Important note: Information in this article was accurate in 2001. The state of the art may have changed since the publication date.
Bangkok Post - March 22, 2001
Those Aids patients are now being diagnosed with wasting, tuberculosis, pneumonia, and other opportunistic infections that for the past several years have placed a substantial burden on the nation's health care system. The study appears in this month's issue of Clinical Infectious Diseases. Even though few developing countries have created as effective and detailed an Aids-reporting system as Thailand, few reports before this one have described the most prevalent health problems of Aids patients.
Researchers looked at more than 100,000 Aids cases between 1994 and 1998.
Senior author Kenrad E Nelson, a professor of epidemiology at the Johns Hopkins School of Public Health, said, "These data on officially reported Aids cases in Thailand allow us to make an estimate of the disease burden due to Aids and to spell out the specific disorders now affecting persons with Aids there.
"These findings should help physicians to suspect and diagnose patients they see with similar symptoms, thereby interrupting the disease's transmission."The government says it will treat opportunistic infections resulting from Aids and HIV as part of its cheap health care scheme. The authors said this information would help officials plan services and come up with prevention strategies for the most frequently seen complications.
The researchers analysed the data from 101,945 sufferers in Thailand over the age of 10 who were diagnosed with Aids between January 1994 and December 1998. The study revealed that the number of reported cases increased from 12,005 in 1994 to 22,542 in 1996, before levelling off at about 24,000 in 1997 and 1998. Although it is too soon to know for certain, scientists said these findings suggest the epidemic may be slowing, due to an intensive national prevention programme directed at decreasing the rate of sexual transmission of HIV, especially during commercial sex. The results also suggested an increasing proportion of women in regular sexual relationships were becoming HIV-infected. Overall, 80% of Aids sufferers were sexually active males; 83% were between ages 20 and 40 years; and 87% of Aids cases were acquired through sexual contact. Male homosexuals or bisexuals accounted for only 1.3% of those with sexual risks. Throughout Thailand, 6.2% of Aids infections were reported to have occurred through injection drug use. The study looked at 25 illnesses that are diagnostic of Aids in HIV-infected individuals and found the most commonly reported Aids-defining conditions to be wasting syndrome (30%), tuberculosis (29%), Pneumocystis carinii pneumonia (20%), cryptococcosis (20%), and esophageal candidiasis (6%).
Kaposi's sarcoma, common among Aids patients in the West, was rare in Thailand, found in only 0.2% of patients. These percentages varied from region to region across Thailand. Tuberculosis, the most commonly reported opportunistic infection and affecting 29% of Aids cases overall, occurred in 43% of Aids patients in Bangkok but in only 22% in the North, probably because of the high numbers of injection drug users in the capital.
Patients with risk factors related to sex were more likely to be diagnosed with PCP and cryptococcal meningitis than were patients who injected drugs. The other authors were Dr Suwat Chariyalertsak and Dr Thira Sirisanthana from Chiang Mai University's faculty of medicine and Orapan Seangwonley from the Public Health Ministry.
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