Sasisopin Kiertiburanakul

Background: Dengue is a major public health concern in Southeast Asia, with increasing incidence and severity among adult populations. Early identification of factors associated with severe dengue is essential for timely clinical management and reducing morbidity and mortality. This study aimed to identify factors associated with severe dengue among adults hospitalized at a single tertiary center in Bangkok, Thailand. Methods: A retrospective cohort study was conducted among adult patients (≥ 18 years) with laboratory-confirmed dengue who were hospitalized at Ramathibodi Hospital, Bangkok, Thailand, between January 2015 and December 2025. Patients were classified as severe or non-severe dengue according to the 2025 World Health Organization (WHO) guidelines. Factors associated with severe dengue were explored using multivariable logistic regression. Because of the small number of severe events, Firth’s penalized logistic regression was applied to a reduced model with four covariates (age, diabetes mellitus, cough, and hepatosplenomegaly), with sensitivity analyses using an extended model and the full initial model. Results: A total of 143 patients were included (median age 36 years; 65.7% female); 21 (14.7%) developed severe dengue. More than half of the patients (52.4%) had underlying comorbidities, most commonly hypertension (31.5%) and dyslipidemia (30.1%), and 55.2% presented with WHO warning signs at admission. The most common severe dengue criteria were dengue shock syndrome (52.4%), aspartate transaminase (AST) or alanine transaminase (ALT) ≥ 1,000 U/L (28.6%), and severe bleeding (23.8%). In the primary Firth-penalized reduced model (143 patients; 21 events), hepatosplenomegaly (AOR 7.27, 95% CI 2.06– 26.18; p=0.002) and cough at presentation (AOR 4.19, 95% CI 1.04– 15.79; p=0.044) were associated with severe dengue, whereas the association with diabetes mellitus did not reach statistical significance (AOR 3.40, 95% CI 0.86– 12.90; p=0.079). Hepatosplenomegaly remained significantly associated with severe dengue in all sensitivity analyses, whereas the association with cough was not consistent across models. Conclusion: Among hospitalized adults with dengue, hepatosplenomegaly was consistently associated with severe dengue across standard and Firth penalized multivariable models. Associations with cough and diabetes mellitus were imprecise and sensitive to model specification. Given the small number of severe cases and single-center design, these findings are exploratory and require confirmation in larger prospective cohorts.

Introduction: Viral load (VL) testing is the recommended approach for monitoring antiretroviral therapy (ART) effectiveness, while guidelines recommend targeted CD4 testing after ART initiation. This study examined trends in VL and CD4 testing frequencies, as well as the relationship with AIDS diagnosis and mortality among people with HIV in the Asia-Pacific region. Methods: We included adults enrolled in the Treat Asia HIV Observational Database (TAHOD) between 2003-2018 who had been on ART for ≥1 year. VL and CD4 testing rates were analysed using Poisson regression models. Associations between testing frequency and AIDS diagnosis or mortality were evaluated using Fine and Gray competing risk regression. Results: Among 8,446 patients, VL testing rates remained steady at 1 per person-year (PYS) between 2003-2018. Increased VL testing was associated with more frequent CD4 testing (>2 tests in the previous year; IRR=1.57, 95%CI 1.53-1.60), later follow-up years (2008-2012: IRR=1.15, 95%CI 1.12-1.18; 2013-2015: IRR=1.07, 95%CI 1.04-1.10), older age (31-40 years: IRR=1.06, 95%CI 1.03-1.08; 41-50 years: IRR=1.08, 95%CI 1.05-1.11; >50 years: IRR=1.07, 95%CI 1.03-1.11), higher current VL (401-1000 copies/mL: IRR=1.16, 95%CI 1.09-1.24; >1000 copies/mL: IRR=1.07, 95%CI 1.04-1.11), initial ART regimen (NRTI+PI: IRR=1.07, 95%CI 1.04-1.10; other combinations: IRR=1.11, 95%CI 1.05-1.17), and higher country income levels (upper-middle: IRR=2.17, 95%CI 2.11-2.23; high: IRR=3.14, 95%CI 3.03-3.26). CD4 testing rates decreased from 2.04 to 1.06/PYS over the same period. Lower CD4 testing frequency was associated with HIV exposure mode (MSM: IRR=0.94, 95%CI 0.92-0.96; IDU: IRR=0.93, 95%CI 0.90-0.97; other/unknown: IRR=0.90, 95%CI 0.87-0.93), higher current CD4 (201-350 cells/µL: IRR=0.95, 95%CI 0.93-0.97; 351-500 cells/µL: IRR=0.89, 95%CI 0.87-0.91; >500 cells/µL: IRR=0.85, 95%CI 0.83-0.87) and receiving an NRTI+PI first-line combination (IRR=0.96, 95% CI 0.94-0.98). VL and CD4 testing frequencies were not significantly associated with AIDS diagnosis. However, having > 2 CD4 tests in the previous year was associated with higher mortality risk. Conclusion: The trends in the rates for CD4 and VL testing in the region between 2003-2018 were significantly affected by demographic, clinical and socio-economic factors. Recognizing these factors is critical to optimizing differentiated monitoring strategies and improving outcomes for PWH in the region.

Switching from efavirenz (EFV) to dolutegravir (DTG) is increasingly common due to DTG's superior efficacy and tolerability, yet its metabolic impact in Southeast Asian populations remains unclear. We conducted a single-center retrospective cohort study (January 2019–December 2022) involving adults on EFV-based antiretroviral therapy for at least 6 months before transitioning to DTG. Weight, body mass index, lipid profiles, fasting blood glucose (FBG), renal function, and alanine transaminase (ALT) were measured at baseline, Month 6, and Month 12. Among 493 participants (mean age 47.6 years; 69% female), mean weight increased from 63.8 to 65.6 kg at Month 12 ( P < .001). TC, low-density lipoprotein cholesterol (LDL-C), and triglycerides decreased, while high-density lipoprotein cholesterol (HDL-C) declined and FBG modestly improved. Estimated glomerular filtration rate (eGFR) dropped by 25% ( P < .001). Higher baseline HDL-C was protective against significant weight gain (OR 0.11 per 10 mg/dL, P = .030). EFV-to-DTG switching leads to weight gain, mixed metabolic effects, and notable eGFR decline, supporting regular monitoring.

Background: Tuberculosis (TB) remains the leading cause of illness and death among people living with HIV (PLHIV), particularly in high-burden areas. This study examined associations between TB and routine clinical markers: serum cholesterol, platelet count, and CD4 cell count. Setting: The analysis included data from the TREAT Asia HIV Observational Database, a multicenter cohort of adult PLHIV receiving care across the Asia-Pacific region. Methods: The authors conducted a cross-sectional matched case–control study of prospective and retrospective patients with TB, comparing clinical and laboratory data within ±3 months of TB diagnosis. Conditional logistic regression assessed associations between TB and covariates. Results: The analysis included 4244 PLHIV from 20 sites: 1427 patients with TB and 2817 matched controls. Patients with TB were predominantly male (75.3%) and 45.7% aged 31–40 years. Multivariable analysis showed greater odds of TB diagnosis among males, those with low BMI, prior AIDS diagnosis, high HIV viral load, low CD4 ⁺ counts, or low total cholesterol. CD4 ⁺ counts 500 cells/μL. Cholesterol 5.5 mmol/L. Conclusions: In this Asia-Pacific cohort of adults living with HIV, low CD4 ⁺ cell count and low total serum cholesterol were associated with increased TB odds. Cholesterol may represent a low-cost adjunct marker to support TB risk stratification in PLHIV in endemic settings, but requires validation and evaluation of feasibility and cost-effectiveness.

Introduction Respiratory syncytial virus (RSV) is a public health concern, particularly among neonates/young infants, in individuals with chronic medical conditions, and for older adults. In contrast to children, limits in surveillance and substantial underreporting obscure the full impact of RSV infections on adults. A structured process for adult RSV disease decision-making can guide public health epidemiology and planning. Methods Twelve experts from six Asian countries (Indonesia, Malaysia, Philippines, Singapore, Taiwan, and Thailand) participated in a modified Delphi consensus study to guide surveillance, diagnosis, and impact of RSV in adults in Asia. The expert recommendations could be organized into four themes: epidemiology and surveillance, diagnosis, high-risk groups, and healthcare utilization. Results The expert panel recommended strengthening RSV disease monitoring through integration within current influenza and COVID-19 surveillance systems. Furthermore, to standardize RSV case definitions, it was recommended that the RSV respiratory infection clinical criteria exclude fever. Although rapid antigen tests are employed as standard of care, polymerase chain reaction (PCR) testing should be utilized whenever feasible. Along with year-round testing in Asia to establish incidence, an adjustment factor of at least 2.2-fold was recommended to address the underestimation of RSV-related hospitalization rates based on single-specimen PCR testing. For all adults aged ≥ 75 as well as for those adults aged ≥ 60 with comorbid or immunocompromising conditions, or those residing in long-term care facilities, the experts recommended universal RSV vaccination (contingent upon vaccine licensure), and cost-effectiveness analyses should be used to inform region-specific policy decisions. Conclusions Priority actions proposed for adult RSV infection and disease include streamlining diagnostic testing processes, launching disease awareness campaigns, and engaging public health authorities to advance prevention programs in coordinated efforts with policymakers and payers.

Introduction: In 2016, the World Health Organization recommended differentiated service delivery (DSD) as a client‐centred approach to simplify HIV care in frequency and intensity, thus reducing the clinic visit burden on individuals and HIV programmes. We describe the scale of DSD implementation among HIV facilities in low‐ and middle‐income countries (LMICs) in Latin America, Africa and the Asia‐Pacific before the COVID‐19 pandemic.Methods: We analysed facility‐level survey data from HIV care facilities participating in the International epidemiology Databases to Evaluate AIDS consortium in 2019. We used descriptive statistics to summarise the availability of DSD, multi‐month dispensing (MMD) and DSD for HIV treatment models. We explored factors associated with DSD implementation using multivariable models.Results: We included 175 facilities in the Asia‐Pacific (n = 30), Latin America (n = 8), Central Africa (n = 21), East Africa (n = 74), Southern Africa (n = 28) and West Africa (n = 14). Overall, 133 facilities (76%) reported implementing DSD. Of these, 91% offered DSD for HIV treatment, 61% for HIV testing and 59% for antiretroviral therapy (ART) initiation. The most common duration of ART refills for clinically stable clients was 3MMD, (70%), followed by monthly (14%) and 6MMD (10%). Facility‐based individual models were the most frequently available DSD for the HIV treatment model (82%), followed by client‐managed group models (60%). Out‐of‐facility individual models were available at 48% of facilities. Facility‐based individual models were particularly common among facilities in East (92%) and Southern Africa (96%). Facilities in medium and high HIV prevalence countries, and those with 3MMD, were more likely to implement DSD.Conclusions: In 2019, DSD was available in most HIV care facilities globally but was not evenly implemented across regions and HIV services. Most offered facility‐based DSD for HIV treatment models and 3MMD for clinically stable clients. Efforts to expand DSD for HIV testing and ART initiation and to offer longer MMD can improve long‐term retention in care of people living with HIV in LMICs, while further alleviating the operational burden on healthcare services. These findings from the pre‐COVID‐19 era underline the need for strengthening DSD in HIV care, which remains at the centre of current efforts towards client‐centred care.

Background: A next-generation, serum-free, highly purified Vero cell rabies vaccine, PVRV-NG2, is in development. Methods: This multicenter, observer-blind, phase 3 study evaluated the immunogenicity and safety of PVRV-NG2, compared with 2 licensed rabies vaccines (purified Vero cell rabies vaccine [PVRV] and human diploid cell vaccine [HDCV]), as a preexposure prophylaxis (PrEP) regimen. Participants were randomized 3:1:1 to PVRV-NG2, PVRV, or HDCV, as a 3-dose (cohort 1; children and adults; day [D] 0, D7, and D28) or 2-dose (cohort 2; adults; D0 and D7) PrEP regimen. The primary objective was noninferiority of PVRV-NG2 to PVRV and HDCV as 3-dose PrEP, based on the proportion of participants with rabies virus–neutralizing antibody titer ≥0.5 IU/mL at D42. Noninferiority of immune responses for 2-dose PrEP at D28 and noninferiority of 2-dose (D28) versus 3-dose (D42) HDCV were also assessed as secondary immunogenicity objectives. Safety was assessed throughout. Results: Overall, 1708 participants were enrolled (cohort 1: 505 children, 505 adults; cohort 2: 698 adults). All participants had rabies virus–neutralizing antibody titers ≥0.5 IU/mL after 3-dose PVRV-NG2 (D42), with noninferiority to PVRV and HDCV demonstrated. All secondary immunogenicity objectives were achieved, including noninferiority of 2-dose PVRV-NG2 versus 2-dose PVRV and HDCV (D28) and 3-dose HDCV (D42), and noninferiority of 2-dose HDCV versus 3-dose HDCV. The safety profile of PVRV-NG2 was comparable to those of PVRV and HDCV. Conclusions: This study supports the use of PVRV-NG2 in 2- or 3-dose PrEP regimens, with no safety concerns identified. Clinical Trials Registration: ClinicalTrials.gov identifier: NCT04127786; EudraCT: 2019-000973-22; WHO: U1111-1217-3241.