Two cases of possible transmitted drug-resistant HIV : likely HIV superinfection and unmasking of pre-existing resistance

In the UK, patients undergo HIV viral load and genotype testing before they are prescribed antiretroviral therapy. The genotype test guides clinicians in prescribing antiretroviral therapy with maximum efficacy against the patient’s specific viral strain. HIV viral load escape under antiretroviral drug therapy, to which the virus was thought to be genotypically susceptible, is commonly observed in patients with poor adherence. We observed early viral escapes in two-newly diagnosed patients, during antiretroviral treatment, with different sequences compared to their original viral resistance test and who reported excellent adherence to and tolerance of their therapy. HIV superinfection with a new viral strain was identified in a patient with multiple risk factors and co-infections with sexually transmitted infections. The second patient was a case of the emergence of primary resistant virus under drug pressure. Both suppressed their virus promptly after treatment switch

Vaccines against leishmaniasis : using controlled human infection models to accelerate development

INTRODUCTION: Leishmaniasis is a neglected tropical disease that is defined by the World Health Organization as vaccine preventable. Although several new candidate vaccines are in development, no vaccine has successfully reached the market for human use. Several species of Leishmania cause human disease and have co-evolved with their respective sand fly vectors. These unique relationships have implications for initiation of infection and vaccine development. An approach to vaccine development for many infectious diseases is the use of controlled human infection models (CHIMs). AREAS COVERED: We describe the history and recent development of experimental and deliberate infection using Leishmania in humans and the rationale for developing a new sand fly-initiated CHIM to progress leishmaniasis vaccine development. Examples from other infectious diseases are discussed in the context of the development of a new leishmaniasis CHIM. We also reflect upon the manufacture of the challenge agent, practical considerations, safety, ethics, and regulatory issues. EXPERT OPINION: A new cutaneous Leishmania CHIM is being developed to enable testing of vaccines in the development pipeline. Questions remain about the use of such CHIMs to determine effectiveness of vaccines against visceral leishmaniasis. However, such a CHIM will be invaluable in expediting time to market for vaccines

Frequency and risk factors for prevalent, incident, and persistent genital carcinogenic human papillomavirus infection in sexually active women: community based cohort study

Objective To investigate frequency and risk factors for prevalent, incident, and persistent carcinogenic human papillomavirus (HPV) in young women before the introduction of immunisation against HPV types 16 and 18 for schoolgirls

Suitability of simple human immunodeficiency virus rapid tests in clinical trials in community-based clinic settings

The suitability and accuracy of using simple human immunodeficiency virus (HIV) rapid (SR) tests in community-based clinics in northwest Tanzania were determined to assess eligibility for participation in clinical trials. The HIV rapid and ELISA test results for 789 women aged 16 to 54 who were screened for two clinical trials of HIV prevention were compared. Women were offered voluntary HIV counseling and testing (VCT) at screening; those who accepted were tested with the Abbott Determine and Trinity Biotech Capillus SR tests in parallel. The results were confirmed by two parallel HIV enzyme-linked immunosorbent assay (ELISA) tests (Abbott Murex HIV Ag/Ab combination and Vironostika Uniform II HIV Ag/Ab) to determine eligibility. Positive samples for any of the four assays were confirmed by a line immunoassay and p24 testing. The parallel SR tests had high concordance (96.2%) with the parallel ELISA algorithm. The sensitivities of the SR tests were 98.6% for Capillus (95% confidence interval [CI], 95.1 to 99.8%), 99.3% for Determine (95% CI, 96.2 to 100%), and 98.6% for the parallel SR (95% CI, 95.1 to 99.8%). The specificities were 99.7% for Capillus (95% CI, 98.9 to 100%), 99.7% for Determine (95% CI, 98.9 to 100%), and 100% for the parallel SR (95% CI, 99.4 to 100%). SR tests are suitable for use in community-based clinical research settings to assess eligibility both for trial participation and for the provision of on-site VCT services. Copyrigh

A New Wood Preservative

The world owes much to pioneers who blazed the way against many obstacles in teaching wood preservation and conservation, and to the Forestry schools that have been established and to there students who carried on and are still carrying on. Not so many years ago the general opinion held that “there was plenty of wood standing for all time.” Today, conservation of wood is a reality and the world is conserving wood. While much has been done and much is yet being done we find the two old enemies of wood, Fire and Decay, taking an enormous annual toll

Cases, Regulations, and Statutes

<p>ND: not detected (i.e.<0.06 µg/ml lower limit of assay).</p><p>* Hrs post - 1^st dose A, 12^th dose B.</p><p>Median, minimum and maximum values for cervico-vaginal levels of 2G12(µg/ml) after adjustment for dilution factors.</p

Hepatitis B vaccination induces mucosal antibody responses in the female genital tract, indicating potential mechanisms of protection against infection

Vaccines against hepatitis B virus confer effective protection. ELISA was developed to test for specific antibodies in female genital tract secretions. Anti-HBs IgG and IgA were detected in the cervico-vaginal secretions of women following Hepatitis B vaccination, indicating a potential genital tract role for neutralising antibodies against sexually transmitted HBV

"The Book of Negroes’ illustrated edition: circulating African-Canadian history through the Middlebrow"

This article examines the 2009 deluxe illustrated edition of Lawrence Hill’s Commonwealth Writers’ Prize– and Canada Reads–winning novel The Book of Negroes, originally published in 2007. It relates the story of Aminata, a West African girl kidnapped and sold into slavery, and her experiences on an indigo plantation in the American south, followed by further displacements to Charleston, Nova Scotia, Sierra Leone, and London. In New York, as the Revolutionary War comes to a close, Aminata becomes the scribe for the Book of Negroes, documenting the Black Loyalists, as well as the slaves and indentured servants of white Loyalists, granted passage by the British to Canada. Hill has commented that the Book of Negroes is an important document about which Canadians are largely ignorant. This desire to circulate knowledge about African-Canadian history through the novel is particularly manifest in the illustrated edition of 2009, where a photograph of the Book of Negroes features prominently, along with countless other images and captions which supplement and interrupt Hill’s narrative. This article considers the significance and implications of this “keepsake” or “souvenir” edition, particularly its circulation of knowledge about African-Canadian history through visual pleasure

Neurocognitive function in HIV infected patients on antiretroviral therapy

OBJECTIVE To describe factors associated with neurocognitive (NC) function in HIV-positive patients on stable combination antiretroviral therapy. DESIGN We undertook a cross-sectional analysis assessing NC data obtained at baseline in patients entering the Protease-Inhibitor-Monotherapy-Versus-Ongoing-Triple therapy (PIVOT) trial. MAIN OUTCOME MEASURE NC testing comprised of 5 domains. Raw results were z-transformed using standard and demographically adjusted normative datasets (ND). Global z-scores (NPZ-5) were derived from averaging the 5 domains and percentage of subjects with test scores >1 standard deviation (SD) below population means in at least two domains (abnormal Frascati score) calculated. Patient characteristics associated with NC results were assessed using multivariable linear regression. RESULTS Of the 587 patients in PIVOT, 557 had full NC results and were included. 77% were male, 68% Caucasian and 28% of Black ethnicity. Mean (SD) baseline and nadir CD4+ lymphocyte counts were 553(217) and 177(117) cells/µL, respectively, and HIV RNA was <50 copies/mL in all. Median (IQR) NPZ-5 score was -0.5 (-1.2/-0) overall, and -0.3 (-0.7/0.1) and -1.4 (-2/-0.8) in subjects of Caucasian and Black ethnicity, respectively. Abnormal Frascati scores using the standard-ND were observed in 51%, 38%, and 81%, respectively, of subjects overall, Caucasian and Black ethnicity (p<0.001), but in 62% and 69% of Caucasian and Black subjects using demographically adjusted-ND (p = 0.20). In the multivariate analysis, only Black ethnicity was associated with poorer NPZ-5 scores (P<0.001). CONCLUSIONS In this large group of HIV-infected subjects with viral load suppression, ethnicity but not HIV-disease factors is closely associated with NC results. The prevalence of abnormal results is highly dependent on control datasets utilised. TRIAL REGISTRY ClinicalTrials.gov, NCT01230580