4 of at least 250 cells/μl and their infants.

Methods: All women received ZDV from 28 weeks' gestation and their newborn infants for one week. Women were also randomized to receive NVP-NVP (reference): maternal intrapartum sdNVP with a 7-day 'tail' of ZDV along with lamivudine, and infant NVP (one dose immediately, another 48 h later); infant-only NVP: maternal placebos for sdNVP and the 'tail', with infant NVP; LPV/r: maternal LPV/r starting at 28 weeks. Infants were formula-fed. HIV-diagnosis was determined by DNA-PCR.

Results: Four-hundred and thirty-five women were randomized between January 2009 and September 2010. Accrual was terminated prematurely following a change in Thai guidelines recommending antiretroviral combination therapy for all pregnant women. Data on 405 mothers and 407 live-born children were analyzed. Baseline characteristics were similar between arms. Intent-to-treat transmission rates were 3.8% (95% confidence interval: 1.2-8.6) in NVP-NVP, 1.6% (0.2-5.6) in infant-only NVP, and 1.4% (0.4-5.1) in LPV/r arms. As-treated rates were 2.2% (0.5-6.4), 3.2% (0.9-7.9), and 1.5% (0.2-5.2), respectively. Factors independently associated with transmission were prophylaxis duration less than 8 weeks (adjusted odds ratio 15.5; 3.6-66.1) and viral load at baseline at least 4 log10copies/ml (adjusted odds ratio 10.9; 1.3-91.5). Regimens appeared well tolerated.

Conclusion: Transmission rates in all arms were low but noninferiority was not proven. Antiretroviral prophylaxis for at least 8 weeks before delivery is necessary to minimize transmission risk.
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http://dx.doi.org/10.1097/QAD.0000000000000865DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4871947PMC
November 2015

Modeling of In-Utero and Intra-Partum Transmissions to Evaluate the Efficacy of Interventions for the Prevention of Perinatal HIV.

PLoS One 2015 19;10(5):e0126647. Epub 2015 May 19.

EAU08 Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Unité de Recherche Clinique, AP-HP, Hôpital Tarnier, Paris, France; CIC1419 INSERM, Cochin-Necker, Paris, France.

Background: Antiretroviral treatments decrease HIV mother-to-child transmission through pre/post exposure prophylaxis and reduction of maternal viral load. We modeled in-utero and intra-partum HIV transmissions to investigate the preventive role of various antiretroviral treatments interventions.

Methods: We analysed data from 3,759 women-infant pairs enrolled in 3 randomized clinical trials evaluating (1) zidovudine monotherapy, (2) zidovudine plus perinatal single-dose nevirapine or (3) zidovudine plus lopinavir/ritonavir for the prevention of mother-to-child transmission of HIV in Thailand. All infants were formula-fed. Non-linear mixed effect modeling was used to express the viral load evolution under antiretroviral treatments and the probability of transmission.

Results: Median viral load was 4 log10 copies/mL (Interquartile range: 3.36-4.56) before antiretroviral treatments initiation. An Emax model described the viral load time-course during pregnancy. Half of the maximum effect of zidovudine (28% decrease) and lopinavir/ritonavir (72% decrease) were achieved after 98 and 12 days, respectively. Adjusted on viral load at baseline (Odds ratio = 1.50 [95% confidence interval: 1.34, 1.68] per log10 copies/mL increment), antiretroviral treatments duration (OR = 0.80 [0.75, 0.84] per week increment) but not the nature of antiretroviral treatments were associated with in-utero transmission. Adjusted on gestational age at delivery (<37 weeks, OR = 2.37 [1.37, 4.10]), baseline CD4 (Odds ratio = 0.79 [0.72, 0.88] per 100 cells/mm3 increment) and predicted viral load at delivery (OR = 1.47 [1.25, 1.64] per log10 copies/mL increment), single-dose nevirapine considerably reduced intra-partum transmission (OR = 0.32 [0.2, 0.51]).

Conclusion: These models determined the respective contributions of various antiretroviral strategies on prevention of mother-to-child transmission. This can help predict the efficacy of new antiretroviral treatments and/or prevention of mother-to-child transmission strategies particularly for women with no or late antenatal care who are at high risk of transmitting HIV to their offspring.

Trial Registration: This analysis is based on secondary data obtained from three clinical trials. ClinicalTrials.gov. NCT00386230, NCT00398684, NCT00409591.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0126647PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4438074PMC
April 2016

New-Onset Diabetes and Antiretroviral Treatments in HIV-Infected Adults in Thailand.

J Acquir Immune Defic Syndr 2015 Aug;69(4):453-9

*Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand; †Institut de recherche pour le développement (IRD) UMI 174-PHPT, Chiang Mai, Thailand; ‡Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand; §Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA; ‖Nakornping Hospital, Chiang Mai, Thailand; ¶Prapokklao Hospital, Chantaburi, Thailand; #Chonburi Hospital, Chonburi, Thailand; **Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand; ††Hat Yai Hospital, Songkla, Thailand; ‡‡Nong Khai Hospital, Nong Khai, Thailand; §§Samutsakhon Hospital, Samutsakhon, Thailand; ‖‖Mahasarakham Hospital, Mahasarakham, Thailand; ¶¶Sanpatong Hospital, Chiang Mai, Thailand; ##Institut National d'Etudes Démographiques, Paris, France; ***Sorbonne Universités, INSERM UPMC UMR_S938, APHP, Univ Paris 06, Paris, France; and †††INSERM U1153, Team ECSTRA, Université Paris Diderot-Paris 7, Hôpital Saint-Louis, Paris, France.

Background: Use of several antiretrovirals (ARVs) has been shown to be associated with a higher risk of diabetes in HIV-infected adults. We estimated the incidence of new-onset diabetes and assessed the association between individual ARVs and ARV combinations, and diabetes in a large cohort in Thailand.

Methods: We selected all HIV-1-infected, nondiabetic, antiretroviral-naive adults enrolled in the Program for HIV Prevention and Treatment cohort (NCT00433030) between January 2000 and December 2011. Diabetes was defined as confirmed fasting plasma glucose ≥ 126 mg/dL or random plasma glucose ≥ 2 00 mg/dL. Incidence was the number of cases divided by the total number of person-years of follow-up. Association between ARVs and ARV combinations, and new-onset diabetes was assessed using Cox proportional hazards models.

Results: Overall, 1594 HIV-infected patients (76% female) were included. Median age at antiretroviral therapy initiation was 32.5 years. The incidence rate of diabetes was 5.0 per 1000 person-years of follow-up (95% confidence interval: 3.8 to 6.6) (53 cases). In analyses adjusted for potential confounders, exposure to stavudine + didanosine [adjusted hazard ratio (aHR) = 3.9; P = 0.001] and cumulative exposure ≥ 1 year to zidovudine (aHR = 2.3 vs. no exposure; P = 0.009) were associated with a higher risk of diabetes. Conversely, cumulative exposure ≥ 1 year to tenofovir (aHR = 0.4 vs. no exposure; P = 0.02) and emtricitabine (aHR = 0.4 vs. no exposure; P = 0.03) were associated with a lower risk.

Conclusions: The incidence of diabetes in this predominantly female, young, lean population was relatively low. Although stavudine and didanosine have now been phased out in most antiretroviral therapy programs, our analysis suggests a higher risk of diabetes with zidovudine, frequently prescribed today in resource-limited settings.
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http://dx.doi.org/10.1097/QAI.0000000000000647DOI Listing
August 2015

Treatment Failure in HIV-Infected Children on Second-line Protease Inhibitor-Based Antiretroviral Therapy.

Clin Infect Dis 2015 Jul 1;61(1):95-101. Epub 2015 Apr 1.

Institut de Recherche pour le Développement, UMI 174-PHPT Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Thailand Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

Background: Human immunodeficiency virus (HIV)-infected children failing second-line antiretroviral therapy (ART) have no access to third-line antiretroviral drugs in many resource-limited settings. It is important to identify risk factors for second-line regimen failure.

Methods: HIV-infected children initiating protease inhibitor (PI)-containing second-line ART within the Program for HIV Prevention and Treatment observational cohort study in Thailand between 2002 and 2010 were included. Treatment failure was defined as confirmed HIV type 1 RNA load >400 copies/mL after at least 6 months on second-line regimen or death. Adherence was assessed by drug plasma levels and patient self-report. Cox proportional hazards regression analyses were used to identify risk factors for failure.

Results: A total of 111 children started a PI-based second-line regimen, including 59 girls (53%). Median first-line ART duration was 1.9 years (interquartile range [IQR], 1.4-3.3 years), and median age at second-line initiation was 10.7 years (IQR, 6.3-13.4 years). Fifty-four children (49%) experienced virologic failure, and 2 (2%) died. The risk of treatment failure 24 months after second-line initiation was 41%. In multivariate analyses, failure was independently associated with exposure to first-line ART for >2 years (adjusted hazard ratio [aHR], 1.8; P = .03), age >13 years (aHR, 2.9; P < .001), body mass index-for-age z score < -2 standard deviations at second-line initiation (aHR, 2.8; P = .03), and undetectable drug levels within 6 months following second-line initiation (aHR, 4.5; P < .001).

Conclusions: Children with longer exposure to first-line ART, entry to adolescence, underweight, and/or undetectable drug levels were at higher risk of failing second-line ART and thus should be closely monitored.
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http://dx.doi.org/10.1093/cid/civ271DOI Listing
July 2015

A comparative planning study of step-and-shoot IMRT versus helical tomotherapy for whole-pelvis irradiation in cervical cancer.

J Radiat Res 2015 May 26;56(3):539-45. Epub 2015 Feb 26.

Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand.

The aim of this study was to compare the dosimetric parameters of whole-pelvis radiotherapy (WPRT) for cervical cancer between step-and-shoot IMRT (SaS-IMRT) and Helical Tomotherapy™ (HT). Retrospective analysis was performed on 20 cervical cancer patients who received WPRT in our center between January 2011 and January 2014. SaS-IMRT and HT treatment plans were generated for each patient. The dosimetric values for target coverage and organ-at-risk (OAR) sparing were compared according to the criteria of the International Commission on Radiation Units and Measurements 83 (ICRU 83) guidelines. Differences in beam-on time (BOT) were also compared. All the PTV dosimetric parameters (D5%, D50% and D95%) for the HT plan were (statistically significantly) of better quality than those for the SaS-IMRT plan (P-value < 0.001 in all respects). HT was also significantly more accurate than SaS-IMRT with respect to the D98% and Dmean of the CTV (P-values of 0.008 and <0.001, respectively). The median Conformity Index (CI) did not differ between the two plans (P-value = 0.057). However, the Uniformity Index for HT was significantly better than that for SaS-IMRT (P-value < 0.001). The median of D50% for the bladder, rectum and small bowel were significantly lower in HT planning than SaS-IMRT (P-value < 0.001). For D2%, we found that HT provided better sparing to the rectum and bladder (P-value < 0.001). However, the median of D2% for the small bowel was comparable for both plans. The median of Dmax of the head of the left femur was significantly lower in the HT plan, but this did not apply for the head of the right femur. BOT for HT was significantly shorter than for SaS-IMRT (P-value < 0.001). HT provided highly accurate plans, with more homogeneous PTV coverage and superior sparing of OARs than SaS-IMRT. In addition, HT enabled a shorter delivery time than SaS-IMRT.
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http://dx.doi.org/10.1093/jrr/rrv004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4426928PMC
May 2015

A dosimetric comparison of two-phase adaptive intensity-modulated radiotherapy for locally advanced nasopharyngeal cancer.

J Radiat Res 2015 May 8;56(3):529-38. Epub 2015 Feb 8.

Department of Radiotherapy, University Radiotherapy Antwerp, UZA/ZNA, Antwerp, Belgium.

The purpose of this investigation was to evaluate the potential dosimetric benefits of a two-phase adaptive intensity-modulated radiotherapy (IMRT) protocol for patients with locally advanced nasopharyngeal cancer (NPC). A total of 17 patients with locally advanced NPC treated with IMRT had a second computed tomography (CT) scan after 17 fractions in order to apply and continue the treatment with an adapted plan after 20 fractions. To simulate the situation without adaptation, a hybrid plan was generated by applying the optimization parameters of the original treatment plan to the anatomy of the second CT scan. The dose-volume histograms (DVHs) and dose statistics of the hybrid plan and the adapted plan were compared. The mean volume of the ipsilateral and contralateral parotid gland decreased by 6.1 cm(3) (30.5%) and 5.4 cm(3) (24.3%), respectively. Compared with the hybrid plan, the adapted plan provided a higher dose to the target volumes with better homogeneity, and a lower dose to the organs at risk (OARs). The Dmin of all planning target volumes (PTVs) increased. The Dmax of the spinal cord and brainstem were lower in 94% of the patients (1.6-5.9 Gy, P < 0.001 and 2.1-9.9 Gy, P < 0.001, respectively). The Dmean of the contralateral parotid decreased in 70% of the patients (range, 0.2-4.4 Gy). We could not find a relationship between dose variability and weight loss. Our two-phase adaptive IMRT protocol improves dosimetric results in terms of target volumes and OARs in patients with locally advanced NPC.
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http://dx.doi.org/10.1093/jrr/rru119DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4426913PMC
May 2015

The association of rectal equivalent dose in 2 Gy fractions (EQD2) to late rectal toxicity in locally advanced cervical cancer patients who were evaluated by rectosigmoidoscopy in Faculty of Medicine, Chiang Mai University.

Radiat Oncol J 2014 Jun 30;32(2):57-62. Epub 2014 Jun 30.

Division of Therapeutic Radiology and Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.

Purpose: To evaluate association between equivalent dose in 2 Gy (EQD2) to rectal point dose and gastrointestinal toxicity from whole pelvic radiotherapy (WPRT) and intracavitary brachytherapy (ICBT) in cervical cancer patients who were evaluated by rectosigmoidoscopy in Faculty of Medicine, Chiang Mai University.

Materials And Methods: Retrospective study was designed for the patients with locally advanced cervical cancer, treated by radical radiotherapy from 2004 to 2009 and were evaluated by rectosigmoidoscopy. The cumulative doses of WPRT and ICBT to the maximally rectal point were calculated to the EQD2 and evaluated the association of toxicities.

Results: Thirty-nine patients were evaluated for late rectal toxicity. The mean cumulative dose in term of EQD2 to rectum was 64.2 Gy. Grade 1 toxicities were the most common findings. According to endoscopic exam, the most common toxicities were congested mucosa (36 patients) and telangiectasia (32 patients). In evaluation between rectal dose in EQD2 and toxicities, no association of cumulative rectal dose to rectal toxicity, except the association of cumulative rectal dose in EQD2 >65 Gy to late effects of normal tissue (LENT-SOMA) scale ≥ grade 2 (p = 0.022; odds ratio, 5.312; 95% confidence interval, 1.269-22.244).

Conclusion: The cumulative rectal dose in EQD2 >65 Gy have association with ≥ grade 2 LENT-SOMA scale.
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http://dx.doi.org/10.3857/roj.2014.32.2.57DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4104220PMC
June 2014