Effectiveness and safety of oral HIV preexposure prophylaxis for all populations.

ObjectivePreexposure prophylaxis (PrEP) offers a promising new approach to HIV prevention. This systematic review and meta-analysis evaluated the evidence for use of oral PrEP containing tenofovir disoproxil fumarate as an additional HIV prevention strategy in populations at substantial risk for HIV based on HIV acquisition, adverse events, drug resistance, sexual behavior, and reproductive health outcomes.DesignRigorous systematic review and meta-analysis.MethodsA comprehensive search strategy reviewed three electronic databases and conference abstracts through April 2015. Pooled effect estimates were calculated using random-effects meta-analysis.ResultsEighteen studies were included, comprising data from 39 articles and six conference abstracts. Across populations and PrEP regimens, PrEP significantly reduced the risk of HIV acquisition compared with placebo. Trials with PrEP use more than 70% demonstrated the highest PrEP effectiveness (risk ratio = 0.30, 95% confidence interval: 0.21-0.45, P < 0.001) compared with placebo. Trials with low PrEP use did not show a significantly protective effect. Adverse events were similar between PrEP and placebo groups. More cases of drug-resistant HIV infection were found among PrEP users who initiated PrEP while acutely HIV-infected, but incidence of acquiring drug-resistant HIV during PrEP use was low. Studies consistently found no association between PrEP use and changes in sexual risk behavior. PrEP was not associated with increased pregnancy-related adverse events or hormonal contraception effectiveness.ConclusionPrEP is protective against HIV infection across populations, presents few significant safety risks, and there is no evidence of behavioral risk compensation. The effective and cost-effective use of PrEP will require development of best practices for fostering uptake and adherence among people at substantial HIV risk

Provisioning Services Decline for Both People and Critically Endangered Wildlife in a Rainforest Transformation Landscape

The loss and degradation of forests and other ecosystems worldwide threaten both global biodiversity and the livelihoods of people who use natural resources. Understanding how natural resource use impacts landscape provisioning services for both people and wildlife is thus critical for designing comprehensive resource management strategies. We used data from community focus groups, botanical plots and an inventory of plant species consumed by the Critically Endangered red-ruffed lemur (Varecia rubra) to assess the availability of key provisioning services for people and endemic wildlife on the Masoala Peninsula, a rainforest transformation landscape, in northeastern Madagascar (Masoala National Park and 13 surrounding communities). We constructed Poisson regression mixed models to evaluate the impact of community factors (i.e. community population size, plot distance to community) and changes over time on the count and species richness of timber trees, medicinal plants and red-ruffed lemur food trees within botanical plots. Over three-quarters of all plant species could be used for at least one purpose by local communities (n = 238 species). Of the 59 V. rubra food tree species, only 15% had no reported human use. Timber and ruffed lemur food tree availability declined both with community population size and time and were predicted to be lower outside of Masoala National Park. In contrast, medicinal plant availability was not strongly predicted by any tested factors. Provisioning service availability also differed strongly across sites, suggesting that additional, untested proxies of human pressure likely also have an effect. Our results highlight the importance of evaluating natural resource availability from a community-based perspective and by resource purpose to inform forest landscape restoration efforts that can support both people and wildlife

Oral abstracts of the 21st International AIDS Conference 18-22 July 2016, Durban, South Africa

The rate at which HIV-1 infected individuals progress to AIDS is highly variable and impacted by T cell immunity. CD8 T cell inhibitory molecules are up-regulated in HIV-1 infection and associate with immune dysfunction. We evaluated participants (n=122) recruited to the SPARTAC randomised clinical trial to determine whether CD8 T cell exhaustion markers PD-1, Lag-3 and Tim-3 were associated with immune activation and disease progression.Expression of PD-1, Tim-3, Lag-3 and CD38 on CD8 T cells from the closest pre-therapy time-point to seroconversion was measured by flow cytometry, and correlated with surrogate markers of HIV-1 disease (HIV-1 plasma viral load (pVL) and CD4 T cell count) and the trial endpoint (time to CD4 count <350 cells/μl or initiation of antiretroviral therapy). To explore the functional significance of these markers, co-expression of Eomes, T-bet and CD39 was assessed.Expression of PD-1 on CD8 and CD38 CD8 T cells correlated with pVL and CD4 count at baseline, and predicted time to the trial endpoint. Lag-3 expression was associated with pVL but not CD4 count. For all exhaustion markers, expression of CD38 on CD8 T cells increased the strength of associations. In Cox models, progression to the trial endpoint was most marked for PD-1/CD38 co-expressing cells, with evidence for a stronger effect within 12 weeks from confirmed diagnosis of PHI. The effect of PD-1 and Lag-3 expression on CD8 T cells retained statistical significance in Cox proportional hazards models including antiretroviral therapy and CD4 count, but not pVL as co-variants.Expression of ‘exhaustion’ or ‘immune checkpoint’ markers in early HIV-1 infection is associated with clinical progression and is impacted by immune activation and the duration of infection. New markers to identify exhausted T cells and novel interventions to reverse exhaustion may inform the development of novel immunotherapeutic approaches

Engaging Patients in Self-Care Management of Type II Diabetes Mellitus in Primary Care

Improving self-care among patients diagnosed with type II diabetes mellitus (DMII) shows improved outcomes for patients. Diabetic self-management education is an effective way to help patients control their blood sugar, the education must be costeffective while satisfying the patient’s needs and desires (Chrvala et al., 2015). In a primary care clinic, chronic care management (CCM) was provided through weekly telephone conversation with a nurse to total 20 minutes of monthly conversation. Over a one-month time frame, a pre and post intervention survey were obtained from patients enrolled in the CCM program. This program allows providers and nurses to have frequent contact with the patient reinforcing education and improving self-care management of DMII patients at the same time receiving reimbursement for documented time spent

Radiochemical stability of the dicyclohexano-18-crown-6 ether (DCH18C6): synthesis and tests in radioactive medium of the DCH18C6 radiolytic products

The cis-syn-cis isomer of the dicyclohexano-18-crown-6 ether (DCH18C6) was subjected to hydrolysis and radiolysis with a 137Cs gamma source, at different doses of irradiation. The cis-syn-cis DCH18C6 radiolytic products previously identified [1], were synthesized in their different configurations. These radiolytic products, all of cis configuration, were tested on aqueous synthetic solutions of spent nuclear fuels. Experiments in radioactive medium showed that, under continuous extraction conditions, the cis-syn-cis DCH18C6 radiolytic products cannot perturb a reprocessing process using the DCH18C6 as selective extractant. Good prospects for the application of DCH18C6 to spent nuclear fuel reprocessing were therefore demonstrated. An X-ray crystallographic study of the DCH18C6 cis-syn-cis-isomer with uranyl nitrate was investigated

Radiochemical stability of the dicyclohexano-18-crown-6 ether (DCH18C6): synthesis and tests in radioactive medium of the DCH18C6 radiolytic products

The cis-syn-cis isomer of the dicyclohexano-18-crown-6 ether (DCH18C6) was subjected to hydrolysis and radiolysis with a 137Cs gamma source, at different doses of irradiation. The cis-syn-cis DCH18C6 radiolytic products previously identified [1], were synthesized in their different configurations. These radiolytic products, all of cis configuration, were tested on aqueous synthetic solutions of spent nuclear fuels. Experiments in radioactive medium showed that, under continuous extraction conditions, the cis-syn-cis DCH18C6 radiolytic products cannot perturb a reprocessing process using the DCH18C6 as selective extractant. Good prospects for the application of DCH18C6 to spent nuclear fuel reprocessing were therefore demonstrated. An X-ray crystallographic study of the DCH18C6 cis-syn-cis-isomer with uranyl nitrate was investigated

Effectiveness and safety of oral HIV preexposure prophylaxis for all populations.

ObjectivePreexposure prophylaxis (PrEP) offers a promising new approach to HIV prevention. This systematic review and meta-analysis evaluated the evidence for use of oral PrEP containing tenofovir disoproxil fumarate as an additional HIV prevention strategy in populations at substantial risk for HIV based on HIV acquisition, adverse events, drug resistance, sexual behavior, and reproductive health outcomes.DesignRigorous systematic review and meta-analysis.MethodsA comprehensive search strategy reviewed three electronic databases and conference abstracts through April 2015. Pooled effect estimates were calculated using random-effects meta-analysis.ResultsEighteen studies were included, comprising data from 39 articles and six conference abstracts. Across populations and PrEP regimens, PrEP significantly reduced the risk of HIV acquisition compared with placebo. Trials with PrEP use more than 70% demonstrated the highest PrEP effectiveness (risk ratio = 0.30, 95% confidence interval: 0.21-0.45, P &lt; 0.001) compared with placebo. Trials with low PrEP use did not show a significantly protective effect. Adverse events were similar between PrEP and placebo groups. More cases of drug-resistant HIV infection were found among PrEP users who initiated PrEP while acutely HIV-infected, but incidence of acquiring drug-resistant HIV during PrEP use was low. Studies consistently found no association between PrEP use and changes in sexual risk behavior. PrEP was not associated with increased pregnancy-related adverse events or hormonal contraception effectiveness.ConclusionPrEP is protective against HIV infection across populations, presents few significant safety risks, and there is no evidence of behavioral risk compensation. The effective and cost-effective use of PrEP will require development of best practices for fostering uptake and adherence among people at substantial HIV risk