Agreement between the Chinese Academy of Agricultural Sciences and the International Maize and Wheat Improvement Center

Agreement between CAAS and CIMMYT signed in Beijing, China on September 25, 1997. Agreement establishes cooperation for the promotion and acceleration in research and training for the scientific improvement of wheat and maize for China and other countries set forth in nine articles

Time since HIV-1⁺ diagnosis until disease progression in patients who have been infected with HIV-1 for more than 7 years and who remain symptomless in the absence of ART.

<p>Patients are stratified according to a history of at least one CD4⁺ T-cell count below the normal range (<450 cells/µl blood).</p>†, ‡<p>See <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0029844#pone-0029844-g001" target="_blank">Figure 1</a> for definition of patient groups.</p>#<p>median (IQR) years.</p><p>p-values using the Logrank chi-squared test.</p

CD4⁺ T-cell counts over the time since HIV-1⁺ diagnosis of (A) 13 LTNP, one of whom fulfilled HIC status, with VLBLD, as detailed in the key and (B) 37 patients with long-term stable low CD4⁺ T-cell count, 3 of whom maintained HIV-1 RNA load to BLD.

<p>Dashed horizontal lines indicate the normal healthy range of CD4⁺ T-cell count (450–1650 cells/µl blood), and a solid vertical line shows the time point 7 years post HIV-1⁺ diagnosis. Repeated CD4 T-cell counts are plotted at the time points indicated, where different symbols represent different individual patients.</p

Synonyms used to describe HIV-1⁺ patients exhibiting atypical disease progression.

<p>No internationally recognised consensus for terminology currently exists, making comparison between studies difficult. ¹<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0029844#pone.0029844-Klein1" target="_blank">[21]</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0029844#pone.0029844-Cao1" target="_blank">[22]</a>, ²<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0029844#pone.0029844-Westrop1" target="_blank">[5]</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0029844#pone.0029844-Deeks1" target="_blank">[6]</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0029844#pone.0029844-Grabar1" target="_blank">[19]</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0029844#pone.0029844-Lambotte1" target="_blank">[23]</a>, ³<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0029844#pone.0029844-Walker1" target="_blank">[24]</a>, ⁴<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0029844#pone.0029844-Deeks1" target="_blank">[6]</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0029844#pone.0029844-Migueles1" target="_blank">[18]</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0029844#pone.0029844-Grabar1" target="_blank">[19]</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0029844#pone.0029844-Walker1" target="_blank">[24]</a>, ⁵<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0029844#pone.0029844-Deeks1" target="_blank">[6]</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0029844#pone.0029844-Han1" target="_blank">[25]</a>, ⁶<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0029844#pone.0029844-Grabar1" target="_blank">[19]</a>, ⁷<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0029844#pone.0029844-Westrop1" target="_blank">[5]</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0029844#pone.0029844-Deeks1" target="_blank">[6]</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0029844#pone.0029844-Lefrre1" target="_blank">[16]</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0029844#pone.0029844-Migueles1" target="_blank">[18]</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0029844#pone.0029844-Grabar1" target="_blank">[19]</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0029844#pone.0029844-Lambotte1" target="_blank">[23]</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0029844#pone.0029844-Aiuti1" target="_blank">[26]</a>–<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0029844#pone.0029844-Migueles3" target="_blank">[28]</a>, ⁸<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0029844#pone.0029844-Lefrre1" target="_blank">[16]</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0029844#pone.0029844-Migueles2" target="_blank">[27]</a>.</p

Flow chart detailing the identification of LTNP and patients with long-term stable low CD4⁺ T-cell counts from the Chelsea and Westminster HIV Cohort, during the study period 1988–2010.

<p>Flow chart detailing the identification of LTNP and patients with long-term stable low CD4⁺ T-cell counts from the Chelsea and Westminster HIV Cohort, during the study period 1988–2010.</p

Expanded HIV Testing in Low-Prevalence, High-Income Countries: A Cost-Effectiveness Analysis for the United Kingdom

<div><p>Objective</p><p>In many high-income countries with low HIV prevalence, significant numbers of persons living with HIV (PLHIV) remain undiagnosed. Identification of PLHIV via HIV testing offers timely access to lifesaving antiretroviral therapy (ART) and decreases HIV transmission. We estimated the effectiveness and cost-effectiveness of HIV testing in the United Kingdom (UK), where 25% of PLHIV are estimated to be undiagnosed.</p><p>Design</p><p>We developed a dynamic compartmental model to analyze strategies to expand HIV testing and treatment in the UK, with particular focus on men who have sex with men (MSM), people who inject drugs (PWID), and individuals from HIV-endemic countries.</p><p>Methods</p><p>We estimated HIV prevalence, incidence, quality-adjusted life years (QALYs), and health care costs over 10 years, and cost-effectiveness.</p><p>Results</p><p>Annual HIV testing of all adults could avert 5% of new infections, even with no behavior change following HIV diagnosis because of earlier ART initiation, or up to 18% if risky behavior is halved. This strategy costs £67,000–£106,000/QALY gained. Providing annual testing only to MSM, PWID, and people from HIV-endemic countries, and one-time testing for all other adults, prevents 4–15% of infections, requires one-fourth as many tests to diagnose each PLHIV, and costs £17,500/QALY gained. Augmenting this program with increased ART access could add 145,000 QALYs to the population over 10 years, at £26,800/QALY gained.</p><p>Conclusions</p><p>Annual HIV testing of key populations in the UK is very cost-effective. Additional one-time testing of all other adults could identify the majority of undiagnosed PLHIV. These findings are potentially relevant to other low-prevalence, high-income countries.</p></div

Projected annual HIV incidence over time in the UK under different testing strategies.

<p>The six graphs correspond to six different risk groups in the UK, with projected annual HIV incidence per 100,000 people shown under current testing and treatment levels (black solid line), universal annual testing of all adults (blue dashed), or universal annual testing coupled with antiretroviral therapy (ART) initiation of 75% at CD4 <350 cells/mm³ (red dotted). The cumulative number of new HIV infections over 10 years is given in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0095735#pone-0095735-t003" target="_blank">Table 3</a>.</p

Summary of key model parameters.

<p>ART = antiretroviral therapy; MSM = men who have sex with men; PWID = people who inject drugs.</p><p>* Quality of life for all PWID is multiplied by this factor, across all health states.</p><p>** Under current UK guidelines <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0095735#pone.0095735-British2" target="_blank">[24]</a>, individuals who are screened for HIV are given a pre-test counseling session and a post-test counseling session.</p><p>The length of the post-test counseling session depends on the outcome of the HIV test.</p

Projected outcomes under different testing strategies.

<p>* Model-projected new HIV infections in the UK between 2013 and 2022 under status quo testing and treatment levels, and projected number of averted infections with increased testing and treatment in parentheses. Three scenarios for the reduction in risky sexual behavior following HIV diagnosis are given.</p><p>** Incremental costs and quality-adjusted life years (QALYs) discounted to the present, are relative to the status quo, assuming a 25% reduction in risky sexual behavior following HIV diagnosis.</p>†<p>Strategies that are dominated, i.e., have higher costs but generate fewer health benefits than a combination of other strategies.</p

Cost-effectiveness of alternative HIV testing and treatment strategies in the UK.

<p>The incremental costs (x-axis) and QALYs (y-axis) of different HIV testing and treatment scenarios are shown, relative to status quo levels. The blue points correspond to universal HIV testing strategies for all adults, with testing every one, two, or three years. The green points correspond to targeted strategies, with annual testing for high-risk persons and testing every two years or one-time for all other persons. The red points correspond to an expanded HIV testing program coupled with 75% antiretroviral therapy initiation of at CD4 <350 cells/mm³. The solid black line marks the cost-effectiveness frontier, or the set of strategies that is most economically efficient, and the corresponding incremental cost-effectiveness ratios are given. Costs and QALYs are discounted at 3% annually, and include the direct costs of the programs over 10 years, as well as the lifetime costs and QALYs of all individuals in the population. HR = high-risk, and includes men who have sex with men (MSM), people who inject drugs (PWID), and men and women from HIV-endemic countries. LR = low-risk, and includes men and women who do not belong to the identified key populations. ART = antiretroviral therapy. QALY = quality-adjusted life year.</p