Sungkanuparph Somnuek, Anekthananon Thanomsak, Hiransuthikul Narin, Bowonwatanuwong Chureeratana, Supparatpinyo Khuanchai, Mootsikapun Piroon, Chetchotisakd Ploenchan, Kiertiburanakul Sasisopin, Tansuphaswadikul Somsit, Buppanharun Wanchai, Manosuthi Weerawat, Techasathit Wichai, Ratanasuwan Winai, Tantisiriwat Woraphot, Suwanagool Surapol, Leechawengwongs Manoon, Ruxrungtham Kiat
Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
J Med Assoc Thai. 2008 Dec;91(12):1925-35.
More than 100,000 patients have been treated, since the implementation of the National Universal Coverage for antiretroviral therapy (ART) in Thailand Although there are several comprehensive guidelines available internationally, there is a need to have guidelines that can be implemented in Thailand.
The guidelines were developed by a panel of 17 members who are the experts on HIV research and/or HIV patient care and appointed without incentive by the Thai AIDS Society (TAS). The recommendations were based on evidences from the published studies and availability of antiretroviral agents. Published studies that are relevant and applicable to Thailand in particular have been taken into consideration.
The recommendations include: when to start ART; what to start; how to monitor the therapy; adverse effects and its management; diagnosis of treatment failure; and antiretroviral treatment options in patients with treatment failure. ART in special circumstances, i.e., patients with co-infection of tuberculosis or hepatitis B virus, is also included Appropriate level of CD4+ T-cell count to start ART among Thai patients has been considered carefully. The authors recommend to start ART at CD4+ T-cell count < 200 cells/mm3.
ART should be initiated in adults and adolescents HIV-1 infected patients with a history of HIV-related illness or AIDS or with a CD4+ T-cell count <200 cells/mm3. For treatment-naive patients, the preferred initial therapy is a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen. CD4' T-cell count and viral load should be monitored for at least twice and once a year, respectively. Proper management of antiretroviral-related toxicity and enhancement of adherence are crucial for the long-term success of ART.
自泰国实施全国抗逆转录病毒疗法（ART）全民覆盖以来，已有超过10万名患者接受了治疗。尽管国际上有多项综合指南，但仍需要有可在泰国实施的指南。
该指南由一个由17名成员组成的小组制定，这些成员是HIV研究和/或HIV患者护理方面的专家，由泰国艾滋病协会（TAS）无偿任命。这些建议基于已发表研究的证据以及抗逆转录病毒药物的可获得性。特别考虑了与泰国相关且适用的已发表研究。
建议包括：何时开始ART；开始使用什么药物；如何监测治疗；不良反应及其管理；治疗失败的诊断；以及治疗失败患者的抗逆转录病毒治疗选择。还包括特殊情况下的ART，即合并感染结核病或乙型肝炎病毒的患者。已仔细考虑泰国患者开始ART时适当的CD4 + T细胞计数水平。作者建议在CD4 + T细胞计数<200个细胞/mm3时开始ART。
对于有HIV相关疾病或艾滋病病史或CD4 + T细胞计数<200个细胞/mm3的成人和青少年HIV-1感染患者，应开始ART。对于初治患者，首选的初始治疗是基于非核苷类逆转录酶抑制剂（NNRTI）的方案。应分别至少每半年和每年监测一次CD4 + T细胞计数和病毒载量。妥善管理抗逆转录病毒相关毒性并提高依从性对于ART的长期成功至关重要。
