•The rate of viral suppression in patients on cART remains below the UNAIDS target of 90% by 2020.•Durable viral suppression noted in this study is a sign that the UN’s 2030 objective of controlling ...the risk of HIV transmission could be achieved.•The finding of high viral rebound rate in individuals on ART in this study has implication for HIV management.•AZT/3TC/NVP, TDF/3TC/EFV or D4T/3TC/EFV were associated with viral rebound in this cohort, suggesting ART resistance.
Limited data are available on the incidence and factors associated with viral rebound following viral suppression among HIV-infected individuals taking antiretroviral therapy (ART) in Kenya. Furthermore, the durability of viral suppression among HIV individuals taking ART is unknown. Information on incidence rates and factors associated with HIV viral load rebound and the durability of viral suppression (undetectable HIV copies in plasma) among HIV-infected individuals taking ART, will help improve the long-term management of HIV-infected individuals and explore approaches to long-term HIV remission or complete cure.
The objectives of this study were to investigate the incidence rates of viral rebound following viral suppression, factors associated with viral rebound, and the durability of viral suppression among HIV-infected individuals on ART from Kilifi, Meru, and Nakuru counties in Kenya.
This was a retrospective study involving 600 HIV-infected individuals taking combination ART (cART) and enrolled in comprehensive care centers (CCCs) at Malindi Sub-county Hospital, Nakuru Level 5 Hospital, and Meru Level 5 Hospital in Kenya. The medical files were inspected and medical history records abstracted for the selected participants. Participant laboratory data including HIV viral loads, types and history of ART, and treatment history of any opportunistic infections were abstracted using an abstraction checklist. Participants were grouped into those who achieved HIV viral suppression, with viral loads lower than the detection limit (LDL) (viral suppression), and those who experienced one or more detectable viral load measurements >40 copies/ml following the initial LDL (viral rebound). Durable viral suppression was defined as all viral load values at LDL over the 2-year period (2017–2019). Univariate and multivariate Poisson regression analyses were performed to assess the rates of viral rebound, as well as to investigate factors associated with it.
Out of 549 HIV-positive patients, 324/549 (59%) achieved HIV viral suppression (Meru 159/194 (82%), Nakuru 21/178 (12%), and Malindi 144/177 (81%)). The overall viral rebound rate was 41%, with site-specific viral rebound of 88.2%, 18.6%, and 18.0% in Nakuru, Malindi, and Meru, respectively. There was an overall rate of first viral rebound of 3.9 (95% confidence interval (CI) 6.9–14.4), 0.7 (95% CI 0.5–1.0), and 0.89 (95% CI 0.64–1.24) per 100 person-months in Nakuru, Malindi, and Meru, respectively. Good ART adherence (p = 0.0002), widow status (p = 0.0062), and World Health Organization (WHO) stage I (p = 0.0002) were associated with viral suppression, while poor ART adherence (p < 0.0001), WHO stage II (p = 0.0024), and duration on ART of 36 months (p = 0.0350) were associated with viral rebound.
The rate of viral suppression in patients on cART in the CCCs fell short of the WHO target. However, the study provides proof of evidence of undetectable viral load levels for more than 2 years, a sign that the United Nation’s 2030 objective of controlling the risk of HIV transmission could be achieved.
ABSTRACT
We present MeerKAT Absorption Line Survey (MALS) observations of the H i gas in the Klemola 31 galaxy group (z = 0.029), located along the line of sight to the radio-loud quasar PKS 2020−370 ...(z = 1.048). Four galaxies of the group are detected in H i emission, and H i absorption is also detected in front of PKS 2020−370 in Klemola 31A. The emission and absorption are somewhat compensating on the line of sight of the quasar, and the derived column density of the absorption appears underestimated, with respect to the neighbouring emission. A symmetric tilted-ring model of Klemola 31A, assuming the absorbing gas in regular rotation in the plane, yields a rather high spin temperature of 530 K. An alternative interpretation is that the absorbing gas is extra-planar, which will also account for its non-circular motion. The Na i/Ca ii ratio also suggests that the absorbing gas is unrelated to cold H i disc. Two of the galaxies in the Klemola group are interacting with a small companion, and reveal typical tidal tails, and velocity perturbations. Only one of the galaxies, ESO 400−13, reveals a strong H i deficiency, and a characteristic ram-pressure stripping, with a total asymmetry in the distribution of its gas. Since a small galaxy group as Klemola 31 is not expected to host a dense intra-group gas, this galaxy must be crossing the group at a very high velocity, mostly in the sky plane.
Aims: To elucidate the stability of superantigenic activity and pathogenesis of toxic shock syndrome toxin 1 (TSST-1) and staphylococcal enterotoxin A (SEA) against heating and digestive enzymes. ...Methods and Results: Purified TSST-1 and SEA were treated with heating, pepsin and trypsin that are related to food cooking, stomach and intestine conditions. The integrity, superantigenic activity and toxicity of treated TSST-1 and SEA were analysed by Western blotting, spleen cell culture, cytokine assay and toxic shock models. Both TSST-1 and SEA showed strong resistance to heating, pepsin and trypsin digestion. Furthermore, the treated TSST-1 showed significant higher induction of interferon-γ and toxic shock compared with that of SEA. Pepsin- or trypsin-digested TSST-1 fragments still showed significant superantigenic and lethal shock toxicities. Conclusions: The superantigenic activity of TSST-1 was stable to heating and digestive enzymes. Pepsin- and trypsin-digested TSST-1 fragments still showed superantigenic and lethal shock activities, indicating that digested TSST-1 could cross epithelial cells and induce systemic toxicity. Significance and Impact of the Study: This study found, for the first time, that pepsin- or trypsin-digested smaller TSST-1 retained significant superantigenic and lethal shock activities. The different resistance of TSST-1 and SEA participates in the different pathogenic activities during food poisoning and toxic shock syndrome.
Assessment of blast fragment size distribution is critical in mining operations because it is the initial step towards mineral extraction. Different empirical models and techniques are available for ...predicting and investigating the consequences of blasting, one of which is the Kuznetsov-Cunningham-Ouchterlony (KCO) model. In this paper we summarize the advances in the empirical models from inception until now, and explore the improvements that have been made so far with particular emphasis is on the most recent KCO model. Utilization of the model and the errors that arise between expected and the actual outcomes are analysed. The results indicate that the KCO model remains useful for predicting the blast fragmentation at limestone mine sites, despite the availability of other advanced prediction models. It is also a valuable instrument for pre-surveying the impact of varying certain parameters of a blast plan.
Highlights • Assesses available data on optimal time to initiate therapy in HIV-infected asymptomatic individuals with respect to CD4+ T cell threshold. • Discuss arguments for and against early or ...late initiation of ART. • Discusses available information from 1998 through 2015. • Presents authors conclusion and views.
Here, we present the first near-complete genome of
(UPV) sequenced from a symptomatic sample of KH7 passion fruit (
Sims) variety. UPV had limited amino acid identity with other potyviruses known to ...cause passion fruit woodiness disease (PWD). The closest relationship (71.2% amino acid similarity) was with
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Vitamin D status and hypertension: a review Ke, Liang; Mason, Rebecca S; Kariuki, Maina ...
Integrated blood pressure control,
01/2015, Letnik:
8, Številka:
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Vitamin D is a steroid prohormone synthesized in the skin following ultraviolet exposure and also achieved through supplemental or dietary intake. While there is strong evidence for its role in ...maintaining bone and muscle health, there has been recent debate regarding the role of vitamin D deficiency in hypertension based on conflicting epidemiological evidence. Thus, we conducted a scoping systematic literature review and meta-analysis of all observational studies published up to early 2014 in order to map trends in the evidence of this association. Mixed-effect meta-analysis was performed to pool risk estimates from ten prospective studies (n=58,262) (pooled risk for incident hypertension, relative risk RR =0.76 (0.63-0.90) for top vs bottom category of 25-hydroxyvitamin D 25OHD) and from 19 cross-sectional studies (n=90,535) (odds ratio OR =0.79 (0.73-0.87)). Findings suggest that the better the assessed quality of the respective study design, the stronger the relationship between higher 25OHD levels and hypertension risk (RR =0.67 (0.51-0.88); OR =0.77 (0.72-0.89)). There was significant heterogeneity among the findings for both prospective and cross-sectional studies, but no evidence of publication bias was shown. There was no increased risk of hypertension when the participants were of older age or when they were vitamin D deficient. Younger females showed strong associations between high 25OHD levels and hypertension risk, especially in prospective studies (RR =0.36 (0.18-0.72); OR =0.62 (0.44-0.87)). Despite the accumulating evidence of a consistent link between vitamin D and blood pressure, these data are observational, so questions still remain in relation to the causality of this relationship. Further studies either combining existing raw data from available cohort studies or conducting further Mendelian analyses are needed to determine whether this represents a causal association. Large randomized controlled trials are also needed to determine whether vitamin supplementation may be beneficial in the prevention or the treatment of hypertension.
Complex histories of chronic and acute sea surface temperature (SST) stresses are expected to trigger taxon- and location-specific responses that will ultimately lead to novel coral communities. The ...2016 El Niño-Southern Oscillation provided an opportunity to examine large-scale and recent environmental histories on emerging patterns in 226 coral communities distributed across 12 countries from East Africa to Fiji. Six main coral communities were identified that largely varied across a gradient of Acropora to massive Porites dominance. Bleaching intensity was taxon-specific and was associated with complex interactions among the 20 environmental variables that we examined. Coral community structure was better aligned with the historical temperature patterns between 1985 and 2015 than the 2016 extreme temperature event. Additionally, bleaching responses observed during 2016 differed from historical reports during past warm years. Consequently, coral communities present in 2016 are likely to have been reorganized by both long-term community change and acclimation mechanisms. For example, less disturbed sites with cooler baseline temperatures, higher mean historical SST background variability, and infrequent extreme warm temperature stresses were associated with Acropora-dominated communities, while more disturbed sites with lower historical SST background variability and frequent acute warm stress were dominated by stress-resistant massive Porites corals. Overall, the combination of taxon-specific responses, community-level reorganization over time, geographic variation, and multiple environmental stressors suggest complex responses and a diversity of future coral communities that can help contextualize management priorities and activities.
► Vulnerability has three dimensions: exposure, sensitivity, and adaptive capacity. ► We explore vulnerability of coastal communities to the impacts of coral bleaching on fisheries. ► We develop a ...network-based approach to measure sensitivity to changes in the fishery. ► The three dimensions of vulnerability differ considerably. ► Key policy actions to reduce vulnerability at varying spatial and temporal scales.
Coral reefs support the livelihood of millions of people especially those engaged in marine fisheries activities. Coral reefs are highly vulnerable to climate change induced stresses that have led to substantial coral mortality over large spatial scales. Such climate change impacts have the potential to lead to declines in marine fish production and compromise the livelihoods of fisheries dependent communities. Yet few studies have examined social vulnerability in the context of changes specific to coral reef ecosystems. In this paper, we examine three dimensions of vulnerability (exposure, sensitivity, and adaptive capacity) of 29 coastal communities across five western Indian Ocean countries to the impacts of coral bleaching on fishery returns. A key contribution is the development of a novel, network-based approach to examining sensitivity to changes in the fishery that incorporates linkages between fishery and non-fishery occupations. We find that key sources of vulnerability differ considerably within and between the five countries. Our approach allows the visualization of how these dimensions of vulnerability differ from site to site, providing important insights into the types of nuanced policy interventions that may help to reduce vulnerability at a specific location. To complement this, we develop framework of policy actions thought to reduce different aspects of vulnerability at varying spatial and temporal scales. Although our results are specific to reef fisheries impacts from coral bleaching, this approach provides a framework for other types of threats and different social-ecological systems more broadly.
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