Hidden Drug Resistant HIV to Emerge in the Era of Universal Treatment Access in Southeast Asia

Background: Universal access to first-line antiretroviral therapy (ART) for HIV infection is becoming more of a reality in most low and middle income countries in Asia. However, second-line therapies are relatively scarce. Methods and Findings: We developed a mathematical model of an HIV epidemic in a Southeast Asian setting and used it to forecast the impact of treatment plans, without second-line options, on the potential degree of acquisition and transmission of drug resistant HIV strains. We show that after 10 years of universal treatment access, up to 20 % of treatment-naïve individuals with HIV may have drug-resistant strains but it depends on the relative fitness of viral strains. Conclusions: If viral load testing of people on ART is carried out on a yearly basis and virological failure leads to effective second-line therapy, then transmitted drug resistance could be reduced by 80%. Greater efforts are required for minimizing first-line failure, to detect virological failure earlier, and to procure access to second-line therapies

Gender differences in the use of cardiovascular interventions in HIV-positive persons; the D:A:D Study

Peer reviewe

Floral changes across the Triassic/Jurassic boundary linked to flood basalt volcanism

One of the five largest mass extinctions of the past 600 million years occurred at the boundary of the Triassic and Jurassic periods, 201.6 million years ago. The loss of marine biodiversity at the time has been linked to extreme greenhouse warming, triggered by the release of carbon dioxide from flood basalt volcanism in the central Atlantic Ocean. In contrast, the biotic turnover in terrestrial ecosystems is not well understood, and cannot be readily reconciled with the effects of massive volcanism. Here we present pollen, spore and geochemical analyses across the Triassic/Jurassic boundary from three drill cores from Germany and Sweden. We show that gymnosperm forests in northwest Europe were transiently replaced by fern and fern-associated vegetation, a pioneer assemblage commonly found in disturbed ecosystems. The Triassic/Jurassic boundary is also marked by an enrichment of polycyclic aromatic hydrocarbons, which, in the absence of charcoal peaks, we interpret as an indication of incomplete combustion of organic matter by ascending flood basalt lava. We conclude that the terrestrial vegetation shift is so severe and wide ranging that it is unlikely to have been triggered by greenhouse warming alone. Instead, we suggest that the release of pollutants such as sulphur dioxide and toxic compounds such as the polycyclic aromatic hydrocarbons may have contributed to the extinction