Guidelines for Antiretroviral Therapy in HIV-1 Infected Adults and Adolescents: The Recommendations of the Thai AIDS Society (TAS) 2008
Somnuek Sungkanuparph MD1, Thanomsak Anekthananon MD2, Narin Hiransuthikul MD, MPH, PhD3, Chureeratana Bowonwatanuwong MD4, Khuanchai Supparatpinyo MD5, Piroon Mootsikapun MD6, Ploenchan Chetchotisakd MD6, Sasisopin Kiertiburanakul MD1, Somsit Tansuphaswadikul MD7, Wanchai Buppanharun MD, MPH8, Weerawat Manosuthi MD7, Wichai Techasathit MD2, Winai Ratanasuwan MD2, Woraphot Tantisiriwat MD, MPH8, Surapol Suwanagool MD2, Manoon Leechawengwongs MD9*, Kiat Ruxrungtham MD, MSc3,10* on behalf of the Thai AIDS Society
Affiliation : 1 Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 2 Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 3 Faculty of Medicine, Chulalongkorn University, Bangkok 4 Chonburi Hospital, Chonburi 5 Faculty of Medicine, Chiang Mai University, Chiang Mai 6 Faculty of Medicine, Khon Kaen University, Khon Kaen 7 Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health, Nonthaburi 8 Faculty of Medicine, Srinakarinwirot University, Nakhon-nayok 9 Vichaiyut Hospital, Bangkok, Thailand; and the president of the TAS 10 HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok * Both share equal contribution as senior authors
Background : 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.
Material and Method: 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.
Results : 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.
Conclusion : 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.
Keywords : HIV, Antiretroviral therapy, Guidelines, Thailand, TAS, 2008
