Sedentary nestlings of Wood Stork as monitors of mercury contamination in the gold mining region of the Brazilian Pantanal

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Sedentary organisms that are at top trophic levels allow inference about the level of local mercury contamination. We evaluated mercury contamination in feather tissue of nestling Wood Storks (Mycteria americana), sampled in different parts of the Brazilian Pantanal that were variably polluted by mercury releases from gold mining activities. Levels of mercury in feathers sampled in seven breeding colonies were determined by atomic absorption spectroscopy, and the mean value of mercury concentration was 0.557 mu g/g, dry weight (n=124), range 0.024-4.423 mu g/g. From this total sample, 21 feathers that represent 30% of nestlings collected in Porto da Fazenda and Tucum colonies, in the northern region, ranged from 1.0 to 4.43 mu g/g, dry weight (median value=1.87 mu/g). We found significant differences among regions (H=57.342; p=0<0.05). Results suggest that permanently flooded areas, or along mainstream rivers are more contaminated by mercury than dry areas, regardless of the distance from the gold mining center, which is located in the northern Pantanal. Highest values found in nestlings feathers were similar to those found in feathers of adult birds and in tissues of adult mammals that are less sedentary and were captured in the same region of Pantanal. These findings indicate that mercury released has been biomagnified and it is present in high concentrations in tissues of top consumers. We suggest a program to monitor mercury availability in this ecosystem using sedentary life forms of top predators like Wood Storks or other piscivorous birds. (C) 2011 Elsevier Inc. All rights reserved.111810911095Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)FAPESP [2000/02632-4, 2004/09321-5, 2004/15205-8, 2010/50406-5

Enhanced infection prophylaxis reduces mortality in severely immunosuppressed HIV-infected adults and older children initiating antiretroviral therapy in Kenya, Malawi, Uganda and Zimbabwe: the REALITY trial

Meeting abstract FRAB0101LB from 21st International AIDS Conference 18–22 July 2016, Durban, South Africa. Introduction: Mortality from infections is high in the first 6 months of antiretroviral therapy (ART) among HIV‐infected adults and children with advanced disease in sub‐Saharan Africa. Whether an enhanced package of infection prophylaxis at ART initiation would reduce mortality is unknown. Methods: The REALITY 2×2×2 factorial open‐label trial (ISRCTN43622374) randomized ART‐naïve HIV‐infected adults and children >5 years with CD4 <100 cells/mm3. This randomization compared initiating ART with enhanced prophylaxis (continuous cotrimoxazole plus 12 weeks isoniazid/pyridoxine (anti‐tuberculosis) and fluconazole (anti‐cryptococcal/candida), 5 days azithromycin (anti‐bacterial/protozoal) and single‐dose albendazole (anti‐helminth)), versus standard‐of‐care cotrimoxazole. Isoniazid/pyridoxine/cotrimoxazole was formulated as a scored fixed‐dose combination. Two other randomizations investigated 12‐week adjunctive raltegravir or supplementary food. The primary endpoint was 24‐week mortality. Results: 1805 eligible adults (n = 1733; 96.0%) and children/adolescents (n = 72; 4.0%) (median 36 years; 53.2% male) were randomized to enhanced (n = 906) or standard prophylaxis (n = 899) and followed for 48 weeks (3.8% loss‐to‐follow‐up). Median baseline CD4 was 36 cells/mm3 (IQR: 16–62) but 47.3% were WHO Stage 1/2. 80 (8.9%) enhanced versus 108(12.2%) standard prophylaxis died before 24 weeks (adjusted hazard ratio (aHR) = 0.73 (95% CI: 0.54–0.97) p = 0.03; Figure 1) and 98(11.0%) versus 127(14.4%) respectively died before 48 weeks (aHR = 0.75 (0.58–0.98) p = 0.04), with no evidence of interaction with the two other randomizations (p > 0.8). Enhanced prophylaxis significantly reduced incidence of tuberculosis (p = 0.02), cryptococcal disease (p = 0.01), oral/oesophageal candidiasis (p = 0.02), deaths of unknown cause (p = 0.02) and (marginally) hospitalisations (p = 0.06) but not presumed severe bacterial infections (p = 0.38). Serious and grade 4 adverse events were marginally less common with enhanced prophylaxis (p = 0.06). CD4 increases and VL suppression were similar between groups (p > 0.2). Conclusions: Enhanced infection prophylaxis at ART initiation reduces early mortality by 25% among HIV‐infected adults and children with advanced disease. The pill burden did not adversely affect VL suppression. Policy makers should consider adopting and implementing this low‐cost broad infection prevention package which could save 3.3 lives for every 100 individuals treated