ResearchPad - aids https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Disseminated Histoplasmosis: Fighting a neglected killer of patients with advanced HIV disease in Latin America]]> https://www.researchpad.co/article/elastic_article_14538 <![CDATA[Pneumonia Caused by Three Separate Microorganisms Simultaneously in a Patient Infected with Human Immunodeficiency Virus]]> https://www.researchpad.co/article/elastic_article_10519 Community-acquired pneumonia (CAP) is usually caused by a single microorganism. Streptococcus pneumoniae is the most common organism associated with CAP. However, in immunocompromised patients, especially those infected with human immunodeficiency virus (HIV), pneumonia may be caused by multiple organisms simultaneously. This report describes a previously healthy 29-year-old man who presented with acute CAP. Blood tests showed that he was positive for HIV antigen/antibody, and urinalysis showed that he was initially positive for pneumococcal antigen. Although blood cultures showed growth of Streptococcus pneumoniae, he did not respond to invasive anti-pneumococcal treatment with ceftriaxone and vancomycin. Rather, his pneumonia worsened, and he was intubated for hypoxic respiratory failure. His bronchoalveolar lavage fluid was positive for Pneumocystis pneumonia and methicillin-resistant Staphylococcus aureus. These findings indicate that pneumonia in immunocompromised patients may be caused by multiple organisms. Patients who fail to respond to treatment for a single identified organism should be suspected of being infected with other pathogenic organisms.

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<![CDATA[Linkage and independence of AIDS and kaposi disease: The interaction of human immunodeficiency virus and some coagents]]> https://www.researchpad.co/article/Nd496d2c8-7099-4478-8a39-01826b2dbe62

Summary

Through epidemiological considerations we conclude that full-blown AIDS may occur only if the index patient is infected by the human immunodeficiency virus (HIV) and, in addition, by some other infectious coagent. Since the dynamical behaviour of the spread of AIDS cases with manifestation of Kaposi's sarcoma differs fundamentally from that of the non-Kaposi cases, we conjecture that two independent coagents (together with HIV) are responsible for the outbreak of full-blown AIDS with or without manifestation of Kaposi's sarcoma, respectively. Our formal epidemiological considerations appear to be supported by recent microbiological findings.

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<![CDATA[A Case of Histoplasmosis with Central Nervous System Relapse after Itraconazole Therapy Needs Further Research]]> https://www.researchpad.co/article/N9ef98422-7009-4aaf-84c9-0ee6bb6b2f86

Central nervous system (CNS) histoplasmosis occurs in 5-20% of all cases and is most commonly seen in immunosuppressed patients who have acquired immunodeficiency syndrome (AIDS) or have received organ transplant. The prevalence of histoplasmosis in patients greater than 65 years old between the years of 1999-2008 in the state of Texas was about 2-3 cases per 100,000 patients year. Since 1990 with the discovery of Triazoles, itraconazole (ICZ) has become the standard initial and suppressive therapy in patients with mild-moderate histoplasmosis without CNS involvement. However, poor penetration of ICZ into the brain, in vitro fluconazole resistance and lack of controlled-trials pose challenge in the treatment of cerebral histoplasmosis.

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<![CDATA[Viral Pathogens Including Human Metapneumovirus Are the Primary Cause of Febrile Respiratory Illness in HIV-Infected Adults Receiving Antiretroviral Therapy]]> https://www.researchpad.co/article/Nf83ae318-12e5-4c6d-88f2-feab337edfad

Abstract

To determine the spectrum of pathogens causing acute febrile respiratory illness in human immunodeficiency virus (HIV)-infected adus, we re-analyzed data from a prospective surveillance study involving 50 outpatients (90% of whom received highly active antiretroviral therapy). Nasopharyngeal samples were tested for 23 respiratory viruses by multiplex reverse-transcriptase polymerase chain reaction (PCR) and for atypical bacteria by PCR. Sputum cultures and serological testing were performed. Viruses accounted for 64% of infections. After influenza (22 cases), humanmetapneumovirus infection (6 cases) was most common and was associated with bronchospasm. Bacterial infections occurred in 6 patients (3 of whom had concurrent viral infection). Over 80% of patients received antibiotics. Rapid testing to identify specific viral pathogens could aid in patient management and reduce unnecessary antibiotic exposure.

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<![CDATA[Human Metapneumovirus–Associated Lower Respiratory Tract Infections among Hospitalized Human Immunodeficiency Virus Type 1 (HIV-1)–Infected and HIV-1–Uninfected African Infants]]> https://www.researchpad.co/article/Nfd36571a-0268-4d3c-b6a5-ee748471a5c6

Abstract

Respiratory tract infections due to human metapneumovirus (hMPV) have been reported worldwide, with the exception of Africa. The prevalence of hMPV infection was studied among human immunodeficiency virus type 1 (HIV-1)–infected and HIV-1–uninfected African infants who were hospitalized for lower respiratory tract infections (LRTIs). Nasopharyngeal aspirate samples obtained from 81 HIV-1–infected and 110 HIV-1–uninfected infants who had tested negative for other respiratory viruses were selected for investigation. hMPV was detected in 10 HIV-1–uninfected infants (9.1%) and 3 HIV-1–infected infants (3.7%). Compared with the entire cohort of HIV-1–uninfected infants, hMPV was 4.6-fold less common than respiratory syncytial virus, but it was 3.2-fold more common than influenza virus and 2.1-fold more common than parainfluenza virus types 1–3. Genotyping of 7 of 14 isolates revealed the circulation of 2 major phylogenetic groups of the virus, which were similar to those described in North America and Europe.

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<![CDATA[Antiretroviral drug class and anaemia risk in the current treatment era among people living with HIV in the USA: a clinical cohort study]]> https://www.researchpad.co/article/N5c70f58a-6052-438a-9a3a-a77390266cb8

Objective

Anaemia is common among people living with HIV (PLWH) and has been associated with certain, often older, antiretroviral medications. Information on current antiretroviral therapy (ART) and anaemia is limited. The objective was to compare the associations between anaemia incidence or haemoglobin change with core ART classes in the current ART era.

Design

Retrospective cohort study.

Setting

USA-based prospective clinical cohort of PLWH aged 18 and above receiving care at eight sites between January 2010 and March 2018.

Participants

16 505 PLWH were included in this study.

Main outcome measures

Anaemia risk and haemoglobin change were estimated among PLWH for person-time on a protease inhibitor (PI) or an integrase strand transfer inhibitor (INSTI)-based regimen, relative to a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based reference. We also examined PLWH on regimens containing multiple core classes. Cox proportional hazards regression analyses were conducted to measure the associations between time-updated ART classes and incident anaemia or severe anaemia. Linear mixed effects models were used to examine the relationships between ART classes and haemoglobin change.

Results

During a median of 4.9 years of follow-up, 1040 developed anaemia and 488 developed severe anaemia. Compared with NNRTI use, INSTI-based regimens were associated with an increased risk of anaemia (adjusted HR (aHR) 1.26, 95% CI 1.00 to 1.58) and severe anaemia (aHR 1.51, 95% CI 1.07 to 2.11) and a decrease in haemoglobin level. Time on multiple core classes was also associated with increased anaemia risk (aHR 1.39, 95% CI 1.13 to 1.70), while no associations were found for PI use.

Conclusion

These findings suggest INSTI use may increase the risk of anaemia. If confirmed, screening for anaemia development in users of INSTIs may be beneficial. Further research into the underlying mechanisms is warranted.

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<![CDATA[Levels of Human Immunodeficiency Virus DNA Are Determined Before ART Initiation and Linked to CD8 T-Cell Activation and Memory Expansion]]> https://www.researchpad.co/article/N3e529d64-77b2-4805-8b00-ed5d04634847

Abstract

Initiation of antiretroviral therapy (ART) in early compared with chronic human immunodeficiency virus (HIV) infection is associated with a smaller HIV reservoir. This longitudinal analysis of 60 individuals who began ART during primary HIV infection (PHI) investigates which pre- and posttherapy factors best predict HIV DNA levels (a correlate of reservoir size) after treatment initiation during PHI. The best predictor of HIV DNA at 1 year was pre-ART HIV DNA, which was in turn significantly associated with CD8 memory T-cell differentiation (effector memory, naive, and T-betEomes subsets), CD8 T-cell activation (CD38 expression) and T-cell immunoglobulin and mucin-domain containing-3 (Tim-3) expression on memory T cells. No associations were found for any immunological variables after 1 year of ART. Levels of HIV DNA are determined around the time of ART initiation in individuals treated during PHI. CD8 T-cell activation and memory expansion are linked to HIV DNA levels, suggesting the importance of the initial host-viral interplay in eventual reservoir size.

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<![CDATA[Zulu Men’s Conceptions, Understanding, and Experiences of Voluntary Medical Male Circumcision in KwaZulu-Natal, South Africa]]> https://www.researchpad.co/article/N90a09506-b117-495a-926a-c8412678a822

Voluntary Medical Male Circumcision (VMMC) is proven to reduce transmission of HIV/AIDS. Despite concerted efforts to scale up VMMC in men aged 18–49, the number of medically circumcised men in this age group remains suboptimal. Research has shown that several individual factors hinder and promote uptake of VMMC. The nature of these factors is not clearly understood within the dimensions of religion, culture and tradition, particularly in a low-income rural setting. This study aimed to analyze Zulu men’s conceptions, understanding and experiences regarding VMMC in KwaZulu-Natal (KZN), South Africa. A qualitative phenomenographic study approach was used to collect data from 20 uncircumcised males at six different clinics that provide VMMC services. Ethical approval to collect data was obtained from the Biomedical Research Ethics Committee of the University of KZN (BREC – BE627/18). Individual in-depth face to face interviews were conducted using a semistructured interview guide. Audiotapes were used to record interviews which were transcribed verbatim and then analyzed manually. The conceptions regarding medical circumcision appeared to be related to religious and cultural beliefs surrounding circumcision and the historical traditional practice thereof. The understanding of males regarding VMMC was mainly attributed to HIV prevention; however, knowledge on the degree of partial protection appeared to be limited. An array of negative accounted in the form of complications such as poor wound healing and postoperative pain undergone by peers and other close influencers’ accounted for participants’ experiences of VMMC. Poor knowledge and negative experiences relating to VMMC could account for reasons why men choose not to undergo VMMC.

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<![CDATA[Atypical Tinea Corporis Revealing a Human Immunodeficiency Virus Infection]]> https://www.researchpad.co/article/Nf61ad699-9358-4da7-950c-e7f1bb668a45

Dermatophytes are fungi that commonly cause superficial skin infections. While these rashes are typically benign and easily treated with topical antifungal medications, extensive presentations can indicate a more serious underlying immunodeficiency. We report on a teenage girl whose extensive rash led to a diagnosis of human immunodeficiency infection.

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<![CDATA[Protocol for a prospective evaluation of postpartum engagement in HIV care among women living with HIV in South Africa]]> https://www.researchpad.co/article/Nb65d2c91-054d-4cb1-8875-65677450ef0c

Introduction

KwaZulu-Natal (KZN), South Africa (SA) has the highest prevalence of pregnant women living with HIV in the world. Pregnancy and the postpartum period offer opportunities to engage women in HIV care, to prevent perinatal transmission and to optimise maternal and infant well-being. However, research suggests that remaining engaged in HIV care during this time can be challenging.

Methods and analysis

We are conducting a 5-year prospective cohort study among pregnant women living with HIV in KZN to estimate the rates and factors associated with attrition from HIV care during this critical period. To determine who is most likely to fall out of care, we are examining a range of relevant variables informed by a socioecological model of HIV care, including individual, relational, community and healthcare system variables. We are enrolling 18–45-year-old women, at 28 weeks or more of pregnancy, who are living with HIV and currently taking antiretroviral therapies. Participants complete quantitative assessments at baseline (pregnancy) and at 6, 12, 18 and 24 months postpartum. A subset of women and their partners are invited to complete qualitative interviews to further explore their experiences in HIV care. The main study outcomes are suppressed HIV RNA and retention in care at each study assessment. Our understanding of the factors that drive postpartum attrition from HIV care will ultimately inform the development of interventions to facilitate continued engagement in postpartum HIV care.

Ethics and dissemination

This protocol has been approved by the Human Research Ethics Committee (Medical) at The University of the Witwatersrand (Johannesburg, SA) and the Partners Human Research Committee at Partners HealthCare (Boston, Massachusetts, USA). Site support and approval were obtained from the District Hospital and the KZN Provincial Department of Health. Results will be disseminated through peer-reviewed manuscripts, reports and both local and international presentations (Ethics Registration #170 212).

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<![CDATA[Acute Retroviral Syndrome Presenting as Acute Hepatitis]]> https://www.researchpad.co/article/5c8bfc61d5eed0c484b2587b

Acute retroviral syndrome (ARS) can present as a wide array of clinical manifestations. Establishing a diagnosis early in the disease course can provide an opportunity to minimize immunosuppression and limit further transmission of human immunodeficiency virus (HIV). We present a case of a previously healthy young male who presented with acute hepatitis, as a manifestation of ARS. Initial HIV antigen/antibody testing was negative; however, a high index of suspicion prompted HIV ribonucleic acid (RNA) virologic testing revealing >10 million RNA copies/mL. Anti-retroviral treatment was initiated, along with supportive measures, accomplishing resolution of the transaminitis and the restoration of CD4 counts within normal at one month. Early in the disease course, HIV screening immunoassay could still be negative; hence, confirmatory testing with HIV RNA virologic testing should be pursued when clinical suspicion is high. Prompt diagnosis and treatment can improve outcome and curtail viral transmission.

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<![CDATA[Treatment of HIV among tuberculosis patients: A replication study of timing of antiretroviral therapy for HIV-1-associated tuberculosis]]> https://www.researchpad.co/article/5c5df36fd5eed0c4845812c9

Co-diagnosis of HIV and tuberculosis presents a treatment dilemma. Starting both treatments at the same time can cause a flood of immune response called immune reconstitution inflammatory syndrome (IRIS) which can be lethal. But, how long to delay HIV treatment is less understood. In 2011, based on the conclusions of three separate studies, WHO recommended starting HIV treatment earlier for those with later HIV disease progression. This paper conducts a replication study of one of the three studies, by Havlir and colleagues. Using their publicly available data, we were able to replicate most of the results presented in the original paper. In our measurement and estimation analyses we use different estimation techniques to assess the robustness of the results. We find that adjusting for loss to follow-up does not affect the main results of the paper. However, an ANCOVA estimation and an instrumental variable model weaken the main result of the paper of better outcomes with early HIV treatment only for those who are sicker, reducing significance from the 5% to the 10% level. A change-point analysis also detects no changes in effect by timing of HIV treatment initiation or different thresholds of CD4 count for the primary outcome. This result suggests that the choice of start time for HIV treatment initiation should be based on other factors including potential drug interactions, overlapping side effects, a high pill burden and severity of illness rather than CD4 threshold and preset timeframes. While we caution against overgeneralizing, the result of this replication is aligned with more recent studies that show no evidence that early initiation of HIV treatment reduces mortality for any patients.

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<![CDATA[Prevalence and correlates of lifetime and recent HIV testing among men who have sex with men (MSM) who use mobile geo-social networking applications in Greater Tokyo]]> https://www.researchpad.co/article/5c5217c1d5eed0c4847944f2

Men who have sex with men (MSM) are disproportionately burdened by the human immunodeficiency virus (HIV), accounting for 78% of all Japanese male HIV cases in 2016. Over 30% of newly identified HIV infections in Japan are diagnosed as AIDS annually, suggesting a large proportion of people living with HIV were unaware of their own infection status. An estimated two-thirds of Japanese men who have sex with men (MSM) are not attached to the gay community, and previous studies have largely sampled gay venues, thus, previous studies have likely failed to reach many men in this population. This study therefore examined HIV testing prevalence and correlates among MSM in Greater Tokyo who use gay mobile geo-social networking applications (gay mobile apps), which have been found to increase access to MSM not traditionally accessible through venue-based surveys. Among a sample of 1657 MSM recruited through advertisements on gay mobile apps, the prevalence of lifetime and six-monthly HIV testing was 72.8% and 29.7% respectively. In multiple regression analysis, higher lifetime HIV testing was associated with older age, education, HIV knowledge, anal intercourse with regular and casual male partners, and gay venue attendance. Testing was negatively associated with regular male partner condom use, marriage, residing outside central Tokyo and having both male and female partners. These results indicated that MSM who use gay mobile apps in Greater Tokyo do not meet the CDC yearly testing recommendations for high risk populations. Considering limited HIV prevention funding in Japan for MSM, moderate lifetime and recent testing, and the large number of gay mobile app users, utilization of popular gay mobile apps to promote nearby HIV testing facilities may be an effective prevention policy to target non-community attached MSM, particularly at-risk youth and individuals at risk of sudden-onset AIDS.

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<![CDATA[Sensitivity analyses for effect modifiers not observed in the target population when generalizing treatment effects from a randomized controlled trial: Assumptions, models, effect scales, data scenarios, and implementation details]]> https://www.researchpad.co/article/5c1966f0d5eed0c484b53620

Background

Randomized controlled trials are often used to inform policy and practice for broad populations. The average treatment effect (ATE) for a target population, however, may be different from the ATE observed in a trial if there are effect modifiers whose distribution in the target population is different that from that in the trial. Methods exist to use trial data to estimate the target population ATE, provided the distributions of treatment effect modifiers are observed in both the trial and target population—an assumption that may not hold in practice.

Methods

The proposed sensitivity analyses address the situation where a treatment effect modifier is observed in the trial but not the target population. These methods are based on an outcome model or the combination of such a model and weighting adjustment for observed differences between the trial sample and target population. They accommodate several types of outcome models: linear models (including single time outcome and pre- and post-treatment outcomes) for additive effects, and models with log or logit link for multiplicative effects. We clarify the methods’ assumptions and provide detailed implementation instructions.

Illustration

We illustrate the methods using an example generalizing the effects of an HIV treatment regimen from a randomized trial to a relevant target population.

Conclusion

These methods allow researchers and decision-makers to have more appropriate confidence when drawing conclusions about target population effects.

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<![CDATA[Global and regional trends of people living with HIV aged 50 and over: Estimates and projections for 2000–2020]]> https://www.researchpad.co/article/5c099459d5eed0c4842aeadd

Background

The increasing numbers of people living with HIV (PLHIV) who are receiving antiretroviral therapy (ART) have near normal life-expectancy, resulting in more people living with HIV over the age of 50 years (PLHIV50+). Estimates of the number of PLHIV50+ are needed for the development of tailored therapeutic and prevention interventions at country, regional and global level.

Methods

The AIDS Impact Module of the Spectrum software was used to compute the numbers of PLHIV, new infections, and AIDS-related deaths for PLHIV50+ for the years 2000–2016. Projections until 2020 were calculated based on an assumed ART scale-up to 81% coverage by 2020, consistent with the UNAIDS 90–90–90 treatment targets.

Results

Globally, there were 5.7 million [4.7 million– 6.6 million] PLHIV50+ in 2016. The proportion of PLHIV50+ increased substantially from 8% in 2000 to 16% in 2016 and is expected to increase to 21% by 2020. In 2016, 80% of PLHIV50+ lived in low- and middle-income countries (LMICs), with Eastern and Southern Africa containing the largest number of PLHIV50+. While the proportion of PLHIV50+ was greater in high income countries, LMICs have higher numbers of PLHIV50+ that are expected to continue to increase by 2020.

Conclusions

The number of PLHIV50+ has increased dramatically since 2000 and this is expected to continue by 2020, especially in LMICs. HIV prevention campaigns, testing and treatment programs should also focus on the specific needs of PLHIV50+. Integrated health and social services should be developed to cater for the changing physical, psychological and social needs of PLHIV50+, many of whom will need to use HIV and non-HIV services.

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<![CDATA[Sexual behaviors, HIV knowledge, HIV testing attitudes and recent HIV testing among female entertainment workers in Cambodia: A cross-sectional study]]> https://www.researchpad.co/article/5b4a08de463d7e3fbe689131

Background

In Cambodian context, female entertainment workers (FEWs) are young women working at establishments such as karaoke bars, restaurants, beer gardens or massage parlors. FEWs may sell sex to male patrons and are considered a high-risk group for HIV. This study aimed to identify factors associated with recent HIV testing among FEWs in Cambodia to inform future prevention activities.

Methods

Data were collected in 2014 as part of the evaluation of a larger HIV prevention project. A two-stage cluster sampling method was used to select participants from Phnom Penh and Siem Reap for face-to-face interviews using a structured questionnaire. A logistic regression model was constructed to identify independent factors associated with recent HIV testing.

Results

Data were collected from 667 FEWs with a mean age of 25.6 (SD = 5.5). Of total, 81.7% reported ever having had an HIV test, and 52.8% had at least one test in the past six months. After adjustment for other covariates, factors independently associated with recent HIV testing included living in Phnom Penh (AOR = 2.17, 95% CI = 1.43–3.28), having received HIV education in the past six months (AOR = 3.48, 95% CI = 2.35–5.15), disagreeing with a statement that ‘I would rather not know if I have HIV’ (AOR = 2.15, 95% CI = 1.41–3.30), agreeing with a statement that ‘getting tested for HIV helps people feel better’ (AOR = 0.32, 95% CI = 0.13–0.81) and not using a condom in the last sexual intercourse with a non-commercial partner (AOR = 0.48, 95% CI = 0.26–0.88).

Conclusions

FEWs with greater knowledge and positive attitudes towards HIV testing got tested for HIV more frequently than those with lesser knowledge and less positive attitudes. These findings suggest that future interventions should focus on disseminating tailored health messages around testing practices as well as specific topics such as condom use with non-commercial partners.

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<![CDATA[Modification of the Association Between T-Cell Immune Responses and Human Immunodeficiency Virus Type 1 Infection Risk by Vaccine-Induced Antibody Responses in the HVTN 505 Trial]]> https://www.researchpad.co/article/5b5bb18f463d7e2238d2d915

Abstract

Background

HVTN 505 was a human immunodeficiency virus type 1 (HIV-1) preventive vaccine efficacy trial of a DNA/recombinant adenovirus serotype 5 (rAd5) vaccine regimen. We assessed antibody responses measured 1 month after final vaccination (month 7) as correlates of HIV-1 acquisition risk.

Methods

Binding antibody responses were quantified in serum samples from 25 primary endpoint vaccine cases (diagnosed with HIV-1 infection between month 7 and month 24) and 125 randomly sampled frequency-matched vaccine controls (HIV-1 negative at month 24). We prespecified for a primary analysis tier 6 antibody response biomarkers that measure immunoglobulin G (IgG) and immunoglobulin A (IgA) binding to Env proteins and 2 previously assessed T-cell response biomarkers.

Results

Envelope-specific IgG responses were significantly correlated with decreased HIV-1 risk. Moreover, the interaction of IgG responses and Env-specific CD8+ T-cell polyfunctionality score had a highly significant association with HIV-1 risk after adjustment for multiple comparisons.

Conclusions

Vaccinees with higher levels of Env IgG have significantly decreased HIV-1 risk when CD8+ T-cell responses are low. Moreover, vaccinees with high CD8+ T-cell responses generally have low risk, and those with low CD8+ T-cell and low Env antibody responses have high risk. These findings suggest the critical importance of inducing a robust IgG Env response when the CD8+ T-cell response is low.

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<![CDATA[Copy Number Variation of CCL3-like Genes Affects Rate of Progression to Simian-AIDS in Rhesus Macaques (Macaca mulatta)]]> https://www.researchpad.co/article/5989da85ab0ee8fa60b9bf3c

Variation in genes underlying host immunity can lead to marked differences in susceptibility to HIV infection among humans. Despite heavy reliance on non-human primates as models for HIV/AIDS, little is known about which host factors are shared and which are unique to a given primate lineage. Here, we investigate whether copy number variation (CNV) at CCL3-like genes (CCL3L), a key genetic host factor for HIV/AIDS susceptibility and cell-mediated immune response in humans, is also a determinant of time until onset of simian-AIDS in rhesus macaques. Using a retrospective study of 57 rhesus macaques experimentally infected with SIVmac, we find that CCL3L CNV explains approximately 18% of the variance in time to simian-AIDS (p<0.001) with lower CCL3L copy number associating with more rapid disease course. We also find that CCL3L copy number varies significantly (p<10−6) among rhesus subpopulations, with Indian-origin macaques having, on average, half as many CCL3L gene copies as Chinese-origin macaques. Lastly, we confirm that CCL3L shows variable copy number in humans and chimpanzees and report on CCL3L CNV within and among three additional primate species. On the basis of our findings we suggest that (1) the difference in population level copy number may explain previously reported observations of longer post-infection survivorship of Chinese-origin rhesus macaques, (2) stratification by CCL3L copy number in rhesus SIV vaccine trials will increase power and reduce noise due to non-vaccine-related differences in survival, and (3) CCL3L CNV is an ancestral component of the primate immune response and, therefore, copy number variation has not been driven by HIV or SIV per se.

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<![CDATA[Six Imprisoned Health-Care Workers in Libya Are Pawns in a Far Larger Strategic Game]]> https://www.researchpad.co/article/5989dadaab0ee8fa60bb971e

It is critical that the scientific community recognize what is at stake in the case of the Benghazi Six, says Laurie Garrett of the Council on Foreign Relations.

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