Expanding HAART Treatment to All Currently Eligible Individuals under the 2008 IAS-USA Guidelines in British Columbia, Canada

Background In 2008, the IAS-USA published the revised guidelines for the use of HAART in adults substantially increasing the number of individuals eligible for HAART. The epidemic in British Columbia (BC) is mainly among men who have sex with men and those with injection drug use. Here, we explored the potential impact of different HAART coverage scenarios, based on the new guidelines, on the HIV-related incidence, morbidity and mortality in BC, Canada. Methodology We built a mathematical transmission model to investigate different HAART coverage scenarios (50%, 60%, 75% and 100%) of those medically eligible to receive HAART under the 2008 IAS guidelines. All new scenarios were compared to the current coverage in BC under the 2006 IAS guidelines (i.e. baseline scenario). In BC, it is estimated that 25–30% of individuals are unaware of their status. Costs were drug-related and reported in Canadian dollars. HIV-related morbidity and mortality were estimated based on the disability-adjusted life years (DALY) methodology. Principal Findings Currently, there are 4379 individuals on HAART under the IAS 2006 guidelines and 6781 individuals who qualify for treatment based on the new guidelines. Within 5 years, increasing HAART coverage decreased yearly new infections by at least 44.8%. In the 50% scenario, in 5 years, DALY decreased by 53% corresponding to 4155 averted DALYs, and in 25 years it decreased by 66% corresponding to 5837 averted DALYs. The effect was even stronger if the 75% scenario was chosen instead. Compared to the 100% expansion scenario, we observed an excess in annual direct treatment expenditures at the end of 5 years of approximately 1 million dollars in the 75% scenario, and of approximately 2 million dollars in the 50% scenario. Conclusions/Significance The individual and public health benefits of these new guidelines are immense. The results show that by increasing the number of individuals on HAART save lives, it is cost averting, and it positively impacts society by decreasing the number of new HIV infections. Thus, public health community should consider incremental gains when considering guidelines and policy

Life expectancy of persons receiving combination antiretroviral therapy in low-income countries: a cohort analysis from Uganda

Little is known about the effect of combination antiretroviral therapy (cART) on life expectancy in sub-Saharan Africa

The Statistical Approach to Quantifying Galaxy Evolution

Studies of the distribution and evolution of galaxies are of fundamental importance to modern cosmology; these studies, however, are hampered by the complexity of the competing effects of spectral and density evolution. Constructing a spectroscopic sample that is able to unambiguously disentangle these processes is currently excessively prohibitive due to the observational requirements. This paper extends and applies an alternative approach that relies on statistical estimates for both distance (z) and spectral type to a deep multi-band dataset that was obtained for this exact purpose. These statistical estimates are extracted directly from the photometric data by capitalizing on the inherent relationships between flux, redshift, and spectral type. These relationships are encapsulated in the empirical photometric redshift relation which we extend to z ~ 1.2, with an intrinsic dispersion of dz = 0.06. We also develop realistic estimates for the photometric redshift error for individual objects, and introduce the utilization of the galaxy ensemble as a tool for quantifying both a cosmological parameter and its measured error. We present deep, multi-band, optical number counts as a demonstration of the integrity of our sample. Using the photometric redshift and the corresponding redshift error, we can divide our data into different redshift intervals and spectral types. As an example application, we present the number redshift distribution as a function of spectral type.Comment: 40 pages (LaTex), 21 Figures, requires aasms4.sty; Accepted by the Astrophysical Journa

The Controversies and Difficulties of Diagnosing Primary Ciliary Dyskinesia

We welcome the correspondence from Lavie and Amirav (1), highlighting the difficulties diagnosing primary ciliary dyskinesia (PCD) and the role of high-speed video analysis (HSVA). As members of the European Respiratory Society (ERS) PCD Diagnostic Task Force (2) and/or large PCD Centres, we agree that HSVA has an important role that is not recognized by the American Thoracic Society (ATS) PCD Diagnostic Guideline (3). This risks a large proportion of false-negative “missed” diagnoses and a sizable number of false-positive cases; we make additional important observations.</div

BioNetGen 2.2: Advances in Rule-Based Modeling

BioNetGen is an open-source software package for rule-based modeling of complex biochemical systems. Version 2.2 of the software introduces numerous new features for both model specification and simulation. Here, we report on these additions, discussing how they facilitate the construction, simulation, and analysis of larger and more complex models than previously possible.Comment: 3 pages, 1 figure, 1 supplementary text file. Supplementary text includes a brief discussion of the RK-PLA along with a performance analysis, two tables listing all new actions/arguments added in BioNetGen 2.2, and the "BioNetGen Quick Reference Guide". Accepted for publication in Bioinformatic

Years of life lost to prison: racial and gender gradients in the United States of America

© 2008 Hogg et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Immunologic Response to Antiretroviral Therapy in Hepatitis C Virus-Coinfected Adults in a Population-Based HIV/AIDS Treatment Program

BackgroundWe sought to characterize the impact that hepatitis C virus (HCV) infection has on CD4 cells during the first 48 weeks of antiretroviral therapy (ART) in previously ART-naive human immunodeficiency virus (HIV)-infected patients MethodsThe HIV/AIDS Drug Treatment Programme at the British Columbia Centre for Excellence in HIV/AIDS distributes all ART in this Canadian province. Eligible individuals were those whose first-ever ART included 2 nucleoside reverse transcriptase inhibitors and either a protease inhibitor or a nonnucleoside reverse transcriptase inhibitor and who had a documented positive result for HCV antibody testing. Outcomes were binary events (time to an increase of ⩾75 CD4 cells/mm3 or an increase of ⩾10% in the percentage of CD4 cells in the total T cell population [CD4 cell fraction]) and continuous repeated measures. Statistical analyses used parametric and nonparametric methods, including multivariate mixed-effects linear regression analysis and Cox proportional hazards analysis ResultsOf 1186 eligible patients, 606 (51%) were positive and 580 (49%) were negative for HCV antibodies. HCV antibody-positive patients were slower to have an absolute (P<.001) and a fraction (P=.02) CD4 cell event. In adjusted Cox proportional hazards analysis (controlling for age, sex, baseline absolute CD4 cell count, baseline pVL, type of ART initiated, AIDS diagnosis at baseline, adherence to ART regimen, and number of CD4 cell measurements), HCV antibody-positive patients were less likely to have an absolute CD4 cell event (adjusted hazard ratio [AHR], 0.84 [95% confidence interval {CI}, 0.72-0.98]) and somewhat less likely to have a CD4 cell fraction event (AHR, 0.89 [95% CI, 0.70-1.14]) than HCV antibody-negative patients. In multivariate mixed-effects linear regression analysis, HCV antibody-negative patients had increases of an average of 75 cells in the absolute CD4 cell count and 4.4% in the CD4 cell fraction, compared with 20 cells and 1.1% in HCV antibody-positive patients, during the first 48 weeks of ART, after adjustment for time-updated pVL, number of CD4 cell measurements, and other factors ConclusionHCV antibody-positive HIV-infected patients may have an altered immunologic response to AR

Using Google Trends to Inform the Population Size Estimation and Spatial Distribution of Gay, Bisexual, and Other Men Who Have Sex With Men: Proof-of-concept Study

Background:We must triangulate data sources to understand best the spatial distribution and population size of marginalized populations to empower public health leaders to address population-specific needs. Existing population size estimation techniques are difficult and limited.&nbsp;Objective:We sought to identify a passive surveillance strategy that utilizes internet and social media to enhance, validate, and triangulate population size estimates of gay, bisexual, and other men who have sex with men (gbMSM).&nbsp;Methods:We explored the Google Trends platform to approximate an estimate of the spatial heterogeneity of the population distribution of gbMSM. This was done by comparing the prevalence of the search term “gay porn” with that of the search term “porn.”&nbsp;Results:Our results suggested that most cities have a gbMSM population size between 2% and 4% of their total population, with large urban centers having higher estimates relative to rural or suburban areas. This represents nearly a double up of population size estimates compared to that found by other methods, which typically find that between 1% and 2% of the total population are gbMSM. We noted that our method was limited by unequal coverage in internet usage across Canada and differences in the frequency of porn use by gender and sexual orientation.&nbsp;Conclusions:We argue that Google Trends estimates may provide, for many public health planning purposes, adequate city-level estimates of gbMSM population size in regions with a high prevalence of internet access and for purposes in which a precise or narrow estimate of the population size is not required. Furthermore, the Google Trends platform does so in less than a minute at no cost, making it extremely timely and cost-effective relative to more precise (and complex) estimates. We also discuss future steps for further validation of this approach