Guidelines for antiretroviral therapy in HIV-1 infected adults and adolescents: the recommendations of the Thai AIDS Society (TAS) 2008.
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.


METHODS
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.


CONCLUSIONS
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.
Sungkanuparph
Somnuek
S
Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand. rasuy@mahidol.ac.th
Anekthananon
Thanomsak
T
Hiransuthikul
Narin
N
Bowonwatanuwong
Chureeratana
C
Supparatpinyo
Khuanchai
K
Mootsikapun
Piroon
P
Chetchotisakd
Ploenchan
P
Kiertiburanakul
Sasisopin
S
Tansuphaswadikul
Somsit
S
Buppanharun
Wanchai
W
Manosuthi
Weerawat
W
Techasathit
Wichai
W
Ratanasuwan
Winai
W
Tantisiriwat
Woraphot
W
Suwanagool
Surapol
S
Leechawengwongs
Manoon
M
Ruxrungtham
Kiat
K
D019380:Anti-HIV Agents / Q000627:therapeutic use*; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D016903:Drug Monitoring; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans; D012955:Societies, Medical; D013785:Thailand
D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents