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Sample records for asia hiv observational

  1. The TREAT Asia HIV Observational Database

    PubMed Central

    Zhou, Jialun; Kumarasamy, N.; Ditangco, Rossana; Kamarulzaman, Adeeba; Lee, Christopher K. C.; Li, Patrick C. K.; Paton, Nicholas I.; Phanuphak, Praphan; Pujari, Sanjay; Vibhagool, Asda; Wong, Wing-Wai; Zhang, Fujie; Chuah, John; Frost, Kevin R.; Cooper, David A.; Law, Matthew G.

    2010-01-01

    Background Relatively little is known regarding HIV disease natural history and response to antiretroviral treatments among Asian people infected with HIV. The Therapeutics Research, Education, and AIDS Training in Asia (TREAT Asia) HIV Observational Database (TAHOD) is a recently established collaborative observational cohort study that aims to assess HIV disease natural history in treated and untreated patients in the Asia-Pacific region. Methods Observational data are collected on HIV-infected patients from 11 sites in the Asia-Pacific region. Data are centrally aggregated for analyses, with the first baseline and retrospective data transferred in September 2003. Retrospective data were analyzed to assess the response to highly active antiretroviral treatment (HAART) over a 6-month period in terms of changes in CD4 count and proportions of patients achieving an undetectable HIV viral load (<400 copies/mL). Results By the end of May 2004, 1887 patients had been recruited to the TAHOD. Seventy-two percent of patients were male, with median age 36 years. Seventy-eight percent of patients reported HIV infection through heterosexual contact. Forty-three percent of patients had a previous AIDS diagnosis, of whom 55% had tuberculosis. The mean 6-month CD4 count increase was 115 cells/μL (SD = 127) after starting triple-combination therapy. Smaller CD4 count increases were associated with a higher CD4 count before starting treatment, prior treatment with monotherapy or double therapy, and treatment with a HAART regimen containing a nucleoside reverse transcriptase inhibitor (NRTI) and/or protease inhibitor (PI) but without a non-nucleoside reverse transcriptase inhibitor (NNRTI). Five hundred and ninety-eight patients started HAART and had a viral load assessment at 6 months, with 69% attaining an undetectable viral load. Older patients, patients not exposed to HIV through heterosexual contact, and patients treated with HAART containing NRTIs and NNRTIs but without PIs

  2. HIV and aging: insights from the Asia Pacific HIV Observational Database (APHOD).

    PubMed

    Han, N; Wright, S T; O'Connor, C C; Hoy, J; Ponnampalavanar, S; Grotowski, M; Zhao, H X; Kamarulzaman, A

    2015-03-01

    The proportion of people living with HIV/AIDS in the ageing population (>50 years old) is increasing. We aimed to explore the relationship between older age and treatment outcomes in HIV-positive persons from the Asia Pacific region. Patients from the Australian HIV Observational Database (AHOD) and the TREAT Asia HIV Observational Database (TAHOD) were included in the analysis. We used survival methods to assess the association between older age and all-cause mortality, as well as time to treatment modification. We used regression analyses to evaluate changes in CD4 counts after combination antiretroviral therapy (cART) initiation and determined the odds of detectable viral load, up to 24 months of treatment. A total of 7142 patients were included in these analyses (60% in TAHOD and 40% in AHOD), of whom 25% were >50 years old. In multivariable analyses, those aged > 50 years were at least twice as likely to die as those aged 30-39 years [hazard ratio (HR) for 50-59 years: 2.27; 95% confidence interval (CI) 1.34-3.83; HR for > 60 years: 4.28; 95% CI 2.42-7.55]. The effect of older age on CD4 count changes was insignificant (p-trend=0.06). The odds of detectable viral load after cART initiation decreased with age (p-trend=< 0.0001). The effect of older age on time to first treatment modification was insignificant (p-trend=0.21). We found no statistically significant differences in outcomes between AHOD and TAHOD participants for all endpoints examined. The associations between older age and typical patient outcomes in HIV-positive patients from the Asia Pacific region are similar in AHOD and TAHOD. Our data indicate that 'age effects' traverse the resource-rich and resource-limited divide and that future ageing-related findings might be applicable to each setting. © 2014 British HIV Association.

  3. Incidence of syphilis seroconversion among HIV-infected persons in Asia: results from the TREAT Asia HIV Observational Database.

    PubMed

    Ahn, Jin Young; Boettiger, David; Kiertiburanakul, Sasisopin; Merati, Tuti Parwati; Huy, Bui Vu; Wong, Wing Wai; Ditangco, Rossana; Lee, Man Po; Oka, Shinichi; Durier, Nicolas; Choi, Jun Yong

    2016-01-01

    Outbreaks of syphilis have been described among HIV-infected men who have sex with men (MSM) in Western communities, whereas reports in Asian countries are limited. We aimed to characterize the incidence and temporal trends of syphilis among HIV-infected MSM compared with HIV-infected non-MSM in Asian countries. Patients enrolled in the TREAT Asia HIV Observational Database cohort and with a negative non-treponemal test since enrolment were analyzed. Incidence of syphilis seroconversion, defined as a positive non-treponemal test after previously testing negative, was evaluated among patients at sites performing non-treponemal tests at least annually. Factors associated with syphilis seroconversion were investigated at sites doing non-treponemal testing in all new patients and subsequently testing routinely or when patients were suspected of having syphilis. We included 1010 patients from five sites that performed non-treponemal tests in all new patients; those included had negative non-treponemal test results during enrolment and subsequent follow-ups. Among them, 657 patients were from three sites conducting regular non-treponemal testing. The incidence of syphilis seroconversion was 5.38/100 person-years (PY). Incidence was higher in MSM than non-MSM (7.64/100 PY vs. 2.44/100 PY, p<0.001). Among MSM, the incidence rate ratio (IRR) for every additional year from 2009 was 1.19 (p=0.051). MSM status (IRR 3.48, 95% confidence interval (CI) 1.88-6.47), past syphilis diagnosis (IRR 5.15, 95% CI 3.69-7.17) and younger age (IRR 0.84 for every additional 10 years, 95% CI 0.706-0.997) were significantly associated with syphilis seroconversion. We observed a higher incidence of syphilis seroconversion among HIV-infected MSM and a trend to increasing annual incidence. Regular screening for syphilis and targeted interventions to limit transmission are needed in this population.

  4. Incidence of syphilis seroconversion among HIV-infected persons in Asia: results from the TREAT Asia HIV Observational Database

    PubMed Central

    Ahn, Jin Young; Boettiger, David; Kiertiburanakul, Sasisopin; Merati, Tuti Parwati; Huy, Bui Vu; Wong, Wing Wai; Ditangco, Rossana; Lee, Man Po; Oka, Shinichi; Durier, Nicolas; Choi, Jun Yong

    2016-01-01

    Introduction Outbreaks of syphilis have been described among HIV-infected men who have sex with men (MSM) in Western communities, whereas reports in Asian countries are limited. We aimed to characterize the incidence and temporal trends of syphilis among HIV-infected MSM compared with HIV-infected non-MSM in Asian countries. Methods Patients enrolled in the TREAT Asia HIV Observational Database cohort and with a negative non-treponemal test since enrolment were analyzed. Incidence of syphilis seroconversion, defined as a positive non-treponemal test after previously testing negative, was evaluated among patients at sites performing non-treponemal tests at least annually. Factors associated with syphilis seroconversion were investigated at sites doing non-treponemal testing in all new patients and subsequently testing routinely or when patients were suspected of having syphilis. Results We included 1010 patients from five sites that performed non-treponemal tests in all new patients; those included had negative non-treponemal test results during enrolment and subsequent follow-ups. Among them, 657 patients were from three sites conducting regular non-treponemal testing. The incidence of syphilis seroconversion was 5.38/100 person-years (PY). Incidence was higher in MSM than non-MSM (7.64/100 PY vs. 2.44/100 PY, p<0.001). Among MSM, the incidence rate ratio (IRR) for every additional year from 2009 was 1.19 (p=0.051). MSM status (IRR 3.48, 95% confidence interval (CI) 1.88–6.47), past syphilis diagnosis (IRR 5.15, 95% CI 3.69–7.17) and younger age (IRR 0.84 for every additional 10 years, 95% CI 0.706–0.997) were significantly associated with syphilis seroconversion. Conclusions We observed a higher incidence of syphilis seroconversion among HIV-infected MSM and a trend to increasing annual incidence. Regular screening for syphilis and targeted interventions to limit transmission are needed in this population. PMID:27774955

  5. Cancers in the TREAT Asia HIV Observational Database (TAHOD): a retrospective analysis of risk factors

    PubMed Central

    2010-01-01

    Background This retrospective survey describes types of cancers diagnosed in HIV-infected subjects in Asia, and assesses risk factors for cancer in HIV-infected subjects using contemporaneous HIV-infected controls without cancer. Methods TREAT Asia HIV Observational Database (TAHOD) sites retrospectively reviewed clinic medical records to determine cancer diagnoses since 2000. For each diagnosis, the following data were recorded: date, type, stage, method of diagnosis, demographic data, medical history, and HIV-related information. For risk factor analyses, two HIV-infected control subjects without cancer diagnoses were also selected. Cancers were grouped as AIDS-defining cancers (ADCs), and non-ADCs. Non-ADCs were further categorized as being infection related (NADC-IR) and unrelated (NADC-IUR). Results A total of 617 patients were included in this study: 215 cancer cases and 402 controls from 13 sites. The majority of cancer cases were male (71%). The mean age (SD) for cases was 39 (10.6), 46 (11.5) and 44 (13.7) for ADCs, NADC-IURs and NADCs-IR, respectively. The majority (66%) of cancers were ADCs (16% Kaposi sarcoma, 40% non-Hodgkin's lymphoma, and 9% cervical cancer). The most common NADCs were lung (6%), breast (5%) and hepatocellular carcinoma and Hodgkin's lymphoma (2% each). There were also three (1.4%) cases of leiomyosarcoma reported in this study. In multivariate analyses, individuals with CD4 counts above 200 cells/mm3 were approximately 80% less likely to be diagnosed with an ADC (p < 0.001). Older age (OR: 1.39, p = 0.001) and currently not receiving antiretroviral treatment (OR: 0.29, p = 0.006) were independent predictors of NADCs overall, and similarly for NADCs-IUR. Lower CD4 cell count and higher CDC stage (p = 0.041) were the only independent predictors of NADCs-IR. Conclusions The spectrum of cancer diagnoses in the Asia region currently does not appear dissimilar to that observed in non-Asian HIV populations. One interesting finding was the

  6. Impact of Antiretroviral Therapy on Opportunistic Infections of HIV-Infected Children in the TREAT Asia Pediatric HIV Observational Database

    PubMed Central

    Prasitsuebsai, Wasana; Kariminia, Azar; Puthanakit, Thanyawee; Lumbiganon, Pagakrong; Hansudewechakul, Rawiwan; Moy, Fong Siew; Law, Matthew; Kumarasamy, Nagalingeswaran; Razali, Kamarul; Sirisanthana, Virat; Sohn, Annette H.; Chokephaibulkit, Kulkanya

    2014-01-01

    Background There are limited data on opportunistic infections (OI) and factors associated with their occurrence after highly active antiretroviral therapy (HAART) in Asian children. The use of HAART in Asia started much later than in developed countries and therefore reported findings may not be fully applicable to the pediatric HIV epidemic in Asia. Methods Retrospective and prospectively collected data from the TREAT Asia Pediatric HIV Observational Database cohort study from March 1993 to March 2009 were analyzed. OIs were defined according to WHO clinical staging criteria, and incidence rates calculated. Factors associated with the incidence of severe OIs were analyzed using random effects Poisson regression modeling. Results Of 2280 children in the cohort, 1752 were ever reported to have received ART, of whom 1480 (84%) started on HAART. Before commencing any ART, OIs occurred at a rate of 89.5 per 100 person-years. The incidence rate was 28.8 infections per 100 person-years during mono- or dual-therapy, and 10.5 infections per 100 person-years during HAART. The most common OIs both before and after ART initiation were recurrent upper respiratory tract infections, persistent oral candidiasis, and pulmonary tuberculosis. The incidence rates of WHO clinical stage 3 or 4 OIs after HAART were highest among children <18 months of age and those with low weight-for-age z scores, CD4 cell percentage <15%, and WHO stage 3 at HAART initiation. Conclusions Despite dramatic declines in their incidence, OIs remained important causes of morbidity after HAART initiation in this regional cohort of HIV-infected children in Asia. PMID:24378942

  7. Efficacy of second-line antiretroviral therapy among people living with HIV/AIDS in Asia: results from the TREAT Asia HIV observational database.

    PubMed

    Boettiger, David C; Nguyen, Van K; Durier, Nicolas; Bui, Huy V; Heng Sim, Benedict L; Azwa, Iskandar; Law, Matthew; Ruxrungtham, Kiat

    2015-02-01

    Roughly 4% of the 1.25 million patients on antiretroviral therapy (ART) in Asia are using second-line therapy. To maximize patient benefit and regional resources, it is important to optimize the timing of second-line ART initiation and use the most effective compounds available. HIV-positive patients enrolled in the TREAT Asia HIV Observational Database who had used second-line ART for ≥6 months were included. ART use and rates and predictors of second-line treatment failure were evaluated. There were 302 eligible patients. Most were male (76.5%) and exposed to HIV via heterosexual contact (71.5%). Median age at second-line initiation was 39.2 years, median CD4 cell count was 146 cells per cubic millimeter, and median HIV viral load was 16,224 copies per milliliter. Patients started second-line ART before 2007 (n = 105), 2007-2010 (n = 147) and after 2010 (n = 50). Ritonavir-boosted lopinavir and atazanavir accounted for the majority of protease inhibitor use after 2006. Median follow-up time on second-line therapy was 2.3 years. The rates of treatment failure and mortality per 100 patient/years were 8.8 (95% confidence interval: 7.1 to 10.9) and 1.1 (95% confidence interval: 0.6 to 1.9), respectively. Older age, high baseline viral load, and use of a protease inhibitor other than lopinavir or atazanavir were associated with a significantly shorter time to second-line failure. Increased access to viral load monitoring to facilitate early detection of first-line ART failure and subsequent treatment switch is important for maximizing the durability of second-line therapy in Asia. Although second-line ART is highly effective in the region, the reported rate of failure emphasizes the need for third-line ART in a small portion of patients.

  8. Efficacy of second-line antiretroviral therapy among people living with HIV/AIDS in Asia: Results from the TREAT Asia HIV Observational Database

    PubMed Central

    BOETTIGER, David C; NGUYEN, Van Kinh; DURIER, Nicolas; BUI, Huy Vu; SIM, Benedict Lim Heng; AZWA, Iskandar; LAW, Matthew; RUXRUNGTHAM, Kiat

    2014-01-01

    Background Roughly 4% of the 1.25 million patients on antiretroviral therapy (ART) in Asia are using second-line therapy. To maximize patient benefit and regional resources it is important to optimize the timing of second-line ART initiation and use the most effective compounds available. Methods HIV positive patients enrolled in the TREAT Asia HIV Observational Database who had used second-line ART for ≥6 months were included. ART use and rates and predictors of second-line treatment failure were evaluated. Results There were 302 eligible patients. Most were male (76.5%) and exposed to HIV via heterosexual contact (71.5%). Median age at second-line initiation was 39.2 years, median CD4 cell count was 146 cells/mm3, and median HIV viral load was 16,224 copies/mL. Patients started second-line ART before 2007 (n=105), 2007-2010 (n=147) and after 2010 (n=50). Ritonavir-boosted lopinavir and atazanavir accounted for the majority of protease inhibitor use after 2006. Median follow-up time on second-line was 2.3 years. The rates of treatment failure and mortality per 100 patient/years were 8.8 (95%CI 7.1 to 10.9) and 1.1 (95%CI 0.6 to 1.9), respectively. Older age, high baseline viral load and use of a protease inhibitor other than lopinavir or atazanavir were associated with a significantly shorter time to second-line failure. Conclusions Increased access to viral load monitoring to facilitate early detection of first-line ART failure and subsequent treatment switch is important for maximizing the durability of second-line therapy in Asia. Although second-line ART is highly effective in the region, the reported rate of failure emphasizes the need for third-line ART in a small portion of patients. PMID:25590271

  9. Trends in First-Line Antiretroviral Therapy in Asia: Results from the TREAT Asia HIV Observational Database

    PubMed Central

    Boettiger, David Charles; Kerr, Stephen; Ditangco, Rossana; Merati, Tuti Parwati; Pham, Thuy Thi Thanh; Chaiwarith, Romanee; Kiertiburanakul, Sasisopin; Li, Chung Ki Patrick; Kumarasamy, Nagalingeswaran; Vonthanak, Saphonn; Lee, Christopher; Van Kinh, Nguyen; Pujari, Sanjay; Wong, Wing Wai; Kamarulzaman, Adeeba; Zhang, Fujie; Yunihastuti, Evy; Choi, Jun Yong; Oka, Shinichi; Ng, Oon Tek; Kantipong, Pacharee; Mustafa, Mahiran; Ratanasuwan, Winai; Sohn, Annette; Law, Matthew

    2014-01-01

    Background Antiretroviral therapy (ART) has evolved rapidly since its beginnings. This analysis describes trends in first-line ART use in Asia and their impact on treatment outcomes. Methods Patients in the TREAT Asia HIV Observational Database receiving first-line ART for ≥6 months were included. Predictors of treatment failure and treatment modification were assessed. Results Data from 4662 eligible patients was analysed. Patients started ART in 2003–2006 (n = 1419), 2007–2010 (n = 2690) and 2011–2013 (n = 553). During the observation period, tenofovir, zidovudine and abacavir use largely replaced stavudine. Stavudine was prescribed to 5.8% of ART starters in 2012/13. Efavirenz use increased at the expense of nevirapine, although both continue to be used extensively (47.5% and 34.5% of patients in 2012/13, respectively). Protease inhibitor use dropped after 2004. The rate of treatment failure or modification declined over time (22.1 [95%CI 20.7–23.5] events per 100 patient/years in 2003–2006, 15.8 [14.9–16.8] in 2007–2010, and 11.6 [9.4–14.2] in 2011–2013). Adjustment for ART regimen had little impact on the temporal decline in treatment failure rates but substantially attenuated the temporal decline in rates of modification due to adverse event. In the final multivariate model, treatment modification due to adverse event was significantly predicted by earlier period of ART initiation (hazard ratio 0.52 [95%CI 0.33–0.81], p = 0.004 for 2011–2013 versus 2003–2006), older age (1.56 [1.19–2.04], p = 0.001 for ≥50 years versus <30years), female sex (1.29 [1.11–1.50], p = 0.001 versus male), positive hepatitis C status (1.33 [1.06–1.66], p = 0.013 versus negative), and ART regimen (11.36 [6.28–20.54], p<0.001 for stavudine-based regimens versus tenofovir-based). Conclusions The observed trends in first-line ART use in Asia reflect changes in drug availability, global treatment recommendations and

  10. Trends in first-line antiretroviral therapy in Asia: results from the TREAT Asia HIV observational database.

    PubMed

    Boettiger, David Charles; Kerr, Stephen; Ditangco, Rossana; Merati, Tuti Parwati; Pham, Thuy Thi Thanh; Chaiwarith, Romanee; Kiertiburanakul, Sasisopin; Li, Chung Ki Patrick; Kumarasamy, Nagalingeswaran; Vonthanak, Saphonn; Lee, Christopher; Van Kinh, Nguyen; Pujari, Sanjay; Wong, Wing Wai; Kamarulzaman, Adeeba; Zhang, Fujie; Yunihastuti, Evy; Choi, Jun Yong; Oka, Shinichi; Ng, Oon Tek; Kantipong, Pacharee; Mustafa, Mahiran; Ratanasuwan, Winai; Sohn, Annette; Law, Matthew

    2014-01-01

    Antiretroviral therapy (ART) has evolved rapidly since its beginnings. This analysis describes trends in first-line ART use in Asia and their impact on treatment outcomes. Patients in the TREAT Asia HIV Observational Database receiving first-line ART for ≥ 6 months were included. Predictors of treatment failure and treatment modification were assessed. Data from 4662 eligible patients was analysed. Patients started ART in 2003-2006 (n = 1419), 2007-2010 (n = 2690) and 2011-2013 (n = 553). During the observation period, tenofovir, zidovudine and abacavir use largely replaced stavudine. Stavudine was prescribed to 5.8% of ART starters in 2012/13. Efavirenz use increased at the expense of nevirapine, although both continue to be used extensively (47.5% and 34.5% of patients in 2012/13, respectively). Protease inhibitor use dropped after 2004. The rate of treatment failure or modification declined over time (22.1 [95%CI 20.7-23.5] events per 100 patient/years in 2003-2006, 15.8 [14.9-16.8] in 2007-2010, and 11.6 [9.4-14.2] in 2011-2013). Adjustment for ART regimen had little impact on the temporal decline in treatment failure rates but substantially attenuated the temporal decline in rates of modification due to adverse event. In the final multivariate model, treatment modification due to adverse event was significantly predicted by earlier period of ART initiation (hazard ratio 0.52 [95%CI 0.33-0.81], p = 0.004 for 2011-2013 versus 2003-2006), older age (1.56 [1.19-2.04], p = 0.001 for ≥ 50 years versus <30 years), female sex (1.29 [1.11-1.50], p = 0.001 versus male), positive hepatitis C status (1.33 [1.06-1.66], p = 0.013 versus negative), and ART regimen (11.36 [6.28-20.54], p<0.001 for stavudine-based regimens versus tenofovir-based). The observed trends in first-line ART use in Asia reflect changes in drug availability, global treatment recommendations and prescriber preferences over the past decade. These changes have contributed to a declining rate of

  11. Trends in CD4 counts in HIV-infected patients with HIV viral load monitoring while on combination antiretroviral treatment: results from The TREAT Asia HIV Observational Database

    PubMed Central

    2010-01-01

    Background The aim of this study was to examine the relationship between trends in CD4 counts (slope) and HIV viral load (VL) after initiation of combination antiretroviral treatment (cART) in Asian patients in The TREAT Asia HIV Observational Database (TAHOD). Methods Treatment-naive HIV-infected patients who started cART with three or more and had three or more CD4 count and HIV VL tests were included. CD4 count slopes were expressed as changes of cells per microliter per year. Predictors of CD4 count slopes from 6 months after initiation were assessed by random-effects linear regression models. Results A total of 1676 patients (74% male) were included. The median time on cART was 4.2 years (IQR 2.5-5.8 years). In the final model, CD4 count slope was associated with age, concurrent HIV VL and CD4 count, disease stage, hepatitis B or C co-infection, and time since cART initiation. CD4 count continues to increase with HIV VL up to 20 000 copies/mL during 6-12 months after cART initiation. However, the HIV VL has to be controlled below 5 000, 4 000 and 500 copies/mL for the CD4 count slope to remain above 20 cells/microliter per year during 12-18, 18-24, and beyond 24 months after cART initiation. Conclusions After cART initiation, CD4 counts continued to increase even when the concurrent HIV VL was detectable. However, HIV VL needed to be controlled at a lower level to maintain a positive CD4 count slope when cART continues. The effect on long-term outcomes through the possible development of HIV drug resistance remains uncertain. PMID:21182796

  12. Hepatitis B and C Co-Infection in HIV Patients from the TREAT Asia HIV Observational Database: Analysis of Risk Factors and Survival.

    PubMed

    Chen, Marcelo; Wong, Wing-Wai; Law, Matthew G; Kiertiburanakul, Sasisopin; Yunihastuti, Evy; Merati, Tuti Parwati; Lim, Poh Lian; Chaiwarith, Romanee; Phanuphak, Praphan; Lee, Man Po; Kumarasamy, Nagalingeswaran; Saphonn, Vonthanak; Ditangco, Rossana; Sim, Benedict L H; Nguyen, Kinh Van; Pujari, Sanjay; Kamarulzaman, Adeeba; Zhang, Fujie; Pham, Thuy Thanh; Choi, Jun Yong; Oka, Shinichi; Kantipong, Pacharee; Mustafa, Mahiran; Ratanasuwan, Winai; Durier, Nicolas; Chen, Yi-Ming Arthur

    2016-01-01

    We assessed the effects of hepatitis B (HBV) or hepatitis C (HCV) co-infection on outcomes of antiretroviral therapy (ART) in HIV-infected patients enrolled in the TREAT Asia HIV Observational Database (TAHOD), a multi-center cohort of HIV-infected patients in the Asia-Pacific region. Patients testing HBs antigen (Ag) or HCV antibody (Ab) positive within enrollment into TAHOD were considered HBV or HCV co-infected. Factors associated with HBV and/or HCV co-infection were assessed by logistic regression models. Factors associated with post-ART HIV immunological response (CD4 change after six months) and virological response (HIV RNA <400 copies/ml after 12 months) were also determined. Survival was assessed by the Kaplan-Meier method and log rank test. A total of 7,455 subjects were recruited by December 2012. Of patients tested, 591/5656 (10.4%) were HBsAg positive, 794/5215 (15.2%) were HCVAb positive, and 88/4966 (1.8%) were positive for both markers. In multivariate analysis, HCV co-infection, age, route of HIV infection, baseline CD4 count, baseline HIV RNA, and HIV-1 subtype were associated with immunological recovery. Age, route of HIV infection, baseline CD4 count, baseline HIV RNA, ART regimen, prior ART and HIV-1 subtype, but not HBV or HCV co-infection, affected HIV RNA suppression. Risk factors affecting mortality included HCV co-infection, age, CDC stage, baseline CD4 count, baseline HIV RNA and prior mono/dual ART. Shortest survival was seen in subjects who were both HBV- and HCV-positive. In this Asian cohort of HIV-infected patients, HCV co-infection, but not HBV co-infection, was associated with lower CD4 cell recovery after ART and increased mortality.

  13. Hepatitis B and C Co-Infection in HIV Patients from the TREAT Asia HIV Observational Database: Analysis of Risk Factors and Survival

    PubMed Central

    Chen, Marcelo; Wong, Wing-Wai; Law, Matthew G.; Kiertiburanakul, Sasisopin; Yunihastuti, Evy; Merati, Tuti Parwati; Lim, Poh Lian; Chaiwarith, Romanee; Phanuphak, Praphan; Lee, Man Po; Kumarasamy, Nagalingeswaran; Saphonn, Vonthanak; Ditangco, Rossana; Sim, Benedict L. H.; Nguyen, Kinh Van; Pujari, Sanjay; Kamarulzaman, Adeeba; Zhang, Fujie; Pham, Thuy Thanh; Choi, Jun Yong; Oka, Shinichi; Kantipong, Pacharee; Mustafa, Mahiran; Ratanasuwan, Winai; Durier, Nicolas; Chen, Yi-Ming Arthur

    2016-01-01

    Background We assessed the effects of hepatitis B (HBV) or hepatitis C (HCV) co-infection on outcomes of antiretroviral therapy (ART) in HIV-infected patients enrolled in the TREAT Asia HIV Observational Database (TAHOD), a multi-center cohort of HIV-infected patients in the Asia-Pacific region. Methods Patients testing HBs antigen (Ag) or HCV antibody (Ab) positive within enrollment into TAHOD were considered HBV or HCV co-infected. Factors associated with HBV and/or HCV co-infection were assessed by logistic regression models. Factors associated with post-ART HIV immunological response (CD4 change after six months) and virological response (HIV RNA <400 copies/ml after 12 months) were also determined. Survival was assessed by the Kaplan-Meier method and log rank test. Results A total of 7,455 subjects were recruited by December 2012. Of patients tested, 591/5656 (10.4%) were HBsAg positive, 794/5215 (15.2%) were HCVAb positive, and 88/4966 (1.8%) were positive for both markers. In multivariate analysis, HCV co-infection, age, route of HIV infection, baseline CD4 count, baseline HIV RNA, and HIV-1 subtype were associated with immunological recovery. Age, route of HIV infection, baseline CD4 count, baseline HIV RNA, ART regimen, prior ART and HIV-1 subtype, but not HBV or HCV co-infection, affected HIV RNA suppression. Risk factors affecting mortality included HCV co-infection, age, CDC stage, baseline CD4 count, baseline HIV RNA and prior mono/dual ART. Shortest survival was seen in subjects who were both HBV- and HCV-positive. Conclusion In this Asian cohort of HIV-infected patients, HCV co-infection, but not HBV co-infection, was associated with lower CD4 cell recovery after ART and increased mortality. PMID:26933963

  14. HIV in Southeast Asia.

    PubMed

    Abrams, S

    1998-01-01

    This article explores the HIV/AIDS epidemic in Southeast Asia. Prostitution and injecting drug use are two major factors in the appearance of HIV/AIDS in a country. But, it is the correct social network that assures its transmission to epidemic proportions. Heterosexual transmission in Cambodia, Myanmar, and Thailand is linked with prevalence among female sex workers and their clients. In Malaysia, the Ministry of Health responded immediately, but the number of new infections continued to increase. The failures suggest the need for more effective, intensive health education programs, outreach by nongovernmental organizations, and peer education at the grassroots level and in remote areas. Public health officials need to promote political change. International agencies could play an important role, if countries such as Myanmar, Cambodia, and Viet Nam were open to international exchanges. In Myanmar, political unrest has a priority over the need for aggressive health interventions. In Indonesia, the Islamic influence prevents recognition of the country's significant sex industry or the existence of a homosexual community. In Cambodia, health officials warned about the high number of sexual partners, high mobility rate, and low condom use, but HIV spread rapidly in the 1990s. Thailand initiated a 100% condom campaign to combat HIV prevalence in the 1990s, and HIV prevalence declined among sex workers and military recruits. Risk factors for rapid transmission include mobility, the number of sexual partners/sex worker, the proportion engaging in commercial sex, and the rate of regular condom use among sex workers.

  15. Impact of antiretroviral therapy on opportunistic infections of HIV-infected children in the therapeutic research, education and AIDS training asia pediatric HIV observational database.

    PubMed

    Prasitsuebsai, Wasana; Kariminia, Azar; Puthanakit, Thanyawee; Lumbiganon, Pagakrong; Hansudewechakul, Rawiwan; Siew Moy, Fong; Law, Matthew; Kumarasamy, Nagalingeswaran; Razali, Kamarul; Sirisanthana, Virat; Sohn, Annette H; Chokephaibulkit, Kulkanya

    2014-07-01

    There are limited data on opportunistic infections (OIs) and factors associated with their occurrence after highly active antiretroviral therapy (HAART) in Asian children. The use of HAART in Asia started much later than in developed countries and therefore reported findings may not be fully applicable to the pediatric HIV epidemic in Asia. Retrospective and prospectively collected data from the Therapeutic Research, Education and AIDS Training Asia Pediatric HIV Observational Database cohort study from March 1993 to March 2009 were analyzed. OIs were defined according to World Health Organization clinical staging criteria and incidence rates calculated. Factors associated with the incidence of severe OIs were analyzed using random effects Poisson regression modeling. Of 2280 children in the cohort, 1752 were ever reported to have received antiretroviral therapy, of whom 1480 (84%) started on HAART. Before commencing any antiretroviral therapy, OIs occurred at a rate of 89.5 per 100 person-years. The incidence rate was 28.8 infections per 100 person-years during mono- or dual-therapy and 10.5 infections per 100 person-years during HAART. The most common OIs both before and after antiretroviral therapy initiation were recurrent upper respiratory tract infections, persistent oral candidiasis and pulmonary tuberculosis. The incidence rates of World Health Organization clinical stage 3 or 4 OIs after HAART were highest among children <18 months of age and those with low weight-for-age z scores, CD4 cell % <15%, and World Health Organization stage 3 at HAART initiation. Despite dramatic declines in their incidence, OIs remained important causes of morbidity after HAART initiation in this regional cohort of HIV-infected children in Asia.

  16. Tenofovir-based Antiretroviral Therapy in Hepatitis B Virus/HIV Co-infection: Results from the TREAT Asia HIV Observational Database

    PubMed Central

    Boettiger, David C; Kerr, Stephen; Ditangco, Rossana; Chaiwarith, Romanee; Li, Patrick CK; Merati, Tuti Parwati; Pham, Thuy Thi Thanh; Kiertiburanakul, Sasisopin; Kumarasamy, Nagalingeswaran; Vonthanak, Saphonn; Lee, Christopher KC; Van Kinh, Nguyen; Pujari, Sanjay; Wong, Wing Wai; Kamarulzaman, Adeeba; Zhang, Fujie; Yunihastuti, Evy; Choi, Jun Yong; Oka, Shinichi; Ng, Oon Tek; Kantipong, Pacharee; Mustafa, Mahiran; Ratanasuwan, Winai; Durier, Nicolas; Law, Matthew

    2016-01-01

    Background The World Health Organisation recommends Hepatitis B virus (HBV)/HIV co-infected individuals start antiretroviral therapy containing tenofovir. Here we describe first-line tenofovir use and treatment outcomes in co-infected patients in Asia. Methods HBV surface antigen positive patients enrolled in the TREAT Asia HIV Observational Database who started first-line antiretroviral therapy were included. Logistic regression adjusted for period of treatment initiation was used to determine factors associated with tenofovir use. Generalised estimating equations were used to evaluate factors associated with alanine transaminase levels and CD4 cell count on treatment. Results There were 548 eligible patients, of whom 149 (27.2%) started tenofovir. Patients treated in high/high-middle income countries (odds ratio 4.4 vs. low/low-middle, 95%CI 2.6-7.4, p<0.001) and those with elevated baseline alanine transaminase (odds ratio 4.2 vs. normal, 95%CI 2.4-7.2, p<0.001) were more likely to receive tenofovir. Hepatitis C antibody positive patients (odds ratio 0.4 vs. negative, 95%CI 0.2-0.8, p=0.008) were less likely. In those starting antiretroviral therapy with elevated alanine transaminase, mean reduction after tenofovir initiation was 11.2 IU/L (95%CI 0.9-21.6, p=0.034) lower compared with those using a non-tenofovir-based regimen although this did not significantly increase the chance of alanine transaminase normalization. Tenofovir use was not associated with a superior CD4 response. Conclusions HBV/HIV co-infected patients in Asia are most likely to receive tenofovir if they are treated in a high/high-middle income country, have elevated alanine transaminase levels, and are hepatitis C antibody negative. Compared to other antiretroviral therapy, tenofovir-based regimens more effectively reduce liver inflammation in HBV/HIV co-infection but do not result in superior CD4 recovery. PMID:26069150

  17. Prevalence, Characteristics, Management, and Outcome of Pulmonary Tuberculosis in HIV-Infected Children in the TREAT Asia Pediatric HIV Observational Database (TApHOD)

    PubMed Central

    Sudjaritruk, Tavitiya; Maleesatharn, Alan; Prasitsuebsai, Wasana; Fong, Siew Moy; Le, Ngoc Oanh; Le, Thanh Thuy Thi; Lumbiganon, Pagakrong; Kumarasamy, Nagalingeswaran; Kurniati, Nia; Hansudewechakul, Rawiwan; Yusoff, Nik Khairulddin Nik; Razali, Kamarul Azahar Mohd; Kariminia, Azar; Sohn, Annette H.

    2013-01-01

    Abstract A multicenter, retrospective, observational study was conducted to determine prevalence, characteristics, management, and outcome of pulmonary tuberculosis (PTB) in Asian HIV-infected children in the TREAT Asia Pediatric HIV Observational Database (TApHOD). Data on PTB episodes diagnosed during the period between 12 months before antiretroviral therapy (ART) initiation and December 31, 2009 were extracted. A total of 2678 HIV-infected children were included in TApHOD over a 13-year period; 457 developed PTB, giving a period prevalence of 17.1% (range 5.7–33.0% per country). There were a total of 484 PTB episodes; 27 children had 2 episodes each. There were 21 deaths (4.3%). One third of episodes (n=175/484) occurred after ART initiation at a median of 14.1 months (interquartile range [IQR] 2.5–28.8 months). The median (IQR) CD4+ values were 9.0% (3.0–16.0%) and 183.5 (37.8–525.0) cells/mm3 when PTB was diagnosed. Most episodes (n=424/436, 97.3%) had abnormal radiographic findings compatible with PTB, whereas half (n=267/484, 55.2%) presented with clinical characteristics of PTB. One third of those tested (n=42/122, 34.4%) had bacteriological evidence of PTB. Of the 156 episodes (32.2%) that were accompanied with extrapulmonary TB, pleuritis was the most common manifestation (81.4%). After treatment completion, most episodes (n=396/484, 81.9%) were recorded as having positive outcomes (cured, treatment completed and child well, and improvement). The prevalence of PTB among Asian HIV-infected children in our cohort was high. Children with persistent immunosuppression remain vulnerable to PTB even after ART initiation. PMID:24206012

  18. The Significance of HIV ‘Blips’ in Resource-Limited Settings: Is It the Same? Analysis of the Treat Asia HIV Observational Database (TAHOD) and the Australian HIV Observational Database (AHOD)

    PubMed Central

    Kanapathipillai, Rupa; McManus, Hamish; Kamarulzaman, Adeeba; Lim, Poh Lian; Templeton, David J.; Law, Matthew; Woolley, Ian

    2014-01-01

    Introduction Magnitude and frequency of HIV viral load blips in resource-limited settings, has not previously been assessed. This study was undertaken in a cohort from a high income country (Australia) known as AHOD (Australian HIV Observational Database) and another cohort from a mixture of Asian countries of varying national income per capita, TAHOD (TREAT Asia HIV Observational Database). Methods Blips were defined as detectable VL (≥ 50 copies/mL) preceded and followed by undetectable VL (<50 copies/mL). Virological failure (VF) was defined as two consecutive VL ≥50 copies/ml. Cox proportional hazard models of time to first VF after entry, were developed. Results 5040 patients (AHOD n = 2597 and TAHOD n = 2521) were included; 910 (18%) of patients experienced blips. 744 (21%) and 166 (11%) of high- and middle/low-income participants, respectively, experienced blips ever. 711 (14%) experienced blips prior to virological failure. 559 (16%) and 152 (10%) of high- and middle/low-income participants, respectively, experienced blips prior to virological failure. VL testing occurred at a median frequency of 175 and 91 days in middle/low- and high-income sites, respectively. Longer time to VF occurred in middle/low income sites, compared with high-income sites (adjusted hazards ratio (AHR) 0.41; p<0.001), adjusted for year of first cART, Hepatitis C co-infection, cART regimen, and prior blips. Prior blips were not a significant predictor of VF in univariate analysis (AHR 0.97, p = 0.82). Differing magnitudes of blips were not significant in univariate analyses as predictors of virological failure (p = 0.360 for blip 50–≤1000, p = 0.309 for blip 50–≤400 and p = 0.300 for blip 50–≤200). 209 of 866 (24%) patients were switched to an alternate regimen in the setting of a blip. Conclusion Despite a lower proportion of blips occurring in low/middle-income settings, no significant difference was found between settings. Nonetheless, a

  19. The significance of HIV 'blips' in resource-limited settings: is it the same? analysis of the treat Asia HIV Observational Database (TAHOD) and the Australian HIV Observational Database (AHOD).

    PubMed

    Kanapathipillai, Rupa; McManus, Hamish; Kamarulzaman, Adeeba; Lim, Poh Lian; Templeton, David J; Law, Matthew; Woolley, Ian

    2014-01-01

    Magnitude and frequency of HIV viral load blips in resource-limited settings, has not previously been assessed. This study was undertaken in a cohort from a high income country (Australia) known as AHOD (Australian HIV Observational Database) and another cohort from a mixture of Asian countries of varying national income per capita, TAHOD (TREAT Asia HIV Observational Database). Blips were defined as detectable VL (≥ 50 copies/mL) preceded and followed by undetectable VL (<50 copies/mL). Virological failure (VF) was defined as two consecutive VL ≥50 copies/ml. Cox proportional hazard models of time to first VF after entry, were developed. 5040 patients (AHOD n = 2597 and TAHOD n = 2521) were included; 910 (18%) of patients experienced blips. 744 (21%) and 166 (11%) of high- and middle/low-income participants, respectively, experienced blips ever. 711 (14%) experienced blips prior to virological failure. 559 (16%) and 152 (10%) of high- and middle/low-income participants, respectively, experienced blips prior to virological failure. VL testing occurred at a median frequency of 175 and 91 days in middle/low- and high-income sites, respectively. Longer time to VF occurred in middle/low income sites, compared with high-income sites (adjusted hazards ratio (AHR) 0.41; p<0.001), adjusted for year of first cART, Hepatitis C co-infection, cART regimen, and prior blips. Prior blips were not a significant predictor of VF in univariate analysis (AHR 0.97, p = 0.82). Differing magnitudes of blips were not significant in univariate analyses as predictors of virological failure (p = 0.360 for blip 50-≤1000, p = 0.309 for blip 50-≤400 and p = 0.300 for blip 50-≤200). 209 of 866 (24%) patients were switched to an alternate regimen in the setting of a blip. Despite a lower proportion of blips occurring in low/middle-income settings, no significant difference was found between settings. Nonetheless, a substantial number of participants were switched

  20. The occurrence of Simpson's paradox if site-level effect was ignored in the TREAT Asia HIV Observational Database.

    PubMed

    Jiamsakul, Awachana; Kerr, Stephen J; Chandrasekaran, Ezhilarasi; Huelgas, Aizobelle; Taecharoenkul, Sineenart; Teeraananchai, Sirinya; Wan, Gang; Ly, Penh Sun; Kiertiburanakul, Sasisopin; Law, Matthew

    2016-08-01

    In multisite human immunodeficiency virus (HIV) observational cohorts, clustering of observations often occurs within sites. Ignoring clustering may lead to "Simpson's paradox" (SP) where the trend observed in the aggregated data is reversed when the groups are separated. This study aimed to investigate the SP in an Asian HIV cohort and the effects of site-level adjustment through various Cox regression models. Survival time from combination antiretroviral therapy (cART) initiation was analyzed using four Cox models: (1) no site adjustment; (2) site as a fixed effect; (3) stratification through site; and (4) shared frailty on site. A total of 6,454 patients were included from 23 sites in Asia. SP was evident in the year of cART initiation variable. Model (1) shows the hazard ratio (HR) for years 2010-2014 was higher than the HR for 2006-2009, compared to 2003-2005 (HR = 0.68 vs. 0.61). Models (2)-(4) consistently implied greater improvement in survival for those who initiated in 2010-2014 than 2006-2009 contrasting findings from model (1). The effects of other significant covariates on survival were similar across four models. Ignoring site can lead to SP causing reversal of treatment effects. Greater emphasis should be made to include site in survival models when possible. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Contextual factors influencing HIV risk behaviour in Central Asia.

    PubMed

    Smolak, Alex

    2010-06-01

    Central Asia has experienced a rapid increase in HIV. HIV interventions and prevention programmes are needed that adequately appreciate and account for the ways that ongoing cultural, political and economic changes in this region affect HIV risk reduction efforts. Drawing on relevant literature, this paper provides a contextual foundation to better understand the impact of context on HIV risk behaviour in the countries of Central Asia and to begin the conversation on the contextual factors of Islam and polygamy.

  2. Contextual factors influencing HIV risk behavior in Central Asia

    PubMed Central

    Smolak, Alex

    2010-01-01

    Central Asia has experienced a rapid increase in HIV. HIV interventions and prevention programmes are needed that adequately appreciate and account for the ways that ongoing cultural, political, and economic changes in this region affect HIV risk reduction efforts. Drawing on relevant literature, this paper provides a contextual foundation to better understand the impact of context on HIV risk behaviour in the countries of Central Asia and to begin the conversation on the contextual factors of Islam and polygamy. PMID:20301020

  3. Impact of drug classes and treatment availability on the rate of antiretroviral treatment change in the TREAT Asia HIV Observational Database (TAHOD)

    PubMed Central

    Srasuebkul, Preeyaporn; Calmy, Alexandra; Zhou, Jialun; Kumarasamy, Nagalingeswaran; Law, Matthew; Lim, Poh Lian

    2007-01-01

    Background It is critical to understand the pattern of antiretroviral treatment (ART) prescription in different regions of the world as ART procurement needs to be anticipated. We aimed at exploring rates and predictors of ART combination changes in clinical practice in Treat Asia HIV Observational Database (TAHOD). Methods Rates of ART changes were examined in patients who started first line triple or more ART combination in TAHOD, and had at least one follow-up visit. Rates of ART changes were summarised per follow-up year, and factors associated with changes assessed using random-effect Poisson regression. The Kaplan-Meier method was used to determine durations of patients in their first, second and third regimen. Results A total of 1846 patients initiated an ART combination with at least three drugs. Median follow up time for the first treatment was 3.2 years. The overall rate of ART change was 29 per 100-person-year. In univariate analyses, rate of treatment change was significantly associated with exposure category, the country income category, the drug class combination, calendar year and the number of combinations. In multivariate analysis, compared to d4T/3TC/NVP, starting ART with another NNRTI-containing regimen, with PI only or with a triple NRTI regimen was associated with a higher risk of combination change (relative risk (RR) 1.6 (95% CI 1.64 – 1.96), p < 0.001, RR 3.39 (2.76 – 4.16) p < 0.001, RR 6.37 (4.51 – 9.00), p < 0.001). Being on a second or a third combination regimen was also associated with a decreased rate of ART change, compared with first ART combination (RR 0.82 (0.68 – 0.99), p = 0.035, RR 0.77 (0.61 – 0.97), p = 0.024). Sites with fewer than 12 drugs used had an increased rate of treatment changes (1.31 (1.13 – 1.51), p < 0.001). Injecting drug users, and other/unknown exposure was found to increase rate of treatment change (1.24 (1.00 – 1.54), p = 0.055). Percentages of patients who stopped treatment due to adverse

  4. Measures of site resourcing predict virologic suppression, immunologic response and HIV disease progression following highly active antiretroviral therapy (HAART) in the TREAT Asia HIV Observational Database (TAHOD)

    PubMed Central

    Oyomopito, R; Lee, MP; Phanuphak, P; Lim, PL; Ditangco, R; Zhou, J; Sirisanthana, T; Chen, YMA; Pujari, S; Kumarasamy, N; Sungkanuparph, S; Lee, CKC; Kamarulzaman, A; Oka, S; Zhang, FJ; Mean, CV; Merati, T; Tau, G; Smith, J; Li, PCK

    2010-01-01

    Objectives Surrogate markers of HIV disease progression are HIV RNA in plasma viral load (VL) and CD4 cell count (immune function). Despite improved international access to antiretrovirals, surrogate marker diagnostics are not routinely available in resource-limited settings. Therefore, the objective was to assess effects of economic and diagnostic resourcing on patient treatment outcomes. Methods Analyses were based on 2333 patients initiating highly active antiretroviral therapy (HAART) from 2000 onwards. Sites were categorized by World Bank country income criteria (high/low) and annual frequency of VL (≥ 3, 1–2 or <1) or CD4 (≥ 3 or <3) testing. Endpoints were time to AIDS/death and change in CD4 cell count and VL suppression (<400 HIV-1 RNA copies/mL) at 12 months. Demographics, Centers for Disease Control and Prevention (CDC) classification, baseline VL/CD4 cell counts, hepatitis B/C coinfections and HAART regimen were covariates. Time to AIDS/death was analysed by proportional hazards models. CD4 and VL endpoints were analysed using linear and logistic regression, respectively. Results Increased disease progression was associated with site-reported VL testing less than once per year [hazard ratio (HR)=1.4; P=0.032], severely symptomatic HIV infection (HR=1.4; P=0.003) and hepatitis C virus coinfection (HR=1.8; P=0.011). A total of 1120 patients (48.2%) had change in CD4 cell count data. Smaller increases were associated with older age (P<0.001) and `Other' HIV source exposures, including injecting drug use and blood products (P=0.043). A total of 785 patients (33.7%) contributed to the VL suppression analyses. Patients from sites with VL testing less than once per year [odds ratio (OR)=0.30; P<0.001] and reporting `Other' HIV exposures experienced reduced suppression (OR=0.28; P<0.001). Conclusion Low measures of site resourcing were associated with less favourable patient outcomes, including a 35% increase in disease progression in patients from sites

  5. Know your epidemic, know your response: targeting HIV in Asia.

    PubMed

    Lazarus, Jeffrey V; Curth, Nadja; Bridge, Jamie; Atun, Rifat

    2010-09-01

    This article provides an overview of the HIV epidemic in Asia, the context within which the epidemic is evolving, and the key actions to address the challenges faced by countries and risk groups. HIV epidemics across Asia are predominantly concentrated among most-at-risk populations. Although there have been many successes in the HIV response in Asia over the past decade, great challenges clearly remain - especially when addressing most-at-risk populations, who are often criminalized, marginalized, and discriminated against. These groups face significant legal and social barriers to accessing HIV prevention and treatment services. In order to reach the Millennium Development Goal of halting and reversing the spread of HIV by 2015 and to achieve universal access to HIV treatment, these barriers must be overcome across Asia. High-impact programs must be targeted at those in need, with continuous and predictable funding for a sustainable response that incorporates prevention and treatment scale-up. Strong political leadership and the involvement of affected communities are key to developing a systematic and comprehensive response. The potential consequences of inaction in Asia are enormous: even small increases in the HIV prevalence levels in the region will translate into vast numbers of new HIV infections due to the sheer size of the population.

  6. The funding landscape for HIV in Asia and the Pacific.

    PubMed

    Stuart, Robyn M; Lief, Eric; Donald, Braedon; Wilson, David; Wilson, David P

    2015-01-01

    Despite recent and robust economic growth across the Asia-Pacific region, the majority of low- and middle-income countries in the region remain dependent on some donor support for HIV programmes. We describe the availability of bilateral and multilateral official development assistance (ODA) for HIV programmes in the region. The donor countries considered in this analysis are Australia, Canada, Denmark, France, Germany, Netherlands, Norway, Sweden, the United Kingdom and the United States. To estimate bilateral and multilateral ODA financing for HIV programmes in the Asia-Pacific region between 2004 and 2013, we obtained funding data from the Organisation for Economic Co-operation and Development Creditor Reporting System database. Where possible, we checked these amounts against the funding data available from government aid agencies. Estimates of multilateral ODA financing for HIV/AIDS were based on the country allocations announcement by the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) for the period 2014 to 2016. Countries in the Asia-Pacific region receive the largest share of aid for HIV from the Global Fund. Bilateral funding for HIV in the region has been relatively stable over the last decade and is projected to remain below 10% of the worldwide response to the epidemic. Bilateral donors continue to prioritize ODA for HIV to other regions, particularly sub-Saharan Africa; Australia is an exception in prioritizing the Asia-Pacific region, but the United States is the bilateral donor providing the greatest amount of assistance in the region. Funding from the Global Fund has increased consistently since 2005, reaching a total of US$1.2 billion for the Asia-Pacific region from 2014 to 2016. Even with Global Fund allocations, countries in the Asia-Pacific region will not have enough resources to meet their epidemiological targets. Prevention funding is particularly vulnerable and requires greater domestic leadership and coordination

  7. Risk and vulnerability: do socioeconomic factors influence the risk of acquiring HIV in Asia?

    PubMed

    Greener, Robert; Sarkar, Swarup

    2010-09-01

    HIV epidemics in Asia have been mainly concentrated among certain population groups such as injecting drug users, sex workers and their clients and men who have sex with men (MSM). HIV risk has also been associated with labour migrants and their partners. Many of the people at risk through these behaviours are very poor, and this raises the question that poverty and social deprivation may be underlying factors that drive the adoption of risk behaviours and can be regarded as 'determinants' of vulnerability to HIV infection in Asia. The study presents some observations of the socioeconomic pattern of HIV spread in Asia, using country-level and household-level data. The discussion then draws tentative conclusions about what is known concerning the mechanisms influencing the risk of HIV acquisition in Asia and what they might imply for programme design and policy. In summary, the data presented here do not support the hypothesis that HIV epidemics in Asia are primarily driven by poverty and social deprivation, though sex inequality and education for women and girls are strongly associated factors. There is clearly a multidimensional relationship between the risk of HIV infection and a host of underlying social and cultural factors that confound any attempt at a single explanation for the HIV epidemic in Asia or elsewhere. There is an undeniable need for further research through multicountry studies and better analysis of existing household data, as well as through further investigation of the quantitative relationship between the barriers to HIV services and the risk of infection. The key message for policy is to seek a broad balance between a focus on prevention and treatment for the higher-risk behaviours without losing sight of the importance of programmes that address vulnerability and behavioural change among the sexually active adult population. The implication of these findings for the allocation of resources for downstream factors such as risk behaviours as

  8. HIV-1 variants in South and South-East Asia.

    PubMed

    Tsuchie, H; Saraswathy, T S; Sinniah, M; Vijayamalar, B; Maniar, J K; Monzon, O T; Santana, R T; Paladin, F J; Wasi, C; Thongcharoen, P

    1995-01-01

    HIV spread in South and South-East Asia is most alarming, and genetic variability of HIV-1 is an important consideration in vaccine development. In this study, we examined the third variable (V3) region of env gene of HIV-1 variants prevalent in Thailand, Malaysia, India, and the Philippines. By phylogenetic tree analyses, an HIV-1 variant from an injecting drug user (IDU) in Thailand belonged to subtype B, and HIV-1 variants from 2 IDUs in Malaysia were classified into 2 subtypes, B and E. One HIV-1 variant from a male homosexual in the Philippines belonged to subtype B. Out of 8 HIV-1 variants from sexually transmitted disease patients in India, 7 belonged to subtype C, and one to subtype A. Although the total number of individuals examined in this study was limited, 4 HIV-1 subtypes were found in South and South-East Asia and large international movements of HIV-1-infected individuals in this region could induce global dissemination of these HIV-1 variants.

  9. Tuberculosis and HIV co-infection-focus on the Asia-Pacific region.

    PubMed

    Trinh, Q M; Nguyen, H L; Nguyen, V N; Nguyen, T V A; Sintchenko, V; Marais, B J

    2015-03-01

    Tuberculosis (TB) is the leading opportunistic disease and cause of death in patients with HIV infection. In 2013 there were 1.1 million new TB/HIV co-infected cases globally, accounting for 12% of incident TB cases and 360,000 deaths. The Asia-Pacific region, which contributes more than a half of all TB cases worldwide, traditionally reports low TB/HIV co-infection rates. However, routine testing of TB patients for HIV infection is not universally implemented and the estimated prevalence of HIV in new TB cases increased to 6.3% in 2013. Although HIV infection rates have not seen the rapid rise observed in Sub-Saharan Africa, indications are that rates are increasing among specific high-risk groups. This paper reviews the risks of TB exposure and progression to disease, including the risk of TB recurrence, in this vulnerable population. There is urgency to scale up interventions such as intensified TB case-finding, isoniazid preventive therapy, and TB infection control, as well as HIV testing and improved access to antiretroviral treatment. Increased awareness and concerted action is required to reduce TB/HIV co-infection rates in the Asia-Pacific region and to improve the outcomes of people living with HIV.

  10. The funding landscape for HIV in Asia and the Pacific

    PubMed Central

    Stuart, Robyn M; Lief, Eric; Donald, Braedon; Wilson, David; Wilson, David P

    2015-01-01

    Introduction Despite recent and robust economic growth across the Asia-Pacific region, the majority of low- and middle-income countries in the region remain dependent on some donor support for HIV programmes. We describe the availability of bilateral and multilateral official development assistance (ODA) for HIV programmes in the region. Methods The donor countries considered in this analysis are Australia, Canada, Denmark, France, Germany, Netherlands, Norway, Sweden, the United Kingdom and the United States. To estimate bilateral and multilateral ODA financing for HIV programmes in the Asia-Pacific region between 2004 and 2013, we obtained funding data from the Organisation for Economic Co-operation and Development Creditor Reporting System database. Where possible, we checked these amounts against the funding data available from government aid agencies. Estimates of multilateral ODA financing for HIV/AIDS were based on the country allocations announcement by the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) for the period 2014 to 2016. Results Countries in the Asia-Pacific region receive the largest share of aid for HIV from the Global Fund. Bilateral funding for HIV in the region has been relatively stable over the last decade and is projected to remain below 10% of the worldwide response to the epidemic. Bilateral donors continue to prioritize ODA for HIV to other regions, particularly sub-Saharan Africa; Australia is an exception in prioritizing the Asia-Pacific region, but the United States is the bilateral donor providing the greatest amount of assistance in the region. Funding from the Global Fund has increased consistently since 2005, reaching a total of US$1.2 billion for the Asia-Pacific region from 2014 to 2016. Conclusions Even with Global Fund allocations, countries in the Asia-Pacific region will not have enough resources to meet their epidemiological targets. Prevention funding is particularly vulnerable and requires greater

  11. HIV continuum of care in Europe and Central Asia.

    PubMed

    Drew, R S; Rice, B; Rüütel, K; Delpech, V; Attawell, K A; Hales, D K; Velasco, C; Amato-Gauci, A J; Pharris, A; Tavoschi, L; Noori, T

    2017-08-01

    The European Centre for Disease Prevention and Control (ECDC) supports countries to monitor progress in their response to the HIV epidemic. In line with these monitoring responsibilities, we assess how, and to what extent, the continuum of care is being measured across countries. The ECDC sent out questionnaires to 55 countries in Europe and Central Asia in 2014. Nominated country representatives were questioned on how they defined and measured six elements of the continuum. We present our results using three previously described frameworks [breakpoints; Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets; diagnosis and treatment quadrant]. Forty countries provided data for at least one element of the continuum. Countries reported most frequently on the number of people diagnosed with HIV infection (37; 93%), and on the number in receipt of antiretroviral therapy (ART) (35; 88%). There was little consensus across countries in their approach to defining linkage to, and retention in, care. The most common breakpoint (>19% reduction between two adjacent elements) related to the estimated number of people living with HIV who were diagnosed (18 of 23; 78%). We present continuum data from multiple countries that provide both a snapshot of care provision and a baseline against which changes over time in care provision across Europe and Central Asia may be measured. To better inform HIV testing and treatment programmes, standard data collection approaches and definitions across the HIV continuum of care are needed. If countries wish to ensure an unbroken HIV continuum of care, people living with HIV need to be diagnosed promptly, and ART needs to be offered to all those diagnosed. © 2017 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association.

  12. Migrant workers spreading HIV in Southeast Asia.

    PubMed

    1996-10-21

    Interruption of the spread of human immunodeficiency virus (HIV) across southeast Asian borders by legal and illegal migrant laborers is a major concern of the Association of Southeast Asian Nations (ASEAN). ASEAN intends to move immediately to implement regional projects focused on education, information sharing, and improved surveillance. HIV transmission from laborers from poorer countries in search of jobs in economically booming regions underscores the global nature of the AIDS problem. Malaysia, for example, has over 1 million illegal workers. Moreover, many legal guest workers who enter Malaysia with letters from a physician stating they are not HIV-infected have falsified documents.

  13. Prognostic significance of the interval between the initiation of antiretroviral therapy and the initiation of anti-tuberculosis treatment in HIV/tuberculosis-coinfected patients: results from the TREAT Asia HIV Observational Database.

    PubMed

    Han, S H; Zhou, J; Lee, M P; Zhao, H; Chen, Y-M A; Kumarasamy, N; Pujari, S; Lee, C; Omar, S F S; Ditangco, R; Phanuphak, N; Kiertiburanakul, S; Chaiwarith, R; Merati, T P; Yunihastuti, E; Tanuma, J; Saphonn, V; Sohn, A H; Choi, J Y

    2014-02-01

    We evaluated the effect of the time interval between the initiation of antiretroviral therapy (ART) and the initiation of tuberculosis (TB) treatment on clinical outcomes in HIV/TB-coinfected patients in an Asian regional cohort. Adult HIV/TB-coinfected patients in an observational HIV-infected cohort database who had a known date of ART initiation and a history of TB treatment were eligible for study inclusion. The time interval between the initiation of ART and the initiation of TB treatment was categorized as follows: TB diagnosed while on ART, ART initiated ≤ 90 days after initiation of TB treatment ('early ART'), ART initiated > 90 days after initiation of TB treatment ('delayed ART'), and ART not started. Outcomes were assessed using survival analyses. A total of 768 HIV/TB-coinfected patients were included in this study. The median CD4 T-cell count at TB diagnosis was 100 [interquartile range (IQR) 40-208] cells/μL. Treatment outcomes were not significantly different between the groups with early ART and delayed ART initiation. Kaplan-Meier analysis indicated that mortality was highest for those diagnosed with TB while on ART (3.77 deaths per 100 person-years), and the prognoses of other groups were not different (in deaths per 100 person-years: 2.12 for early ART, 1.46 for delayed ART, and 2.94 for ART not started). In a multivariate model, the interval between ART initiation and TB therapy initiation did not significantly impact all-cause mortality. A negative impact of delayed ART in patients coinfected with TB was not observed in this observational cohort of moderately to severely immunosuppressed patients. The broader impact of earlier ART initiation in actual clinical practice should be monitored more closely. © 2013 British HIV Association.

  14. The HIV epidemic in Eastern Europe and Central Asia.

    PubMed

    DeHovitz, Jack; Uuskula, Anneli; El-Bassel, Nabila

    2014-06-01

    Eastern Europe and Central Asia represent one of the few regions globally where there is a continued increase in the incidence of HIV infection. For example, in Eastern Europe the rate of diagnosed cases of HIV infection per 100 000 population has increased from 11.7 in 2004 to 22.5 in 2011. Initially propelled by injection drug use, heterosexual transmission has now become a major driver of new infections in the region. Nonetheless substance use remains an important factor, with its control limited by challenges in scaling up harm reduction efforts. While most countries have implemented opioid substitution therapy programs, their scale remains very limited. Similarly, coverage of needles syringe programs across the region is variable. Complicating the control of HIV has been the emergence of non-injection drugs and inadequate access to antiretroviral therapy. In addition, structural barriers and stigma toward HIV infected people may contribute to the high proportion of late presentations for HIV care. Finally in the wake of the HIV epidemic, high rates of hepatitis C infection and tuberculosis have been noted.

  15. A role for businesses in HIV prevention in Asia.

    PubMed

    Kimball, A M; Thant, M

    1996-06-15

    The estimated number of HIV cases in Asia now exceeds the "worst case" scenario envisioned by the World Bank in 1993. While prevention efforts have failed to contain the epidemic in other parts of the world, Asia's private sector has the resources to contain the epidemic if it acts quickly. In parts of Asia, work place-based medical and health services already exist, but, to date, efforts to gain the cooperation of business and industry in HIV prevention programs have led to disappointment. Businesses in Thailand, on the other hand, have begun a vigorous prevention campaign led by the Thailand Business Coalition on AIDS. The countries where the epidemic has not yet made a big impact (Japan, Korea, Hong Kong, Indonesia, Viet Nam, and the Philippines) are those where intervention could be most effective. Unfortunately, little corporate cooperation is occurring in these areas. Asian companies seem to fear contamination from the disease if they engage in prevention activities. Businesses in Asia have not faced the reality of the costs of AIDS which will rob companies of highly skilled workers who are expensive to replace, drive away foreign capital, and shrink the home market as people dedicate their resources to health care. While the impact of AIDS on businesses follows a tiered approach, all enterprises will eventually be affected adversely. The interrelated nature of Asia economies will also mean that even nations which are not experiencing the epidemic will feel its economic impact (for example, Japan will see its gross national product decrease because of trade losses caused by the epidemic in Thailand). Prevention efforts by businesses must be supported and encouraged by governments with financial and other incentives. Multinational corporations can have an effect on national companies as well as organize programs for their own employees. Because they depend upon longterm strategic thinking, Asian financial institutions are beginning to understand the role that

  16. HIV/AIDS-related mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites.

    PubMed

    Streatfield, P Kim; Khan, Wasif A; Bhuiya, Abbas; Hanifi, Syed M A; Alam, Nurul; Millogo, Ourohiré; Sié, Ali; Zabré, Pascal; Rossier, Clementine; Soura, Abdramane B; Bonfoh, Bassirou; Kone, Siaka; Ngoran, Eliezer K; Utzinger, Juerg; Abera, Semaw F; Melaku, Yohannes A; Weldearegawi, Berhe; Gomez, Pierre; Jasseh, Momodou; Ansah, Patrick; Azongo, Daniel; Kondayire, Felix; Oduro, Abraham; Amu, Alberta; Gyapong, Margaret; Kwarteng, Odette; Kant, Shashi; Pandav, Chandrakant S; Rai, Sanjay K; Juvekar, Sanjay; Muralidharan, Veena; Wahab, Abdul; Wilopo, Siswanto; Bauni, Evasius; Mochamah, George; Ndila, Carolyne; Williams, Thomas N; Khagayi, Sammy; Laserson, Kayla F; Nyaguara, Amek; Van Eijk, Anna M; Ezeh, Alex; Kyobutungi, Catherine; Wamukoya, Marylene; Chihana, Menard; Crampin, Amelia; Price, Alison; Delaunay, Valérie; Diallo, Aldiouma; Douillot, Laetitia; Sokhna, Cheikh; Gómez-Olivé, F Xavier; Mee, Paul; Tollman, Stephen M; Herbst, Kobus; Mossong, Joël; Chuc, Nguyen T K; Arthur, Samuelina S; Sankoh, Osman A; Byass, Peter

    2014-01-01

    As the HIV/AIDS pandemic has evolved over recent decades, Africa has been the most affected region, even though a large proportion of HIV/AIDS deaths have not been documented at the individual level. Systematic application of verbal autopsy (VA) methods in defined populations provides an opportunity to assess the mortality burden of the pandemic from individual data. To present standardised comparisons of HIV/AIDS-related mortality at sites across Africa and Asia, including closely related causes of death such as pulmonary tuberculosis (PTB) and pneumonia. Deaths related to HIV/AIDS were extracted from individual demographic and VA data from 22 INDEPTH sites across Africa and Asia. VA data were standardised to WHO 2012 standard causes of death assigned using the InterVA-4 model. Between-site comparisons of mortality rates were standardised using the INDEPTH 2013 standard population. The dataset covered a total of 10,773 deaths attributed to HIV/AIDS, observed over 12,204,043 person-years. HIV/AIDS-related mortality fractions and mortality rates varied widely across Africa and Asia, with highest burdens in eastern and southern Africa, and lowest burdens in Asia. There was evidence of rapidly declining rates at the sites with the heaviest burdens. HIV/AIDS mortality was also strongly related to PTB mortality. On a country basis, there were strong similarities between HIV/AIDS mortality rates at INDEPTH sites and those derived from modelled estimates. Measuring HIV/AIDS-related mortality continues to be a challenging issue, all the more so as anti-retroviral treatment programmes alleviate mortality risks. The congruence between these results and other estimates adds plausibility to both approaches. These data, covering some of the highest mortality observed during the pandemic, will be an important baseline for understanding the future decline of HIV/AIDS.

  17. Sporadic aurorae observed in East Asia

    NASA Astrophysics Data System (ADS)

    Willis, D. M.; Stephenson, F. R.; Fang, Huiping

    2007-03-01

    1880-1940. The localised nature and spatial structure of some sporadic aurorae observed in East Asia is indicated by the use of descriptive terms such as "lightning", "rainbow", "streak" and "grid".

  18. Policy responses to HIV/AIDS in Central Asia.

    PubMed

    Ancker, Svetlana; Rechel, Bernd

    2015-01-01

    The countries of Central Asia (Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan) are confronted with one of the fastest growing HIV/AIDS epidemics worldwide, largely driven through injecting drug use. This article, based on a review of academic and grey literature, explores how they have responded. We find major similarities and differences across the region. At one extreme is Turkmenistan, which denies that there is any problem, does not offer harm reduction services or HIV/AIDS treatment and does not report any meaningful data to the international community. Uzbekistan is also pretty closed to outside influences, has discontinued its opioid substitution project and shares with Turkmenistan the legal prohibition of male-to-male sex. Kyrgyzstan originally led many progressive approaches in the region and, like neighbouring Tajikistan, has received substantial assistance by international agencies, in particular the Global Fund. Kazakhstan, with a much higher gross domestic product per capita, has taken on the financing of harm reduction activities through its national budget and has liberalised its drug policies. Yet, across the region punitive approaches to injecting drug use and people living with HIV/AIDS persist as do stigma and discrimination, while coverage with harm reduction programmes and treatment services is still low although with substantial variation across countries.

  19. Pediatric HIV clinical care resources and management practices in Asia: a regional survey of the TREAT Asia pediatric network.

    PubMed

    Prasitsuebsai, Wasana; Bowen, Asha C; Pang, Joselyn; Hesp, Cees; Kariminia, Azar; Sohn, Annette H

    2010-02-01

    Characterizing intraregional differences in current pediatric HIV care and treatment in Asia can guide the development of clinical practice guidelines and improve the understanding of local resource availability. The Therapeutics Research, Education, and AIDS Training in Asia (TREAT Asia) Pediatric Program is a collaboration of clinics and referral hospitals studying pediatric HIV outcomes in the region. A Web-based survey to characterize clinical management practices and monitoring resources was developed and distributed to 20 sites in January 2008. Seventeen (85%) sites from 6 countries responded through April 2008; 14 (82%) were hospital-based and 16 (94%) were public facilities. Of 4050 HIV-infected children under care, 3606 (89%) were on antiretroviral treatment; 80% were on their first mono-, dual-, or triple-drug regimen and 74% were on nevirapine- or efavirenz-based regimens. Fifteen (88%) sites had consistent access to polymerase chain reaction (PCR) testing for infant diagnosis. All sites had access to CD4 testing, with 13 (76%) routinely monitoring patients every 3-6 months; 7 (41%) sites monitored viral load at 6- to 12-month intervals. Although there is some variation in clinical practices, high levels of treatment and monitoring resources were available at these sites. The availability of PCR for early infant diagnosis positions them to implement recent WHO recommendations to treat HIV-infected children younger than 1 year of age. This information will be used to develop future research and programs to support children with HIV in Asia.

  20. A Pn Spreading Model Constrained with Observed Amplitudes in Asia

    DTIC Science & Technology

    2011-09-01

    of observed Pn amplitudes from the tectonically active regions of Asia to evaluate the performance of Y2007 and to develop new, observation-based...a set of observed Pn amplitudes from the tectonically active regions of Asia to evaluate the performance of Y2007 and to develop new observation-based...tomographic inversions to map the lateral Pn attenuation variation. RESEARCH ACCOMPLISHED Introduction It has long been recognized that the

  1. Global vegetation dynamics - Satellite observations over Asia

    NASA Technical Reports Server (NTRS)

    Malingreau, J.-P.

    1986-01-01

    The weekly global vegetation index (GVI) derived from the NOAA AVHRR instrument has been analyzed for the 1982-1985 period over a wide range of vegetation formations of Asia. Temporal development curves of the index are presented for environments ranging from the desert of central Asia to the tropical forest of Borneo. The paper shows that, despite the coarse resolution of the GVI product, a large set of useful information on ecosystem dynamics and cropping practices can be consistently derived from time series of such data. In addition, it is shown that the impact of the 1982-1983 El Nino Southern Oscillation-related drought can be detected in the GVI data through an analysis of anomalies in the development of selected vegetation formations. The relevance of such analysis for global vegetation monitoring and change detection is then underlined.

  2. Global vegetation dynamics - Satellite observations over Asia

    NASA Technical Reports Server (NTRS)

    Malingreau, J.-P.

    1986-01-01

    The weekly global vegetation index (GVI) derived from the NOAA AVHRR instrument has been analyzed for the 1982-1985 period over a wide range of vegetation formations of Asia. Temporal development curves of the index are presented for environments ranging from the desert of central Asia to the tropical forest of Borneo. The paper shows that, despite the coarse resolution of the GVI product, a large set of useful information on ecosystem dynamics and cropping practices can be consistently derived from time series of such data. In addition, it is shown that the impact of the 1982-1983 El Nino Southern Oscillation-related drought can be detected in the GVI data through an analysis of anomalies in the development of selected vegetation formations. The relevance of such analysis for global vegetation monitoring and change detection is then underlined.

  3. Suboptimal HIV Testing Uptake Among Men Who Engage in Commercial Sex Work with Men in Asia

    PubMed Central

    Jin, Harry; Friedman, Mackey Reuel; Lim, Sin How; Guadamuz, Thomas E.

    2016-01-01

    Abstract Purpose: Men who have sex with men and are sex workers (MSMSW) are disproportionately affected by the growing and emerging HIV epidemic. As sex work and same-sex behavior are heavily stigmatized and often illegal in most Asian countries, HIV research focusing on MSMSW has been limited. The goal of this analysis is to examine HIV testing practices and identify correlates of HIV testing among MSMSW in Asia. Methods: The Asia Internet MSM Sex Survey, an online cross-sectional survey of 10,861 men who have sex with men (MSM), was conducted in 2010. Data on sociodemographic characteristics, HIV testing behaviors, and sexual behaviors were collected. Five hundred and seventy-four HIV-negative/unknown respondents reported receiving payment for sex with men at least once in the past 6 months and were included in this analysis. Multivariable logistic regression was conducted to identify independent correlates of HIV testing in the past year. Results: About half (48.6%) of the participants had been tested for HIV at least once within the past year, and 30.5% had never been tested. We also found that MSMSW participants who engaged in risky behaviors were less likely to be tested. Conclusion: While one might expect a high HIV testing rate among MSMSW due to the risks associated with engaging in sex work, we found that HIV testing uptake is suboptimal among MSMSW in Asia. These results suggest that targeted HIV prevention and testing promotion among MSMSW are needed. PMID:26982598

  4. Oral manifestations of HIV/AIDS in Asia: Systematic review and future research guidelines

    PubMed Central

    Oberoi, Sukhvinder-Singh; Vohra, Puneeta; Nagpal, Archna

    2015-01-01

    Objectives The authors have conducted a systematic review of oral manifestations of HIV from studies conducted in Asia to establish the characteristics and prevalence of individual oral manifestations in Asia, and to assess the direction of future research studies on oral manifestations of HIV in Asia. Material and Methods The electronic retrieval systems and databases searched for relevant articles were PubMed [MEDLINE], EBSCO, and EMBASE. The search was for limited articles published in English or with an English abstract and articles published during the period January 1995 to August 2014. The authors reached a final overall sample of 39 studies that were conducted in Asia. Results The median population size among all studies was 312.7 patients. Oral candidiasis [OC] was the most common oral manifestation [37.7%] in studies conducted in Asia. The overall prevalence of oral hairy leukoplakia and melanotic hyperpigmentation was computed to be 10.1% and 22.8% respectively. Thailand and India are primarily countries with maximum research on oral manifestations. Conclusions The research on oral manifestations of HIV in Asia has to upgrade to more interventional and therapeutic studies rather than the contemporary cross- sectional epidemiological descriptive studies. The authors have given suggestions and future directions for the implementation of clinical research of oral manifestations in HIV patients. Key words:Oral manifestations, HIV/AIDS, Asia, Systematic review. PMID:26330942

  5. Assessing the trend of HIV/AIDS mortality rate in Asia and North Africa: an application of latent growth models.

    PubMed

    Zayeri, F; Talebi Ghane, E; Borumandnia, N

    2016-02-01

    Over the last 30 years, HIV/AIDS has emerged as a major global health challenge. This study evaluates the change of HIV/AIDS mortality rates in Asian and North African countries from 1990 to 2010 using the Global Burden of Disease (GBD) study. HIV/AIDS mortality rates were derived from the GBD database from 1990 to 2010, for 52 countries in Asia and North Africa. First, a Latent Growth Model was employed to assess the change in AIDS mortality rate over time in six different regions of Asia, and also the change in AIDS mortality rate over time for males and females in Asia and North Africa. Finally, Latent Growth Mixture Models (LGMMs) were applied to identify distinct groups in which countries within each group have similar trends over time. Our results showed that increase in mortality rate over time for males is about three times greater than for females. The highest and lowest trend of AIDS mortality rates were observed in South-East Asia and high-income Asia-Pacific regions, respectively. The LGMM allocated most countries in the South and South-East region into two classes with the highest trend of AIDS mortality rates. Although the HIV/AIDS mortality rates are decreasing in some countries and clusters, the general trend in the Asian continent is upwards. Therefore, it is necessary to provide programmes to achieve the goal of access to HIV prevention measures, treatment, care, and support for high-risk groups, especially in countries with a higher trend of AIDS mortality rates.

  6. Multilevel stigma as a barrier to HIV testing in Central Asia: a context quantified.

    PubMed

    Smolak, Alex; El-Bassel, Nabila

    2013-10-01

    Central Asia is experiencing one of the fastest growing HIV epidemics in the world, with some areas' infection rates doubling yearly since 2000. This study examines the impact of multilevel stigma (individual, family, and community) on uptake of HIV testing and receipt of HIV testing results among women in Central Asia. The sample consists of 38,884 ever-married, Central Asian women between the ages of 15 and 49. Using multilevel modeling (MLM), HIV stigma variables at the individual, family, and community levels were used to assess the significance of differences in HIV testing and receipt of HIV test results among participants while adjusting for possible confounding factors, such as age, wealth, and education. MLM results indicate that HIV stigma is significantly associated with decreased HIV testing uptake at the individual, family, and community levels and with a decrease in receipt at the community level. A one standard deviation increase in individual, family, and community level composite stigma score was associated with a respective 49 %, 59 %, and 94 % (p < 0.001) decrease in the odds of having been tested for HIV. A one standard deviation increase in community composite stigma score was associated with a 99 % (p < 0.001) decrease in the odds of test receipt. HIV stigma operates on the individual, family, and community levels to hinder HIV testing uptake and at the community level to hinder receipt. These findings have important interventions implications to improve uptake of HIV testing and receipt of HIV test results.

  7. HIV-1 drug resistance mutations among antiretroviral-naive HIV-1-infected patients in Asia: results from the TREAT Asia Studies to Evaluate Resistance-Monitoring Study.

    PubMed

    Sungkanuparph, Somnuek; Oyomopito, Rebecca; Sirivichayakul, Sunee; Sirisanthana, Thira; Li, Patrick C K; Kantipong, Pacharee; Lee, Christopher K C; Kamarulzaman, Adeeba; Messerschmidt, Liesl; Law, Matthew G; Phanuphak, Praphan

    2011-04-15

    Of 682 antiretroviral-naïve patients initiating antiretroviral therapy in a prospective, multicenter human immunodeficiency virus type 1 (HIV-1) drug resistance monitoring study involving 8 sites in Hong Kong, Malaysia, and Thailand, the prevalence of patients with ≥1 drug resistance mutation was 13.8%. Primary HIV drug resistance is emerging after rapid scaling-up of antiretroviral therapy use in Asia.

  8. HIV Epidemic in Asia: Implications for HIV Vaccine and Other Prevention Trials.

    PubMed

    Phanuphak, Nittaya; Lo, Ying-Ru; Shao, Yiming; Solomon, Sunil Suhas; O'Connell, Robert J; Tovanabutra, Sodsai; Chang, David; Kim, Jerome H; Excler, Jean Louis

    2015-11-01

    An overall decrease of HIV prevalence is now observed in several key Asian countries due to effective prevention programs. The decrease in HIV prevalence and incidence may further improve with the scale-up of combination prevention interventions. The implementation of future prevention trials then faces important challenges. The opportunity to identify heterosexual populations at high risk such as female sex workers may rapidly wane. With unabating HIV epidemics among men who have sex with men (MSM) and transgender (TG) populations, an effective vaccine would likely be the only option to turn the epidemic. It is more likely that efficacy trials will occur among MSM and TG because their higher HIV incidence permits smaller and less costly trials. The constantly evolving patterns of HIV-1 diversity in the region suggest close monitoring of the molecular HIV epidemic in potential target populations for HIV vaccine efficacy trials. CRF01_AE remains predominant in southeast Asian countries and MSM populations in China. This relatively steady pattern is conducive to regional efficacy trials, and as efficacy warrants, to regional licensure. While vaccines inducing nonneutralizing antibodies have promise against HIV acquisition, vaccines designed to induce broadly neutralizing antibodies and cell-mediated immune responses of greater breadth and depth in the mucosal compartments should be considered for testing in MSM and TG. The rationale and design of efficacy trials of combination prevention modalities such as HIV vaccine and preexposure prophylaxis (PrEP) remain hypothetical, require high adherence to PrEP, are more costly, and present new regulatory challenges. The prioritization of prevention interventions should be driven by the HIV epidemic and decided by the country-specific health and regulatory authorities. Modeling the impact and cost-benefit may help this decision process.

  9. HIV Epidemic in Asia: Implications for HIV Vaccine and Other Prevention Trials

    PubMed Central

    Phanuphak, Nittaya; Lo, Ying-Ru; Shao, Yiming; Solomon, Sunil Suhas; O'Connell, Robert J.; Tovanabutra, Sodsai; Chang, David; Kim, Jerome H.

    2015-01-01

    Abstract An overall decrease of HIV prevalence is now observed in several key Asian countries due to effective prevention programs. The decrease in HIV prevalence and incidence may further improve with the scale-up of combination prevention interventions. The implementation of future prevention trials then faces important challenges. The opportunity to identify heterosexual populations at high risk such as female sex workers may rapidly wane. With unabating HIV epidemics among men who have sex with men (MSM) and transgender (TG) populations, an effective vaccine would likely be the only option to turn the epidemic. It is more likely that efficacy trials will occur among MSM and TG because their higher HIV incidence permits smaller and less costly trials. The constantly evolving patterns of HIV-1 diversity in the region suggest close monitoring of the molecular HIV epidemic in potential target populations for HIV vaccine efficacy trials. CRF01_AE remains predominant in southeast Asian countries and MSM populations in China. This relatively steady pattern is conducive to regional efficacy trials, and as efficacy warrants, to regional licensure. While vaccines inducing nonneutralizing antibodies have promise against HIV acquisition, vaccines designed to induce broadly neutralizing antibodies and cell-mediated immune responses of greater breadth and depth in the mucosal compartments should be considered for testing in MSM and TG. The rationale and design of efficacy trials of combination prevention modalities such as HIV vaccine and preexposure prophylaxis (PrEP) remain hypothetical, require high adherence to PrEP, are more costly, and present new regulatory challenges. The prioritization of prevention interventions should be driven by the HIV epidemic and decided by the country-specific health and regulatory authorities. Modeling the impact and cost–benefit may help this decision process. PMID:26107771

  10. The Asian Epidemic Model: a process model for exploring HIV policy and programme alternatives in Asia.

    PubMed

    Brown, T; Peerapatanapokin, W

    2004-08-01

    Process models offer opportunities to explore the effectiveness of different programme and policy alternatives by varying input behaviours and model parameters to reflect programmatic/policy effects. The Asian Epidemic Model (AEM) has been designed to reflect the primary groups and transmission modes driving HIV transmission in Asia. The user adjusts AEM fitting parameters until HIV prevalence outputs from the model agree with observed epidemiological trends. The AEM resultant projections are closely tied to the epidemiological and behavioural data in the country. In Thailand and Cambodia they have shown good agreement with observed epidemiological trends in surveillance populations and with changes in HIV transmission modes, AIDS cases, male:female ratios over time, and other external validation checks. By varying the input behaviours and STI trends, one can examine the impact of different prevention efforts on the future course of the epidemic. In conclusion, the AEM is a semi-empirical model, which has worked well in Asian settings. It provides a useful tool for policy and programme analysis in Asian countries.

  11. Tuberculosis, drug use and HIV infection in Central Asia: an urgent need for attention.

    PubMed

    Schluger, Neil W; El-Bassel, Nabila; Hermosilla, Sabrina; Terlikbayeva, Assel; Darisheva, Meruyert; Aifah, Angela; Galea, Sandro

    2013-11-01

    Rates of tuberculosis in Central Asia are extremely high, and even more alarming are the very high rates of multidrug-resistant tuberculosis (MDR-TB) in Kazakhstan, Uzbekistan, Tajikistan and Kyrgyzstan. In addition, rates of HIV infection related to injection drug use seems to be rising as well, thus creating conditions for a potentially devastating co-epidemic of TB/HIV and MDR-TB/HIV which would have terrible consequences for public health in these countries. In many countries of Central Asia, diagnosis of tuberculosis still rests on clinical grounds or simple technologies such as chest radiograph and sputum smear examination. Modern molecular techniques such as GenExpert are being introduced in Kazakhstan and Uzbekistan, and perhaps soon in Kyrgyzstan. Treatment of TB is still often centered around prolonged inpatient stay at TB hospitals. Only a minority of patients with HIV infection are receiving ART, and TB and HIV services are not well integrated. Needle exchange programs are becoming increasingly available, but opioid substitution therapy is rarely used in Central Asia. TB, drug treatment and HIV services are generally not well-integrated. To combat this developing storm, integration of TB services, HIV care, and substance abuse treatment programs is needed urgently to allow efficient and effective diagnosis and treatment of these conditions in a coordinated manner. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  12. HIV/AIDS in the transitional countries of Eastern Europe and Central Asia.

    PubMed

    Donoghoe, Martin C; Lazarus, Jeffrey V; Matic, Srdan

    2005-01-01

    In the 1990s, HIV/AIDS became a major threat to health, economic stability and human development in countries in eastern Europe and central Asia. Social, political and economic transition exacerbated the structural conditions that allowed HIV/AIDS to flourish as dramatic changes led to increasing drug injection, economic decline and failing health and healthcare systems. There is a need to address the professional and ideological opposition - even in countries considered to be fully functioning democracies - to evidence-based public health interventions like harm reduction, coupled with treating HIV/AIDS for all those in need, if countries are to provide a more effective response.

  13. HIV/AIDS in Asia: Human Rights and the Education Sector. Discussion Paper No. II

    ERIC Educational Resources Information Center

    Wijngaarden, Jan; Shaeffer, Sheldon

    2005-01-01

    An evaluation is presented on the impact of HIV/AIDS on the education sector in the Asia Pacific region. Its focus is how human rights in relation to education have been upset by the epidemic. The education sector is urged to develop more initiatives to educate about the epidemic, and to build measures that deal with both immediate and long-term…

  14. Gender disparities in HIV infection among persons who inject drugs in Central Asia: a systematic review and meta-analysis.

    PubMed

    Des Jarlais, Don C; Boltaev, Azizbek; Feelemyer, Jonathan; Bramson, Heidi; Arasteh, Kamyar; Phillips, Benjamin W; Hagan, Holly

    2013-11-01

    Disparities in HIV infection, with females having higher rates of HIV infection than males, have been noted among persons who inject drugs (PWID) in many countries. We examined male/female HIV disparities among PWID in Central Asia and compared these disparities with patterns worldwide. A systematic review and meta-analyses were conducted for studies reporting HIV prevalence by gender among PWID. To be included in the analyses, reports had to contain (1) samples of PWID from Central Asia, (2) HIV data based on laboratory testing, (3) HIV prevalence reported for males and females, and (4) samples that were not recruited on the basis of HIV status. Data were abstracted from 11 studies in 5 countries in Central Asia: China, Kazakhstan, Russia, Tajikistan, and Uzbekistan; the total sample size was 12,225. The mean weighted OR for HIV prevalence among females to males was 0.913 (95% CI 0.07, 1.26), with high heterogeneity among studies (I(2)=70.0%) and a possible publication bias among studies with small sample sizes (Eggers test=-1.81, 95% CI -5.18, 0.54). The non-significant higher HIV prevalence among male PWID in Central Asia contrasts with the worldwide findings which show slightly higher HIV prevalence among female PWID. This may reflect the relative recency of the HIV epidemics in Central Asia. The findings also suggest there may be factors that protect female PWID from HIV in some settings. Further examination of transmission dynamics in Central Asia is necessary to better understand the HIV epidemic among PWID. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  15. Geographically structured populations of Cryptococcus neoformans Variety grubii in Asia correlate with HIV status and show a clonal population structure.

    PubMed

    Khayhan, Kantarawee; Hagen, Ferry; Pan, Weihua; Simwami, Sitali; Fisher, Matthew C; Wahyuningsih, Retno; Chakrabarti, Arunaloke; Chowdhary, Anuradha; Ikeda, Reiko; Taj-Aldeen, Saad J; Khan, Ziauddin; Ip, Margaret; Imran, Darma; Sjam, Ridhawati; Sriburee, Pojana; Liao, Wanqing; Chaicumpar, Kunyaluk; Vuddhakul, Varaporn; Meyer, Wieland; Trilles, Luciana; van Iersel, Leo J J; Meis, Jacques F; Klaassen, Corné H W; Boekhout, Teun

    2013-01-01

    Cryptococcosis is an important fungal disease in Asia with an estimated 140,000 new infections annually the majority of which occurs in patients suffering from HIV/AIDS. Cryptococcus neoformans variety grubii (serotype A) is the major causative agent of this disease. In the present study, multilocus sequence typing (MLST) using the ISHAM MLST consensus scheme for the C. neoformans/C. gattii species complex was used to analyse nucleotide polymorphisms among 476 isolates of this pathogen obtained from 8 Asian countries. Population genetic analysis showed that the Asian C. neoformans var. grubii population shows limited genetic diversity and demonstrates a largely clonal mode of reproduction when compared with the global MLST dataset. HIV-status, sequence types and geography were found to be confounded. However, a correlation between sequence types and isolates from HIV-negative patients was observed among the Asian isolates. Observations of high gene flow between the Middle Eastern and the Southeastern Asian populations suggest that immigrant workers in the Middle East were originally infected in Southeastern Asia.

  16. HIV and HCV among people who inject drugs in Central Asia.

    PubMed

    Walsh, Nick; Maher, Lisa

    2013-11-01

    Over the last decade, Central Asia has become a focal point of HIV and hepatitis C virus (HCV) transmission among people who inject drugs (PWID). PWID account for the majority of HIV infections in most countries in the region, while a large proportion have been exposed to HCV. Shared modes of transmission of these infections point to an increasing burden of HIV/HCV co-infection in this population. HIV/HCV co-infection is more likely to result in progressive liver disease, increased mortality and hepatic complications from antiretroviral therapy (ART). While the HIV treatment response has improved, less than a quarter of people living with HIV (PLHIV) in the region are receiving ART, with treatment uptake among PWID particularly low. HCV treatment is available in some areas, though at a very high cost to patients thereby preventing access to those at most need. Robust surveillance of HIV/HCV infection among PWID is needed to inform a comprehensive response to HIV and HCV prevention and treatment among PWID, including increasing coverage of opioid substitution therapy (OST) and needle and syringe programs (NSPs), improving access and uptake of ART, and lowering costs and other barriers to HCV treatment across the five republics. Optimising uptake of these initiatives by increasing prevention and treatment literacy among PWID and decreasing barriers to screening and testing will also be necessary to mitigate the increasing burden of HIV/HCV co-infection in the region. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  17. Changing patterns of HIV epidemic in 30 years in East Asia.

    PubMed

    Suguimoto, S Pilar; Techasrivichien, Teeranee; Musumari, Patou Masika; El-saaidi, Christina; Lukhele, Bhekumusa Wellington; Ono-Kihara, Masako; Kihara, Masahiro

    2014-06-01

    The HIV epidemic in East Asia started relatively late compared to the rest of the world. All countries or areas, except for North Korea, had reported HIV and AIDS cases, with China being the major contributor to the epidemic. Though initially driven by injecting drug use in China, East Asia did not experience an explosive spread. Strong commitment in China and early harm reduction programs in Taiwan managed to reduce transmission substantially among injecting drug users. In contrast to China and Taiwan, injection drug use has accounted just a little, if not at all, for the spread of HIV in other East Asian counties. However, following a global trend, sexual contact has become a major route of infection across the region. While much progress has been achieved in this region, with the epidemic among other key populations relatively stable, the emerging epidemic through sex between men is a growing concern. Recent estimates suggest that HIV prevalence among men who have sex with men (MSM) has reached 6.3 % in China, 7.5 % in Mongolia, and ranges between 8.1 %-10.7 % in Taiwan and between 2.7 %- 6.5 % in South Korea. In Japan, 74 % of male HIV cases were among MSM in 2012, while Hong Kong has witnessed a sharp increase of HIV cases among MSM since 2004. There is urgent need to address issues of discrimination and stigma toward homosexuality, and to strengthen the strategies to reach and care for this population.

  18. Uncovering the epidemic of HIV among men who have sex with men in Central Asia.

    PubMed

    Wirtz, Andrea L; Kirey, Anna; Peryskina, Alena; Houdart, Fabrice; Beyrer, Chris

    2013-11-01

    Research among people who inject drugs (PWID) in Central Asia has described same sex behavior among male PWID and may be associated with HIV and other infections. Little is known about the population of men who have sex with men (MSM) and the burden of HIV among MSM in Central Asian countries. We conducted a comprehensive search of peer-reviewed publications and gray literature on MSM and HIV in the region. Search strategies included terms for MSM combined with five Central Asian countries and neighbors, including Mongolia, Afghanistan, and Xinjiang Province, China. 230 sources were identified with 43 eligible for inclusion: 12 provided HIV prevalence and population size estimates for MSM, none provided incidence estimates, and no publications for Turkmenistan were identified. National reports estimate HIV prevalence among MSM to range from 1 to 2% in Kazakhstan, Kyrgyzstan, Tajikistan, Uzbekistan, Xinjiang, to 10% in Mongolia. Biobehavioral studies estimated HIV prevalence at 0.4% in Afghanistan and 20.2% in Kazakhstan. Sexual identities and behaviors vary across countries. Injection drug use was relatively low among MSM (<5% for most). Non-injection drugs, alcohol use prior to sex, and binge drinking were more common and potentially associated with violence. Criminalization of homosexuality (Afghanistan, Uzbekistan, and Turkmenistan) and stigma has limited research and HIV prevention. Improved understanding of risks, including potential linkages between sexual exposures and substance use, among MSM are important for response. The little known about HIV among MSM in Central Asia speaks to the urgency of improvements in HIV research, prevention, and care. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  19. Pain and palliative care for people living with HIV/AIDS in Asia.

    PubMed

    Coughlan, Marie

    2003-01-01

    Millions of people living with HIV/AIDS (PLHA) in Asia need access to palliative care as part of a comprehensive response to their support needs. There are many causes of pain in HIV/AIDS, and its prevalence is as high if not higher than in cancer, but it is frequently undertreated. Access to adequate pain relief and palliative care is impeded by the barriers which face PLHA in Asia. These include few care and support services, lack of recognition and acknowledgement of pain in HIV/AIDS by health care professionals, widespread stigma and discrimination especially towards vulnerable groups such as injecting drug users, government regulatory mechanisms which make access to opioids even more difficult for the care services which have developed and a lack of understanding of or advocacy for pain relief and palliative care in the literature on HIV/AIDS care and support. During the growth of palliative care in Asia, there is opportunity for advocates of palliative care and care for PLHA to collaborate to influence national policy.

  20. Challenges of cross-cultural research: lessons from a U.S.-Asia HIV collaboration.

    PubMed

    Chen, Wei-Ti; Shiu, Cheng-Shi; Simoni, Jane M; Chuang, Peing; Zhao, Hongxin; Bao, Meijuan; Lu, Hongzhou

    2013-01-01

    Many Asian countries have scaled up their research to combat human immunodeficiency virus (HIV). HIV experts from the West have teamed up with these countries to assist in designing research protocols and providing necessary training. In this paper, we document the formation and maintenance of international and interdisciplinary HIV research collaboration among cross-disciplinary researchers working in the United States, Taiwan, and China. We conducted international social-behavioral HIV studies in several major metropolitan areas in Asia. Culturally sensitive issues that could be attributed to social and disciplinary differences have emerged throughout the collaboration process, including questions of who should be the research leader, where should resources be allocated, how should tasks be shared, which topics are valuable for investigation, and what survey questions are allowable. There is now a window of opportunity for greater international and interdisciplinary collaboration; however, for such collaboration to flourish, team dynamics in international research collaboration should be carefully identified and managed before studies are begun.

  1. Overview of HIV molecular epidemiology among people who inject drugs in Europe and Asia.

    PubMed

    Nikolopoulos, Georgios K; Kostaki, Evangelia-Georgia; Paraskevis, Dimitrios

    2016-12-01

    HIV strains continuously evolve, tend to recombine, and new circulating variants are being discovered. Novel strains complicate efforts to develop a vaccine against HIV and may exhibit higher transmission efficiency and virulence, and elevated resistance to antiretroviral agents. The United Nations Joint Programme on HIV/AIDS (UNAIDS) set an ambitious goal to end HIV as a public health threat by 2030 through comprehensive strategies that include epidemiological input as the first step of the process. In this context, molecular epidemiology becomes invaluable as it captures trends in HIV evolution rates that shape epidemiological pictures across several geographical areas. This review briefly summarizes the molecular epidemiology of HIV among people who inject drugs (PWID) in Europe and Asia. Following high transmission rates of subtype G and CRF14_BG among PWID in Portugal and Spain, two European countries, Greece and Romania, experienced recent HIV outbreaks in PWID that consisted of multiple transmission clusters including subtypes B, A, F1, and recombinants CRF14_BG and CRF35_AD. The latter was first identified in Afghanistan. Russia, Ukraine, and other Former Soviet Union (FSU) states are still facing the devastating effects of epidemics in PWID produced by AFSU (also known as IDU-A), BFSU (known as IDU-B), and CRF03_AB. In Asia, CRF01_AE and subtype B (Western B and Thai B) travelled from PWID in Thailand to neighboring countries. Recombination hotspots in South China, Northern Myanmar, and Malaysia have been generating several intersubtype and inter-CRF recombinants (e.g. CRF07_BC, CRF08_BC, CRF33_01B etc.), increasing the complexity of HIV molecular patterns. Copyright © 2016 Elsevier B.V. All rights reserved.

  2. Clinical implications of HIV and hepatitis B co-infection in Asia and Africa.

    PubMed

    Hoffmann, Christopher J; Thio, Chloe L

    2007-06-01

    Hepatitis B virus (HBV) is the leading cause of chronic liver disease and liver-related death worldwide, with the majority of these cases occurring in areas of Africa and Asia where HBV prevalence is high. Many of the countries that are affected by hepatitis B are also affected by a high HIV burden, leading to frequent HIV/HBV co-infection. The consequences of co-infection, including increased liver-related morbidity and mortality, increased hepatitis B viral replication, immune reconstitution to HBV in the setting of antiretroviral therapy, and hepatotoxicity from antiretroviral drugs, are especially important in regions with expanding antiretroviral programmes. Little data, however, are available on HIV/HBV co-infection from regions with high chronic hepatitis B prevalence. This Review discusses the epidemiology, natural history, pathogenesis, and management of HIV/HBV co-infection from these areas. Topics for future research relevant to HIV/HBV co-infection in Africa and Asia are also highlighted.

  3. An HIV Vaccine for South-East Asia-Opportunities and Challenges.

    PubMed

    Pitisuttithum, Punnee; Rerks-Ngarm, Supachai; O'Connell, Robert J; Kim, Jerome H; Excler, Jean-Louis

    2013-08-14

    Recent advances in HIV vaccine development along with a better understanding of the immune correlates of risk have emerged from the RV144 efficacy trial conducted in Thailand. Epidemiological data suggest that CRF01_AE is still predominant in South-East Asia and is spreading in China with a growing number of circulating recombinant forms due to increasing human contact, particularly in large urban centers, tourist locations and in sites of common infrastructure. A vaccine countering CRF01_AE is a priority for the region. An Asia HIV vaccine against expanding B/E or BCE recombinant forms should be actively pursued. A major challenge that remains is the conduct of efficacy trials in heterosexual populations in this region. Men who have sex with men represent the main target population for future efficacy trials in Asia. Coupling HIV vaccines with other prevention modalities in efficacy trials might also be envisaged. These new avenues will only be made possible through the conduct of large-scale efficacy trials, interdisciplinary teams, international collaborations, and strong political and community commitments.

  4. Confronting the HIV, Tuberculosis, Addiction, and Incarceration Syndemic in Southeast Asia: Lessons Learned from Malaysia.

    PubMed

    Culbert, Gabriel J; Pillai, Veena; Bick, Joseph; Al-Darraji, Haider A; Wickersham, Jeffrey A; Wegman, Martin P; Bazazi, Alexander R; Ferro, Enrico; Copenhaver, Michael; Kamarulzaman, Adeeba; Altice, Frederick L

    2016-09-01

    Throughout Southeast Asia, repressive drug laws have resulted in high rates of imprisonment in people who inject drugs (PWID) and people living with HIV (PLH), greatly magnifying the harm associated with HIV, tuberculosis, and addiction. We review findings from Malaysia's largest prison to describe the negative synergistic effects of HIV, tuberculosis, addiction, and incarceration that contribute to a 'perfect storm' of events challenging public and personal health and offer insights into innovative strategies to control these converging epidemics. The majority of PLH who are imprisoned in Malaysia are opioid dependent PWID. Although promoted by official policy, evidence-based addiction treatment is largely unavailable, contributing to rapid relapse and/or overdose after release. Similarly, HIV treatment in prisons and compulsory drug treatment centers is sometimes inadequate or absent. The prevalence of active tuberculosis is high, particularly in PLH, and over 80 % of prisoners and prison personnel are latently infected. Mandatory HIV testing and subsequent segregation of HIV-infected prisoners increases the likelihood of tuberculosis acquisition and progression to active disease, amplifying the reservoir of infection for other prisoners. We discuss strategies to control these intersecting epidemics including screening linked to standardized treatment protocols for all three conditions, and effective transitional programs for released prisoners. For example, recently introduced evidence-based interventions in prisons like antiretroviral therapy (ART) to treat HIV, isoniazid preventive therapy to treat latent tuberculosis infection, and methadone maintenance to treat opioid dependence, have markedly improved clinical care and reduced morbidity and mortality. Since introduction of these interventions in September 2012, all-cause and HIV-related mortality have decreased by 50.0 % and 75.7 %, respectively. We discuss the further deployment of these

  5. Confronting the HIV, Tuberculosis, Addiction, and Incarceration Syndemic in Southeast Asia: Lessons Learned from Malaysia

    PubMed Central

    Culbert, Gabriel J.; Pillai, Veena; Bick, Joseph; Al-Darraji, Haider A.; Wickersham, Jeffrey A.; Wegman, Martin P.; Bazazi, Alexander R.; Ferro, Enrico; Copenhaver, Michael; Kamarulzaman, Adeeba; Altice, Frederick L.

    2016-01-01

    Throughout Southeast Asia, repressive drug laws have resulted in high rates of imprisonment in people who inject drugs and people living with HIV (PLH), greatly magnifying the harm associated with HIV, tuberculosis, and addiction. We review findings from Malaysia's largest prison to describe the synergistic effects of HIV, tuberculosis, addiction, and incarceration that contribute to a‘perfect storm’of events challenging public and personal health and offer insights into innovative strategies to control these converging epidemics. The majority of PLH who are imprisoned in Malaysia are opioid dependent. Although promoted by official policy, evidence-based drug treatment is largely unavailable, contributing to rapid relapse and/or overdose after release. Similarly, HIV treatment in prisons and compulsory drug treatment centers is sometimes inadequate or absent. The prevalence of active tuberculosis is high, particularly in PLH, and over 80% of prisoners and prison personnel are latently infected. Mandatory HIV testing and subsequent segregation of HIV-infected prisoners increases the likelihood of tuberculosis acquisition and progression to active disease, enlarging the reservoir of infection for other prisoners. We discuss strategies to control these intersecting epidemics including screening linked to standardized treatment protocols for all three conditions, and effective transitional programs for released prisoners. For example, recently introduced evidence-based interventions in prisons like antiretroviral therapy (ART) to treat HIV, isoniazid preventive therapy to treat latent tuberculosis infection, and methadone maintenance to treat opioid dependence, have markedly improved clinical care and reduced mortality. Since introduction of these interventions in September 2012, all-cause and HIV-related mortality have decreased by 50.0% and 75.7% respectively. We discuss the further deployment of these interventions in Malaysian prisons. PMID:27216260

  6. Drug use, HIV, HCV and TB: major interlinked challenges in Eastern Europe and Central Asia

    PubMed Central

    Kazatchkine, Michel

    2014-01-01

    Eastern Europe and Central Asia have the largest drug epidemic globally and the fastest and still expanding HIV epidemic. The Russian Federation and Ukraine together account for over 90% of the reported AIDS cases in the region. If small in absolute numbers, the epidemics are however significant in prevalence rate in most countries of Central Asia. Most heroin and many of the new synthetic or home-made drugs are injected, which has led to high prevalence levels (up to 90%) of HCV infection in people who inject drugs (PWID). The two epidemics of HIV and HCV are in turn interlinked with TB and MDR-TB that are highly prevalent among marginalized populations in the region. Despite progress in the last two years, access to antiretroviral treatment remains far below global levels and increases more slowly than new reported cases of HIV. Access to prevention is limited with low coverage of needle exchange programs and very low or inexistent access to opioid substitutive therapy. There are few exceptions to this situation, including Ukraine where harm reduction programs are being scaled up together with significant peer outreach programs for PWIDs. This is likely to be the reason why the epidemic curves in the Russian Federation and Ukraine are now diverging. The region faces many structural, cultural, societal and political obstacles in responding to these quadruple epidemics. Without a significantly expanded and strengthened response, these epidemics will remain major causes of illness and premature deaths in the region. PMID:25394010

  7. A meta-analysis of the efficacy of HIV/AIDS prevention interventions in Asia, 1995-2009.

    PubMed

    Tan, Judy Y; Huedo-Medina, Tania B; Warren, Michelle R; Carey, Michael P; Johnson, Blair T

    2012-08-01

    The HIV/AIDS epidemic continues to grow in pockets across Asia, despite early successes at curtailing its spread in countries like Thailand. Recent evidence documents dramatic increases in incidence among risk groups and, alarmingly, the general population. This meta-analysis summarizes the sexual risk-reduction interventions for the prevention of HIV-infection that have been evaluated in Asia. Sexual risk-reduction outcomes (condom use, number of sexual partners, incident sexually transmitted infections [STI], including HIV) from 46 behavioral intervention studies with a comparison condition and available by August 2010 were included. Overall, behavioral interventions in Asia consistently reduced sexual risk outcomes. Condom use improved when interventions sampled more women, included motivational content, or did not include STI testing and treatment. Incident HIV/STI efficacy improved most when interventions sampled more women, were conducted more recently, or when they included STI counseling and testing. Sexual frequency efficacy improved more in interventions that were conducted in countries with lower human development capacities, when younger individuals were sampled, or when condom skills training was included. Behavioral interventions for reducing sexual risk in Asia are efficacious; yet, the magnitude of the effects co-varies with specific intervention and structural components. The impact of structural factors on HIV intervention efficacy must be considered when implementing and evaluating behavioral interventions. Implications and recommendations for HIV/AIDS interventions are discussed. Copyright © 2011 Elsevier Ltd. All rights reserved.

  8. CD41 T cell recovery during suppression of HIV replication: an international comparison of the immunological efficacy of antiretroviral therapy in North America, Asia and Africa.

    PubMed

    Geng, Elvin H; Neilands, Torsten B; Thièbaut, Rodolphe; Bwana, Mwebesa Bosco; Nash, Denis; Moore, Richard D; Wood, Robin; Zannou, Djimon Marcel; Althoff, Keri N; Lim, Poh Lian; Nachega, Jean B; Easterbrook, Philippa J; Kambugu, Andrew; Little, Francesca; Nakigozi, Gertrude; Nakanjako, Damalie; Kiggundu, Valerian; Ki Li, Patrick Chung; Bangsberg, David R; Fox, Matthew P; Prozesky, HansW; Hunt, Peter W; Davies, Mary-Ann; Reynolds, Steven J; Egger, Matthias; Yiannoutsos, Constantin T; Vittinghoff, Eric V; Deeks, Steven G; Martin, Jeffrey N

    2015-02-01

    Even among HIV-infected patients who fully suppress plasma HIV RNA replication on antiretroviral therapy, genetic (e.g. CCL3L1 copy number), viral (e.g. tropism) and environmental (e.g. chronic exposure to microbial antigens) factors influence CD4 recovery. These factors differ markedly around the world and therefore the expected CD4 recovery during HIV RNA suppression may differ globally. We evaluated HIV-infected adults from North America, West Africa, East Africa, Southern Africa and Asia starting non-nucleoside reverse transcriptase inhibitorbased regimens containing efavirenz or nevirapine, who achieved at least one HIV RNA level <500/ml in the first year of therapy and observed CD4 changes during HIV RNA suppression. We used a piecewise linear regression to estimate the influence of region of residence on CD4 recovery, adjusting for socio-demographic and clinical characteristics. We observed 28 217 patients from 105 cohorts over 37 825 person-years. After adjustment, patients from East Africa showed diminished CD4 recovery as compared with other regions. Three years after antiretroviral therapy initiation, the mean CD4 count for a prototypical patient with a pre-therapy CD4 count of 150/ml was 529/ml [95% confidence interval (CI): 517–541] in North America, 494/ml (95% CI: 429–559) in West Africa, 515/ml (95% CI: 508–522) in Southern Africa, 503/ml (95% CI: 478–528) in Asia and 437/ml (95% CI: 425–449) in East Africa. CD4 recovery during HIV RNA suppression is diminished in East Africa as compared with other regions of the world, and observed differences are large enough to potentially influence clinical outcomes. Epidemiological analyses on a global scale can identify macroscopic effects unobservable at the clinical, national or individual regional level.

  9. Predawn plasma bubble cluster observed in Southeast Asia

    NASA Astrophysics Data System (ADS)

    Watthanasangmechai, Kornyanat; Yamamoto, Mamoru; Saito, Akinori; Tsunoda, Roland; Yokoyama, Tatsuhiro; Supnithi, Pornchai; Ishii, Mamoru; Yatini, Clara

    2016-06-01

    Predawn plasma bubble was detected as deep plasma depletion by GNU Radio Beacon Receiver (GRBR) network and in situ measurement onboard Defense Meteorological Satellite Program F15 (DMSPF15) satellite and was confirmed by sparse GPS network in Southeast Asia. In addition to the deep depletion, the GPS network revealed the coexisting submesoscale irregularities. A deep depletion is regarded as a primary bubble. Submesoscale irregularities are regarded as secondary bubbles. Primary bubble and secondary bubbles appeared together as a cluster with zonal wavelength of 50 km. An altitude of secondary bubbles happened to be lower than that of the primary bubble in the same cluster. The observed pattern of plasma bubble cluster is consistent with the simulation result of the recent high-resolution bubble (HIRB) model. This event is only a single event out of 76 satellite passes at nighttime during 3-25 March 2012 that significantly shows plasma depletion at plasma bubble wall. The inside structure of the primary bubble was clearly revealed from the in situ density data of DMSPF15 satellite and the ground-based GRBR total electron content.

  10. HIV-1 Drug Resistance Mutations Among Antiretroviral-Naïve HIV-1–Infected Patients in Asia: Results From the TREAT Asia Studies to Evaluate Resistance-Monitoring Study

    PubMed Central

    Oyomopito, Rebecca; Sirivichayakul, Sunee; Sirisanthana, Thira; Kantipong, Pacharee; Lee, Christopher K. C.; Kamarulzaman, Adeeba; Messerschmidt, Liesl; Law, Matthew G.; Phanuphak, Praphan

    2011-01-01

    (See editorial commentary by Jordan on pages 1058–1060.) Of 682 antiretroviral-naïve patients initiating antiretroviral therapy in a prospective, multicenter human immunodeficiency virus type 1 (HIV-1) drug resistance monitoring study involving 8 sites in Hong Kong, Malaysia, and Thailand, the prevalence of patients with ≥1 drug resistance mutation was 13.8%. Primary HIV drug resistance is emerging after rapid scaling-up of antiretroviral therapy use in Asia. PMID:21460324

  11. Challenges of cross-cultural research: Lessons from a U.S.-Asia HIV collaboration

    PubMed Central

    Chen, Wei-Ti; Shiu, Cheng-Shi; Simoni, Jane M.; Chuang, Peing; Zhao, Hongxin; Bao, Meijuan; Lu, Hongzhou

    2013-01-01

    Many Asian countries have scaled up their research to combat human immunodeficiency virus (HIV). HIV experts from the West have teamed up with these countries to assist in designing research protocols and providing necessary training. In this paper, we document the formation and maintenance of international and interdisciplinary HIV research collaboration among cross-disciplinary researchers working in the United States, Taiwan, and China. We conducted international social-behavioral HIV studies in several major metropolitan areas in Asia. Culturally sensitive issues that could be attributed to social and disciplinary differences have emerged throughout the collaboration process, including questions of who should be the research leader, where should resources be allocated, how should tasks be shared, which topics are valuable for investigation, and what survey questions are allowable. There is now a window of opportunity for greater international and interdisciplinary collaboration; however, for such collaboration to flourish, team dynamics in international research collaboration should be carefully identified and managed before studies are begun. PMID:23419838

  12. Sexual Transmission Behaviors and Serodiscordant Partnerships among HIV-positive Men Who Have Sex with Men in Asia

    PubMed Central

    Wei, Chongyi; Guadamuz, Thomas E.; Lim, Sin How; Koe, Stuart

    2011-01-01

    We described sexual transmission behaviors and serodiscordant partnerships among an online sample of HIV-positive MSM (N = 416) in Asia. High rates of UAI (74.8%), serodiscordant partnerships (68.5%), and unprotected sex within serodiscordant partnerships (~60.0%) were reported. Increased number of partners, meeting partners on the Internet, drug use before sex, and not knowing one’s viral load were associated with UAI. Efforts to develop and scale up biomedical and behavioral interventions for HIV-positive MSM in Asia are needed. PMID:22421700

  13. HIV Disclosure and Sexual Transmission Behaviors among an Internet Sample of HIV-positive Men Who Have Sex with Men in Asia: Implications for Prevention with Positives

    PubMed Central

    Wei, Chongyi; Lim, Sin How; Guadamuz, Thomas E.; Koe, Stuart

    2012-01-01

    The relationship between HIV disclosure and sexual transmission behaviors, and factors that influence disclosure are unknown among HIV-positive men who have sex with men (MSM) in Asia. We describe disclosure practices and sexual transmission behaviors, and correlates of disclosure among this group of MSM in Asia. A cross-sectional multi-country online survey was conducted among 416 HIV-positive MSM. Data on disclosure status, HIV-related risk behaviors, disease status, and other characteristics were collected. Multivariable logistic regression was used to identify significant correlates of disclosure. Only 7.0% reported having disclosed their HIV status to all partners while 67.3% did not disclose to any. The majority (86.5%) of non-disclosing participants had multiple partners and unprotected insertive or receptive anal intercourse with their partners (67.5%). Non-disclosure was significantly associated with non-disclosure from partners (AOR = 37.13, 95% CI: 17.22, 80.07), having casual partners only (AOR = 1.91, 95% CI: 1.03, 3.53), drug use before sex on a weekly basis (AOR: 6.48, 95% CI: 0.99, 42.50), being diagnosed with HIV between 1–5 years ago (AOR = 2.23, 95% CI: 1.05, 4.74), and not knowing one’s viral load (AOR = 2.80, 95% CI: 1.00, 7.83). Given the high HIV prevalence and incidence among MSM in Asia, it is imperative to include Prevention with Positives for MSM. Interventions on disclosure should not solely focus on HIV-positive men but also need to include their sexual partners and HIV-negative men. PMID:22198313

  14. Confronting the HIV epidemic in Asia and the Pacific: developing successful strategies to minimize the spread of HIV infection.

    PubMed

    Moodie, R; Aboagye-Kwarteng, T

    1993-12-01

    In Asia, the cumulative total of HIV-infected adults will reach 1.22 million by 1995, and, by 2000, the number is estimated to reach 11-45 million. The modes of transmission vary from country to country and include injecting drug users, commercial sex workers and their clients, commercial blood donors, hemophiliacs, and homosexuals. Social, cultural, and health factors also affect transmission, such as rites of passage to adulthood, lack of female autonomy, multiple sex partners, wars and civil unrest, and availability of drugs. The HIV epidemic has economic ramifications and causes, e.g., migrant worker camps, the sex industry, and rapid urbanization luring Burmese girls to Thailand. Governments must create an environment for behavior-change through financial, political, and legislative measures. Community organizations also play a role in prevention, as in programs initiated by a squatter settlement in Bangkok, where 36% of IV drug users were found to be HIV-positive. In Maharashtra State, India, peer-based prevention programs were developed for sex workers. Successful behavior change of individuals is based on redefinition of peer norms, understanding the danger and vulnerability to infection, and building confidence to change behavior. Successful programs require placing priority on HIV issues on the political agenda, negotiation and consensus-building skills, and competent program management. For instance, in Zimbabwe a project enlisted 380,000 people in 4500 education sessions within 2 years, and distributed 2.5 million condoms. Among sex workers, condom use increased from 5% to 50%. Implementation strategies include the provision of information and interpersonal education. In Zaire, mass media and social marketing efforts boosted condom sales from less than half a million in 1987 to over 20 million in 1991. The means to change behavior requires the availability of good quality condoms, disinfectants, and syringes. Furthermore, clinical management of

  15. Systematic Review of HIV Drug Resistance in the World Health Organization Southeast Asia Region

    PubMed Central

    Trotter, Andrew B.; Hong, Steven Y.; Srikantiah, Padmini; Abeyewickreme, Iyanthi; Bertagnolio, Silvia; Jordan, Michael R.

    2014-01-01

    In 2010, 3.5 million people were living with HIV in the World Health Organization (WHO) Southeast Asia Region (SEAR), giving this region the greatest burden of HIV after Africa. Scale-up of antiretroviral therapy (ART) has resulted in over 717,000 benefitting from it at the end of 2010. A systematic review of studies of HIV drug resistance (HIVDR) in SEAR published between 2000 and 2011 was performed. Of 10 studies of transmitted HIVDR in recently infected patients, all but two reported low levels (<5%) of transmitted HIVDR. Of 23 studies of HIVDR in pre-treatment populations initiating ART, three reported moderate levels (5–15%) of HIVDR and 20 reported low levels. Amongst 17 studies of acquired HIVDR, levels of nucleoside reverse transcriptase inhibitor (NRTI) and non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance ranged from 52%–92% and 43%–100%, respectively amongst those with virological failure. Overall, data included in this review suggest that currently recommended first- and second-line regimens are appropriate for the cohorts studied. However, data were only available from two of 11 SEAR countries and studies largely examined urban populations. Results are unlikely to be representative of the region. Studies lacked standardized methods which greatly limit comparability of data and their use for public health and ART program planning. Routine, standardized and nationally representative HIVDR surveillance should be strongly encouraged in SEAR to best characterize population-level HIVDR. National-level HIVDR surveillance data may be used to optimize delivery of HIV care and treatment and minimize emergence of population-level HIVDR, thus promoting the long-term efficacy and durability of available first- and second-line ART regimens. PMID:24002200

  16. HIV service delivery models towards 'Zero AIDS-related Deaths': a collaborative case study of 6 Asia and Pacific countries.

    PubMed

    Fujita, Masami; Poudel, Krishna C; Green, Kimberly; Wi, Teodora; Abeyewickreme, Iyanthi; Ghidinelli, Massimo; Kato, Masaya; Vun, Mean Chhi; Sopheap, Seng; San, Khin Ohnmar; Bollen, Phavady; Rai, Krishna Kumar; Dahal, Atul; Bhandari, Durga; Boas, Peniel; Yaipupu, Jessica; Sirinirund, Petchsri; Saonuam, Pairoj; Duong, Bui Duc; Nhan, Do Thi; Thu, Nguyen Thi Minh; Jimba, Masamine

    2015-04-24

    In the Asia-Pacific region, limited systematic assessment has been conducted on HIV service delivery models. Applying an analytical framework of the continuum of prevention and care, this study aimed to assess HIV service deliveries in six Asia and Pacific countries from the perspective of service availability, linking approaches and performance monitoring for maximizing HIV case detection and retention. Each country formed a review team that provided published and unpublished information from the national HIV program. Four types of continuum were examined: (i) service linkages between key population outreach and HIV diagnosis (vertical-community continuum); (ii) chronic care provision across HIV diagnosis and treatment (chronological continuum); (iii) linkages between HIV and other health services (horizontal continuum); and (iv) comprehensive care sites coordinating care provision (hub and heart of continuum). Regarding the vertical-community continuum, all districts had voluntary counselling and testing (VCT) in all countries except for Myanmar and Vietnam. In these two countries, limited VCT availability was a constraint for referring key populations reached. All countries monitored HIV testing coverage among key populations. Concerning the chronological continuum, the proportion of districts/townships having antiretroviral treatment (ART) was less than 70% except in Thailand, posing a barrier for accessing pre-ART/ART care. Mechanisms for providing chronic care and monitoring retention were less developed for VCT/pre-ART process compared to ART process in all countries. On the horizontal continuum, the availability of HIV testing for tuberculosis patients and pregnant women was limited and there were sub-optimal linkages between tuberculosis, antenatal care and HIV services except for Cambodia and Thailand. These two countries indicated higher HIV testing coverage than other countries. Regarding hub and heart of continuum, all countries had comprehensive care

  17. Antiretroviral therapy for prevention of HIV transmission: potential role for people who inject drugs in Central Asia.

    PubMed

    McNairy, Margaret L; Deryabina, Anna; Hoos, David; El-Sadr, Wafaa M

    2013-11-01

    Interest in the use of antiretroviral therapy (ART) for prevention stems from mounting evidence from research studies demonstrating that ART is associated with a decrease in sexual HIV transmission among serodiscordant couples and, perhaps, in other populations at risk. There is paucity of data on the efficacy of ART for prevention in key populations, including persons who inject drugs (PWID). In this paper, we examine the current status of HIV services for PWID in Central Asia, the use of ART by this population and explore ART for prevention for PWID in this context. We also discuss research and implementation questions with relevance to such a strategy in the region.

  18. The Impact of HIV/AIDS on Children and Young People: Reviewing Research Conducted and Distilling Implications for the Education Sector in Asia. Discussion Paper No. I

    ERIC Educational Resources Information Center

    Wijngaarden, Jan; Shaeffer, Sheldon

    2005-01-01

    This discussion paper evaluates the impact of HIV/AIDS on the education sector in the Asia Pacific region. It looks at the impact of the epidemic on children (aged 0-18) focusing on how the presence of HIV/AIDS in the household affects the education sector. Examples are summarized from research papers from inter-governmental agencies including…

  19. Global Health Donor Presence, Variations in HIV/AIDS Prevalence, and External Resources for Health in Developing Countries in Africa and Asia

    PubMed Central

    Azuine, Romuladus Emeka; Singh, Gopal K.; Ekejiuba, Sussan E.; Ashu, Eta; Azuine, Magnus A.

    2014-01-01

    Objective: The presence of multiple global health aid organizations in donor recipient countries at any point in time has led to arguments for and against aid coordination and aid pluralism. Little data, however, exist to empirically demonstrate the relationship between donor presence and longitudinal disease outcomes in donor-recipient countries. We examined the association between global health donor presence and changes in HIV/AIDS prevalence in 14 developing countries: 12 in Africa (Ethiopia, Kenya, Tanzania, Malawi, Zimbabwe, Mozambique, Rwanda, South Africa, Uganda, Zambia, Burkina Faso and Mali) and compared them with two developing countries in Asia (India and Vietnam). Methods: To conduct our analyses, we conceptualized a framework for examining global health donor presence and disease outcomes. Donor presence data were derived from Mapping the Donor Landscape in Global Health: HIV/AIDS, a report published by the Kaiser Family Foundation, Washington, DC, USA. HIV/AIDS prevalence data were obtained and analyzed from the World Health Statistics and the Demographic and Health Surveys. Percent changes in national HIV/AIDS prevalence between 2009 and 2011 in the 14 developing countries were computed and correlation coefficients between donor presence and prevalence changes were calculated. Results: Between 2009 and 2011, HIV/AIDS prevalence decreased in all but one of the 14 developing countries with the presence of 21 or more global health donors. There was about 40% overall reduction in HIV/AIDS prevalence across the 14 countries in our analyses. South Africa recorded the most reduction in HIV/AIDS prevalence (-6.7%) followed by Zambia (-6.3, %), and Mozambique (-5.7%). Ethiopia was the only country without a reduction in HIV/AIDS prevalence (+0.1%). A correlation coefficient of 0.43 implied greater reductions in HIV/AIDS prevalence associated with increased donor presence. Conclusions and Public Health Implications: Our study shows a correlation between

  20. HIV Programs in Iran (Persia), Iraq and Saudi Arabia: A Brief Review of Current Evidence in West and Southwest Asia

    PubMed Central

    Massah, Omid; Moradi, Afsaneh; Farhoudian, Ali; Amini-Lari, Mahmood; Joulaei, Hassan; Daneshmand, Reza

    2016-01-01

    Background In Western and Southwest Asia, literature is not documented on human immunodeficiency virus (HIV) programs in Iran, Iraq and Saudi Arabia. The present study is the first brief review that describes HIV programs in these three neighboring countries. Methods Data regarding the evidence of HIV programs were gathered through a systematic literature searching. English publications were retrieved through searching online scientific databases. Grey literature was also searched online. The review was based on the studies related to the last decade. Findings Systematic searching resulted in retrieving 21,948 studies but only 21 studies were relevant to the study aim. The review findings indicated that Iran has provided a nationwide sero-surveillance data system and has identified its key populations. Detecting HIV prevalence has been limited to case-finding in Iraq and Saudi Arabia. However, strategic plans for HIV have been provided in the three countries. HIV education, knowledge and support have been provided but still needs consideration in the three countries especially in Iraq. The low coverage of antiretroviral therapy (ART) has remained a critical gap in the provision of comprehensive HIV programs in these three countries. This issue has been followed by the lack of opiate substitution therapies for drug dependents and injecting drug users in Iraq and Saudi Arabia. Condom promotion and voluntary HIV counselling and testing have been provided for at-risk groups in the three countries but need more nationwide coverages. However, needle and syringe programs (NSPs) have been only provided in Iran. Conclusion The review concluded that the provision of effective HIV programs should address training human resources and infrastructural development. This issue should be facilitated by international collaborations and governmental supports. PMID:28496952

  1. Characterizing HIV manifestations and treatment outcomes of perinatally infected adolescents in Asia.

    PubMed

    Chokephaibulkit, Kulkanya; Kariminia, Azar; Oberdorfer, Peninnah; Nallusamy, Revathy; Bunupuradah, Torsak; Hansudewechakul, Rawiwan; Dung, Khu Thi Khanh; Saphonn, Vonthanak; Kumarasamy, Nagalingeswaran; Lumbiganon, Pagakrong; Viet, Do Chau; Kurniati, Nia; Yusoff, Nik Khairuddin Nik; Razali, Kamarul; Fong, Siew Moy; Khanh, Truong Huu; Wati, Dewi Kumara; Sohn, Annette H

    2014-03-01

    More perinatally HIV-infected children in Asia are reaching adolescence. We analyzed data from July 1991 to March 2011 reported by 18 clinics in 6 countries of children age >12 years. Of 1254 adolescents, 33 (2.6%) died, and 52 (4.1%) were lost to follow-up within 2.4-year (3566 person-years) median follow-up period. Of 1061 adolescents under active follow-up, 485 (46%) were male, median (interquartile range) age was 14.7 (13.3-16.4) years, 73% had lost a parent(s), 93% attended school and 62% were aware of their HIV status. At the most recent evaluation, 93% were receiving highly active antiretroviral therapy, 71% (N = 737/1035) had CD4 ≥ 500 cells/mm(3) and 87% (N = 718/830) had viral load (VL) <400 copies/mL. Current CD4 ≥ 200 cells/mm(3), no previous World Health Organization stage 3 or 4 and being on a first-line regimen were independently associated with recent VL <400 copies/mL. Current age <15 years, VL <400 copies/mL, CD4 15-24% (vs. <10%) at antiretroviral therapy initiation, no previous World Health Organization stage 3 or 4 and antiretroviral therapy duration of ≥ 1 year were associated with recent CD4 ≥ 500 cells/mm(3). Primary causes of death after age 12 were opportunistic infections (N = 15/33) and other AIDS- or treatment-related conditions (N = 9/33). Those at age 12 with CD4 <200 versus ≥ 500 cells/mm and those with VL ≥ 10,000 versus <10,000 copies/mL were 17.4 and 4.76 times more likely to die in adolescence, respectively. Adolescents in this cohort have been successfully maintained in HIV care. Initiating treatment at earlier stages of disease was associated with immune recovery and virologic suppression during adolescence.

  2. Realigning government action with public health evidence: the legal and policy environment affecting sex work and HIV in Asia.

    PubMed

    Gruskin, Sofia; Pierce, Gretchen Williams; Ferguson, Laura

    2014-01-01

    The HIV epidemic has shed light on how government regulation of sex work directly affects the health and well-being of sex workers, their families and communities. A review of the public health evidence highlights the need for supportive legal and policy environments, yet criminalisation of sex work remains standard around the world. Emerging evidence, coupled with evolving political ideologies, is increasingly shaping legal environments that promote the rights and health of sex workers but even as new legislation is created, contradictions often exist with standing problematic legislation. As a region, Asia provides a compelling example in that progressive HIV policies often sit side by side with laws that criminalise sex work. Data from the 21 Asian countries reporting under the UN General Assembly Special Session on HIV in 2010 were analysed to provide evidence of how countries' approach to sex-work regulation might affect HIV-related outcomes. Attention to the links between law and HIV-related outcomes can aid governments to meet their international obligations and ensure appropriate legal environments that cultivate the safe and healthy development and expression of sexuality, ensure access to HIV and other related services and promote and protect human rights.

  3. The burden of HIV-associated neurocognitive disorder (HAND) in the Asia-Pacific region and recommendations for screening.

    PubMed

    Ian, Everall; Gwen, Chan Lai; Soo, Chow Ting; Melissa, Corr; Chun-Kai, Huang; Eosu, Kim; Hyo-Youl, Kim; Asad, Khan; Scott, Letendre; Chung-Ki, Li Patrick; Anekthananon, Thanomsak; Jordan, Treisman Glenn; Han-Ting, Wei; Wing-Wai, Wong

    2016-08-01

    HIV-associated neurocognitive disorder incurs a significant burden on HIV patients in Asia-Pacific countries; however, the incidence is difficult to estimate due to a lack of local epidemiological data. The impact of neurocognitive impairment in HIV patients is often underestimated due to a lack of education and awareness, and there are consequently gaps in the provision of screening and diagnosis to enable earlier intervention to limit neurocognitive impairment. This review seeks to redress the imbalance by promoting awareness and education among physicians concerning the neurovirulence of HIV and thereby increase screening efforts to improve diagnosis rates and clinical outcomes for underserved patients in this region. The Asia, Australia, and Middle East (AAME) HAND Advisory Board convened expert regional representatives to review current practice and recommend appropriate measures related to the implementation of standardised screening programmes and treatment recommendations to curb the developing HAND epidemic in the region. In particular, we recommend basic neuropsychological testing protocols that could be efficiently introduced into clinical practice for routine screening. We also propose simple guidelines for the management of HAND. We believe that HAND is a significant and under-reported diagnosis in HIV patients that warrants both greater recognition and further clinical investigation of the underlying pathophysiology and the impact of HIV disease progression, with HAND being associated with worse medication adherence and therefore possibly increased risk of ARV treatment failure. Widespread screening will lead to greater recognition of HAND and earlier intervention, which may lead to improved management strategies in the future. Copyright © 2015 Elsevier B.V. All rights reserved.

  4. Scaling up HIV prevention efforts targeting people who inject drugs in Central Asia: a review of key challenges and ways forward.

    PubMed

    Boltaev, Azizbek A; El-Bassel, Nabila; Deryabina, Anna P; Terlikbaeva, Assel; Gilbert, Louisa; Hunt, Timothy; Primbetova, Sholpan; Strathdee, Steffanie A

    2013-11-01

    In Central Asia, between 33% and 72% of cumulative HIV infections has been attributed to unsafe injection practices among people who inject drugs (PWID). We reviewed the current status and trends of national efforts in Central Asian countries to control HIV among PWID, and also reviewed the key structural and health-systems-related challenges that facilitate drug-use-related HIV risk in Central Asia. The spectrum and scale of HIV prevention services targeting PWID vary considerably among Central Asian countries. In all countries, the potential impact of these interventions is hindered by several key features: a restrictive legal environment, poor performance of service providers, widespread opposition to harm reduction, deficient human resources and funding mechanisms, poor services integration, insufficient community involvement, and other structural factors. Scaling up HIV prevention interventions in Central Asia will demand greater attention to the structural, health-care-related and social factors that facilitate HIV risk and impede service utilization among PWID. Multi-level combination prevention interventions should be developed with a focus on the sexual partners and risk networks of PWID, aiming at early detection of HIV, timely enrollment in HIV care, and retention in HIV care. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  5. Redressing the epidemics of opioid overdose and HIV among people who inject drugs in Central Asia: the need for a syndemic approach.

    PubMed

    Gilbert, Louisa; Primbetova, Sholpan; Nikitin, Danil; Hunt, Timothy; Terlikbayeva, Assel; Momenghalibaf, Azzi; Ruziev, Murodali; El-Bassel, Nabila

    2013-11-01

    Accumulating evidence suggests that opioid overdose and HIV infection are burgeoning intertwined epidemics among people who inject drugs (PWID) in Central Asia. To date, however, research on overdose and its associations with HIV risks among PWID in Central Asia remains virtually absent. This paper aims to provide a regional overview of the hidden epidemic of overdose and how it is linked to HIV among PWID in Central Asia, using a syndemic framework that is guided by risk environment research. We conducted a comprehensive literature search of peer-reviewed publications and gray literature on opioid overdose and its associations with HIV in five countries of Central Asia (Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan) as well as on policies and programs that address these co-occurring epidemics. Regional data indicate high rates of fatal and non-fatal overdose among PWID. Evidence suggests mortality rates from overdose exceed HIV/AIDS as the leading cause of death among PWID. The syndemic framework suggests multiple macro-level and micro-level environmental risk factors that drive the co-occurring epidemics of HIV and overdose. This framework identifies several interacting biological and behavioral risks that result in additive effects for HIV and overdose. The high rates of overdose and its associations with HIV underscore the need for a syndemic approach that considers overdose on parity with HIV. Such an approach should focus on the biological, behavioral and structural interactions between these epidemics to reduce social suffering, morbidity and mortality among PWID in Central Asia. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  6. Redressing the Epidemics of Opioid Overdose and HIV among People who Inject Drugs in Central Asia: The Need for a Syndemic Approach

    PubMed Central

    Gilbert, Louisa; Primbetova, Sholpan; Nikitin, Danil; Hunt, Timothy; Terlikbayeva, Assel; Momenghalibaf, Azzi; Ruziev, Murodali; El-Bassel, Nabila

    2013-01-01

    Background Accumulating evidence suggests that opioid overdose and HIV infection are burgeoning intertwined epidemics among people who inject drugs (PWID) in Central Asia. To date, however, research on overdose and its associations with HIV risks among PWID in Central Asia remains virtually absent. This paper aims to provide a regional overview of the hidden epidemic of overdose and how it is linked to HIV among PWID in Central Asia, using a syndemic framework that is guided by risk environment research. Methods We conducted a comprehensive literature search of peer-reviewed publications and grey literature on opioid overdose and its associations with HIV in five countries of Central Asia (Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan) as well as on policies and programs that address these co-occurring epidemics. Results Regional data indicate high rates of fatal and non-fatal overdose among PWID. Evidence suggests mortality rates from overdose exceed HIV/AIDS as the leading cause of death among PWID. The syndemic framework suggests multiple macro-level and micro-level environmental risk factors that drive the co-occurring epidemics of HIV and overdose. This framework identifies several interacting biological and behavioral risks that result in additive effects for HIV and overdose. Conclusion The high rates of overdose and its associations with HIV underscore the need for a syndemic approach that considers overdose on parity with HIV. Such an approach should focus on the biological, behavioral and structural interactions between these epidemics to reduce social suffering, morbidity and mortality among PWID in Central Asia. PMID:23954070

  7. Access to HIV counseling and testing among people who inject drugs in Central Asia: Strategies for improving access and linkages to treatment and care

    PubMed Central

    Terlikbayeva, Assel; Zhussupov, Baurzhan; Primbetova, Sholpan; Gilbert, Louisa; Atabekov, Nurmat; Giyasova, Gusal; Ruziev, Murodali; Soliev, Alijon; Saliev, Daniiar; El-Bassel, Nabila

    2013-01-01

    Introduction As a population profoundly affected by the HIV epidemic and in critical need of linkages to HIV treatment and care, PWID in Central Asia remain largely underserved. This paper provides an overview of the current state of HIV testing and counseling in Central Asia for PWID, identifies main barriers leading to gaps in service delivery, and discusses implications for improving strategies that promote HIV testing for PWID. Methods We reviewed a number of sources for this paper including unpublished government reports, published papers, and Ministries of Health of Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan country progress reports to the UN General Assembly Special Session on HIV/AIDS (UNGASS) for 2012. Results Between 29 to 65% of PLWH in some Central Asian countries have been tested for HIV in the last 12 months. The rates have been increasing in the recent years but still are relatively low. Stigma, discrimination, human rights violations, and repressive legislation are barriers to HTC for people who inject drugs (PWID). Conclusion The use of innovative evidence-based HTC models, such as community mobile-vans, self-testing at home, and rapid HIV testing among PWID in Central Asia are discussed and recommendations given regarding amendments in legislation and scaling up of existing community-based pilot projects to support HIV testing among PWID in CA. PMID:23916319

  8. Access to HIV counseling and testing among people who inject drugs in Central Asia: strategies for improving access and linkages to treatment and care.

    PubMed

    Terlikbayeva, Assel; Zhussupov, Baurzhan; Primbetova, Sholpan; Gilbert, Louisa; Atabekov, Nurmat; Giyasova, Gusal; Ruziev, Murodali; Soliev, Alijon; Saliev, Daniiar; El-Bassel, Nabila

    2013-11-01

    As a population profoundly affected by the HIV epidemic and in critical need of linkages to HIV treatment and care, PWID in Central Asia remain largely underserved. This paper provides an overview of the current state of HIV testing and counseling in Central Asia for PWID, identifies main barriers leading to gaps in service delivery, and discusses implications for improving strategies that promote HIV testing for PWID. We reviewed a number of sources for this paper including unpublished government reports, published papers, and Ministries of Health of Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan country progress reports to the UN General Assembly Special Session on HIV/AIDS (UNGASS) for 2012. Between 29 and 65% of PLWH in some Central Asian countries have been tested for HIV in the last 12 months. The rates have been increasing in the recent years but still are relatively low. Stigma, discrimination, human rights violations, and repressive legislation are barriers to HTC for people who inject drugs (PWID). The use of innovative evidence-based HTC models, such as community mobile-vans, self-testing at home, and rapid HIV testing among PWID in Central Asia are discussed and recommendations given regarding amendments in legislation and scaling up of existing community-based pilot projects to support HIV testing among PWID in CA. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  9. Observations on the physiology of adult anophelines in Asia

    PubMed Central

    Büttiker, W.

    1958-01-01

    Some recent physiological observations made in Afghanistan, Ceylon and Burma on adults of Anopheles culicifacies and A. aconitus are described. The specimens from Ceylon and Burma, in particular, showed a peculiar physiological process in which, at the beginning of the dry season, the coagulated, dark red, and almost desiccated stomach contents indicated a period of partial quiescence. As there were in most cases no signs of apparent growth of the fat-body, it appeared that a hitherto undescribed form of physiological behaviour occurred under certain climatic and seasonal conditions. PMID:20604030

  10. HIV among people who inject drugs in Central and Eastern Europe and Central Asia: a systematic review with implications for policy

    PubMed Central

    Jolley, Emma; Rhodes, Tim; Platt, Lucy; Hope, Vivian; Latypov, Alisher; Donoghoe, Martin; Wilson, David

    2012-01-01

    Background and objectives HIV among people who inject drugs (PWID) is a major public health concern in Eastern and Central Europe and Central Asia. HIV transmission in this group is growing and over 27 000 HIV cases were diagnosed among PWID in 2010 alone. The objective of this systematic review was to examine risk factors associated with HIV prevalence among PWID in Central and Eastern Europe and Central Asia and to describe the response to HIV in this population and the policy environments in which they live. Design A systematic review of peer-reviewed and grey literature addressing HIV prevalence and risk factors for HIV prevalence among PWID and a synthesis of key resources describing the response to HIV in this population. We used a comprehensive search strategy across multiple electronic databases to collect original research papers addressing HIV prevalence and risk factors among PWID since 2005. We summarised the extent of key harm reduction interventions, and using a simple index of ‘enabling’ environment described the policy environments in which they are implemented. Studies reviewed Of the 5644 research papers identified from electronic databases and 40 documents collected from our grey literature search, 70 documents provided unique estimates of HIV and 14 provided multivariate risk factors for HIV among PWID. Results HIV prevalence varies widely, with generally low or medium (<5%) prevalence in Central Europe and high (>10%) prevalence in Eastern Europe. We found evidence for a number of structural factors associated with HIV including gender, socio-economic position and contact with law enforcement agencies. Conclusions The HIV epidemic among PWID in the region is varied, with the greatest burden generally in Eastern Europe. Data suggest that the current response to HIV among PWID is insufficient, and hindered by multiple environmental barriers including restricted access to services and unsupportive policy or social environments. PMID:23087014

  11. Observed Holiday Aerosol Reduction and Temperature Cooling over East Asia

    SciTech Connect

    Gong, Daoyi; Wang, Wenshan; Qian, Yun; Bai, Wenbing; Guo, Yuanxi; Mao, Rui

    2014-06-16

    The Spring Festival air pollution in China was investigated using the long-term observations from 2001-2012 over 323 stations. During the Spring Festival with nearly half of urban population leaving the cities for holidays, the particulate matter (PM10) concentration is about 24.5μgm-3 (23%) lower than normal days. Associated with the national-wide burning of firework, the PM10 concentration sharply increases to 123.8μgm-3 at Chinese New Year Day (increment of 35%). Similar to PM10, the SO2 and NO2 decrease from high values in normal days to a holiday minimum with reduction of 23.3% and 30.6%, respectively. The NO2 has no peak in New Year Day because of the different emission source. The night mean and minimum temperature co-vary with PM10. Both nighttime mean and minimum temperature decrease by about 2.1°C during the holidays. And in association with the pollution jump at New Year Day the night temperature simultaneously increase by about 0.89°C. The in-phase co-variations between PM10 and night temperature suggest an overall warming effect of holiday aerosol during winter in China.

  12. Accelerating harm reduction interventions to confront the HIV epidemic in the Western Pacific and Asia: the role of WHO (WPRO)

    PubMed Central

    Mesquita, Fabio; Jacka, David; Ricard, Dominique; Shaw, Graham; Tieru, Han; Yifei, Hu; Poundstone, Katharine; Salva, Madeline; Fujita, Masami; Singh, Nirmal

    2008-01-01

    The epidemic of HIV/AIDS linked to injecting drug usage is one of the most explosive in recent years. After a historical epicentre in Europe, South and North America, at present it is clearly the main cause of dissemination of the epidemic in Eastern Europe and some key Asian countries. Recently, 10 African countries reported the spread of HIV through people who inject drugs (PWID), breaking one of the final geographical barriers to the globalization of the epidemic of HIV among and from PWID. Several countries of the Asia and Pacific Region have HIV epidemics that are driven by injecting drug usage. Harm reduction interventions have been implemented in many countries and potential barriers to implementation are being overcome. Harm reduction is no longer a marginal approach in the Region; instead, it is the core tool for responding to the HIV/AIDS epidemic among PWID. The development of a comprehensive response in the Region has been remarkable, including scaling up of needle and syringe programmes (NSPs), methadone maintenance treatment (MMT), and care, support and treatment for PWID. This development is being followed up by strong ongoing changes in policies and legislations. The main issue now is to enhance interventions to a level that can impact the epidemic. The World Health Organization (WHO) is one of the leading UN agencies promoting harm reduction. Since the establishment of the Global Programme on AIDS, WHO has been working towards an effective response to the HIV epidemic among PWID. WHO's work is organized into a number of components: establishing an evidence base; advocacy; development of normative standards, tools and guidelines; providing technical support to countries; ensuring access to essential medicines, diagnostics and commodities; and mobilizing resources. In this paper, we trace the course of development of the HIV/AIDS epidemic among and from PWID in the Western Pacific and Asia Region (WPRO) as well as WHO's role in supporting the

  13. Accelerating harm reduction interventions to confront the HIV epidemic in the Western Pacific and Asia: the role of WHO (WPRO).

    PubMed

    Mesquita, Fabio; Jacka, David; Ricard, Dominique; Shaw, Graham; Tieru, Han; Hu, Yifei; Poundstone, Katharine; Salva, Madeline; Fujita, Masami; Singh, Nirmal

    2008-08-05

    The epidemic of HIV/AIDS linked to injecting drug usage is one of the most explosive in recent years. After a historical epicentre in Europe, South and North America, at present it is clearly the main cause of dissemination of the epidemic in Eastern Europe and some key Asian countries. Recently, 10 African countries reported the spread of HIV through people who inject drugs (PWID), breaking one of the final geographical barriers to the globalization of the epidemic of HIV among and from PWID. Several countries of the Asia and Pacific Region have HIV epidemics that are driven by injecting drug usage. Harm reduction interventions have been implemented in many countries and potential barriers to implementation are being overcome. Harm reduction is no longer a marginal approach in the Region; instead, it is the core tool for responding to the HIV/AIDS epidemic among PWID. The development of a comprehensive response in the Region has been remarkable, including scaling up of needle and syringe programmes (NSPs), methadone maintenance treatment (MMT), and care, support and treatment for PWID. This development is being followed up by strong ongoing changes in policies and legislations. The main issue now is to enhance interventions to a level that can impact the epidemic. The World Health Organization (WHO) is one of the leading UN agencies promoting harm reduction. Since the establishment of the Global Programme on AIDS, WHO has been working towards an effective response to the HIV epidemic among PWID. WHO's work is organized into a number of components: establishing an evidence base; advocacy; development of normative standards, tools and guidelines; providing technical support to countries; ensuring access to essential medicines, diagnostics and commodities; and mobilizing resources. In this paper, we trace the course of development of the HIV/AIDS epidemic among and from PWID in the Western Pacific and Asia Region (WPRO) as well as WHO's role in supporting the

  14. Identification of Two New HIV-1 Circulating Recombinant Forms (CRF87_cpx and CRF88_BC) from Reported Unique Recombinant Forms in Asia.

    PubMed

    Hu, Yihong; Wan, Zhenzhou; Zhou, Yan-Heng; Smith, Davey; Zheng, Yong-Tang; Zhang, Chiyu

    2017-04-01

    The on-going generation of HIV-1 intersubtype recombination has led to new circulating recombinant forms (CRFs) and unique recombinant forms (URFs) in Asia. In this study, we evaluated whether previously reported URFs were actually CRFs. All available complete or near full-length HIV-1 URF sequences from Asia were retrieved from the HIV Los Alamos National Laboratory Sequence database, and phylogenetic, transmission cluster, and bootscan analyses were performed using MEGA 6.0, Cluster Picker 1.2.1, and SimPlot3.5.1. According to the criterion of new CRFs, two new HIV-1 CRFs (CRF87_cpx and CRF88_BC) were identified from these available URFs. CRF87_cpx comprised HIV-1 subtypes B, C, and CRF01_AE, and CRF88_BC comprised subtypes B and C. HIV Blast and bootscan analysis revealed that besides the three representative strains, there were two additional CRF87_cpx strains. Furthermore, we defined seven dominant URFs (dURF01-dURF07), each of which contained two strains sharing same recombination map and can be used as sequence references to facilitate the finding of new potential CRFs in future. These results will benefit the molecular epidemiological investigation of HIV-1 in Asia.

  15. Identification of a novel HIV type 1 circulating recombinant form (CRF52_01B) in Southeast Asia.

    PubMed

    Liu, Yongjian; Li, Lin; Bao, Zuoyi; Li, Hanping; Zhuang, Daomin; Liu, Siyang; Wang, Xiaolin; Li, Tianyi; Jia, Lei; Yang, Shaomin; Li, Jingyun

    2012-10-01

    Thirty HIV-1 URF_01AE/ B' complete or nearly full-length genome sequences sampled within Southeast Asia were obtained from the Los Alamos HIV Sequence Database. Phylogenetic and recombinant analyses revealed that three sequences indeed displayed the identical recombinant structure. Of note, the three subjects, harboring novel CRF01_AE/B recombinants, did not have apparent epidemiological linkage. They fulfilled the criteria for the designation of a new circulating recombinant form (CRF) and constituted the 52nd CRF identified in the worldwide HIV-1 pandemic. In this chimera, two short subtype B segments were inserted into a backbone of CRF_01AE. The breakpoints corresponded to HXB2 nucleotide positions 2930, 3251, 8521, and 9004 approximately. This CRF is the first one identified by neatening and analyzing the sequences already presented in the Los Alamos HIV Sequence Database. This indicates that we should pay attention not only to explicit subtype sequences but also to those classified as a unique recombinant form (URF) so far.

  16. Prevalence of sexually transmitted infections in HIV positive and HIV negative females, in a tertiary care hospital - An observational study

    PubMed Central

    Chopra, Dimple; Sandhu, Ivy; Bahl, RK; Bhatia, Ruby; Goyal, Anupama

    2015-01-01

    The presentation and course of Sexually transmitted diseases(STI) may be altered by presence of coexisting HIV status. Aim of the study was to study the prevalence of STI in 50 females with HIV infection and 50 females without HIV infection and to study the pap smear of patients to look for any cellular changes (dysplasia) due to sexually transmitted infections. Material and methods: The present study was an observational study, which was undertaken on 100 females with STIs (50 females with coexistent HIV infection and 50 females without HIV infection), in the age group 15-49 years attending Skin and VD OPD of Rajindra hospital, Patiala. Results: In our study, the commonest presenting complaint in case of both HIV positive (66%) and HIV negative (80%) women was vaginal discharge. PAP smear abnormalities were present in 28 (56%) HIV positive women and 11 (22%) HIV negative women. In case of HIV positive women, the inflammation was trichomonal in 4 (8%), bacterial in 2 (4%), fungal in 2 (4%) and non-specific in 20 (40%) patients. In HIV negative women, the inflammation was trichomonal in 2 (4%) patients, bacterial in 2 (4%) patients and non-specific in 7 (14%) patients. The difference in abnormality seen in PAP smear between HIV positive and HIV negative women is statistically significant only in case of non-specific inflammation which is more common in case of HIV positive women. Conclusion: From the present study, it was concluded vaginal discharge was the commonest presenting complaint in both HIV positive and HIV negative women, though the commonest cause of vaginal discharge was candidiasis in HIV positive females and bacterial vaginosis in HIV negative females. Also, PAP smear abnormalities were significantly higher in HIV positive women than HIV negative women. So it is important that HIV positive women should have complete gynecological evaluation including a PAP smear with aggressive screening of STIs. PMID:26392656

  17. Observations of Light-Absorbing Carbonaceous Aerosols in East and South Asia

    NASA Astrophysics Data System (ADS)

    Yoon, S.; Kim, S.; Choi, W.

    2013-05-01

    Light-absorbing aerosols, such as black carbon (BC), brown carbon and mineral dust, typically constitute a small fraction of ambient particle mass but can contribute to solar radiative forcing through absorption of solar radiation and heating of the absorbing aerosol layer. Besides the direct radiative effect, the heating can evaporate clouds and change the atmospheric dynamics. In this study, we investigate the optical and radiative properties of light-absorbing aerosols from ground-based and aircraft measurements in East and South Asia within the framework of UNEP Atmospheric Brown Cloud-Asia (ABC-Asia) project and Sustainable Atmosphere for the Kathmandu Valley (SusKat) campaign (December 2012 ~ February 2013). BC mass concentration, aerosol scattering and absorption coefficients measurements and radiative forcing calculations were performed at four sites: Gosan (Korea), Anmyeon (Korea), Hanimaadhoo (Maldives) and Pyramid (Nepal). No significant seasonal variations of aerosol properties, except for summer due to wet scavenging by rainfall, were observed in East Asia, whereas dramatic changes of light-absorbing aerosol properties were observed in South Asia between dry and wet monsoon periods. Although BC mass concentration in East Asia is generally higher than that observed in South Asia, BC mass concentration at Hanimaadhoo during winter dry monsoon is similar to that of East Asia. The observed solar absorption efficiency (absorption coefficient/extinction coefficient) at 550 nm at Gosan and Anmyeon is higher than that in Hanimaadhoo due to large portions of BC emission from fossil fuel combustion. Interestingly, solar absorption efficiency at Pyramid is 0.14, which is two times great than that in Hanimaadhoo and is about 40% higher than that in East Asia, though BC mass concentration at Pyramid is the lowest among four sites. Throughout the unmanned aerial vehicle experiment in Jeju, Korea during August-September 2008, long-range transport of aerosols from

  18. Comparison of predicted susceptibility between genotype and virtual phenotype HIV drug resistance interpretation systems among treatment-naive HIV-infected patients in Asia: TASER-M cohort analysis

    PubMed Central

    2012-01-01

    Background Accurate interpretation of HIV drug resistance (HIVDR) testing is challenging, yet important for patient care. We compared genotyping interpretation, based on the Stanford University HIV Drug Resistance Database (Stanford HIVdb), and virtual phenotyping, based on the Janssen Diagnostics BVBA’s vircoTYPE™ HIV-1, and investigated their level of agreement in antiretroviral (ARV) naive patients in Asia, where non-B subtypes predominate. Methods Sequences from 1301 ARV-naive patients enrolled in the TREAT Asia Studies to Evaluate Resistance – Monitoring Study (TASER-M) were analysed by both interpreting systems. Interpretations from both Stanford HIVdb and vircoTYPE™ HIV-1 were initially grouped into 2 levels: susceptible and non-susceptible. Discrepancy was defined as a discordant result between the susceptible and non-susceptible interpretations from the two systems for the same ARV. Further analysis was performed when interpretations from both systems were categorised into 3 levels: susceptible, intermediate and resistant; whereby discrepancies could be categorised as major discrepancies and minor discrepancies. Major discrepancy was defined as having a susceptible result from one system and resistant from the other. Minor discrepancy corresponded to having an intermediate interpretation in one system, with a susceptible or resistant result in the other. The level of agreement was analysed using the prevalence adjusted bias adjusted kappa (PABAK). Results Overall, the agreement was high, with each ARV being in “almost perfect agreement”, using Landis and Koch’s categorisation. Highest discordance was observed for efavirenz (75/1301, 5.8%), all arising from susceptible Stanford HIVdb versus non-susceptible vircoTYPE™ HIV-1 predictions. Protease Inhibitors had highest level of concordance with PABAKs all above 0.99, followed by Nucleoside Reverse Transcriptase Inhibitors with PABAKs above 0.97 and non-NRTIs with the lowest PABAK of 0.88. The

  19. Digital clubbing in HIV-infected patients: an observational study.

    PubMed

    Dever, Lisa L; Matta, Jyoti S

    2009-01-01

    Digital clubbing is characterized by bulbous enlargement of the distal phalanges due to an increase in soft tissue. It has been associated with a variety of conditions including cyanotic heart disease, neoplasms and infections of the lungs, bronchiectasis, liver cirrhosis, and inflammatory bowel disease. We conducted an observational study at an urban Veterans Affairs Medical Center outpatient HIV clinic to confirm our clinical impression that clubbing is common in HIV-infected patients and to identify factors that might be associated with it. Clinical, laboratory, and physical examination data including measurement of the circumference of the nail bed and distal phalanx of each finger were obtained on 78 HIV-infected patients seen for their routine care over a 3-month period. A digital index (DI), the ratio of the nail bed:distal phalanx circumference was determined for each patient. Clubbing was found in 28 patients (36%). Clubbed patients did not differ from nonclubbed patients with respect to most patient characteristics; CD4 cell counts and quantitative HIV RNA were similar in both groups. Clubbed patients had a significantly higher DI than controls (1.03 versus 0.96, p < 0.001), were younger (45 versus 49 years, p = 0.04), and had longer duration of HIV disease (48 versus, 42 months, p = 0.03). HIV infection should be considered in the differential diagnosis of acquired digital clubbing.

  20. TREAT Asia Quality Assessment Scheme (TAQAS) to standardize the outcome of HIV genotypic resistance testing in a group of Asian laboratories.

    PubMed

    Land, Sally; Cunningham, Philip; Zhou, Jialun; Frost, Kevin; Katzenstein, David; Kantor, Rami; Chen, Yi-Ming Arthur; Oka, Shinichi; DeLong, Allison; Sayer, David; Smith, Jeffery; Dax, Elizabeth M; Law, Matthew

    2009-08-01

    The TREAT Asia (Therapeutics, Research, Education, and AIDS Training in Asia) Network is building capacity for Human Immunodeficiency Virus Type-1 (HIV-1) drug resistance testing in the region. The objective of the TREAT Asia Quality Assessment Scheme - designated TAQAS - is to standardize HIV-1 genotypic resistance testing (HIV genotyping) among laboratories to permit rigorous comparison of results from different clinics and testing centres. TAQAS has evaluated three panels of HIV-1-positive plasma from clinical material or low-passage, culture supernatant for up to 10 Asian laboratories. Laboratory participants used their standard protocols to perform HIV genotyping. Assessment was in comparison to a target genotype derived from all participants and the reference laboratory's result. Agreement between most participants at the edited nucleotide sequence level was high (>98%). Most participants performed to the reference laboratory standard in detection of drug resistance mutations (DRMs). However, there was variation in the detection of nucleotide mixtures (0-83%) and a significant correlation with the detection of DRMs (p<0.01). Interpretation of antiretroviral resistance showed approximately 70% agreement among participants when different interpretation systems were used but >90% agreement with a common interpretation system, within the Stanford University Drug Resistance Database. Using the principles of external quality assessment and a reference laboratory, TAQAS has demonstrated high quality HIV genotyping results from Asian laboratories.

  1. Comparison of seasonal variation between anthropogenic and natural emission inventory and Satellite observation in Southeast Asia

    NASA Astrophysics Data System (ADS)

    Kurata, G.; Lalitaporn, P.

    2012-12-01

    Since the economic growth of the countries in Southeast Asia is significantly rapid, the emission of air pollutant from the anthropogenic activity, such as industry, power generation and transportation is rapidly increasing. Moreover, biomass burning due to unsuitable agricultural management, deforestation and expansion of farmland are discharging large amount of pollutants, such as Carbon monoxide, volatile organic compound and particulate matter. Especially, the particulate matter from biomass burning causes the serious haze pollution in surrounding area in Southeast Asia. Furthermore, the biomass fuel used for cooking at residential sector discharges harmful pollutants including a particulate matter, and causes the adverse health impact to people on indoor and outdoor. In this study, we evaluated the spatial distribution and the seasonal variation of emission inventory for Southeast Asia region by comparing with satellite observation data in order to improve the accuracy of the impact assessment of air pollution by regional atmospheric chemistry transport model (WRF and CMAQ). As an emission inventory data, we used our original regional emission inventory for Southeast Asia region developed from detail transportation and industry data sets as well as a several existing emission inventories. As satellite observation data, the vertical column density of NO2, Particulate matter and Carbon monoxide obtained by various satellite, such as GOME, GOME2, SCIAMACY, OMI and so on. As a result of comparisons between satellite observation and emission inventories from 1996 to 2011, in the case of anthropogenic emission, seasonal variation was comparatively well in agreement with the seasonal variation of satellite data. However, the uncertainty of the seasonal variation was large on several large cities. In the case of emission from biomass burning, the seasonal variation was clear, but inter-annual variation was also large due to large scale climate condition.

  2. Capacity building and predictors of success for HIV-1 drug resistance testing in the Asia-Pacific region and Africa

    PubMed Central

    Land, Sally; Zhou, Julian; Cunningham, Philip; Sohn, Annette H; Singtoroj, Thida; Katzenstein, David; Mann, Marita; Sayer, David; Kantor, Rami

    2013-01-01

    Background The TREAT Asia Quality Assessment Scheme (TAQAS) was developed as a quality assessment programme through expert education and training, for laboratories in the Asia-Pacific and Africa that perform HIV drug-resistance (HIVDR) genotyping. We evaluated the programme performance and factors associated with high-quality HIVDR genotyping. Methods Laboratories used their standard protocols to test panels of human immunodeficiency virus (HIV)-positive plasma samples or electropherograms. Protocols were documented and performance was evaluated according to a newly developed scoring system, agreement with panel-specific consensus sequence, and detection of drug-resistance mutations (DRMs) and mixtures of wild-type and resistant virus (mixtures). High-quality performance was defined as detection of ≥95% DRMs. Results Over 4.5 years, 23 participating laboratories in 13 countries tested 45 samples (30 HIV-1 subtype B; 15 non-B subtypes) in nine panels. Median detection of DRMs was 88–98% in plasma panels and 90–97% in electropherogram panels. Laboratories were supported to amend and improve their test outcomes as appropriate. Three laboratories that detected <80% DRMs in early panels demonstrated subsequent improvement. Sample complexity factors – number of DRMs (p<0.001) and number of DRMs as mixtures (p<0.001); and laboratory performance factors – detection of mixtures (p<0.001) and agreement with consensus sequence (p<0.001), were associated with high performance; sample format (plasma or electropherogram), subtype and genotyping protocol were not. Conclusion High-quality HIVDR genotyping was achieved in the TAQAS collaborative laboratory network. Sample complexity and detection of mixtures were associated with performance quality. Laboratories conducting HIVDR genotyping are encouraged to participate in quality assessment programmes. PMID:23845227

  3. Comparisons of anemia, thrombocytopenia, and neutropenia at initiation of HIV antiretroviral therapy in Africa, Asia, and the Americas

    PubMed Central

    Firnhaber, Cynthia; Smeaton, Laura; Saukila, Nasinuku; Flanigan, Timothy; Gangakhedkar, Raman; Kumwenda, Johnstone; La Rosa, Alberto; Kumarasamy, Nagalingeswaran; De Gruttola, Victor; Hakim, James Gita; Campbell, Thomas B.

    2010-01-01

    Summary Background Hematological abnormalities are common manifestations of advanced HIV-1 infection that could affect the outcomes of highly-active antiretroviral therapy (HAART). Although most HIV-1-infected individuals live in resource-constrained countries, there is little information about the frequency of hematological abnormalities such as anemia, neutropenia, and thrombocytopenia among individuals with advanced HIV-1 disease. Methods This study compared the prevalence of pre-antiretroviral therapy hematological abnormalities among 1571 participants in a randomized trial of antiretroviral efficacy in Africa, Asia, South America, the Caribbean, and the USA. Potential covariates for anemia, neutropenia, and thrombocytopenia were identified in univariate analyses and evaluated in separate multivariable models for each hematological condition. Results The frequencies of neutropenia (absolute neutrophil count ≤ 1.3 × 109/l), anemia (hemoglobin ≤ 10 g/dl), and thrombocytopenia (platelets ≤ 125 × 109/l) at initiation of antiretroviral therapy were 14%, 12%, and 7%, respectively, and varied by country (p < 0.0001 for each). In multivariable models, anemia was associated with gender, platelet count, and country; neutropenia was associated with CD4+ lymphocyte and platelet counts; and thrombocytopenia was associated with country, gender, and chronic hepatitis B infection. Conclusions Differences in the frequency of pretreatment hematological abnormalities could have important implications for the choice of antiretroviral regimen in resource-constrained settings. PMID:20961784

  4. Comparisons of anemia, thrombocytopenia, and neutropenia at initiation of HIV antiretroviral therapy in Africa, Asia, and the Americas.

    PubMed

    Firnhaber, Cynthia; Smeaton, Laura; Saukila, Nasinuku; Flanigan, Timothy; Gangakhedkar, Raman; Kumwenda, Johnstone; La Rosa, Alberto; Kumarasamy, Nagalingeswaran; De Gruttola, Victor; Hakim, James Gita; Campbell, Thomas B

    2010-12-01

    Hematological abnormalities are common manifestations of advanced HIV-1 infection that could affect the outcomes of highly-active antiretroviral therapy (HAART). Although most HIV-1-infected individuals live in resource-constrained countries, there is little information about the frequency of hematological abnormalities such as anemia, neutropenia, and thrombocytopenia among individuals with advanced HIV-1 disease. This study compared the prevalence of pre-antiretroviral therapy hematological abnormalities among 1571 participants in a randomized trial of antiretroviral efficacy in Africa, Asia, South America, the Caribbean, and the USA. Potential covariates for anemia, neutropenia, and thrombocytopenia were identified in univariate analyses and evaluated in separate multivariable models for each hematological condition. The frequencies of neutropenia (absolute neutrophil count ≤1.3×10⁹/l), anemia (hemoglobin ≤10g/dl), and thrombocytopenia (platelets ≤125×10⁹/l) at initiation of antiretroviral therapy were 14%, 12%, and 7%, respectively, and varied by country (p<0.0001 for each). In multivariable models, anemia was associated with gender, platelet count, and country; neutropenia was associated with CD4+ lymphocyte and platelet counts; and thrombocytopenia was associated with country, gender, and chronic hepatitis B infection. Differences in the frequency of pretreatment hematological abnormalities could have important implications for the choice of antiretroviral regimen in resource-constrained settings. Copyright © 2010 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  5. Behavioral interventions to reduce HIV risk behavior for MSM and transwomen in Southeast Asia: a systematic review.

    PubMed

    Nugroho, Adi; Erasmus, Vicki; Zomer, Tizza P; Wu, Qing; Richardus, Jan Hendrik

    2017-01-01

    This systematic review aims to gain insights from existing literature from Southeast Asian countries to improve future HIV prevention programs for men who have sex with men (MSM) and transgender women (transwomen). We conducted a systematic search in six international databases for literature published prior to 1 January 2015. We included studies describing behavioral interventions targeting MSM and/or transwomen, and conducted in at least one Southeast Asian country. Five out of 575 screened studies met the inclusion criteria and reported a significant intervention effect on at least one outcome measure, that is, condom use (with casual or commercial partner), water-based lubricant use, number of sex partners, HIV prevention knowledge, or willingness to use pre-exposure prophylaxis. Peer education/outreach was the most commonly employed type of intervention in the five included studies and was usually delivered as an element of a larger intervention package, together with condom distribution and the provision of drop-in centers. Motivational interviewing was effective, while internet-based interventions appeared to be a viable platform for intervention delivery. Nevertheless, research on behavioral interventions among MSM and transwomen in Southeast Asia is limited. Future interventions should be culturally appropriate, theoretically grounded, and rigorously evaluated. Only then can we best address the HIV epidemic among MSM and transwomen in this region.

  6. Legislative and policy analysis of HIV prevention, treatment and care for people who use drugs and incarcerated people in Central Asia and Azerbaijan.

    PubMed

    Cozac, David; Elliott, Richard

    2011-04-01

    In January 2011, the Regional Office for Central Asia of the UN Office on Drugs and Crime (UNODC) and the Canadian HIV/AIDS Legal Network released an extensive report assessing the legislative and policy environment affecting the response to HIV in six countries of the Commonwealth of Independent States (CIS). The report, which draws in part upon the work of a national expert group in each country, puts forward dozens of recommendations for legislative and policy reform, including recommendations for specific reform tailored to the situation in each of the participating countries, with a particular focus on addressing the fast-growing HIV epidemic linked to injection drug use and in prisons.

  7. Partnering with law enforcement to deliver good public health: the experience of the HIV/AIDS Asia regional program

    PubMed Central

    2012-01-01

    In the South-East Asia region, the drug control and supply reduction agenda is of high political importance. A multitude of law enforcement agencies are engaged in this work. Nationwide campaigns such as the “Strike- Hard” campaign in China or the “war on drugs” in Thailand dominate the landscape. Viet Nam’s response to drug use has historically focused on deterrence through punishment and supply-side measures. This policy environment is further complicated by lack of evidence-based drug dependence treatment in several settings. The public health consequences of this approach have been extremely serious, with some of the highest documented prevalence of preventable blood-borne viral infections, including HIV, and hepatitis B and C. The wider socioeconomic consequences of this have been borne by families, communities and the governments themselves. The HIV/AIDS Asia Regional Program (HAARP) aims to stop the spread of HIV associated with drug use in South-East Asia and parts of southern China. HAARP works across five countries (Cambodia, China Burma, Laos, Viet Nam) chiefly through the Ministries of Health and Social Affairs, National Drug Control Agencies, and Public Security sectors, including prisons. HAARP has also engaged with UN agencies and a wide range of civil society organisations, including organisations of people who use drugs, to ensure their meaningful involvement in matters that directly affect them. We describe the experience of HAARP in implementing a large-scale harm reduction programme in the Sub-Mekong Region. HAARP chose to direct its efforts in three main areas: supporting an enabling environment for effective harm reduction policies, building core capacity among national health and law enforcement agencies, and supporting “universal access” goals by making effective, high-coverage services available to injecting drug users and their partners. The activities supported by HAARP are humble yet important steps. However, a much higher

  8. Partnering with law enforcement to deliver good public health: the experience of the HIV/AIDS Asia regional program.

    PubMed

    Sharma, Mukta; Chatterjee, Anindya

    2012-07-09

    In the South-East Asia region, the drug control and supply reduction agenda is of high political importance. A multitude of law enforcement agencies are engaged in this work. Nationwide campaigns such as the "Strike- Hard" campaign in China or the "war on drugs" in Thailand dominate the landscape. Viet Nam's response to drug use has historically focused on deterrence through punishment and supply-side measures. This policy environment is further complicated by lack of evidence-based drug dependence treatment in several settings. The public health consequences of this approach have been extremely serious, with some of the highest documented prevalence of preventable blood-borne viral infections, including HIV, and hepatitis B and C. The wider socioeconomic consequences of this have been borne by families, communities and the governments themselves.The HIV/AIDS Asia Regional Program (HAARP) aims to stop the spread of HIV associated with drug use in South-East Asia and parts of southern China. HAARP works across five countries (Cambodia, China Burma, Laos, Viet Nam) chiefly through the Ministries of Health and Social Affairs, National Drug Control Agencies, and Public Security sectors, including prisons. HAARP has also engaged with UN agencies and a wide range of civil society organisations, including organisations of people who use drugs, to ensure their meaningful involvement in matters that directly affect them. We describe the experience of HAARP in implementing a large-scale harm reduction programme in the Sub-Mekong Region. HAARP chose to direct its efforts in three main areas: supporting an enabling environment for effective harm reduction policies, building core capacity among national health and law enforcement agencies, and supporting "universal access" goals by making effective, high-coverage services available to injecting drug users and their partners.The activities supported by HAARP are humble yet important steps. However, a much higher political

  9. HIV spreading among women and children in Asia and Eastern Europe.

    PubMed

    1996-12-16

    This December 16, 1996, article gives some statistics published in "HIV/AIDS: The Global Epidemic," recently released by the United Nations Agency on AIDS (UNAIDS). 25% of all deaths (6.4 million total) due to acquired immunodeficiency syndrome (AIDS) occurred within the last year. 3.1 million persons were infected with human immunodeficiency virus (HIV) in 1996; the total number of HIV/AIDS cases is 22.6 million. About 90% of HIV/AIDS cases live in developing countries. Most of the newly infected adults (2.7 million total) are younger than 25; 50% are women. In 1996, 400,000 children were infected with HIV; the total number of cases in children is 830,000. Drug abuse and sexually transmitted diseases (STDs) are responsible for the rapid spread of HIV in central and eastern Europe. In Nikolayev (Ukraine), the proportion of HIV cases among injecting drug users rose from 1.7% in January 1995 to 56.5% 11 months later. In Kaliningrad (Russia), the number of reported cases increased from 21 to 387 since January 1996. These countries do not have the infrastructure to provide programs. Figures cited from the Chinese Academy of Preventive Medicine show that the number of cases of HIV in China rose from 10,000 at the end of 1993 to 100,000 by the end of 1995. In Vietnam, HIV rates among prostitutes increased from 9% in 1992 to 38% in 1994. Sub-Saharan Africa has 14 million cases (63% of the world total). Refugees in Rwanda and Burundi come from areas where over 20% of pregnant women, and 50% of those with other STDs, have HIV. In South Africa's Free State, HIV rates among pregnant women grew from 1/25 to greater than 1/10, in 2 years. In El Salvador, according to one study of female sex workers, the HIV rate among 15- to 19-year-olds was 3.1%, as opposed to 2.2% overall. Dr. Peter Piot, of UNAIDS, urges promotion of safe sex programs for women and development of a vaccine.

  10. Observationally-constrained estimates of aerosol optical depths (AODs) over East Asia via data assimilation techniques

    NASA Astrophysics Data System (ADS)

    Lee, K.; Lee, S.; Song, C. H.

    2015-12-01

    Not only aerosol's direct effect on climate by scattering and absorbing the incident solar radiation, but also they indirectly perturbs the radiation budget by influencing microphysics and dynamics of clouds. Aerosols also have a significant adverse impact on human health. With an importance of aerosols in climate, considerable research efforts have been made to quantify the amount of aerosols in the form of the aerosol optical depth (AOD). AOD is provided with ground-based aerosol networks such as the Aerosol Robotic NETwork (AERONET), and is derived from satellite measurements. However, these observational datasets have a limited areal and temporal coverage. To compensate for the data gaps, there have been several studies to provide AOD without data gaps by assimilating observational data and model outputs. In this study, AODs over East Asia simulated with the Community Multi-scale Air Quality (CMAQ) model and derived from the Geostationary Ocean Color Imager (GOCI) observation are interpolated via different data assimilation (DA) techniques such as Cressman's method, Optimal Interpolation (OI), and Kriging for the period of the Distributed Regional Aerosol Gridded Observation Networks (DRAGON) Campaign (March - May 2012). Here, the interpolated results using the three DA techniques are validated intensively by comparing with AERONET AODs to examine the optimal DA method providing the most reliable AODs over East Asia.

  11. Impact of orphan status on HIV treatment outcomes and retention in care of children and adolescents in Asia.

    PubMed

    Huy, Bui Vu; Teeraananchai, Sirinya; Oanh, Le Ngoc; Tucker, John; Kurniati, Nia; Hansudewechakul, Rawiwan; Truong, Khanh Huu; Khol, Vohith; Nguyen, Lam Van; Chau Do, Viet; Lumbiganon, Pagakrong; Kongstan, Nantaka; Bunupuradah, Torsak; Sudjaritruk, Tavitiya; Kumarasamy, Nagalingeswaran; Yusoff, Nik Khairulddin Nik; Mohd Razali, Kamarul Azahar; Wati, Dewi Kumara; Fong, Moy Siew; Nallusamy, Revathy; Kariminia, Azar; Sohn, Annette H

    2016-10-05

    An analysis of the impact of orphanhood at antiretroviral therapy (ART) initiation on HIV outcomes in Asia included 4300 children; 51% were male. At ART initiation, 1805 (42%) were non-orphans (median age: 3 years), 1437 (33%) were single orphans (6 years) and 1058 (25%) were double orphans (7 years). Ten-year post-ART survival was 93.4-95.2% across orphan categories. Clinic transfers were higher among single and double orphans than non-orphans (41% vs 11%, P<0.001). On multivariate analysis, children ≥3 years at ART initiation (hazard ratio 1.58 vs <3 years, 95% confidence interval: 1.11-2.24) were more likely to be lost to follow-up. Although post-ART mortality and retention did not differ by orphan status, orphans were at greater risk of starting ART at older ages, and with more severe immunosuppression and poorer growth.

  12. Observed Increase of TTL Temperature and Water Vapor in Polluted Couds over Asia

    SciTech Connect

    Su, Hui; Jiang, Jonathan; Liu, Xiaohong; Penner, J.; Read, William G.; Massie, Steven T.; Schoeberl, Mark R.; Colarco, Peter; Livesey, Nathaniel J.; Santee, Michelle L.

    2011-06-01

    Aerosols can affect cloud particle size and lifetime, which impacts precipitation, radiation and climate. Previous studies1-4 suggested that reduced ice cloud particle size and fall speed due to the influence of aerosols may increase evaporation of ice crystals and/or cloud radiative heating in the tropical tropopause layer (TTL), leading to higher water vapor abundance in air entering the stratosphere. Observational substantiation of such processes is still lacking. Here, we analyze new observations from multiple NASA satellites to show the imprint of pollution influence on stratospheric water vapor. We focus our analysis on the highly-polluted South and East Asia region during boreal summer. We find that "polluted" ice clouds have smaller ice effective radius than "clean" clouds. In the TTL, the polluted clouds are associated with warmer temperature and higher specific humidity than the clean clouds. The water vapor difference between the polluted and clean clouds cannot be explained by other meteorological factors, such as updraft and detrainment strength. Therefore, the observed higher water vapor entry value into the stratosphere in the polluted clouds than in the clean clouds is likely a manifestation of aerosol pollution influence on stratospheric water vapor. Given the radiative and chemical importance of stratospheric water vapor, the increasing emission of aerosols over Asia may have profound impacts on stratospheric chemistry and global energy balance and water cycle.

  13. Six years of high resolution of surface solar radiation in East Asia based on MTSAT observations

    NASA Astrophysics Data System (ADS)

    Niu, X.; Yang, K.; Tang, W.; Qin, J.

    2016-12-01

    Climate change has become a challenge of the sustainable development in East Asia due to its long coastline, population density, strong dependence of economic on agriculture and resource, extremely vulnerable to climate change impact. The Tibetan Plateau (TP) in this region, which is the highest plateau in the world, has strong interactions among the atmosphere, hydrosphere, cryosphere, and biosphere. The TP has been experiencing an overall increase in surface air temperature and moistening, solar dimming and wind stilling since the beginning of the 1980s. Surface Solar Radiation (SSR) plays an important role of the hydrological and land process modeling, which particularly contributes more than 90% to the total melt energy for the TP ice melting. The primary motivation for this study is to advance the quality and resolution of currently available information on SSR in East Asia. Six years (2007-2012) of high resolution (hourly; 0.1⁰) of SSR have been recently developed for the main East Asian region (20⁰N-60⁰N; 70⁰E-140⁰E). The SSR estimates have been derived from the optimized geostationary satellite observations - the Multi-functional Transport Satellite (MTSAT), based on updating an existing physical model, the UMD-SRB (University of Maryland Surface Radiation Budget) which is the basis of the well-known GEWEX-SRB model. The six years of SSR have been evaluated against ground observations and the universal used satellite products (i.e. ISCCP-FD, GEWEX-SRB) in relatively low spatial resolution (0.5⁰-2.5⁰) and temporal resolution (3-hourly, daily, or monthly). Such information is needed to meet the challenge for accurate input into the land process and hydrological models for us to better understand the mechanism of the climate change in East Asia.Bottom of Form

  14. Late Presentation into Care of HIV Disease and Its Associated Factors in Asia: Results of TAHOD

    PubMed Central

    Jeong, Su Jin; Italiano, Claire; Chaiwarith, Romanee; Ng, Oon Tek; Vanar, Sasheela; Jiamsakul, Awachana; Saphonn, Vonthanak; Nguyen, Kinh Van; Kiertiburanakul, Sasisopin; Lee, Man Po; Merati, Tuti Parwati; Pham, Thuy Thanh; Yunihastuti, Evy; Ditangco, Rossana; Kumarasamy, Nagalingeswaran; Zhang, Fujie; Wong, Wingwai; Sim, Benedict L.H.; Pujari, Sanjay; Kantipong, Pacharee; Phanuphak, Praphan; Ratanasuwan, Winai; Oka, Shinichi; Mustafa, Mahiran; Durier, Nicolas

    2016-01-01

    Abstract Many HIV-infected individuals do not enter health care until late in the infection course. Despite encouraging earlier testing, this situation has continued for several years. We investigated the prevalence of late presenters and factors associated with late presentation among HIV-infected patients in an Asian regional cohort. This cohort study included HIV-infected patients with their first positive HIV test during 2003–2012 and CD4 count and clinical status data within 3 months of that test. Factors associated with late presentation into care (CD4 count <200 cells/μl or an AIDS-defining event within ±3 months of first positive HIV test) were analyzed in a random effects logistic regression model. Among 3,744 patients, 2,681 (72%) were late presenters. In the multivariable model, older patients were more likely to be late presenters than younger (≤30 years) patients [31–40, 41–50, and ≥51 years: odds ratio (OR) = 1.57, 95% confidence interval (CI) 1.31–1.88; OR = 2.01, 95% CI 1.58–2.56; and OR = 1.69, 95% CI 1.23–2.31, respectively; all p ≤ 0.001]. Injecting drug users (IDU) were more likely (OR = 2.15, 95% CI 1.42–3.27, p < 0.001) and those with homosexual HIV exposure were less likely (OR = 0.45, 95% CI 0.35–0.58, p < 0.001) to be late presenters compared to those with heterosexual HIV exposure. Females were less likely to be late presenters (OR = 0.44, 95% CI 0.36–0.53, p < 0.001). The year of first positive HIV test was not associated with late presentation. Efforts to reduce the patients who first seek HIV care at the late stage are needed. The identified risk factors associated with late presentation should be utilized in formulating targeted public health intervention to improve earlier entry into HIV care. PMID:26414065

  15. Cancers in the Australian HIV Observational Database (AHOD)

    PubMed Central

    Petoumenos, Kathy; van Leuwen, Marina; Vajdic, Claire M; Woolley, Ian; Chuah, John; Templeton, David J; Grulich, Andrew; Law, Matthew

    2012-01-01

    Objectives To conduct a within cohort assessment of risk factors for incident AIDS defining cancers (ADC) and non-ADC (NADC) within the Australian HIV Observational Database (AHOD). Methods 2181 AHOD registrants were linked to the National AIDS Registry/National HIV Database NAR/NHD and the Australian cancer registry to identify those with a notified cancer diagnosis. Included in the current analyses were cancers diagnosed after HIV infection. Risk factors for cancers were also assessed using logistic regression methods. Results 139 cancer cases were diagnosed after HIV infection among 129 patients. More than half the diagnoses (n=68, 60%) were ADC, of which 69% were KS and 31% NHL. Among the NADC, the most common cancers were melanoma (n=10), lung cancer (n=6), and 5 cases each of Hodgkin’s lymphoma and anal cancer. Over a total of 21021 person years (PY) of follow-up since HIV diagnosis, the overall crude cancer incidence rate for any cancer was 5.09/1000 PY. The overall rate of cancers decreased from 15.9/1000 PY (95%CI: 9.25-25.40/1000) for CD4 counts below 100 cells/μL to 2.4/1000 PY (95%CI: 1.62-3.39/1000) for CD4 counts above 350 cells/μL. Lower CD4 cell count and prior AIDS diagnoses were significant predictors for both ADC and NADC. Conclusion ADC remain the predominant cancers in this population, although NADC rates have increased in the more recent time period. Immune deficiency is a risk factor for both ADC and NADC. PMID:22934689

  16. STS-57 Earth observation of the Eastern Mediterranean, Nile River, Asia Minor

    NASA Technical Reports Server (NTRS)

    1993-01-01

    STS-57 Earth observation of the Eastern Mediterranean. From a high vantage point over the Nile River, this north-looking view shows the eastern Mediterranean and the entire landmass of Asia Minor, with the Black Sea dimly visible at the horizon. Many of the Greek islands can be seen in the Aegean Sea (top left), off the coast of Asia Minor. Cyprus is visible under atmospheric dust in the northeastern corner of the Mediterranean. The dust cloud covers the east end of the Mediterranean, its western edge demarcated by a line that cuts the center of the Nile Delta. This dust cloud originated far to the west, in Algeria, and moved northeast. A gyre of clouds in the southeast corner of the Mediterranean indicates a complementary counterclockwise (cyclonic) circulation of air. The Euphrates River appears as a thin green line (upper right) in the yellow Syrian desert just south of the mountains of Turkey. The Dead Sea (lower right) lies in a rift valley which extends north into Turkey and sout

  17. Structured Observations Reveal Slow HIV-1 CTL Escape

    PubMed Central

    Roberts, Hannah E.; Hurst, Jacob; Robinson, Nicola; Brown, Helen; Flanagan, Peter; Vass, Laura; Fidler, Sarah; Weber, Jonathan; Babiker, Abdel; Phillips, Rodney E.; McLean, Angela R.; Frater, John

    2015-01-01

    The existence of viral variants that escape from the selection pressures imposed by cytotoxic T-lymphocytes (CTLs) in HIV-1 infection is well documented, but it is unclear when they arise, with reported measures of the time to escape in individuals ranging from days to years. A study of participants enrolled in the SPARTAC (Short Pulse Anti-Retroviral Therapy at HIV Seroconversion) clinical trial allowed direct observation of the evolution of CTL escape variants in 125 adults with primary HIV-1 infection observed for up to three years. Patient HLA-type, longitudinal CD8+ T-cell responses measured by IFN-γ ELISpot and longitudinal HIV-1 gag, pol, and nef sequence data were used to study the timing and prevalence of CTL escape in the participants whilst untreated. Results showed that sequence variation within CTL epitopes at the first time point (within six months of the estimated date of seroconversion) was consistent with most mutations being transmitted in the infecting viral strain rather than with escape arising within the first few weeks of infection. Escape arose throughout the first three years of infection, but slowly and steadily. Approximately one third of patients did not drive any new escape in an HLA-restricted epitope in just under two years. Patients driving several escape mutations during these two years were rare and the median and modal numbers of new escape events in each patient were one and zero respectively. Survival analysis of time to escape found that possession of a protective HLA type significantly reduced time to first escape in a patient (p = 0.01), and epitopes escaped faster in the face of a measurable CD8+ ELISpot response (p = 0.001). However, even in an HLA matched host who mounted a measurable, specific, CD8+ response the average time before the targeted epitope evolved an escape mutation was longer than two years. PMID:25642847

  18. The perfect storm: incarceration and the high-risk environment perpetuating transmission of HIV, hepatitis C virus, and tuberculosis in Eastern Europe and Central Asia.

    PubMed

    Altice, Frederick L; Azbel, Lyuba; Stone, Jack; Brooks-Pollock, Ellen; Smyrnov, Pavlo; Dvoriak, Sergii; Taxman, Faye S; El-Bassel, Nabila; Martin, Natasha K; Booth, Robert; Stöver, Heino; Dolan, Kate; Vickerman, Peter

    2016-09-17

    Despite global reductions in HIV incidence and mortality, the 15 UNAIDS-designated countries of Eastern Europe and Central Asia (EECA) that gained independence from the Soviet Union in 1991 constitute the only region where both continue to rise. HIV transmission in EECA is fuelled primarily by injection of opioids, with harsh criminalisation of drug use that has resulted in extraordinarily high levels of incarceration. Consequently, people who inject drugs, including those with HIV, hepatitis C virus, and tuberculosis, are concentrated within prisons. Evidence-based primary and secondary prevention of HIV using opioid agonist therapies such as methadone and buprenorphine is available in prisons in only a handful of EECA countries (methadone or buprenorphine in five countries and needle and syringe programmes in three countries), with none of them meeting recommended coverage levels. Similarly, antiretroviral therapy coverage, especially among people who inject drugs, is markedly under-scaled. Russia completely bans opioid agonist therapies and does not support needle and syringe programmes-with neither available in prisons-despite the country's high incarceration rate and having the largest burden of people with HIV who inject drugs in the region. Mathematical modelling for Ukraine suggests that high levels of incarceration in EECA countries facilitate HIV transmission among people who inject drugs, with 28-55% of all new HIV infections over the next 15 years predicted to be attributable to heightened HIV transmission risk among currently or previously incarcerated people who inject drugs. Scaling up of opioid agonist therapies within prisons and maintaining treatment after release would yield the greatest HIV transmission reduction in people who inject drugs. Additional analyses also suggest that at least 6% of all incident tuberculosis cases, and 75% of incident tuberculosis cases in people who inject drugs are due to incarceration. Interventions that reduce

  19. Influence of Madden-Julian Oscillation on Southeast Asia rainfall extremes: Observations and predictability

    NASA Astrophysics Data System (ADS)

    Xavier, Prince; Rahmat, Raizan; Cheong, Wee Kiong; Wallace, Emily

    2014-06-01

    The influence of Madden-Julian Oscillation (MJO) on the rainfall distribution of Southeast Asia is studied using TRMM satellite-derived rainfall and rain gauge data. It is shown that convectively active (suppressed) phases of MJO can increase (decrease) the probability of extreme rain events over the land regions by about 30-50% (20-25%) during November-March season. The influence of MJO on localized rainfall extremes are also observed both in rainfall intensity and duration. The Met Office Global Seasonal forecasting system seasonal forecasting system is shown to reproduce the MJO influence on rainfall distribution well despite the model biases over land. Skills scores for forecasting 90th percentile extreme rainfall shows significant skills for convective phases. This study demonstrates the feasibility of deriving probabilistic forecasts of extreme rainfall at medium range.

  20. Anthropogenic emissions and space-borne observations of carbon monoxide over South Asia

    NASA Astrophysics Data System (ADS)

    Ul-Haq, Zia; Tariq, Salman; Ali, Muhammad

    2016-11-01

    The focus of this study is to understand anthropogenic emissions, spatiotemporal variability and trends of carbon monoxide (CO) over South Asia by using datasets from MACCity (Monitoring Atmospheric Composition and Climate, MACC and megaCITY - Zoom for the Environment, CityZEN), REAS (Regional Emission inventory in Asia), AIRS (Atmospheric Infrared Sounder) and SCIAMACHY (SCanning Imaging Absorption spectroMeter for Atmospheric CartograpHY). MACCity anthropogenic emissions show an overall increase of 16.5% during 2000-2010. Elevated levels of MACCity CO are found in Indo-Gangetic Basin (IGB), eastern mining region of India, Bangladesh and large urban areas. Some of the major contributors of these emissions have been identified as agricultural waste burning, land transport, industrial production, and energy generation and distribution. An area averaged mean value of AIRS CO at 600 hPa is found to be 114 ± 2 ppbv (slope -0.48 ± 0.2 ppbv yr-1, y-intercept 117 ± 1 ppbv and r = 0.68) with a minor declining trend at -0.41 ± 0.18% yr-1 over the region during 2003-2015. A strong seasonality in AIRS CO concentration is observed with spring season peak in March 129 ± 1.9 ppbv, whereas low values have been observed in summer monsoon with sturdy dip in July 99.6 ± 1.94 ppbv. AIRS CO and SCIAMACHY CO Total Column (CO TC) over the study region show spatial patterns similar to MACCity and REAS emissions. An analysis of SCIAMACHY CO TC tendencies has been performed which indicates minor rising trends over some parts of the region. Background CO, Recent Emissions (RE), and spatial anomalies in RE over high anthropogenic activity zones of Indus Basin, Ganges Basin and Eastern Region were analyzed using AIRS and SCIAMACHY CO data.

  1. Regional occurrence characteristics of ESF backscatter plumes observed with the VHF radar in Southeast Asia

    NASA Astrophysics Data System (ADS)

    Ning, Baiqi; Li, Guozhu

    The development of the equatorial spread-F (ESF) plumes can be well recorded by steerable backscatter radars operated at and off the magnetic equator due to the fact that the vertically extended plume structures are tracers of magnetically north-south aligned larger scale structures. In this study, the temporal and spatial evolutions of ESF plasma plumes and their smaller scale longitudinal differences in Southeast Asia are investigated using the beam steering capability of the two radars, the Equatorial Atmosphere Radar (EAR) (0.2ºS, 100.3ºE; dip lat 10.4ºS) and the Sanya VHF radar (18.4ºN, 109.6ºE; dip lat 12.8ºN) separated in longitude by ~1000 km. In the beam steering mode of operation, the scanned area at a height of 300 km covers approximately 360 km and 280 km in east-west direction for the EAR and the Sanya radar, respectively. Thus the beam steering measurements by the two radars provide a good spatial coverage, and can be used to study the occurrence and dynamics of equatorial plasma plumes in Southeast Asia and possible short longitude scale differences in their characteristics. We present observations of periodic backscatter plume structures with the EAR and Sanya radar during geomagnetic quiet days and examine the mechanism responsible for the generation of these structures. A tracing analysis on the onset locations of plasma plumes reveals spatially well-separated backscatter plumes, with a maximum east-west wavelength of about 1000 km, periodically generated in longitudes of Southeast Asia. The post-sunset backscatter plumes seen by the Sanya VHF radar are found to be due to the passage of sunset plumes initiated around the longitude of EAR. On the other hand, the EAR measurements show multiple plume structures that developed successively in the radar scanned area with east-west separation of ~50 km, with however, no sunset plasma plume over Sanya at times. This could indicate that the small scale waves, unlike the large scale wave structure

  2. Quantifying VOC emissions from East Asia using 10 years of satellite observations

    NASA Astrophysics Data System (ADS)

    Stavrakou, T.; Muller, J. F.; Bauwens, M.; De Smedt, I.; Van Roozendael, M.; Boersma, F.; van der A, R. J.; Pierre-Francois, C.; Clerbaux, C.

    2016-12-01

    China's emissions are in the spotlight of efforts to mitigate climate change and improve regional and city-scale air quality. Despite growing efforts to better quantify China's emissions, the current estimates are often poor or inadequate. Complementary to bottom-up inventories, inverse modeling of fluxes has the potential to improve those estimates through the use of atmospheric observations of trace gas compounds. As formaldehyde (HCHO) is a high-yield product in the oxidation of most volatile organic compounds (VOCs) emitted by anthropogenic and natural sources, satellite observations of HCHO hold the potential to inform us on the spatial and temporal variability of the underlying VOC sources. The 10-year record of space-based HCHO column observations from the OMI instrument is used to constrain VOC emission fluxes in East Asia in a source inversion framework built on the IMAGES chemistry-transport model and its adjoint. The interannual and seasonal variability, spatial distribution and potential trends of the top-down VOC fluxes (anthropogenic, pyrogenic and biogenic) are presented and confronted to existing emission inventories, satellite observations of other species (e.g. glyoxal and nitrogen oxides), and past studies.

  3. Constraining Aerosol Distributions in Asia by Integrating Models with Multi-sensor Observations (Invited)

    NASA Astrophysics Data System (ADS)

    Carmichael, G. R.; Kulkarni, S.; Chung, C. E.; Ramanathan, V.

    2010-12-01

    Aerosols are ubiquitous components of the atmosphere that are linked to various adverse impacts including increased health risks, visibility degradation, alteration of cloud properties and changing climate patterns on local, regional and global scales. The past decade has witnessed an alarming growth in Asian emissions thereby causing a great concern for global air quality. The Chemical Transport Models (CTM’s) provide a means to link the emissions with observations and greatly assist in policy-making decisions. The underlying uncertainties associated with emissions, meteorology and various chemical processes in CTMs can be greatly reduced by constraining them with observations. In this regard, satellite borne observations provide unprecedented data due to their continuous global coverage. In particular, the AOD measurements available from the MODIS and MISR instruments onboard the NASA TERRA satellites are being increasingly used for both CTM evaluation and as input to aerosol data assimilation studies. In this study, we present a regional scale modeling analysis over Asia constrained with surface AERONET and MODIS AODs via data assimilation using optimal interpolation. The MODIS AOD retrieved by different methods including Deep Blue algorithm over land was used in this study. The climatic effects of absorbing aerosols were studied by testing constraints provided by AERONET, MISR and OMI absorption AOD measurements.

  4. Clade C HIV-1 isolates circulating in Southern Africa exhibit a greater frequency of dicysteine motif-containing Tat variants than those in Southeast Asia and cause increased neurovirulence

    PubMed Central

    2013-01-01

    Background HIV-1 Clade C (Subtype C; HIV-1C) is responsible for greater than 50% of infections worldwide. Unlike clade B HIV-1 (Subtype B; HIV-1B), which is known to cause HIV associated dementia (HAD) in approximately 15% to 30% of the infected individuals, HIV-1C has been linked with lower prevalence of HAD (0 to 6%) in India and Ethiopia. However, recent studies report a higher prevalence of HAD in South Africa, Zambia and Botswana, where HIV-1C infections predominate. Therefore, we examined whether Southern African HIV-1C is genetically distinct and investigated its neurovirulence. HIV-1 Tat protein is a viral determinant of neurocognitive dysfunction. Therefore, we focused our study on the variations seen in tat gene and its contribution to HIV associated neuropathogenesis. Results A phylogenetic analysis of tat sequences of Southern African (South Africa and Zambia) HIV isolates with those from the geographically distant Southeast Asian (India and Bangladesh) isolates revealed that Southern African tat sequences are distinct from Southeast Asian isolates. The proportion of HIV − 1C variants with an intact dicysteine motif in Tat protein (C30C31) was significantly higher in the Southern African countries compared to Southeast Asia and broadly paralleled the high incidence of HAD in these countries. Neuropathogenic potential of a Southern African HIV-1C isolate (from Zambia; HIV-1C1084i), a HIV-1C isolate (HIV-1IndieC1) from Southeast Asia and a HIV-1B isolate (HIV-1ADA) from the US were tested using in vitro assays to measure neurovirulence and a SCID mouse HIV encephalitis model to measure cognitive deficits. In vitro assays revealed that the Southern African isolate, HIV-1C1084i exhibited increased monocyte chemotaxis and greater neurotoxicity compared to Southeast Asian HIV-1C. In neurocognitive tests, SCID mice injected with MDM infected with Southern African HIV-1C1084i showed greater cognitive dysfunction similar to HIV-1B but much higher than

  5. Virtual versus physical spaces: which facilitates greater HIV risk taking among men who have sex with men in East and South-East Asia?

    PubMed

    Wei, Chongyi; Lim, Sin How; Guadamuz, Thomas E; Koe, Stuart

    2014-08-01

    Increasing use of the Internet to seek sex partners is accompanied by rising HIV infections among men who have sex with men (MSM) in East and South-East Asia. We examined whether the Internet facilitates greater HIV risk taking among MSM in the region. A cross-sectional sample of 9,367 MSM was recruited via the Internet in 2010. We compared socio-demographic and HIV-related behavioral characteristics among MSM who met sex partners on the Internet only, who met sex partners offline only, and who met sex partners through both. Multinomial logistic regression was used to identify independent correlates that were associated with differences in where participants met their male sex partners. Compared to MSM who met partners offline only, those who met partners online only were less likely to have multiple male sex partners, have paid for sex, have consumed recreational drugs, and have used alcohol before sex. MSM who met partners both online and offline appeared to be the riskiest group that they were more likely to have multiple male sex partners, have engaged in UIAI, and have consumed alcohol before sex. These findings suggest that social networking websites alone do not facilitate greater HIV risk taking among MSM. Rather, they provide additional venues for MSM who already engage in HIV-related high risk behaviors to seek sex partners. The Internet offers incredible opportunities to reach large numbers of MSM in East and South-East Asia for HIV prevention and research. Web-based outreach and prevention activities are needed to reach these men. In addition, mobile and application-based interventions should also be developed and disseminated.

  6. Identification of possible intense historical geomagnetic storms using combined sunspot and auroral observations from East Asia

    NASA Astrophysics Data System (ADS)

    Willis, D. M.; Armstrong, G. M.; Ault, C. E.; Stephenson, F. R.

    2005-03-01

    Comprehensive catalogues of ancient sunspot and auroral observations from East Asia are used to identify possible intense historical geomagnetic storms in the interval 210 BC-AD 1918. There are about 270 entries in the sunspot catalogue and about 1150 entries in the auroral catalogue. Special databases have been constructed in which the scientific information in these two catalogues is placed in specified fields. For the purposes of this study, an historical geomagnetic storm is defined in terms of an auroral observation that is apparently associated with a particular sunspot observation, in the sense that the auroral observation occurred within several days of the sunspot observation. More precisely, a selection criterion is formulated for the automatic identification of such geomagnetic storms, using the oriental records stored in the sunspot and auroral databases. The selection criterion is based on specific assumptions about the duration of sunspot visibility with the unaided eye, the likely range of heliographic longitudes of an energetic solar feature, and the likely range of transit times for ejected solar plasma to travel from the Sun to the Earth. This selection criterion results in the identification of nineteen putative historical geomagnetic storms, although two of these storms are spurious in the sense that there are two examples of a single sunspot observation being associated with two different auroral observations separated by more than half a (synodic) solar rotation period. The literary and scientific reliabilities of the East Asian sunspot and auroral records that define the nineteen historical geomagnetic storms are discussed in detail in a set of appendices. A possible time sequence of events is presented for each geomagnetic storm, including possible dates for both the central meridian passage of the sunspot and the occurrence of the energetic solar feature, as well as likely transit times for the ejected solar plasma. European telescopic

  7. Linkage to HIV care, postpartum depression, and HIV-related stigma in newly diagnosed pregnant women living with HIV in Kenya: a longitudinal observational study.

    PubMed

    Turan, Bulent; Stringer, Kristi L; Onono, Maricianah; Bukusi, Elizabeth A; Weiser, Sheri D; Cohen, Craig R; Turan, Janet M

    2014-12-03

    While studies have suggested that depression and HIV-related stigma may impede access to care, a growing body of literature also suggests that access to HIV care itself may help to decrease internalized HIV-related stigma and symptoms of depression in the general population of persons living with HIV. However, this has not been investigated in postpartum women living with HIV. Furthermore, linkage to care itself may have additional impacts on postpartum depression beyond the effects of antiretroviral therapy. We examined associations between linkage to HIV care, postpartum depression, and internalized stigma in a population with a high risk of depression: newly diagnosed HIV-positive pregnant women. In this prospective observational study, data were obtained from 135 HIV-positive women from eight antenatal clinics in the rural Nyanza Province of Kenya at their first antenatal visit (prior to testing HIV-positive for the first time) and subsequently at 6 weeks after giving birth. At 6 weeks postpartum, women who had not linked to HIV care after testing positive at their first antenatal visit had higher levels of depression and internalized stigma, compared to women who had linked to care. Internalized stigma mediated the effect of linkage to care on depression. Furthermore, participants who had both linked to HIV care and initiated antiretroviral therapy reported the lowest levels of depressive symptoms. These results provide further support for current efforts to ensure that women who are newly diagnosed with HIV during pregnancy become linked to HIV care as early as possible, with important benefits for both physical and mental health.

  8. Aerosol impacts on cloud thermodynamic phase change over East Asia observed with CALIPSO and CloudSat measurements

    NASA Astrophysics Data System (ADS)

    Zhang, Damao; Liu, Dong; Luo, Tao; Wang, Zhien; Yin, Yan

    2015-02-01

    Impacts of aerosols on subfreezing cloud thermodynamic phase change over East Asia are studied by using 4 year combined CloudSat radar and Cloud-Aerosol Lidar and Infrared Pathfinder Satellite Observation (CALIPSO) lidar measurements. The mean occurrence frequencies of supercooled-liquid, mixed-phase, and glaciated clouds over East Asia are 10.4%, 10.3%, and 16.9%, respectively. Over northwest of East Asia (32-44°N, 75-100°E), subfreezing clouds are dominated by glaciated clouds with a mean relative cloud fraction (RCF) of 60% and over southeast (16-32°N, 95-120°E) are dominated by supercooled-liquid clouds with a mean RCF of 50%. Although cloud top temperature (CTT) differences contribute largely to the thermodynamic phase differences, northwest of East Asia has 20% larger glaciated (smaller mixed-phase) RCFs than those of southeast at the same CTT. Seasonal anomalies of glaciated and mixed-phase RCFs correlate well with the seasonal variations of dust occurrence frequency. In addition, subfreezing clouds associated with mineral dust contain approximately 5%, 10%, and 20% larger glaciated (smaller mixed-phase) RCFs than those associated with polluted dust, smoke, and background aerosols at any given CTT. It is suggested that dust impacts on subfreezing clouds over East Asia by providing abundant effective ice nuclei to glaciate mixed-phase clouds, although the impacts of large-scale dynamics and water supply mechanisms cannot be ruled out.

  9. Effect of remote forcings on the winter precipitation of central southwest Asia part 1: observations

    NASA Astrophysics Data System (ADS)

    Syed, F. S.; Giorgi, F.; Pal, J. S.; King, M. P.

    2006-09-01

    We investigate the effects of the North Atlantic Oscillation (NAO) and the El Nino Southern Oscillation (ENSO) on winter precipitation in Central Southwest Asia (CSWA) using an analysis of available observed climate data. The analysis is based on correlations, composites and Singular Value Decomposition (SVD) performed using the gridded dataset of the Climatic Research Unit (CRU) and station data for the region. We find that both the NAO and ENSO affect climate over the region. In particular a positive precipitation anomaly is typically found in correspondence of the positive NAO phase and warm ENSO phase over a sub-region encompassing northern Pakistan, Afghanistan, Tajikistan and southern Uzbekistan. This conclusion is supported by a consistency across the different analysis methods and observation datasets employed in our study. A physical mechanism for such effect is proposed, by which western disturbances are intensified over the region as they encounter a low pressure trough, which is a dominant feature during positive NAO and warm ENSO conditions. Our results give encouraging indications towards the development of statistically-based prediction tools for winter precipitation over the CSWA region.

  10. Radiation, Aerosol Joint Observation-Modeling Exploration over Glaciers in Himalayan Asia (RAJO-MEGHA)

    NASA Astrophysics Data System (ADS)

    Tsay, S. C.; Holben, B. N.

    2016-12-01

    All major rivers that run through densely populated Asia (i.e., Yangtze, Yellow in China; Mekong in Southeast Asian peninsula; Brahmaputra, Ganges, Indus in Indian subcontinent) originate in High Mountain Asia (HMA) and are fed by the seasonal melt of snowpack and glaciers. Although varying greatly in space and time, the overall snowpack/ glaciers in the HMA are losing mass and retreating at an accelerated rate (e.g., Kulkarni et al., 2007; Kehrwald et al., 2008), as revealed from recent observations. This situation poses an imminent danger to the water supply and environmental hazards (e.g., soil erosion, glacial-lake-outburst flood) not only to regional inhabitants, but also to the global ecosystem through feedback mechanisms. Comprehensive regional-to-global assimilation models, advancing in lockstep with the advent of satellite observations (e.g., MODIS-/CERES-like sensors) and complementary surface measurements (e.g., AERONET), are playing an ever-increasing role in developing mitigation strategies. However, the complex characteristics of HMA, such as its ragged terrain, atmospheric inhomogeneity, snow susceptibility, and ground-truth accessibility, introduces difficulties for the aforementioned research tools to retrieve/assess radiative forcing on snow/ice melting with a high degree of fidelity. In terms of quantifying radiative forcing, the key components are transport/evolution of light-absorbing aerosols (e.g., dust, black carbon) aloft, the surface solar/terrestrial irradiance budget, and snow reflectivity/absorptivity with/without impurities. The RAJO-MEGHA (Sanskrit for Dust-Cloud) project is an initiative on the integrated (aerosols, clouds, and precipitation) measurements in the vicinity of HMA (e.g., Indo-Gangetic Plain, Himalaya-Tibetan Plateau). We will discuss an array of ground-based (e.g., AERONET, MPLNET, SMARTLabs, etc.) and satellite (e.g., Terra, A-Train, etc.) sensors utilized to acquire aerosol characteristics, sources/sinks, and

  11. Increased incidence of cancer observed in HIV/HCV-coinfected patients versus HIV-monoinfected, 1993-2014.

    PubMed

    Meijide, Héctor; Pértega, Sonia; Rodríguez-Osorio, Iria; Castro-Iglesias, Ángeles; Baliñas, Josefa; Rodríguez-Martínez, Guillermo; Mena, Álvaro; Poveda, Eva

    2017-03-21

    Cancer is a growing problem in persons living with HIV infection (PLWH) and hepatitis C virus (HCV) coinfection could play an additional role in carcinogenesis. Herein, all cancers in an HIV-mono and HIV/HCV-coinfected cohort were evaluated and compared to identify any differences between these two populations. A retrospective cohort study was conducted including all cancers in PLWH between 1993 and 2014. Cancers were classified in two groups, AIDS-defining cancer (ADC) and non AIDS-defining cancer (NADC). Cancer incidence rates were calculated and compared with that observed in the Spanish general population (GLOBOCAN, 2012), computing the standardized incidence ratios (SIR). A competing risk approach was used to estimate the probability of cancer after HIV diagnosis. Cumulative incidence in HIV-monoinfected and HIV/HCV-coinfected was also compared using multivariable analysis. A total of 185 patients (117 HIV-monoinfected and 68 HIV/HCV) developed cancer in the 26,580 patient-years cohort; with an incidence rate of 696 cancers per 100,000 person-years, higher than in the general population (SIR = 3.8). The incidence rate of NADC in HIV/HCV-coinfected was 415.0 (SIR = 3.4), significantly higher than in monoinfected (377.3; SIR = 1.8). After adjustments, HIV/HCV-coinfected patients had a higher cumulative incidence of NADC than HIV-monoinfected (adjusted hazard ratio = 1.80), even when excluding hepatocellular carcinomas (adjusted hazard ratio = 1.26). PLWH have a higher incidence of NADC than the general population and HCV-coinfection is associated with a higher incidence of NADC. This data justifies the need for prevention strategies in these two populations and the importance of eradicating HCV.

  12. Increased incidence of cancer observed in HIV/hepatitis C virus-coinfected patients versus HIV-monoinfected.

    PubMed

    Meijide, Héctor; Pértega, Sonia; Rodríguez-Osorio, Iria; Castro-Iglesias, Ángeles; Baliñas, Josefa; Rodríguez-Martínez, Guillermo; Mena, Álvaro; Poveda, Eva

    2017-05-15

    Cancer is a growing problem in persons living with HIV infection (PLWH) and hepatitis C virus (HCV) coinfection could play an additional role in carcinogenesis. Herein, all cancers in an HIV-mono and HIV/HCV-coinfected cohort were evaluated and compared to identify any differences between these two populations. A retrospective cohort study was conducted including all cancers in PLWH between 1993 and 2014. Cancers were classified in two groups: AIDS-defining cancer (ADC) and non-AIDS-defining cancer (NADC). Cancer incidence rates were calculated and compared with that observed in the Spanish general population (GLOBOCAN, 2012), computing the standardized incidence ratios (SIRs). A competing risk approach was used to estimate the probability of cancer after HIV diagnosis. Cumulative incidence in HIV-monoinfected and HIV/HCV-coinfected patients was also compared using multivariable analysis. A total of 185 patients (117 HIV-monoinfected and 68 HIV/HCV) developed cancer in the 26 580 patient-years cohort, with an incidence rate of 696 cancers per 100 000 person-years, higher than in the general population (SIR = 3.8). The incidence rate of NADC in HIV/HCV-coinfected patients was 415.0 (SIR = 3.4), significantly higher than in monoinfected (377.3; SIR = 1.8). After adjustments, HIV/HCV-coinfected patients had a higher cumulative incidence of NADC than HIV-monoinfected (adjusted hazard ratio = 1.80), even when excluding hepatocellular carcinomas (adjusted hazard ratio = 1.26). PLWH have a higher incidence of NADC than the general population and HCV-coinfection is associated with a higher incidence of NADC. These data justify the need for prevention strategies in these two populations and the importance of eradicating HCV.

  13. Age and climate contribution to observed forest carbon sinks in East Asia

    NASA Astrophysics Data System (ADS)

    Gao, Shan; Zhou, Tao; Zhao, Xiang; Wu, Donghai; Li, Zheng; Wu, Hao; Du, Ling; Luo, Hui

    2016-03-01

    The observed forest carbon sink, i.e. positive net ecosystem productivity (NEP), in East Asia reported by the eddy covariance flux tower network is an integrated result of forests themselves (e.g. age) and abiotic factors such as climate. However the relative contribution of climate alone to that sink is highly uncertain and has been in debate. In this study we de-trended a primary effect of forest age on carbon sinks by a statistical regression model between NEP and forest ages. Then, modeled residual NEP was regressed against climate factors again so that its relative contribution could be evaluated appropriately in the region. The analysis for data from the 2000s showed that forest age appeared to be the primary impact factor on the carbon sink of the region (R 2 = 0.347), and the mean annual temperature (MAT) was the second (R 2 = 0.23), while the mean annual precipitation effect might not be as apparent as MAT. Particularly for forests in China, climate might contribute to about 31.7% of the total NEP of 0.540 Pg C yr-1. Given that forests in China are relatively young under current climate conditions, we predicted that they would be capable of atmospheric carbon sequestration in the near future.

  14. A simulation for UV-VIS observations of tropospheric composition from a geostationary satellite over Asia

    NASA Astrophysics Data System (ADS)

    Irie, Hitoshi; Iwabuchi, Hironobu; Noguchi, Katsuyuki; Kasai, Yasuko; Kita, Kazuyuki; Akimoto, Hajime

    To investigate the potential for observing tropospheric composition from a geostationary (GEO) satellite over Asia, we perform a simulation for UV-VIS ranges (280-600 nm). A sophisticated radiative transfer model JACOSPAR is used to calculate radiance spectra that would be mea-sured at a GEO point. The air mass factor (AMF) is also calculated at different altitudes, wavelengths, and solar zenith angles (SZAs), to investigate whether the measured backscat-tered photons penetrate deep inside the planetary boundary layer (PBL). According to the AMF dependence on wavelength, visible wavelengths can provide much more PBL information. Compared to the nadir geometry, a geometry observing Tokyo reveals that AMFs near the sur-face drop by only about 15% (30%), at SZA<40 (60) degrees, where the elevated concentration of surface ozone is generally anticipated. This suggests that a GEO satellite would enable ob-servation of elevated ozone events, similar to existing low earth orbit satellites. Next, radiance spectra, to which noises corresponding to given signal-to-noise ratios (SNRs) are added, are analyzed using the Differential Optical Absorption Spectroscopy to estimate the precision for the slant column retrieval as a function of SNR. For the retrieval of ozone from UV (Huggins bands), the precision reaches 1% at SNR>1000. AMF calculations, however, indicate that as a mean path, the measured photons do not penetrate deep inside the PBL. As an alterna-tive way, we analyze Chappuis bands using the fitting window 450-550 nm and find that the precision can be as high as 1% at SNR>1000, with much improved sensitivity to PBL ozone. Similar analyses are made for other trace gases such as NO2 and HCHO, providing a basis for characterizing overall performance of GEO satellite measurements with UV-VIS regions. An instrument design proposed based on these simulations in Japan is also presented.

  15. Programmes, resources, and needs of HIV-prevention nongovernmental organizations (NGOs) in Africa, Central/Eastern Europe and Central Asia, Latin America and the Caribbean

    PubMed Central

    KELLY, J. A.; SOMLAI, A. M.; BENOTSCH, E. G.; AMIRKHANIAN, Y. A.; FERNANDEZ, M. I.; STEVENSON, L. Y.; SITZLER, C. A.; MCAULIFFE, T. L.; BROWN, K. D.; OPGENORTH, K. M.

    2008-01-01

    This study assessed the programmes, resources, and needs of HIV-prevention nongovernmental organizations (NGOs) in 75 countries in Africa, Central/Eastern Europe and Central Asia, Latin America and the Caribbean. Multiple databases and expert recommendations were used to identify one major HIV-prevention NGO in the capital or a large city in each country, and in-depth interviews were conducted with each NGO Director. Most NGOs are carrying out their programmes with minimal funding and few regularly employed personnel. Most are highly dependent on international donors, but reliance on small grants with short funding periods limits programme development capacity. HIV-prevention activities varied by region, with African NGOs most likely to use peer education and community awareness events; Eastern European NGOs most likely to offer needle exchange; Latin American NGOs to have resource centres and offer risk reduction programmes; and Caribbean organizations to use mass education approaches. Across regions, NGOs most often targeted the general public and youth, although specialized at-risk groups were the additional focus of attention in some regions. Limited funding, governmental indifference or opposition, AIDS stigma, and social discomfort discussing sex were often cited as barriers to new HIV-prevention programmes. NGOs are critical service providers. However, their funding, programmes, and resource capacities must be strengthened if NGOs are to realize their full potential in HIV prevention. PMID:16282071

  16. Programmes, resources, and needs of HIV-prevention nongovernmental organizations (NGOs) in Africa, Central/Eastern Europe and Central Asia, Latin America and the Caribbean.

    PubMed

    Kelly, J A; Somlai, A M; Benotsch, E G; Amirkhanian, Y A; Fernandez, M I; Stevenson, L Y; Sitzler, C A; McAuliffe, T L; Brown, K D; Opgenorth, K M

    2006-01-01

    This study assessed the programmes, resources, and needs of HIV-prevention nongovernmental organizations (NGOs) in 75 countries in Africa, Central/Eastern Europe and Central Asia, Latin America and the Caribbean. Multiple databases and expert recommendations were used to identify one major HIV-prevention NGO in the capital or a large city in each country, and in-depth interviews were conducted with each NGO Director. Most NGOs are carrying out their programmes with minimal funding and few regularly employed personnel. Most are highly dependent on international donors, but reliance on small grants with short funding periods limits programme development capacity. HIV-prevention activities varied by region, with African NGOs most likely to use peer education and community awareness events; Eastern European NGOs most likely to offer needle exchange; Latin American NGOs to have resource centres and offer risk reduction programmes; and Caribbean organizations to use mass education approaches. Across regions, NGOs most often targeted the general public and youth, although specialized at-risk groups were the additional focus of attention in some regions. Limited funding, governmental indifference or opposition, AIDS stigma, and social discomfort discussing sex were often cited as barriers to new HIV-prevention programmes. NGOs are critical service providers. However, their funding, programmes, and resource capacities must be strengthened if NGOs are to realize their full potential in HIV prevention.

  17. Interannual variations and recent trends of surface ozone in East Asia: Integrated observations and chemical transport model analysis

    NASA Astrophysics Data System (ADS)

    Tanimoto, H.; Ohara, T.; Kurokawa, J.; Mukai, H.; Uno, I.; Yamaji, K.

    2006-12-01

    Socio-economic activities are rapidly increasing in many countries of Asia due to a population explosion. The emissions of nitrogen oxides from East Asia have been rising in the past decades, and are now more than those from Europe and North America. Under such circumstances, systematic observational networks with wide spatial and temporal coverage are required to detect current and future changes in air quality (ozone and aerosols). In this work, ground-based measurement data of ozone, PM, and precursors at ~15 remote sites from multiple monitoring networks including operational programs (NIES, JMA, EANET, WMO/GAW) and collaborative research projects (SKYNET) in East Asia are integrated. The idea and basis is that in-situ data are more accurate than satellite and sounding data, though its spatial coverage is limited. The intercomparisons of reference scales in each network make ambient data compatible with each other, and the integration of such traceable data allows us to cover wide latitudinal zones ranging from subtropical to boreal regions in the western Pacific within ~2% uncertainties. The data are further utilized to test multi-year simulations by a regional chemistry transport model (CMAQ). With these efforts, we reproduce "bottom-up" climatology of surface ozone in East Asia during the past 7 years (1998-2004). The data, widely combined in the range of 25-45 deg N in East Asia, show significant latitudinal gradient in surface ozone distributions and seasonal cycles. Interestingly, there are sizable interannual variations (and latitudinal dependences) associated with El Nino/La Nina events, suggesting that changes in regional meteorology (e.g., transport paths, patterns, and efficiency) and/or enhanced precursor emissions from biomass burning may contribute to the anomalies. Trends for 7 years are not visible at boundary layer sites, but are substantial at mountainous sites during continental outflow seasons, possibly due to increasing NOx emissions from

  18. Synergy of Satellite-Surface Observations for Studying the Properties of Absorbing Aerosols in Asia

    NASA Technical Reports Server (NTRS)

    Tsay, Si-Chee

    2010-01-01

    , in major international research projects such as the Joint Aerosol Monsoon Experiment (JAM EX), a core element of the Asian Monsoon Years (AMY, 2008-2012). SMART-COMMIT deployments during 2008 AMY/JAMEX were conducted in northwestern China to characterize the properties of dust-laden aerosols and in the vicinity of Beijing for mega-city aerosols. In 2009, SMART-COMMIT also participated in the JAMEX/RAJO-MEGHA (Radiation, Aerosol Joint Observations-Monsoon Experiment in the Gangetic-Himalayan Area; Sanskrit for Dust-Cloud) to study the aerosol properties, solar absorption and the associated atmospheric warming, and the climatic impact of elevated aerosols during the pre-monsoon season in South Asia. We will show results from these field experiments, as well as discuss a new initiative of 7-SEAS (7 South East Asian Studies) to study the interaction of anthropogenic aerosols with regional meteorology, particularly with clouds.

  19. Synergy of Satellite-Surface Observations for Studying the Properties of Absorbing Aerosols in Asia

    NASA Technical Reports Server (NTRS)

    Tsay, Si-Chee

    2010-01-01

    , in major international research projects such as the Joint Aerosol Monsoon Experiment (JAM EX), a core element of the Asian Monsoon Years (AMY, 2008-2012). SMART-COMMIT deployments during 2008 AMY/JAMEX were conducted in northwestern China to characterize the properties of dust-laden aerosols and in the vicinity of Beijing for mega-city aerosols. In 2009, SMART-COMMIT also participated in the JAMEX/RAJO-MEGHA (Radiation, Aerosol Joint Observations-Monsoon Experiment in the Gangetic-Himalayan Area; Sanskrit for Dust-Cloud) to study the aerosol properties, solar absorption and the associated atmospheric warming, and the climatic impact of elevated aerosols during the pre-monsoon season in South Asia. We will show results from these field experiments, as well as discuss a new initiative of 7-SEAS (7 South East Asian Studies) to study the interaction of anthropogenic aerosols with regional meteorology, particularly with clouds.

  20. Observations of the Magnitude Dependence of Pn/Lg Ratios from Underground Explosions in Central Asia

    NASA Astrophysics Data System (ADS)

    Xie, J.; Patton, H. J.; Kim, W.

    2001-12-01

    Xie and Patton (1999, JGR) developed scaling relationships for seismic moment M0 and corner frequency fc determined from Pn and Lg spectra for many explosions and earthquakes located in central Asia. Scaling relationships were found to depend on the phase and the source type. Pn/Lg ratios ratios are predicted to increase significantly in a frequency range determined by Lg fc (lower limit) and Pn fc (upper limit). The increase slows down or stops outside this frequency range, and the range shifts to higher frequency with decreasing event magnitude. As a result, ratios from smaller events reach maxima at higher frequencies than do larger events. This predicted magnitude-dependent frequency shift of Pn/Lg ratios has been marked by controversy over whether direct observations support it or not. Here we summarize results from direct observations of Pn/Lg spectral ratios for Semipalatinsk and Lop Nor explosions. These observations include (1) ratios from Lop Nor explosions between 1992-1996 recorded on multiple broad-band stations, (2) ratios from Semipalatinsk explosions between 1987-1989 recorded on the Chinese station WMQ, (3) ratios from chemical explosions at Semipalatinsk between 1997-1999 recorded on broad-band Kazakhstan network stations, and (4) ratios from Semipalatinsk explosions between 1987-1989 from the Borovoye Digital Seismogram Archive (Kim et al., 2001). Pn/Lg ratios are stacked in three event populations with mb values of ~ 6.0, 5.0 and 4.0, respectively. Additionally, Pn/Lg ratios are available from multiple stations from a mb=6.6 explosion. The stacked ratios are compared with one another for near-repeated paths or for paths for which corrections are known based on path Q-inversions. All of the stacked Pn/Lg ratios show magnitude-dependence and statistically support the predicted magnitude-dependent frequency shift. The observations also indicate more complexity in Pn/Lg ratios from the mb ~ 4 population, which is largely made up of recent chemical

  1. The perfect storm: incarceration and the high-risk environment perpetuating transmission of HIV, hepatitis C virus, and tuberculosis in Eastern Europe and Central Asia

    PubMed Central

    Altice, Frederick L; Azbel, Lyuba; Stone, Jack; Brooks-Pollock, Ellen; Smyrnov, Pavlo; Dvoriak, Sergii; Taxman, Faye S; El-Bassel, Nabila; Martin, Natasha K; Booth, Robert; Stöver, Heino; Dolan, Kate; Vickerman, Peter

    2016-01-01

    Despite global reductions in HIV incidence and mortality, the 15 UNAIDS-designated countries of Eastern Europe and Central Asia (EECA) that gained independence from the Soviet Union in 1991 constitute the only region where both continue to rise. HIV transmission in EECA is fuelled primarily by injection of opioids, with harsh criminalisation of drug use that has resulted in extraordinarily high levels of incarceration. Consequently, people who inject drugs, including those with HIV, hepatitis C virus, and tuberculosis, are concentrated within prisons. Evidence-based primary and secondary prevention of HIV using opioid agonist therapies such as methadone and buprenorphine is available in prisons in only a handful of EECA countries (methadone or buprenorphine in five countries and needle and syringe programmes in three countries), with none of them meeting recommended coverage levels. Similarly, antiretroviral therapy coverage, especially among people who inject drugs, is markedly under-scaled. Russia completely bans opioid agonist therapies and does not support needle and syringe programmes—with neither available in prisons—despite the country’s high incarceration rate and having the largest burden of people with HIV who inject drugs in the region. Mathematical modelling for Ukraine suggests that high levels of incarceration in EECA countries facilitate HIV transmission among people who inject drugs, with 28–55% of all new HIV infections over the next 15 years predicted to be attributable to heightened HIV transmission risk among currently or previously incarcerated people who inject drugs. Scaling up of opioid agonist therapies within prisons and maintaining treatment after release would yield the greatest HIV transmission reduction in people who inject drugs. Additional analyses also suggest that at least 6% of all incident tuberculosis cases, and 75% of incident tuberculosis cases in people who inject drugs are due to incarceration. Interventions that

  2. 3D aerosol climatology over East Asia derived from CALIOP observations

    NASA Astrophysics Data System (ADS)

    Zhou, Yongbo; Sun, Xuejin; Zhang, Chuanliang; Zhang, Riwei; Li, Yan; Li, Haoran

    2017-03-01

    The seasonal mean extinction coefficient profile (ECP), single scattering albedo (SSA), and scattering phase function (SPF) derived from the CALIOP (Cloud-Aerosol Lidar with Orthogonal Polarization) version 3 Level 2 5-km aerosol profile product (2011-2014) were compiled into a three-dimensional (3D) aerosol climatology for East Asia. The SSA and SPF were calculated as the weighted averages of the scattering properties of the CALIOP aerosol subtypes. The weights were set to the occurrence frequencies of the subtypes. The single scattering properties of each subtype were extrapolated from the volume-based size distribution and complex refractive indexes based on Mie calculations. For the high-loading episodes (aerosol optical depth ≥ 0.6), the exponential ECP structures were most frequently observed over the farmland and desert areas, along with the uplifted ECP structures over the marine and coastal areas. Besides the desert areas, high-loading episodes also occurred over areas with frequent agricultural and industry activities. Unlike the conventional half-3D aerosol climatology (vertically constant SSA and SPF), this newly generated climatology specified SSA and SPF in the full-3D space (full-3D aerosol climatology). Errors on the shortwave radiative heating rate (SW RHR) due to the half-3D aerosol climatology approximation were quantified. The SW RHR errors were around ±1 K/day, implying that the half-3D aerosol climatology should be used with caution in climate modeling. This study is among the first to generate a full-3D aerosol climatology from the CALIOP data. This full-3D aerosol climatology is potentially useful for aerosol remote sensing and climate modeling.

  3. Antiretroviral Treatment Interruption and Loss to Follow-Up in Two HIV Cohorts in Australia and Asia: Implications for ‘Test and Treat’ Prevention Strategy

    PubMed Central

    Wand, Handan; McManus, Hamish; Vonthanak, Saphonn; Woolley, Ian; Honda, Miwako; Read, Tim; Sirisanthana, Thira; Zhou, Julian; Carr, on behalf of Australia HIV Observational Database (AHOD) and Treat Asia HIV Observation Database (TAHOD), Andrew

    2013-01-01

    Abstract Both antiretroviral treatment interruption (TI) and cessation have been strongly discouraged since 2006. We describe the incidence, duration, and risk factors for TI and loss-to-follow-up (LTFU) rates across 13 countries. All 4689 adults (76% men) in two large HIV cohorts in Australia and Asia commencing combination antiretroviral therapy (ART) to March 2010 were included. TI was defined by ART cessation >30 days, then recommencement, and loss to follow-up (LTFU) by no visit since 31 March 2009 and no record of death. Survival analysis and Poisson regression methods were used. With median follow-up of 4.4 years [interquartile range (IQR):2.1–6.5], TI incidence was 6.7 per 100 person years (PY) (95% CI:6.1–7.3) pre-2006, falling to 2.0 (95% CI:1.7–2.2) from 2006 (p<0.01). LTFU incidence was 3.5 per 100 PY (95% CI:3.1–3.9) pre-2006, and 4.1 (95% CI:3.5–4.9) from 2006 (p=0.22). TIs accounted for 6.4% of potential time on ART pre-2006 and 1.2% from 2006 (p<0.01), and LTFU 4.7% of potential time on ART pre-2006 and 6.6% from 2006 (p<0.01). Median TI duration was 163 (IQR: 75–391) days pre-2006 and 118 (IQR: 67–270) days from 2006 (p<0.01). Independent risk factors for the first TI were: Australia HIV Observational Database participation; ART initiation pre-2006; ART regimens including stavudine and didanosine; three nucleoside analogue reverse transcriptase inhibitors; ≥7 pills per day; and ART with food restrictions (fasting or with food). In conclusion, since 2006, 7.8% of patients had significant time off treatment, which has the potential to compromise any ‘test and treat’ policy as during the interruption viral load will rebound and increase the risk of transmission. PMID:24320013

  4. Spending of HIV resources in Asia and Eastern Europe: systematic review reveals the need to shift funding allocations towards priority populations

    PubMed Central

    Craig, Andrew P; Thein, Hla-Hla; Zhang, Lei; Gray, Richard T; Henderson, Klara; Wilson, David; Gorgens, Marelize; Wilson, David P

    2014-01-01

    Introduction It is increasingly important to prioritize the most cost-effective HIV interventions. We sought to summarize the evidence on which types of interventions provide the best value for money in regions with concentrated HIV epidemics. Methods We conducted a systematic review of peer-reviewed and grey literature reporting measurements of cost-effectiveness or cost-benefit for HIV/AIDS interventions in Asia and Eastern Europe. We also collated HIV/AIDS spending assessment data from case-study countries in the region. Results We identified 91 studies for inclusion, 47 of which were from peer-reviewed journals. Generally, in concentrated settings, prevention of mother-to-child transmission programmes and prevention programmes targeting people who inject drugs and sex workers had lower incremental cost-effectiveness ratios than programmes aimed at the general population. The few studies evaluating programmes targeting men who have sex with men indicate moderate cost-effectiveness. Collation of prevention programme spending data from 12 countries in the region (none of which had generalized epidemics) indicated that resources for the general population/non-targeted was greater than 30% for eight countries and greater than 50% for five countries. Conclusions There is a misalignment between national spending on HIV/AIDS responses and the most affected populations across the region. In concentrated epidemics, scarce funding should be directed more towards most-at-risk populations. Reaching consensus on general principles of cost-effectiveness of programmes by epidemic settings is difficult due to inconsistent evaluation approaches. Adopting a standard costing, impact evaluation, benefits calculation, analysis and reporting framework would enable cross comparisons and improve HIV resource prioritization and allocation. PMID:24572053

  5. Observations of Aerosol Optical Properties over 15 AERONET Sites in Southeast Asia

    NASA Astrophysics Data System (ADS)

    Chan, J. D.; Lagrosas, N.; Uy, S. N.; Holben, B. N.; Dorado, S.; Tobias, V., Jr.; Anh, N. X.; Po-Hsiung, L.; Janjai, S.; Salinas Cortijo, S. V.; Liew, S. C.; Lim, H. S.; Lestari, P.

    2014-12-01

    Mean column-integrated optical properties from ground sun photometers of the Aerosol Robotic Network (AERONET) are studied to provide an overview of the characteristics of aerosols over the region as part of the 7 Southeast Asian Studies (7-SEAS) mission. The 15 AERONET sites with the most available level 2 data products are selected from Thailand (Chiang Mai, Mukdahan, Songkhla and Silpakorn University), Malaysia (University Sains Malaysia), Laos (Vientiane), Vietnam (Bac Giang, Bac Lieu and Nha Trang), Taiwan (National Cheng Kung University and Central Weather Bureau Taipei), Singapore, Indonesia (Bandung) and the Philippines (Manila Observatory and Notre Dame of Marbel University). For all 15 sites, high angstrom exponent values (α>1) have been observed. Chiang Mai and USM have the highest mean Angstrom exponent indicating the dominance of fine particles that can be ascribed to biomass burning and urbanization. Sites with the lowest Angstrom exponent values include Bac Lieu (α=1.047) and Manila Observatory (α=1.021). From the average lognormal size distribution curves, Songkhla and NDMU show the smallest annual variation in the fine mode region, indicating the observed fine aerosols are local to the sites. The rest of the sites show high variation which could be due to large scale forcings (e.g., monsoons and biomass burnings) that affect aerosol properties in these sites. Both high and low single scattering albedo at 440 nm (ω0440) values are found in sites located in major urban areas. Silpakorn University, Manila Observatory and Vientiane have all mean ω0440 < 0.90. Singapore and CWB Taipei have ω0440 > 0.94. The discrepancy in ω0 suggests different types of major emission sources present in urban areas. The absorptivity of urban aerosols can vary depending on the strength of traffic emissions, types of fuel combusted and automobile engines used, and the effect of biomass burning aerosols during the dry season. High aerosol optical depth values (τa550

  6. Carbon Flux Estimation in Southeast Asia using a Eulerian-Lagrangian Coupled Inversion System and Observational Data from Multiple Platforms

    NASA Astrophysics Data System (ADS)

    Ishizawa, M.; Shirai, T.; Terao, Y.; Mukai, H.; Nomura, S.; Mohamad, M.; Jahaya, M. F.; Inoue, M.; Morino, I.; Yoshida, Y.; Uchino, O.; Zhuravlev, R.; Ganshin, A.; Maksyutov, S. S.

    2015-12-01

    Southeast Asia is rich in tropical forest and biodiversity. Previous inversion studies show large inter-annual variability in the biosphere-atmosphere carbon exchange attributable to climate anomalies. However, the magnitudes of estimated fluxes are significantly different among the inversions. On the other hand, land-use change has been accelerating the anthropogenic emissions. For the sustainable development in Southeast Asia under the on-going climate change, it is important to understand the biosphere-atmosphere carbon exchange and access the regional emissions. One of the reasons for the large uncertainty in flux estimate is a limited coverage of atmospheric observation against the large variety of ecosystems and the geographical complexity. Recently, the number of measurements has been increasing, including ground-based and satellite-based measurements. We estimated the regional CO2fluxes using a Eulerian-Lagrangian inverse modeling system and examined the characteristics of observational constraints and their impacts on the flux estimate in Southeast Asia. The results show that the temporal variations and source/sink strength of estimated regional fluxes are sensitive to the observational constraints. As a control run, we used the Observational Package (ObsPack) data product since 2001 as a global dataset of atmospheric CO2 measurement. In the addition to Bukit, Sumatra Island (BKT) in ObsPack, we included a stationary CO2 data at Danum Valley in Borneo Island (DMV) since late 2009. Compared to BKT, DMV shows a clear seasonal cycle. The inversion including DMV tends to increase the regional carbon sink in the second half of year. Remotely the aircraft measurements over Rarotonga (RTA) in the tropical Pacific Ocean see the signals from Southeast Asia through an atmospheric convection. The sensitivity test shows RTA impacts on the inter-annual variations of estimated flux, which might be associated with ENSO events. Since June 2009, Greenhouse gases Observing

  7. Impact of biomass burning on ocean water quality in Southeast Asia through atmospheric deposition: field observations

    NASA Astrophysics Data System (ADS)

    Sundarambal, P.; Balasubramanian, R.; Tkalich, P.; He, J.

    2010-12-01

    Atmospheric nutrients have recently gained considerable attention as a significant additional source of new nitrogen (N) and phosphorus (P) loading to the ocean. The effect of atmospheric macro nutrients on marine productivity depends on the biological availability of both inorganic and organic N and P forms. During October 2006, the regional smoke haze episodes in Southeast Asia (SEA) that resulted from uncontrolled forest and peat fires in Sumatra and Borneo blanketed large parts of the region. In this work, we determined the chemical composition of nutrients in aerosols and rainwater during hazy and non-hazy days to assess their impacts on aquatic ecosystem in SEA for the first time. We compared atmospheric dry and wet deposition of N and P species in aerosol and rainwater in Singapore between hazy and non-hazy days. Air mass back trajectories showed that large-scale forest and peat fires in Sumatra and Kalimantan were a significant source of atmospheric nutrients to aquatic environments in Singapore and SEA region on hazy days. It was observed that the average concentrations of nutrients increased approximately by a factor of 3 to 8 on hazy days when compared with non-hazy days. The estimated mean dry and wet atmospheric fluxes (mg/m2/day) of total nitrogen (TN) were 12.72 ± 2.12 and 2.49 ± 1.29 during non-hazy days and 132.86 ± 38.39 and 29.43 ± 10.75 during hazy days; the uncertainty estimates are represented as 1 standard deviation (1σ) here and throughout the text. The estimated mean dry and wet deposition fluxes (mg/m2/day) of total phosphorous (TP) were 0.82 ± 0.23 and 0.13 ± 0.03 for non-hazy days and 7.89 ± 0.80 and 1.56 ± 0.65 for hazy days. The occurrences of higher concentrations of nutrients from atmospheric deposition during smoke haze episodes may have adverse consequences on receiving aquatic ecosystems with cascading impacts on water quality.

  8. Adolescents with HIV and transition to adult care in the Caribbean, Central America and South America, Eastern Europe and Asia and Pacific regions.

    PubMed

    Bailey, Heather; Cruz, Maria Letícia Santos; Songtaweesin, Wipaporn Natalie; Puthanakit, Thanyawee

    2017-05-16

    The HIV epidemics in the Caribbean, Central America and South America (CCASA), Eastern Europe (EE) and Asia and Pacific (AP) regions are diverse epidemics affecting different key populations in predominantly middle-income countries. This narrative review describes the populations of HIV-positive youth approaching adolescence and adulthood in CCASA, EE and AP, what is known of their outcomes in paediatric and adult care to date, ongoing research efforts and future research priorities. We searched PubMed and abstracts from recent conferences and workshops using keywords including HIV, transition and adolescents, to identify published data on transition outcomes in CCASA, EE and AP. We also searched within our regional clinical/research networks for work conducted in this area and presented at local or national meetings. To give insight into future research priorities, we describe published data on characteristics and health status of young people as they approach age of transition, as a key determinant of health in early adulthood, and information available on current transition processes. The perinatally HIV-infected populations in these three regions face a range of challenges including parental death and loss of family support; HIV-related stigma and socio-economic disparities; exposure to maternal injecting drug use; and late disclosure of HIV status. Behaviourally HIV-infected youth often belong to marginalized sub-groups, with particular challenges accessing services and care. Differences between and within countries in characteristics of HIV-positive youth and models of care need to be considered in comparisons of outcomes in young adulthood. The very little data published to date on transition outcomes across these three regions highlight some emerging issues around adherence, virological failure and loss to follow-up, alongside examples of programmes which have successfully supported adolescents to remain engaged with services and virologically suppressed

  9. Spatial and Temporal Analysis of Winter Fog Episodes over South Asia by exploiting ground-based and satellite observations

    NASA Astrophysics Data System (ADS)

    Fahim Khokhar, Muhammad; Yasmin, Naila; Zaib, Naila; Murtaza, Rabia; Noreen, Asma; Ishtiaq, Hira; Khayyam, Junaid; Panday, Arnico

    2016-04-01

    The South Asian region in general and the Indo-Gangetic Plains (IGP) in particular hold about 1/6th of the world's population and is considered as one of the major hotspots with increasing air pollution. Due to growing population and globalization, South Asia is experiencing high transformations in the urban and industrial sectors. Fog is one of the meteorological/environmental phenomena which can generate significant social and economic problems especially havoc to air and road traffic. Meteorological stations provide information about the fog episodes only on the basis of point observation. Continuous monitoring as well as a spatially coherent picture of fog distribution can only be possible through the use of satellite imagery. Current study focus on winter fog episodes over South Asian region using Moderate Resolution Image Spectrometer (MODIS) Level 2 Terra Product and other MODIS Aerosol Product in addition to ground-based sampling and AERONET measurements. MODIS Corrected Reflectance RGBs are used to analyse the spatial extent of fog over study area. MOD04 level 2 Collection 6 data is used to study aerosol load and distribution which are further characterised by using aerosol type land product of MODIS. In order to study the variation of ground based observations from satellite data MODIS, AERONET and high volume air Sampler were used. Main objective of this study was to explore the spatial extent of fog, its causes and to analyse the Aerosol Optical Depth (AOD) over South Asia with particular focus over Indo-Gangetic Plains (IGP). Current studies show a descent increase in AOD from past few decades over South Asia and is contributing to poor air quality in the region due to growing population, urbanization, and industrialization. Smoke and absorbing aerosol are major constituent of fog over South Asia. Furthermore, winter 2014-15 extended span of Fog was also observed over South Asia. A significant correlation between MODIS (AOD) and AERONET Station (AOD

  10. Combined observational and modeling efforts of aerosol-cloud-precipitation interactions over Southeast Asia

    NASA Astrophysics Data System (ADS)

    Loftus, Adrian; Tsay, Si-Chee; Nguyen, Xuan Anh

    2016-04-01

    Low-level stratocumulus (Sc) clouds cover more of the Earth's surface than any other cloud type rendering them critical for Earth's energy balance, primarily via reflection of solar radiation, as well as their role in the global hydrological cycle. Stratocumuli are particularly sensitive to changes in aerosol loading on both microphysical and macrophysical scales, yet the complex feedbacks involved in aerosol-cloud-precipitation interactions remain poorly understood. Moreover, research on these clouds has largely been confined to marine environments, with far fewer studies over land where major sources of anthropogenic aerosols exist. The aerosol burden over Southeast Asia (SEA) in boreal spring, attributed to biomass burning (BB), exhibits highly consistent spatiotemporal distribution patterns, with major variability due to changes in aerosol loading mediated by processes ranging from large-scale climate factors to diurnal meteorological events. Downwind from source regions, the transported BB aerosols often overlap with low-level Sc cloud decks associated with the development of the region's pre-monsoon system, providing a unique, natural laboratory for further exploring their complex micro- and macro-scale relationships. Compared to other locations worldwide, studies of springtime biomass-burning aerosols and the predominately Sc cloud systems over SEA and their ensuing interactions are underrepresented in scientific literature. Measurements of aerosol and cloud properties, whether ground-based or from satellites, generally lack information on microphysical processes; thus cloud-resolving models are often employed to simulate the underlying physical processes in aerosol-cloud-precipitation interactions. The Goddard Cumulus Ensemble (GCE) cloud model has recently been enhanced with a triple-moment (3M) bulk microphysics scheme as well as the Regional Atmospheric Modeling System (RAMS) version 6 aerosol module. Because the aerosol burden not only affects cloud

  11. Early infant HIV diagnosis and entry to HIV care cascade in Thailand: an observational study.

    PubMed

    Sirirungsi, Wasna; Khamduang, Woottichai; Collins, Intira Jeannie; Pusamang, Artit; Leechanachai, Pranee; Chaivooth, Suchada; Ngo-Giang-Huong, Nicole; Samleerat, Tanawan

    2016-06-01

    Early infant diagnosis of HIV is crucial for timely initiation of antiretroviral therapy (ART) in infected children who are at high risk of mortality. Early infant diagnosis with dried blood spot testing was provided by the National AIDS Programme in Thailand from 2007. We report ART initiation and vital status in children with HIV after 7 years of rollout in Thailand. Dried blood spot samples were collected from HIV-exposed children in hospitals in Thailand and mailed to the Faculty of Associated Medical Sciences, Chiang Mai University, where HIV DNA was assessed with real-time PCR to establish HIV infection. We linked data from children with an HIV infection to the National AIDS Programme database to ascertain ART and vital status. Between April 5, 2007, and Oct 1, 2014, 16 046 dried blood spot samples were sent from 8859 children in 364 hospitals in Thailand. Median age at first dried blood spot test was 2·1 (IQR 1·8-2·5) months. Of 7174 (81%) children with two or more samples, 223 (3%) were HIV positive (including five unconfirmed). Of 1685 (19%) children with one sample, 70 (4%) were unconfirmed positive. Of 293 (3%) children who were HIV positive, 220 (75%) registered for HIV care and 170 (58%) initiated ART. Median age at ART initiation decreased from 14·2 months (IQR 10·2-25·6) in 2007 to 6·1 months (4·2-9·2) in 2013, and the number of children initiating ART aged younger than 1 year increased from five (33%) of 15 children initiating ART in 2007 to ten (83%) of 12 initiating ART in 2013. 15 (9%) of 170 children who initiated ART died and 16 (32%) of 50 who had no ART record died. Early infant diagnosis with dried blood spot testing had high uptake in primary care settings. Further improvement of linkage to HIV care is needed to ensure timely treatment of all children with an HIV infection. None. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. East Asia: Southeast Asia

    DTIC Science & Technology

    1990-08-03

    JPRS-SEA-90-023 3 AUGUST 1990 !■■■■■ !■■■■■ FOREIGN BROADCAST INFORMATION SERVICE JPRS 91$ East Asia Southeast Asia 19990510 139...DTIC QUALITY INSPECTED 4 East Asia Southeast Asia JPRS-SEA-90-023 CONTENTS 3 A UGUST1990 INDONESIA East Timor Governor Describes Province’s...Sam Neua District. This did not include the small shops in front of houses. In one month they were able to collect 500,000 kip in taxes . The tax

  13. Correlation slopes of GEM / CO, GEM / CO2, and GEM / CH4 and estimated mercury emissions in China, South Asia, the Indochinese Peninsula, and Central Asia derived from observations in northwestern and southwestern China

    NASA Astrophysics Data System (ADS)

    Fu, X. W.; Zhang, H.; Lin, C.-J.; Feng, X. B.; Zhou, L. X.; Fang, S. X.

    2015-01-01

    Correlation analyses between atmospheric mercury (Hg) and other trace gases are useful for identification of sources and constraining regional Hg emissions. Emissions of Hg in Asia contribute significantly to the global budget of atmospheric Hg. However, due to the lack of reliable data on the source strength, large uncertainties remain in the emission inventories of Hg in Asia. In the present study, we calculated the correlation slopes of GEM / CO, GEM / CO2, and GEM / CH4 for mainland China, South Asia, the Indochinese Peninsula, and Central Asia using the ground-based observations at three remote sites in northwestern and southwestern China, and applied these values to estimate GEM emissions in the four source regions. The geometric mean GEM / CO correlation slopes for mainland China, South Asia, the Indochinese Peninsula, and Central Asia were 7.3 ± 4.3, 7.8 ± 6.4, 7.8 ± 5.0, and 13.4 ± 9.5 pg m-3 ppb-1, respectively, and values in the same source regions were 33.3 ± 30.4, 27.4 ± 31.0, 23.5 ± 15.3, and 20.5 ± 10.0 pg m-3 ppb-1 for the GEM / CH4 correlation slopes, respectively. The geometric means of GEM / CO2 correlation slopes for mainland China, South Asia, and Central Asia were 240 ± 119, 278 ± 164, 315 ± 289 pg m-3 ppm-1, respectively. These values were the first reported correlation slopes of GEM / CO, GEM / CO2, and GEM / CH4 in four important source regions of Asia, not including the GEM / CO ratios in mainland China. The correlation slopes of GEM / CO, GEM / CO2, and GEM / CH4 in Asia were relatively higher than those observed in Europe, North America, and South Africa, which may highlight GEM emissions from non-ferrous smelting, large-scale and artisanal mercury and gold production, natural sources, and historically deposited mercury (re-emission) in Asia. Using the observed GEM / CO and GEM / CO2 slopes, and the recently reported emission inventories of CO and CO2, the annual GEM emissions in mainland China, South Asia, the Indochinese

  14. Evaluation of VIIRS, GOCI, and MODIS Collection 6 AOD retrievals against ground sunphotometer observations over East Asia

    NASA Astrophysics Data System (ADS)

    Xiao, Q.; Zhang, H.; Choi, M.; Li, S.; Kondragunta, S.; Kim, J.; Holben, B.; Levy, R. C.; Liu, Y.

    2016-02-01

    Persistent high aerosol loadings together with extremely high population densities have raised serious air quality and public health concerns in many urban centers in East Asia. However, ground-based air quality monitoring is relatively limited in this area. Recently, satellite-retrieved Aerosol Optical Depth (AOD) at high resolution has become a powerful tool to characterize aerosol patterns in space and time. Using ground AOD observations from the Aerosol Robotic Network (AERONET) and the Distributed Regional Aerosol Gridded Observation Networks (DRAGON)-Asia Campaign, as well as from handheld sunphotometers, we evaluated emerging aerosol products from the Visible Infrared Imaging Radiometer Suite (VIIRS) aboard the Suomi National Polar-orbiting Partnership (S-NPP), the Geostationary Ocean Color Imager (GOCI) aboard the Communication, Ocean, and Meteorology Satellite (COMS), and Terra and Aqua Moderate Resolution Imaging Spectroradiometer (MODIS) (Collection 6) in East Asia in 2012 and 2013. In the case study in Beijing, when compared with AOD observations from handheld sunphotometers, 51 % of VIIRS Environmental Data Record (EDR) AOD, 37 % of GOCI AOD, 33 % of VIIRS Intermediate Product (IP) AOD, 26 % of Terra MODIS C6 3 km AOD, and 16 % of Aqua MODIS C6 3 km AOD fell within the reference expected error (EE) envelope (±0.05 ± 0.15 AOD). Comparing against AERONET AOD over the Japan-South Korea region, 64 % of EDR, 37 % of IP, 61 % of GOCI, 39 % of Terra MODIS, and 56 % of Aqua MODIS C6 3 km AOD fell within the EE. In general, satellite aerosol products performed better in tracking the day-to-day variability than tracking the spatial variability at high resolutions. The VIIRS EDR and GOCI products provided the most accurate AOD retrievals, while VIIRS IP and MODIS C6 3 km products had positive biases.

  15. Evaluation of VIIRS, GOCI, and MODIS Collection 6 AOD Retrievals Against Ground Sunphotometer Observations Over East Asia

    NASA Technical Reports Server (NTRS)

    Xiao, Q.; Zhang, H.; Choi, M.; Li, S.; Kondragunta, S.; Kim, J.; Holben, B.; Levy, R. C.; Liu, Y.

    2016-01-01

    Persistent high aerosol loadings together with extremely high population densities have raised serious air quality and public health concerns in many urban centers in East Asia. However, ground-based air quality monitoring is relatively limited in this area. Recently, satellite-retrieved Aerosol Optical Depth (AOD) at high resolution has become a powerful tool to characterize aerosol patterns in space and time. Using ground AOD observations from the Aerosol Robotic Network (AERONET) and the Distributed Regional Aerosol Gridded Observation Networks (DRAGON)-Asia Campaign, as well as from handheld sunphotometers, we evaluated emerging aerosol products from the Visible Infrared Imaging Radiometer Suite (VIIRS) aboard the Suomi National Polar-orbiting Partnership (S-NPP), the Geostationary Ocean Color Imager (GOCI) aboard the Communication, Ocean, and Meteorology Satellite (COMS), and Terra and Aqua Moderate Resolution Imaging Spectroradiometer (MODIS) (Collection 6) in East Asia in 2012 and 2013. In the case study in Beijing, when compared with AOD observations from handheld sunphotometers, 51% of VIIRS Environmental Data Record (EDR) AOD, 37% of GOCI AOD, 33% of VIIRS Intermediate Product (IP) AOD, 26% of Terra MODIS C6 3km AOD, and 16% of Aqua MODIS C6 3km AOD fell within the reference expected error (EE) envelope (+/-0.05/+/- 0.15 AOD). Comparing against AERONET AOD over the JapanSouth Korea region, 64% of EDR, 37% of IP, 61% of GOCI, 39% of Terra MODIS, and 56% of Aqua MODIS C6 3km AOD fell within the EE. In general, satellite aerosol products performed better in tracking the day-to-day variability than tracking the spatial variability at high resolutions. The VIIRS EDR and GOCI products provided the most accurate AOD retrievals, while VIIRS IP and MODIS C6 3km products had positive biases.

  16. A survey of paediatric HIV programmatic and clinical management practices in Asia and sub-Saharan Africa—the International epidemiologic Databases to Evaluate AIDS (IeDEA)

    PubMed Central

    2013-01-01

    Introduction There are limited data on paediatric HIV care and treatment programmes in low-resource settings. Methods A standardized survey was completed by International epidemiologic Databases to Evaluate AIDS paediatric cohort sites in the regions of Asia-Pacific (AP), Central Africa (CA), East Africa (EA), Southern Africa (SA) and West Africa (WA) to understand operational resource availability and paediatric management practices. Data were collected through January 2010 using a secure, web-based software program (REDCap). Results A total of 64,552 children were under care at 63 clinics (AP, N=10; CA, N=4; EA, N=29; SA, N=10; WA, N=10). Most were in urban settings (N=41, 65%) and received funding from governments (N=51, 81%), PEPFAR (N=34, 54%), and/or the Global Fund (N=15, 24%). The majority were combined adult–paediatric clinics (N=36, 57%). Prevention of mother-to-child transmission was integrated at 35 (56%) sites; 89% (N=56) had access to DNA PCR for infant diagnosis. African (N=40/53) but not Asian sites recommended exclusive breastfeeding up until 4–6 months. Regular laboratory monitoring included CD4 (N=60, 95%), and viral load (N=24, 38%). Although 42 (67%) sites had the ability to conduct acid-fast bacilli (AFB) smears, 23 (37%) sites could conduct AFB cultures and 18 (29%) sites could conduct tuberculosis drug susceptibility testing. Loss to follow-up was defined as >3 months of lost contact for 25 (40%) sites, >6 months for 27 sites (43%) and >12 months for 6 sites (10%). Telephone calls (N=52, 83%) and outreach worker home visits to trace children lost to follow-up (N=45, 71%) were common. Conclusions In general, there was a high level of patient and laboratory monitoring within this multiregional paediatric cohort consortium that will facilitate detailed observational research studies. Practices will continue to be monitored as the WHO/UNAIDS Treatment 2.0 framework is implemented. PMID:23336728

  17. Effects of experimental protocol on global vegetation model accuracy: a comparison of simulated and observed vegetation patterns for Asia

    USGS Publications Warehouse

    Tang, Guoping; Shafer, Sarah L.; Barlein, Patrick J.; Holman, Justin O.

    2009-01-01

    Prognostic vegetation models have been widely used to study the interactions between environmental change and biological systems. This study examines the sensitivity of vegetation model simulations to: (i) the selection of input climatologies representing different time periods and their associated atmospheric CO2 concentrations, (ii) the choice of observed vegetation data for evaluating the model results, and (iii) the methods used to compare simulated and observed vegetation. We use vegetation simulated for Asia by the equilibrium vegetation model BIOME4 as a typical example of vegetation model output. BIOME4 was run using 19 different climatologies and their associated atmospheric CO2 concentrations. The Kappa statistic, Fuzzy Kappa statistic and a newly developed map-comparison method, the Nomad index, were used to quantify the agreement between the biomes simulated under each scenario and the observed vegetation from three different global land- and tree-cover data sets: the global Potential Natural Vegetation data set (PNV), the Global Land Cover Characteristics data set (GLCC), and the Global Land Cover Facility data set (GLCF). The results indicate that the 30-year mean climatology (and its associated atmospheric CO2 concentration) for the time period immediately preceding the collection date of the observed vegetation data produce the most accurate vegetation simulations when compared with all three observed vegetation data sets. The study also indicates that the BIOME4-simulated vegetation for Asia more closely matches the PNV data than the other two observed vegetation data sets. Given the same observed data, the accuracy assessments of the BIOME4 simulations made using the Kappa, Fuzzy Kappa and Nomad index map-comparison methods agree well when the compared vegetation types consist of a large number of spatially continuous grid cells. The results of this analysis can assist model users in designing experimental protocols for simulating vegetation.

  18. Neutralization of soil aerosol and its impact on the distribution of acid rain over east Asia: Observations and model results

    NASA Astrophysics Data System (ADS)

    Wang, Zifa; Akimoto, Hajime; Uno, Itsushi

    2002-10-01

    A comprehensive Air Quality Prediction Modeling System is applied to simulate the pH values in precipitation and to investigate neutralization by soil aerosols and their influence on the distribution of acid rain over east Asia. A modified deflation module is designed to provide explicit information on the soil aerosol loading. Numerical simulation was performed for 1 year, from 15 December 1998 to 31 December 1999. Wet deposition monitoring data at 17 sites of the Acid Deposition Monitoring Network in east Asia in addition to State Environmental Protection Agency data were used to evaluate the model, and a reasonable agreement was obtained. Observed evidence clearly shows that in northern China acid deposition is heavily influenced and buffered by natural soil dust from desert and semiarid areas. The observed mean rainwater pH value in northern China is the highest, between 6.0 and 7.2, while in southern China, where many areas severely impacted by acid precipitation are located, the pH value is much lower, between 3.5 and 5. In Japan the mean pH value is 4.7, significantly higher than that in southern China, while in South Korea the pH value is intermediate between those in northern China and Japan. The model is capable of reproducing this geographical distribution of rainwater pH over east Asia. The simulation results for 1999 demonstrated strong neutralization of precipitation by soil aerosols over northeast Asia, and the distribution pattern of acid rain was also altered. The annual mean pH values in northern China and Korea show a remarkable increase of 0.8-2.5, while the increase in mean pH values over southern China and Japan are less than 0.1. The neutralization effects vary by season, with the greatest influence in spring, when pH values increased by 0.1-0.4 in Japan, 0.5-1.5 in Korea, and more than 2 in northern China.

  19. Lidar observation of Asian dust events during the ACE-Asia 2001 IOP at Gosan, Jeju Island, Korea

    NASA Astrophysics Data System (ADS)

    Hong, Chun Sang; Lee, Kwon Ho; Kim, Young Joon; Kim, Sang Woo; Won, Jae Gwang; Yoon, Soon Chang; Iwasaka, Yasunobu

    2003-12-01

    In general Asian dust storms occurring during the spring season in the northeast Asia play an important role in radiative forcing and regional climate change. In order to investigate the characteristic of optical properties of Asian dust particles atmospheric aerosol vertical profile was measured with a multi-wavelength LIDAR system developed by ADEMRC, K-JIST and a collocated micro-pulse LIDAR (MPL) during the ACE-Asia intensive observation period, 11 March ~ 4 May 2001 at the Gosan super site (33°17'N, 126°10'E) in Jeju Island, Korea. Air mass backward trajectory analysis shows that air masses came from either the northwestern Chinese desert regions or northeastern Chinese sandy areas. It has been shown that combining the LIDAR data and back trajectory analysis can assess the transport characteristics of atmospheric aerosol during the Asian dust events. The LIDAR-derived aerosol optical depth values were compared with those measured by a collocated AERONET sun photometer. Relationship between the LIDAR data and chemical data of atmospheric particulate matters observed at the surface has been analyzed.

  20. Directly Observed Highly Active Antiretroviral Therapy for HIV-Infected Children in Cambodia

    PubMed Central

    Myung, Patricia; Pugatch, David; Brady, Mark F.; Many, Phok; Harwell, Joseph I.; Lurie, Mark; Tucker, John

    2007-01-01

    Antiretroviral medications are becoming available for HIV-infected children in resource-limited settings. Maryknoll, an international Catholic charity, provided directly observed antiretroviral therapy to HIV-infected children in Phnom Penh, Cambodia. Child care workers administered generic antiretroviral drugs twice daily to children, ensuring adherence. Treatment began with 117 late-stage HIV-infected children; 22 died of AIDS during the first 6 months. The rest were treated for at least 6 months and showed CD4 count increases comparable to those achieved in US and European children. Staffing cost for this program was approximately US $5 per child per month, or 15% more than the price of the medications. Drug toxicities were uncommon and easily managed. Directly observed antiretroviral therapy appears to be a promising, low-cost strategy for ensuring adherent treatment for HIV-infected children in a resource-limited setting. PMID:17463375

  1. How much will it cost? Estimation of resource needs and availability for HIV prevention, treatment and care for people who inject drugs in Asia.

    PubMed

    Bergenstrom, Anne; McLeod, Ross; Sharma, Mukta; Mesquita, Fabio; Dorabjee, Jimmy; Atun, Rifat; Lewis, Gary; Rao, J V R Prasada

    2010-03-01

    As countries in Asia strive to meet their universal access targets, harm-reduction programmes are yet to be scaled up to reach effective levels of coverage. Resource tracking and estimation of resource needs and gaps is critical to inform the financing decisions of major donors of harm-reduction programmes in the region. This study aimed at estimating the financial resource needs and gaps for scaling-up harm reduction in the region, building on previous research conducted by the Independent Commission on AIDS in Asia. The overall resource need for achieving universal access in the target population in 2009 was US $0.5 billion, with NSP and OST accounting for nearly 70% of the overall regional resource need. A significant resource gap, approximately 90%, of the resource need in 2009, was identified for harm reduction in the region, representing less than 2% of the overall global resource need to address AIDS. Additional resources will be required to support the introduction and scaling-up of integrated, comprehensive harm-reduction programmes that provide a full range of services to reduce HIV transmission among people who inject drugs.

  2. STS-57 Earth observation of the Eastern Mediterranean, Nile River, Asia Minor

    NASA Image and Video Library

    1993-07-01

    STS057-73-075 (21 June-1 July 1993) --- Eastern Mediterranean from an unusually high vantage point over the Nile River, this north-looking view shows not only the eastern Mediterranean but also the entire landmass of Asia Minor, with the Black Sea dimly visible at the horizon. Many of the Greek islands can be seen in the Aegean Sea (top left), off the coast of Asia Minor. Cyprus is visible under atmospheric dust in the northeast corner of the Mediterranean. The dust cloud covers the east end of the Mediterranean, its western edge demarcated by a line that cuts the center of the Nile Delta. This dust cloud originated far to the west, in Algeria, and moved northeast over Sicily, southern Italy, and Greece. Part of the cloud then moved on over the Black Sea, but another part swerved southward back towards Egypt. A gyre of clouds in the southeast corner of the Mediterranean indicates a complementary counterclockwise (cyclonic) circulation of air. The Euphrates River appears as a thin green line (upper right) in the yellow Syrian Desert just south of the blue-green mountains of Turkey. The Dead Sea (lower right) lies in a rift valley which extends north into Turkey and south thousands of miles down the Gulf of Aqaba, the Red Sea, and on through East Africa. The straight international boundary between Israel and Egypt (where the coastline angles) is particularly clear in this view, marked by the thicker vegetation on the Israeli side of the border. The green delta of the Nile River appears in the foreground, with the great conurbation of Cairo seen as a gray area at the apex of the triangle. Most of Egypt's 52 million inhabitants live in the delta. On the east side of the delta, the Suez Canal is visible. On the western corner of the delta lies the ancient city of Alexandria, beside the orange and white salt pans. The World War II battlesite El Alamein lies on the coast.

  3. A novel calibration approach using satellite and visibility observations to estimate fine particulate matter exposures in Southwest Asia and Afghanistan.

    PubMed

    Masri, Shahir; Garshick, Eric; Coull, Brent A; Koutrakis, Petros

    2017-01-01

    In order to study effects of ambient particulate matter (PM) it was previously necessary to have access to a comprehensive air monitoring network. However, there are locations in the world where PM levels are above generally accepted exposure standards but lack a monitoring infrastructure. This is true in Iraq and other locations in Southwest Asia and Afghanistan where U.S. and other coalition troops were deployed beginning in 2001. Since aerosol optical depth (AOD), determined by satellite, and visibility are both highly related to atmospheric PM2.5 (particulate matter with an aerodynamic diameter ≤2.5 μm) concentrations, we employed a novel approach that took advantage of historic airport visibility measurements to calibrate the AOD-visibility relationship and determine visibility spatially and temporally (2006-2007) over an approximately 17,000 km(2) region of Iraq. We obtained daily visibility predictions that were highly associated with satellite-based 1x1 km AOD daily observations (R(2)=0.87). Based on a previously derived calibration between PM2.5 and visibility, we were able to predict spatially and temporally resolved PM2.5 concentrations. Variability of PM2.5 among sites was high, with daily concentrations differing by as much as ~30 μg/m3. This study demonstrates the feasibility of characterizing historic PM2.5 exposures in Iraq and other locations in Southwest Asia and Afghanistan with similar climate characteristics. This is of utility for epidemiologists seeking to assess the potential health effects related to PM2.5 exposures among previously deployed military personnel and of the population of the region. This study demonstrates the ability to utilize aerosol optical depth to successfully estimate visibility spatially and temporally in Southwest Asia and Afghanistan. This enables for the estimation of spatially resolved PM2.5 concentrations in the region. The ability to caracterize PM2.5 concentrations in Southwest Asia and Afghanistan is highly

  4. How does sex trafficking increase the risk of HIV Infection? An observational study from Southern India.

    PubMed

    Wirth, Kathleen E; Tchetgen Tchetgen, Eric J; Silverman, Jay G; Murray, Megan B

    2013-02-01

    Studies have documented the substantial risk of human immunodeficiency virus (HIV) infection endured by sex-trafficked women, but it remains unclear how exposure to trafficking puts its victims at risk. We assessed whether the association between sex trafficking and HIV could be explained by self-reported forced prostitution or young age at entry into prostitution using cross-sectional data collected from 1,814 adult female sex workers in Karnataka, India, between August 2005 and August 2006. Marginal structural logistic regression was used to estimate adjusted odds ratios for HIV infection. Overall, 372 (21%) women met 1 or both criteria used to define sex trafficking: 278 (16%) began sex work before age 18 years, and 107 (5%) reported being forcibly prostituted. Thirteen (0.7%) met both criteria. Forcibly prostituted women were more likely to be HIV-infected than were women who joined the industry voluntarily, independent of age at entering prostitution (odds ratio = 2.30, 95% confidence interval: 1.08, 4.90). Conversely, after adjustment for forced prostitution and other confounders, no association between age at entry into prostitution and HIV was observed. The association between forced prostitution and HIV infection became stronger in the presence of sexual violence (odds ratio = 11.13, 95% confidence interval: 2.41, 51.40). These findings indicate that forced prostitution coupled with sexual violence probably explains the association between sex trafficking and HIV.

  5. How Does Sex Trafficking Increase the Risk of HIV Infection? An Observational Study From Southern India

    PubMed Central

    Wirth, Kathleen E.; Tchetgen Tchetgen, Eric J.; Silverman, Jay G.; Murray, Megan B.

    2013-01-01

    Studies have documented the substantial risk of human immunodeficiency virus (HIV) infection endured by sex-trafficked women, but it remains unclear how exposure to trafficking puts its victims at risk. We assessed whether the association between sex trafficking and HIV could be explained by self-reported forced prostitution or young age at entry into prostitution using cross-sectional data collected from 1,814 adult female sex workers in Karnataka, India, between August 2005 and August 2006. Marginal structural logistic regression was used to estimate adjusted odds ratios for HIV infection. Overall, 372 (21%) women met 1 or both criteria used to define sex trafficking: 278 (16%) began sex work before age 18 years, and 107 (5%) reported being forcibly prostituted. Thirteen (0.7%) met both criteria. Forcibly prostituted women were more likely to be HIV-infected than were women who joined the industry voluntarily, independent of age at entering prostitution (odds ratio = 2.30, 95% confidence interval: 1.08, 4.90). Conversely, after adjustment for forced prostitution and other confounders, no association between age at entry into prostitution and HIV was observed. The association between forced prostitution and HIV infection became stronger in the presence of sexual violence (odds ratio = 11.13, 95% confidence interval: 2.41, 51.40). These findings indicate that forced prostitution coupled with sexual violence probably explains the association between sex trafficking and HIV. PMID:23324332

  6. Factors associated with presenting late or with advanced HIV disease in the Netherlands, 1996–2014: results from a national observational cohort

    PubMed Central

    Op de Coul, Eline L M; van Sighem, Ard; Brinkman, Kees; van Benthem, Birgit H; van der Ende, Marchina E; Geerlings, Suzanne; Reiss, Peter

    2016-01-01

    Objectives Early testing for HIV and entry into care are crucial to optimise treatment outcomes of HIV-infected patients and to prevent spread of HIV. We examined risk factors for presentation with late or advanced disease in HIV-infected patients in the Netherlands. Methods HIV-infected patients registered in care between January 1996 and June 2014 were selected from the ATHENA national observational HIV cohort. Risk factors for late presentation and advanced disease were analysed by multivariable logistic regression. Furthermore, geographical differences and time trends were examined. Results Of 20 965 patients, 53% presented with late-stage HIV infection, and 35% had advanced disease. Late presentation decreased from 62% (1996) to 42% (2013), while advanced disease decreased from 46% to 26%. Late presentation only declined significantly among men having sex with men (MSM; p <0.001), but not among heterosexual males (p=0.08) and females (p=0.73). Factors associated with late presentation were: heterosexual male (adjusted OR (aOR), 1.59; 95% CI 1.44 to 1.75 vs MSM), injecting drug use (2.00; CI 1.69 to 2.38), age ≥50 years (1.46; CI 1.33 to 1.60 vs 30–49 years), region of origin (South-East Asia 2.14; 1.80 to 2.54, sub-Saharan Africa 2.11; 1.88 to 2.36, Surinam 1.59; 1.37 to 1.84, Caribbean 1.31; 1.13 to 1.53, Latin America 1.23; 1.04 to 1.46 vs the Netherlands), and location of HIV diagnosis (hospital 3.27; 2.94 to 3.63, general practitioner 1.66; 1.50 to 1.83, antenatal screening 1.76; 1.38 to 2.34 vs sexually transmitted infection clinic). No association was found for socioeconomic status or level of urbanisation. Compared with Amsterdam, 2 regions had higher adjusted odds and 2 regions had lower odds of late presentation. Results were highly similar for advanced disease. Conclusions Although the overall rate of late presentation is declining in the Netherlands, targeted programmes to reduce late HIV diagnoses remain needed for all risk groups, but

  7. East Asia: Southeast Asia

    DTIC Science & Technology

    1990-07-25

    JPRS-SEA-90-022 25 JULY 1990 FOREIGN BROADCAST INFORMATION SERVICE JPRS Report— East Asia Southeast Asia 19990510 141 REPRODUCED BY U.S...Burmese have been forcibly resettled to new towns from densely-populated areas of Rangoon and Mandalay , often without running water and elec- tricity... settlement of some 100,000 people in bamboo houses. Situated in what were rice fields, the town suffers from flooding in the current monsoon season

  8. Trans-Pacific transport of dust aerosols from East Asia: Insights gained from multiple observations and modeling.

    PubMed

    Guo, Jianping; Lou, Mengyun; Miao, Yucong; Wang, Yuan; Zeng, Zhaoliang; Liu, Huan; He, Jing; Xu, Hui; Wang, Fu; Min, Min; Zhai, Panmao

    2017-11-01

    East Asia is one of the world's largest sources of dust and anthropogenic pollution. Dust particles originating from East Asia have been recognized to travel across the Pacific to North America and beyond, thereby affecting the radiation incident on the surface as well as clouds aloft in the atmosphere. In this study, integrated analyses are performed focusing on one trans-Pacific dust episode during 12-22 March 2015, based on space-borne, ground-based observations, reanalysis data combined with Hybrid Single Particle Lagrangian Integrated Trajectory Model (HYSPLIT), and the Weather Research and Forecasting Model coupled with Chemistry (WRF-Chem). From the perspective of synoptic patterns, the location and strength of Aleutian low pressure system largely determined the eastward transport of dust plumes towards western North America. Multi-sensor satellite observations reveal that dust aerosols in this episode originated from the Taklimakan and Gobi Deserts. Moreover, the satellite observations suggest that the dust particles can be transformed to polluted particles over the East Asian regions after encountering high concentration of anthropogenic pollutants. In terms of the vertical distribution of polluted dust particles, at the very beginning, they were mainly located in the altitudes ranging from 1 km to 7 km over the source region, then ascended to 2 km-9 km over the Pacific Ocean. The simulations confirm that these elevated dust particles in the lower free troposphere were largely transported along the prevailing westerly jet stream. Overall, observations and modeling demonstrate how a typical springtime dust episode develops and how the dust particles travel over the North Pacific Ocean all the way to North America. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Phylogeographic Analyses Reveal a Crucial Role of Xinjiang in HIV-1 CRF07_BC and HCV 3a Transmissions in Asia

    PubMed Central

    Liu, Jun; Zhang, Chiyu

    2011-01-01

    Background China faces an increasing prevalence of two HIV-1 circulating recombinant forms (CRFs) 07_BC and 08_BC. Both CRFs_BC were previously demonstrated to originate in Yunnan and spread to Liaoning from Yunnan via injection drug use (IDU) in China. Supposing it is true, we are unable to answer why only CRF07_BC, rather than both CRFs_BC together, was transmitted to Xinjiang. Methodology/Principal Findings We investigated the phylogeography of CRF07_BC and CRF08_BC using multiple HIV-1 genomic regions with Bayesian phylogeography method. Phylogenetic reconstructions showed that all CRF07_BC sequences were divided into two clades, Yunnan and Xinjiang, and all strains from other regions of mainland China clustered within the Xinjiang clade. Significant geographic diffusion links of Xinjiang with other regions (including Liaoning, Beijing, Jiangsu and Guangdong) were supported by Bayes factor tests. The temporal dynamics analyses showed that CRF07_BC spread from Xinjiang to Liaoning in 1996.10, and to Jiangsu in 2000.9. The analyses of CRF08_BC not only confirmed the previous conclusion on temporal and spatial dynamics of CRF08_BC, but also indicated that the CRF08_BC strains from Guangdong and Shanghai originated from Yunnan. The analyses of HCV 3a showed that it was introduced into Xinjiang in the early 1980s, and spread from Xinjiang to Yunnan in 1990.10 and to Jiangsu in 1999.2, and further from Yunnan to Guangxi in 1995.3. The temporal and spatial dynamics of HCV 3a were similar to some extent to that of HIV-1 CRF07_BC and/or CRF08_BC, suggesting a possible association in migration patterns between HCV and HIV-1 through IDU. In addition, HCV 3a spread from Xinjiang to Pakistan, implying a drug trafficking route linking them. Conclusions/Significance Xinjiang, as the most important transfer station for drug trafficking from Golden Crescent to other regions of China, plays a very crucial role in the transmission of viruses (e.g., HIV-1 and HCV) through IDU in

  10. CARIBIC observations of short-lived halocarbons and carbonyl sulphide over Asia

    NASA Astrophysics Data System (ADS)

    Leedham, E.; Wisher, A.; Oram, D.; Baker, A. K.; Brenninkmeijer, C. A.

    2013-12-01

    The CARIBIC project (Civil Aircraft for the Regular Investigation of the atmosphere Based on an Instrument Container, www.caribic-atmospheric.com) aims to investigate the spatial and temporal distribution of a wide-range of compounds, including those of marine origin/influence, via ~monthly flights to collect in situ data and whole air samples aboard a commercial Lufthansa aircraft. CARIBIC measures up to an altitude of 12 km, allowing the influence of marine compounds on the upper troposphere/lower stratosphere (UTLS) to be explored. In particular, CARIBIC is a useful tool for exploring the impact of very short lived halocarbons (e.g. CH2Br2, CHBr3), whose impact on stratospheric ozone is dependent on convective uplift to the UTLS, a process which is not yet fully quantified. As part of the suite of CARIBIC measurements, whole air samples are analysed at the University of East Anglia (UEA) via gas chromatography mass spectrometry for carbonyl sulphide (OCS) and up to 40 halocarbons (accounting for virtually 100% of organic chlorine, bromine and iodine in the UTLS). Here we present an overview of short-lived halocarbons and OCS measured by CARIBIC. We focus on two regions of particular interest. (1) measurements made in 2012 over the tropical west Pacific to link with UEA measurements made during the SHIVA campaign. (2) measurements made during a collection of flights over India in 2008. Flights over India investigated the impact of monsoon circulation on the distribution of these compounds; for example, elevated concentrations of OCS were seen in CARIBIC samples taken over India during the summer monsoon (July - September). These flights, along with a wider range of flights over Asia (from Frankfurt to Guangzhou, Manila, Bangkok and Kuala Lumpur) can provide unique information on the influence of tropical convection and monsoon circulation on halocarbon and OCS transport within this region.

  11. Precipitation systems with and without lightning in Eastern Asia as observed from TRMM satellite

    NASA Astrophysics Data System (ADS)

    Yuan, T.; Qie, X.; Feng, G.

    2006-12-01

    Precipitation systems in two land and three ocean regions in Eastern Asia are investigated by using the data from the precipitation radar(PR), TRMM Microwave Imager(TMI) and lightning imaging sensor(LIS) aboard the Tropical Rainfall Measuring Mission(TRMM) satellite from 1998 to 2003, and the relationships between flash rate and related thunderstorm parameters are analyzed quantitatively. According to the method given by Nesbitt et al.(2000), precipitation systems are classified as systems without ice scattering(NoIces), with ice scattering(IcePFs) and with an MCS(McsPFs). In addition, Precipitation systems are again classified as thunderstorms and non-thunderstorms based on whether there are lightning flashes or not. The result indicates that McsPFs contribute 43% of the total rainfall, though it takes only 1.7% of the total systems, IcePFs contribute 14% of the total systems and 35% of the total rainfall, and NoIces contribute 84% of the total systems but only 21% of the total rainfall. Among the IcePFs and McsPFs, thunderstorms account for 27%, and contribute nearly 40% of the total rainfall. Between thunderstorms and non-thunderstorms over both land and ocean, there are always significant difference in the measures such as 85/37GHz polarization corrected temperatures (PCTs), maximum echo at 6/7/8/9km, maximum near surface echo, maximum height of 20/30/40dBZ, vertical profile of radar reflectivity (VPRR), the integral of rain rate from rain top to rain bottom, and the ratio of convective rain to stratiform rain. Otherwise, several other measures are not evidently different between the two kinds of systems, such as system total area, the area of 85GHz PCTs <=250K, and the area of greater than 20dBZ etc. In the present database, although there are relatively steady relationships between flash rate and thunderstorm heights over land and ocean, it appears that the flash rate is a function of eleventh power of the maximum storm height, instead of fifth power, whose y

  12. An offline constrained data assimilation technique for aerosols: Improving GCM simulations over South Asia using observations from two satellite sensors

    NASA Astrophysics Data System (ADS)

    Baraskar, Ankit; Bhushan, Mani; Venkataraman, Chandra; Cherian, Ribu

    2016-05-01

    Aerosol properties simulated by general circulation models (GCMs) exhibit large uncertainties due to biases in model processes and inaccuracies in aerosol emission inputs. In this work, we propose an offline, constrained optimization based procedure to improve these simulations by assimilating them with observational data. The proposed approach explicitly incorporates the non-negativity constraint on the aerosol optical depth (AOD) which is a key metric to quantify aerosol distributions. The resulting optimization problem is quadratic programming in nature and can be easily solved by available optimization routines. The utility of the approach is demonstrated by performing offline assimilation of GCM simulated aerosol optical properties and radiative forcing over South Asia (40-120 E, 5-40 N), with satellite AOD measurements from two sensors, namely Moderate Resolution Imaging SpectroRadiometer (MODIS) and Multi-Angle Imaging SpectroRadiometer (MISR). Uncertainty in observational data used in the assimilation is computed by developing different error bands around regional AOD observations, based on their quality assurance flags. The assimilation, evaluated on monthly and daily scales, compares well with Aerosol Robotic Network (AERONET) observations as determined by goodness of fit statistics. Assimilation increased both model predicted atmospheric absorption and clear sky radiative forcing by factors consistent with recent estimates in literature. Thus, the constrained assimilation algorithm helps in systematically reducing uncertainties in aerosol simulations.

  13. Investigation of Ionospheric Disturbances Using Radio and Optical Observations in South-East Asia -- The Initial Results of the ASI and FPI Observations in Chiang Mai, Thailand

    NASA Astrophysics Data System (ADS)

    Kubota, M.; Nagatsuma, T.; Otsuka, Y.; Shiokawa, K.; Komonjinda, S.; Komolmis, T.; Somboon, E.; Tsugawa, T.; Maruyama, T.; Murata, K. T.

    2010-12-01

    For the purpose of monitoring and forecasting equatorial ionospheric disturbances, SEALION (SouthEast Asia Low-latitude IOnospheric Network) has been developed since 2003 as a cooperation project by National Institute of Information and Communications Technology (NICT), King Mongkut's Institute of Technology Ladkrabang (KMITL) in Thailand, Chiang Mai University (CMU) in Thailand, National Institute of Aeronautics and Space (LAPAN) in Indonesia, Hanoi Institute of Geophysics (HIG), Vietnamese Academy of Science and Technology in Vietnam, Center for Space Science and Applied Research (CSSAR), Chinese Academy of Sciences in China, Kyoto University in Japan, and Solar-Terrestrial Environment Laboratory (STEL), Nagoya University in Japan. SEALION consists of five ionosondes, four GPS receivers, two GPS scintillation monitors, and a magnetometer. As a part of this project, we newly installed an all-sky imager (ASI) and a Fabry-Perot Interferometer (FPI) at Sirindhorn observatory in Chiang Mai (18.8N, 98.9E, Dip lat. 13.1), Thailand. This site is located near conjugate to EAR site in Kototabang, Indonesia. One of main targets of the ASI observation is the large-scale wave structure (LSWS) with wavelengths of 100-1000 km. The LSWS is thought to be connected to the generation mechanism of equatorial plasma bubbles (EPB). The optical observations in Chiang Mai started in February 2010, and we have detected several ionospheric disturbance events with these instruments In this paper, we will show the initial results of the optical observations from Sirindhorn observatory, and discuss the features of ionospheric disturbances in Southeast Asia.

  14. CMAQ simulation of atmospheric CO2 concentration in East Asia: Comparison with GOSAT observations and ground measurements

    NASA Astrophysics Data System (ADS)

    Li, Rong; Zhang, Meigen; Chen, Liangfu; Kou, Xingxia; Skorokhod, Andrei

    2017-07-01

    Satellite observations are widely used in global CO2 assimilations, but their quality for use in regional assimilation systems has not yet been thoroughly determined. Validation of satellite observations and model simulations of CO2 is crucial for carbon flux inversions. In this study, we focus on evaluating the uncertainties of model simulations and satellite observations. The atmospheric CO2 distribution in East Asia during 2012 was simulated using a regional chemical transport model (RAMS-CMAQ) and compared with both CO2 column density (XCO2) from the Gases Observing SATellite (GOSAT) and CO2 concentrations from the World Data Centre for Greenhouse Gases (WDCGG). The results indicate that simulated XCO2 is generally lower than GOSAT XCO2 by 1.19 ppm on average, and their monthly differences vary from 0.05 to 2.84 ppm, with the corresponding correlation coefficients ranging between 0.1 and 0.67. CMAQ simulations are good to capture the CO2 variation as ground-based observations, and their correlation coefficients are from 0.62 to 0.93, but the average value of CMAQ simulation is 2.4 ppm higher than ground-based observation. Thus, we inferred that the GOSAT retrievals may overestimate XCO2, which is consistent with the validation of GOSAT XCO2 using Total Carbon Column Observing Network measurements. The near-surface CO2 concentration was obviously overestimated in GOSAT XCO2. Compared with the relatively small difference between CMAQ and GOSAT XCO2, the large difference in CO2 near surface or their vertical profiles indicates more improvements are needed to reduce the uncertainties in both satellite observations and model simulations.

  15. The low vitrinite reflectance observed in the Miocene formations in S. E. Asia - suppressed or cooler thermal history

    SciTech Connect

    Kazuo, Nakayama )

    1996-01-01

    The vitrinite reflectance data in the Miocene formations in S. E. Asia are found too low relative to the measured bottom hole temperatures and lower than the vitrinite reflectance values predicted by basin modeling. Such observation appears on the data from Khmer Trough, Vietnam offshore, South China Sea, and Japan Sea. Two possibilities are accounted for: (1) the vitrinite reflectance is suppressed under the certain conditions such as over pressure or the existence of generated oil, and (2) the paleo-heat flow in the area was significantly lower than we postulated as a rift basin. The latter possibility has been rarely considered, however, one of the sites indicates that only suppression cannot recover the differences, but also the effect of low paleo-heat flow is necessary. It is considered the heat flow was high at the initial stage of forming a rift and it exponentially decreased, then it increased recently to indicate a relatively high heat regime at present stage. Introducing such assumption could solve the observed low value of vitrinite reflectance. Although this conclusion must be verified by other inorganic source such as Apatite Fission Track Analysis or X-ray diffraction of clays (smectite/ illite transformation), the thermal history with low heat flow would affect significantly the timing of oil/gas generation and expulsion. Thus the observation of less mature vitrinite lead us a new exploration strategy for the area.

  16. The low vitrinite reflectance observed in the Miocene formations in S.E. Asia - suppressed or cooler thermal history?

    SciTech Connect

    Kazuo, Nakayama

    1996-12-31

    The vitrinite reflectance data in the Miocene formations in S. E. Asia are found too low relative to the measured bottom hole temperatures and lower than the vitrinite reflectance values predicted by basin modeling. Such observation appears on the data from Khmer Trough, Vietnam offshore, South China Sea, and Japan Sea. Two possibilities are accounted for: (1) the vitrinite reflectance is suppressed under the certain conditions such as over pressure or the existence of generated oil, and (2) the paleo-heat flow in the area was significantly lower than we postulated as a rift basin. The latter possibility has been rarely considered, however, one of the sites indicates that only suppression cannot recover the differences, but also the effect of low paleo-heat flow is necessary. It is considered the heat flow was high at the initial stage of forming a rift and it exponentially decreased, then it increased recently to indicate a relatively high heat regime at present stage. Introducing such assumption could solve the observed low value of vitrinite reflectance. Although this conclusion must be verified by other inorganic source such as Apatite Fission Track Analysis or X-ray diffraction of clays (smectite/ illite transformation), the thermal history with low heat flow would affect significantly the timing of oil/gas generation and expulsion. Thus the observation of less mature vitrinite lead us a new exploration strategy for the area.

  17. On observation of local strong heterogeneity in the Earth's inner core below southeastern Asia

    NASA Astrophysics Data System (ADS)

    Krasnoshchekov, D. N.; Kaazik, P. B.; Ovtchinnikov, V. M.

    2016-12-01

    The dimensions and nature of multi-scale structural heterogeneities in the Earth's inner core (IC) provide important constraints on its mineralogy and formation history. Teleseismic body waves with turn points close to the inner core boundary (ICB) provide a unique tool for imaging the fine structure of the upper IC. In this study, we invoke differential travel times and amplitudes of PKPBC and PKPDF waveforms observed in crossing polar and equatorial paths to provide more constraints on the heterogeneity previously located in the quasi-eastern hemisphere of the IC (Kaazik et al., 2015; Krasnoshchekov et al., 2016). A more refined analysis of quasi-polar PKPBC/PKPDF amplitude ratios measured within the heterogeneity indicates that seismic attenuation is both frequency and depth dependent, and its relatively low Q-factor at 1 Hz of approximately 118 tends to grow with depth. Outside the heterogeneity, no pronounced polar-equatorial differences are observed; the estimated Q factor is about twice as large and not directionally dependent. We also analyse new differential travel times of rays that enable sampling of the anomaly at greater depths. The analysis exhibits the polar - equatorial contrasts observed in the heterogeneity terminate at approximately 520 km below the ICB, which we interpret to be its bottom. The earlier interpretation of the heterogeneity in terms of strong anisotropic volume amidst the almost isotropic eastern hemisphere of the IC can be retained, and the lower bound of anisotropy strength within the anomaly is determined to be 2%.

  18. A 12-Month Prospective, Observational Study of Treatment Regimen and Quality of Life Associated with ADHD in Central and Eastern Europe and Eastern Asia

    ERIC Educational Resources Information Center

    Goetz, Michal; Yeh, Chin-Bin; Ondrejka, Igor; Akay, Aynur; Herczeg, Ilona; Dobrescu, Iuliana; Kim, Boong Nyun; Jin, Xingming; Riley, Anne W.; Martenyi, Ferenc; Harrison, Gavan; Treuer, Tamas

    2012-01-01

    Objectives: This prospective, observational, non-randomized study aimed to describe the relationship between treatment regimen prescribed and the quality of life (QoL) of ADHD patients in countries of Central and Eastern Europe (CEE) and Eastern Asia over 12 months. Methods: 977 Male and female patients aged 6-17 years seeking treatment for…

  19. A 12-Month Prospective, Observational Study of Treatment Regimen and Quality of Life Associated with ADHD in Central and Eastern Europe and Eastern Asia

    ERIC Educational Resources Information Center

    Goetz, Michal; Yeh, Chin-Bin; Ondrejka, Igor; Akay, Aynur; Herczeg, Ilona; Dobrescu, Iuliana; Kim, Boong Nyun; Jin, Xingming; Riley, Anne W.; Martenyi, Ferenc; Harrison, Gavan; Treuer, Tamas

    2012-01-01

    Objectives: This prospective, observational, non-randomized study aimed to describe the relationship between treatment regimen prescribed and the quality of life (QoL) of ADHD patients in countries of Central and Eastern Europe (CEE) and Eastern Asia over 12 months. Methods: 977 Male and female patients aged 6-17 years seeking treatment for…

  20. The Silk Road Health Project: How Mobility and Migration Status Influence HIV Risks among Male Migrant Workers in Central Asia

    PubMed Central

    El-Bassel, Nabila; Gilbert, Louisa; Shaw, Stacey A.; Mergenova, Gaukhar; Terlikbayeva, Assel; Primbetova, Sholpan; Ma, Xin; Chang, Mingway; Ismayilova, Leyla; Hunt, Tim; West, Brooke; Wu, Elwin; Beyrer, Chris

    2016-01-01

    Objectives We examined whether mobility, migrant status, and risk environments are associated with sexually transmitted infections (STIs) and HIV risk behaviors (e.g. sex trading, multiple partners, and unprotected sex). Methods We used Respondent Driven Sampling (RDS) to recruit external male migrant market vendors from Kyrgyzstan, Uzbekistan, and Tajikistan as well internal migrant and non-migrant market vendors from Kazakhstan. We conducted multivariate logistic regressions to examine the effects of mobility combined with the interaction between mobility and migration status on STIs and sexual risk behaviors, when controlling for risk environment characteristics. Results Mobility was associated with increased risk for biologically-confirmed STIs, sex trading, and unprotected sex among non-migrants, but not among internal or external migrants. Condom use rates were low among all three groups, particularly external migrants. Risk environment factors of low-income status, debt, homelessness, and limited access to medical care were associated with unprotected sex among external migrants. Conclusion Study findings underscore the role mobility and risk environments play in shaping HIV/STI risks. They highlight the need to consider mobility in the context of migration status and other risk environment factors in developing effective prevention strategies for this population. PMID:26967159

  1. The Silk Road Health Project: How Mobility and Migration Status Influence HIV Risks among Male Migrant Workers in Central Asia.

    PubMed

    El-Bassel, Nabila; Gilbert, Louisa; Shaw, Stacey A; Mergenova, Gaukhar; Terlikbayeva, Assel; Primbetova, Sholpan; Ma, Xin; Chang, Mingway; Ismayilova, Leyla; Hunt, Tim; West, Brooke; Wu, Elwin; Beyrer, Chris

    2016-01-01

    We examined whether mobility, migrant status, and risk environments are associated with sexually transmitted infections (STIs) and HIV risk behaviors (e.g. sex trading, multiple partners, and unprotected sex). We used Respondent Driven Sampling (RDS) to recruit external male migrant market vendors from Kyrgyzstan, Uzbekistan, and Tajikistan as well internal migrant and non-migrant market vendors from Kazakhstan. We conducted multivariate logistic regressions to examine the effects of mobility combined with the interaction between mobility and migration status on STIs and sexual risk behaviors, when controlling for risk environment characteristics. Mobility was associated with increased risk for biologically-confirmed STIs, sex trading, and unprotected sex among non-migrants, but not among internal or external migrants. Condom use rates were low among all three groups, particularly external migrants. Risk environment factors of low-income status, debt, homelessness, and limited access to medical care were associated with unprotected sex among external migrants. Study findings underscore the role mobility and risk environments play in shaping HIV/STI risks. They highlight the need to consider mobility in the context of migration status and other risk environment factors in developing effective prevention strategies for this population.

  2. Observational evidence of predawn plasma bubble and its irregularity scales in Southeast Asia

    NASA Astrophysics Data System (ADS)

    Watthanasangmechai, K.; Tsunoda, R. T.; Yokoyama, T.; Ishii, M.; Tsugawa, T.

    2016-12-01

    This paper describes an event of deep plasma depletion simultaneously detected with GPS, GNU Radio Beacon Receiver (GRBR) and in situ satellite measurement from DMFPF15. The event is on March 7, 2012 at 4:30 LT with geomagnetic quiet condition. Such a sharp depletion at plasma bubble wall detected at predawn is interesting but apparently rare event. Only one event is found from all dataset in March 2012. The inside structure of the predawn plasma bubble was clearly captured by DMSPF15 and the ground-based GRBR. The envelop structure seen from the precessed GPS-TEC appeares as a cluster. The observed cluster is concluded as the structure at the westwall of an upwelling of the large-scale wave structure, that accompanies the fifty- and thousand-km scales. This event is consistent with the plasma bubble structure simulated from the high-resolution bubble (HIRB) model.

  3. Direct radiative effects of aerosols over South Asia from observations and modeling

    NASA Astrophysics Data System (ADS)

    Nair, Vijayakumar S.; Babu, S. Suresh; Manoj, M. R.; Moorthy, K. Krishna; Chin, Mian

    2017-08-01

    Quantitative assessment of the seasonal variations in the direct radiative effect (DRE) of composite aerosols as well as the constituent species over the Indian sub continent has been carried out using a synergy of observations from a dense network of ground based aerosol observatories and modeling based on chemical transport model simulations. Seasonal variation of aerosol constituents depict significant influence of anthropogenic aerosol sources in winter and the dominance of natural sources in spring, even though the aerosol optical depth doesn't change significantly between these two seasons. A significant increase in the surface cooling and atmospheric warming has been observed as season changes from winter (DRESUR = -28 ± 12 W m-2 and DREATM = +19.6 ± 9 W m-2) to spring (DRESUR = -33.7 ± 12 W m-2 and DREATM = +27 ± 9 W m-2). Interestingly, springtime aerosols are more absorptive in nature compared to winter and consequently the aerosol induced diabatic heating of the atmosphere goes as high as 1 K day-1 during spring, especially over eastern India. The atmospheric DRE due to dust aerosols (+14 ± 7 W m-2) during spring overwhelms that of black carbon DRE (+11.8 ± 6 W m-2) during winter. The DRE at the top of the atmosphere is mostly governed by the anthropogenic aerosols during all the seasons. The columnar aerosol loading, its anthropogenic fraction and radiative effects shows a steady increase with latitude across Indian mainland leading to a larger aerosol-induced atmospheric warming during spring than in winter.

  4. New Particle Formation in Anthropogenic Plumes Advecting from Asia Observed During TRACE-P

    NASA Technical Reports Server (NTRS)

    Weber, R. J.; Lee, S.; Chen, G.; Wang, B.; Kapustin, V.; Moore, K.; Clarke, A. D.; Mauldin, L.; Kosciuch, E.; Cantrell, C.

    2003-01-01

    The characteristics and sources of what are believed to be newly formed 3 to 4 nm particles in anthropogenic plumes advecting from Asian are reported. Airborne measurements were made from March to April 2001 as part of the NASA TRACE-P experiment at latitudes ranging from North of the Philippines to Northern Japan (20 to 45 deg. N). In the more polluted plumes, high concentrations of 3 to 4 nm diameter particles (less than 100/qu cm) were observed both within and along the upper outer edges of plumes that were identified by enhanced carbon monoxide and fine particulate sulfate concentrations. The results from two research flights are investigated in detail. Three to four-nm particle concentrations are generally correlated with gas phase sulfuric acid and found in regions of low surface areas relative to the immediate surroundings or where there are steep transitions to lower surface areas. Sulfuric acid and surface area concentrations in the most polluted plume reached 6 x l0(exp 7) and 750 micro sq m/qu cm, respectively, in regions of particle formation. In contrast to these anthropogenic plumes, few 3 to 4 nm particles were observed in the clean background and few were detected within a volcanic plume where the studies highest H2SO4 concentrations (less than lO(exp 8)/qu cm) were recorded. Enhanced SO2 concentrations in the range of approximately 2 to 7 ppb, in conjunction with other unidentified, possibly coemitted species, appear to be the driving factor for nucleation. (0345, 4801); 0322 Atmospheric Composition and Structure: Constituent sources and sinks; 0345 Atmospheric Composition and Structure: Pollution-urban and regional (0305); 4801 Oceanography: Biological and Chemical: Aerosols (0305).

  5. Direct radiative effects of aerosols over South Asia from observations and modeling

    NASA Astrophysics Data System (ADS)

    Nair, Vijayakumar S.; Babu, S. Suresh; Manoj, M. R.; Moorthy, K. Krishna; Chin, Mian

    2016-10-01

    Quantitative assessment of the seasonal variations in the direct radiative effect (DRE) of composite aerosols as well as the constituent species over the Indian sub continent has been carried out using a synergy of observations from a dense network of ground based aerosol observatories and modeling based on chemical transport model simulations. Seasonal variation of aerosol constituents depict significant influence of anthropogenic aerosol sources in winter and the dominance of natural sources in spring, even though the aerosol optical depth doesn't change significantly between these two seasons. A significant increase in the surface cooling and atmospheric warming has been observed as season changes from winter (DRESUR = -28 ± 12 W m-2 and DREATM = +19.6 ± 9 W m-2) to spring (DRESUR = -33.7 ± 12 W m-2 and DREATM = +27 ± 9 W m-2). Interestingly, springtime aerosols are more absorptive in nature compared to winter and consequently the aerosol induced diabatic heating of the atmosphere goes as high as 1 K day-1 during spring, especially over eastern India. The atmospheric DRE due to dust aerosols (+14 ± 7 W m-2) during spring overwhelms that of black carbon DRE (+11.8 ± 6 W m-2) during winter. The DRE at the top of the atmosphere is mostly governed by the anthropogenic aerosols during all the seasons. The columnar aerosol loading, its anthropogenic fraction and radiative effects shows a steady increase with latitude across Indian mainland leading to a larger aerosol-induced atmospheric warming during spring than in winter.

  6. Direct Radiative Effects of Aerosols Over South Asia From Observations and Modeling

    NASA Technical Reports Server (NTRS)

    Nair, Vijayakumar S.; Babu, S. Suresh; Manoj, M. R.; Moorthy, Krishna K.; Chin, Mian

    2016-01-01

    Quantitative assessment of the seasonal variations in the direct radiative effect (DRE) of composite aerosols as well as the constituent species over the Indian sub continent has been carried out using a synergy of observations from a dense network of ground based aerosol observatories and modeling based on chemical transport model simulations. Seasonal variation of aerosol constituents depict significant influence of anthropogenic aerosol sources in winter and the dominance of natural sources in spring, even though the aerosol optical depth doesn't change significantly between these two seasons. A significant increase in the surface cooling and atmospheric warming has been observed as season changes from winter DRE(sub SUR) = -28 +/- 12 W m(exp -2) and DRE(sub ATM) = +19.6 +/- 9 W m(exp -2) to spring DRE(sub SUR) = -33.7 +/- 12 W m(exp -2) and DRE(sub ATM) = +27 +/- 9 W m(exp-2). Interestingly, springtime aerosols are more absorptive in nature compared to winter and consequently the aerosol induced diabatic heating of the atmosphere goes as high as approximately 1 K day(exp -1) during spring, especially over eastern India. The atmospheric DRE due to dust aerosols (+14 +/- 7 W m(exp 2) during spring overwhelms that of black carbon DRE (+11.8 +/- 6 W m(exp -2) during winter. The DRE at the top of the atmosphere is mostly governed by the anthropogenic aerosols during all the seasons. The columnar aerosol loading, its anthropogenic fraction and radiative effects shows a steady increase with latitude across Indian mainland leading to a larger aerosol-induced atmospheric warming during spring than in winter.

  7. Spatial analysis of ecosystem production from coordinated in-situ and satellite observations over semi-arid East Asia

    NASA Astrophysics Data System (ADS)

    Jia, G.; Wang, H.; Zhang, A.

    2016-12-01

    Ecosystem production is a fundamental component of biogeochemical cycles and land-atmosphere interactions at various scales. Semi-arid ecosystems are key contributors to the global carbon cycle and may even dominate the inter-annual variability and decadal trends of the land carbon sink, as demonstrated by several recent studies. Over past years, major achievements have been made to estimate ecosystem productions with satellite data at global and regional scales. However, those estimates were often done with very sparse in-situ data, especially in semi-arid East Asia portion. To better estimate finer resolution primary and ecosystem productions at regional scales, localized field measurements and integration with state-of-art satellite data are necessary. In-situ measurements of green vegetation fractions and CO2 flux between land and atmosphere are critical for understanding regional land-atmosphere interactions and for validating satellite data. Here, we integrated multi-scale satellite data and eddy covariance flux measurements from a pilot experiment of coordinated observation with 24 participant field sites to estimate the gross primary production (GPP) and net ecosystem production (NEP) over semi-arid East Asia from site to regional scale at high temporal and spatial resolution. The coordination started with intensive instruments calibration and field survey based on common protocol. We calculated the footprint sizes and landscape heterogeneity over each site with fine resolution satellite data (Landsat and GF) and evaluated the contribution of vegetation patches to flux signals. The vegetation photosynthesis model was driven with MODIS derived albedo and EVI and coordinated flux measurements. Generally, the GPP in this region were higher in east and lower in west, with distinguished green spots over oasis and montane forests. The estimated annual GPP was 40% greater than MOD17 products. Further, we validated and corrected microwave (AMSR-E and AMSR2) derived

  8. Maternal infection and risk of intrapartum death: a population based observational study in South Asia

    PubMed Central

    2013-01-01

    Background Approximately 1.2 million stillbirths occur in the intrapartum period, and a further 717,000 annual neonatal deaths are caused by intrapartum events, most of which occur in resource poor settings. We aim to test the ‘double-hit’ hypothesis that maternal infection in the perinatal period predisposes to neurodevelopmental sequelae from an intrapartum asphyxia insult, increasing the likelihood of an early neonatal death compared with asphyxia alone. This is an observational study of singleton newborn infants with signs of intrapartum asphyxia that uses data from three previously conducted cluster randomized controlled trials taking place in rural Bangladesh and India. Methods From a population of 81,778 births in 54 community clusters in rural Bangladesh and India, we applied mixed effects logistic regression to data on 3890 singleton infants who had signs of intrapartum asphyxia, of whom 769 (20%) died in the early neonatal period. Poor infant condition at five minutes post-delivery was our proxy measure of intrapartum asphyxia. We had data for two markers of maternal infection: fever up to three days prior to labour, and prolonged rupture of membranes (PROM). Cause-specific verbal autopsy data were used to validate our findings using previously mentioned mixed effect logistic regression methods and the outcome of a neonatal death due to intrapartum asphyxia. Results Signs of maternal infection as indicated by PROM, combined with intrapartum asphyxia, increased the risk of an early neonatal death relative to intrapartum asphyxia alone (adjusted odds ratio (AOR) 1.28, 95% CI 1.03 – 1.59). Results from cause-specific verbal autopsy data verified our findings where there was a significantly increased odds of a early neonatal death due to intrapartum asphyxia in newborns exposed to both PROM and intrapartum asphyxia (AOR: 1.52, 95% CI 1.15 – 2.02). Conclusions Our data support the double-hit hypothesis for signs of maternal infection as indicated by

  9. Observational research on NCDs in HIV-positive populations: conceptual and methodological considerations.

    PubMed

    Petersen, Maya; Yiannoutsos, Constantin T; Justice, Amy; Egger, Matthias

    2014-09-01

    Noncommunicable diseases (NCDs) account for a growing burden of morbidity and mortality among people living with HIV in low- and middle-income countries (LMICs). HIV infection and antiretroviral therapy interact with NCD risk factors in complex ways, and research into this "web of causation" has so far been largely based on data from high-income countries. However, improving the understanding, treatment, and prevention of NCDs in LMICs requires region-specific evidence. Priority research areas include: (1) defining the burden of NCDs among people living with HIV, (2) understanding the impact of modifiable risk factors, (3) evaluating effective and efficient care strategies at individual and health systems levels, and (4) evaluating cost-effective prevention strategies. Meeting these needs will require observational data, both to inform the design of randomized trials and to replace trials that would be unethical or infeasible. Focusing on Sub-Saharan Africa, we discuss data resources currently available to inform this effort and consider key limitations and methodological challenges. Existing data resources often lack population-based samples; HIV-negative, HIV-positive, and antiretroviral therapy-naive comparison groups; and measurements of key NCD risk factors and outcomes. Other challenges include loss to follow-up, competing risk of death, incomplete outcome ascertainment and measurement of factors affecting clinical decision making, and the need to control for (time-dependent) confounding. We review these challenges and discuss strategies for overcoming them through augmented data collection and appropriate analysis. We conclude with recommendations to improve the quality of data and analyses available to inform the response to HIV and NCD comorbidity in LMICs.

  10. Addressing injecting drug use in Asia and Eastern Europe.

    PubMed

    Wu, Zunyou; Shi, Cynthia X; Detels, Roger

    2013-06-01

    While the global HIV incidence dropped about 20% in the past 10 years, HIV incidences among people who inject drugs (PWID) in Asia and Europe continue to increase and to account for high proportions of new HIV infections among PWID globally. Great changes have been observed in this region, such as progressing from rejection to acceptance of harm reduction strategies in Asian countries, but no such change has occurred in Eastern European countries. China has quickly scaled up harm reduction activities nationwide, resulting in the decline of HIV incidence and HIV prevalence among PWID since 2006. However, insufficient scaling up of harm reduction programs in other countries has failed to slow down their HIV epidemics. In Eastern European countries where the spread of HIV among PWID is the most severe, only about 15% of funding for harm reduction programs are from domestic sources. Strong political and financial commitment from countries in this region is urgently needed to quickly scale up evidence-based harm reduction strategies in order to prevent the HIV epidemic from spreading rapidly from PWID to the heterosexual general population.

  11. Comparison of Observed and Modeled Regional Scale Aerosol Characteristics for ACE-ASIA and TRACE-P

    NASA Astrophysics Data System (ADS)

    Kapustin, V.; Clarke, A.; Carmichael, G.; Tang, Y.; McNaughton, C.

    2002-12-01

    During spring of 2001 we measured aerosol physical, chemical and optical properties for Asian aerosol with our similar instrument sets [University of Hawaii] from two aircraft - the NASA P3-B (TRACE-P) and NSF C-130 (ACE-ASIA). Observed aerosol characteristics included aerosol number concentration, measured with Ultrafine Condensation Nuclei counter (UCN) and CN counters; size distributions, obtained from a radial differential mobility analyzer (RDMA), a laser optical particle counter (OPC), aerodynamic particle sizer (APS) and wing mounted probes; aerosol light scattering and absorption obtained from nephelometers and a Particle Soot Absorption Photometers (PSAP). On the C-130 a dry and humidified nephelometer was operated to measure humidity dependence of aerosol light scattering, f(RH). Size distributions and number concentrations were measured with thermal aerosol volatilization to infer particles volatility and refractory properties linked to dust and soot aerosol components. Here we compare these observations to results from the University of Iowa CFORS/STEM model of related aerosol characteristics during these measurement periods. This model includes a wide variety of aerosol chemical and optical properties - black and organic carbon (BC and OC), dust, sulfate concentrations and calculated aerosol optical depth. This comparison is based not only on case studies bur also on regional scale air mass characterization. To facilitate this comparison a set of scatter "signature" plots of measured aerosol parameters like f(RH) vs. fractional submicron aerosol surface area or submicron refractory volume vs. total aerosol absorption is used. This approach generates clusters of data characteristics for different air masses. The model shows a high degree of consistency in identifying the main features of biomass burning, urban/industrial pollution, and dust events. This combination of measured and modeled aerosol parameters is shown to be valuable in quantifying the

  12. Therapeutic Drug Monitoring of Lopinavir in HIV-Infected Children on Second-Line Antiretroviral Therapy in Asia.

    PubMed

    Aurpibul, Linda; Teerananchai, Sirinya; Prasitsuebsai, Wasana; Sudjaritruk, Tavitiya; Kosalaraksa, Pope; Kurniati, Nia; Truong, Khanh Huu; Do, Viet Chau; Nguyen, Lam Van; Chokephaibulkit, Kulkanya; Singtoroj, Thida; Kerr, Stephen J

    2016-12-01

    Failure rates of second-line boosted protease inhibitor antiretroviral therapy regimens in children rise over time. Therapeutic drug monitoring can contribute to assessments of adherence. The authors assessed the performance characteristics of the US DHHS-recommended lopinavir (LPV) concentration of 1.0 mg/L for predicting virologic failure (VF) and intermediate- to high-level LPV resistance in Asian children. LPV concentration, HIV RNA level, and adherence data from study participants in Thailand, Vietnam, and Indonesia receiving second-line LPV-based ART and followed for ≥24 weeks were analyzed. A total of 223 children at a median age of 10.4 (interquartile range, 7.9-13.4) years were enrolled, and 61% of them were male. Their mean CD4 was 842 ± 438 cells per cubic millimeter, and the median LPV duration was 2.5 (interquartile range, 1.3-4.2) years. Five of 84 (6%) and 18 of 139 (13%) children had LPV trough and random concentrations <1.0 mg/L at study week 24. Using either of these trough or random LPV concentrations, a cutoff at 1.0 mg/L gave an area under the receiver operating characteristics curve of 0.69 in predicting VF with sensitivity of 44% (95% CI 23-66) and specificity of 94% (95% CI 89-97). Seven of 21 with VF and resistance results available had ≥1 major protease inhibitor mutation. Multivariate logistic regression found LPV concentrations <1.0 mg/L (odds ratio, 6.47; 95% CI 2.15-19.50, P = 0.001) and CD4 ≤20% (odds ratio, 2.83; 95% CI 1.01-7.89, P = 0.05) were independently associated with HIV RNA >1000 copies per milliliter. No factors predicted major LPV resistance mutations. The authors support that the DHHS target LPV concentration of <1.0 mg/L is predictive of VF, but not of the presence of major LPV mutations.

  13. Horizontal motion in elastic response to seasonal loading of rain water in the Amazon Basin and monsoon water in Southeast Asia observed by GPS and inferred from GRACE

    NASA Astrophysics Data System (ADS)

    Fu, Yuning; Argus, Donald F.; Freymueller, Jeffrey T.; Heflin, Michael B.

    2013-12-01

    find seasonal horizontal crustal motions observed by GPS positioning in elastic response to heavy rainfall in the Amazon Basin and to monsoons in Southeast Asia to be consistent with those inferred from Gravity Recovery and Climate Experiment (GRACE) gravity observations of water mass loading. Solid Earth moves toward the Amazon during heavy spring rainfall and toward Southeast Asia during summer monsoons and back away from these areas 6 months later when the water load is minimum. Vertical oscillations observed by GPS and inferred from GRACE are 2 to 3 times larger than horizontal oscillation near the margins of the areas of large mass loading. Some discrepancies between GPS and GRACE are probably caused by local effects that influence GPS measurements, because the GPS sites that show significant discrepancies also do not match nearby GPS sites. However, when the load is short wavelength, the limited spatial resolution of GRACE can cause systematic misfits.

  14. An Observational, Prospective Survey Assessing the Control of Atrial Fibrillation in Asia Pacific: Rationale and Design of the RecordAF-AP Registry

    PubMed Central

    Amerena, John; Chen, Shih-Ann; Sriratanasathavorn, Charn; Cho, Jeong-Gwan; Dejia, Huang; Omar, Razali; Fat, Tse Hung; King, Anthony

    2011-01-01

    Background: The literature suggests that the prevalence of atrial fibrillation (AF) may be lower in Asian countries than in Western countries. Nevertheless, AF remains a significant public health problem in the region. The burden of AF, the experiences of previous trials and the lack of data on AF and its management in Asia Pacific highlight the need for a comprehensive prospective study of AF management. Methods: The REgistry on Cardiac rhythm disORDers assessing the control of Atrial Fibrillation Asia Pacific (RecordAF-AP) is a prospective, observational survey of the management of recently diagnosed AF patients with 1-year follow-up in 8 countries across Asia Pacific. Eligible patients presenting with AF, treated or not, will be included in the registry and data will be recorded prospectively during follow-up visits at 6 and 12 months. Results: RecordAF-AP will recruit more than 3000 patients. Study recruitment commenced in April 2009 and the final results anticipated at the end of 2011. Conclusions: RecordAF-AP will assess the real-life management of AF patients in Asia Pacific, including a comparison of clinical outcomes in rhythm versus rate control strategies, providing much needed insight into the costs, treatment choices and clinical outcomes of AF patients in this region. PMID:21344019

  15. Longitudinal characteristics of spread F backscatter plumes observed with the EAR and Sanya VHF radar in Southeast Asia

    NASA Astrophysics Data System (ADS)

    Li, Guozhu; Ning, Baiqi; Abdu, M. A.; Otsuka, Yuchi; Yokoyama, T.; Yamamoto, M.; Liu, Libo

    2013-10-01

    development of equatorial plasma irregularity plumes can be well recorded by steerable backscatter radars operated at and off the magnetic equator due to the fact that the vertically extended plume structures are tracers of magnetically north-south aligned larger scale structures. From observations during March 2012, using two low latitude steerable backscatter radars in Southeast Asia, the Equatorial Atmosphere Radar (EAR) (0.2°S, 100.3°E; dip lat 10.4°S) and the Sanya VHF radar (18.4°N, 109.6°E; dip lat 12.8°N), the characteristics of backscatter plumes over the two sites separated in longitude by ~1000 km were simultaneously investigated. The beam steering measurements reveal frequent occurrences of multiple plumes over both radar sites, of which two cases are analyzed here. The observations on 30 March 2012 show plume structures initiated within the radar scanned area, followed by others drifting from the west of the radar beam over both stations. A tracing analysis on the onset locations of plasma plumes reveals spatially well-separated backscatter plumes, with a maximum east-west wavelength of about 1000 km, periodically generated in longitudes between 85°E and 110°E. The postsunset backscatter plumes seen by the Sanya VHF radar are found to be due to the passage of sunset plumes initiated around the longitude of EAR. Most interestingly, the EAR measurements on the night of 21 March 2012 show multiple plume structures that developed successively in the radar scanned area with east-west separation of ~50 km, with however no sunset plasma plume over Sanya. Colocated ionogram measurements show that spread F irregularities occurred mainly in the bottomside F region at Sanya, whereas satellite traces in ionograms that are indications of large-scale wave structures were observed on that night at both stations. Possible causes for the longitudinal difference in the characteristics of radar backscatter plumes are discussed.

  16. Impacts of dust on regional tropospheric chemistry during the ACE-Asia experiment: A model study with observations

    NASA Astrophysics Data System (ADS)

    Tang, Youhua; Carmichael, Gregory R.; Kurata, Gakuji; Uno, Itsushi; Weber, Rodney J.; Song, Chul-Han; Guttikunda, Sarath K.; Woo, Jung-Hun; Streets, David G.; Wei, Cao; Clarke, Antony D.; Huebert, Barry; Anderson, Theodore L.

    2004-10-01

    A comprehensive regional-scale chemical transport model, Sulfur Transport and Emissions Model 2001 (STEM-2K1), is employed to study dust outflows and their influence on regional chemistry in the high-dust Asian Pacific Regional Aerosol Characterization Experiment (ACE-Asia) period, from 4-14 April 2001. In this period, dust storms are initialized in the Taklamagan and Gobi deserts because of cold air outbreaks, are transported eastward, and are often intensified by dust emitted from exposed soils as the front moves off the continent. Simulated dust agrees well with surface weather observations, satellite images, and the measurements of the C-130 aircraft. The C-130 aircraft observations of chemical constituents of the aerosol are analyzed for dust-rich and low-dust periods. In the submicron aerosol, dust-rich air masses have elevated ratios of ΔCa/ΔMg, ΔNH4+/ΔSO42-, and ΔNO3-/ΔCO (Δ represents the difference between observed and background concentrations). The impacts of heterogeneous reactions on dust involving O3, NO2, SO2, and HNO3 are studied by incorporating these reactions into the analysis. These reactions have significant influence on regional chemistry. For example, the low O3 concentrations in C-130 flight 6 can be explained only by the influence of heterogeneous reactions. In the near-surface layer, the modeled heterogeneous reactions indicated that O3, SO2, NO2, and HNO3 are decreased by up to 20%, 55%, 20%, and 95%, respectively, when averaged over this period. In addition, NO, HONO, and daytime OH can increase by 20%, 30%, and 4%, respectively, over polluted regions. When dust encounters fresh pollutants, these heterogeneous reactions can lead to a series of complex responses of the photochemical system. In addition, these reactions can alter the chemical-size distribution of the aerosol. Under heavy dust loadings, these reactions can lead to >20% of the sulfate and >70% of the nitrate being associated with the coarse fraction. The radiative

  17. Tongue Inspection in TCM: Observations in a Study Sample of Patients Living with HIV.

    PubMed

    Anastasi, Joyce K; Chang, Michelle; Quinn, Jessica; Capili, Bernadette

    2014-02-01

    Background: One of the principal diagnostic methods in Traditional Chinese Medicine (TCM) is the inspection of the tongue. This method involves examination of the shape, size, color, and texture of the tongue body and coat and helps reveal the state of organ functions and progression of conditions. Literature on tongue observations for patients who have human immunodeficiency virus (HIV) is minimal. Objective: The goal of this study was to provide a clinical "snapshot" of initial tongue assessments of 159 patients living with HIV, who participated in an acupuncture clinical trial for chronic nausea. The aim was to explore the similarities and differences observed in tongue assessments. Design: This study was part of a prospective, randomized, controlled, double-blinded (subjects and evaluators), parallel-groups, acupuncture clinical trial for treating chronic nausea. Setting: The study was conducted at a large urban New York City academic health center. Patients: The patients in this study were 159 individuals who had HIV infections and who had histories of chronic nausea for ≥3 months. Main Outcome Measures: Initial tongue assessments were recorded for seven basic characteristics: (1) tongue color; (2) tongue shape; (3) tongue body quality; (4) coat color; (5) coat weight; (6) coat surface; and (7) tongue action. Results: The overall tongue picture seen in these patients was that the tongue was swollen and toothmarked, had a pink body with cracks, and had a thick, dry white coat. Conclusions: The HIV disease itself and the use of long term medications affect the Blood, Qi, Yin, and Yang. The observation of the tongue provides a window into the process of the disease and, ultimately, insight for clinical care. This sample population snapshot illustrates the complex processes seen in long-term chronic conditions managed by pharmacologic medications.

  18. HIV multi-drug resistance at first-line antiretroviral failure and subsequent virological response in Asia

    PubMed Central

    Jiamsakul, Awachana; Sungkanuparph, Somnuek; Law, Matthew; Kantor, Rami; Praparattanapan, Jutarat; Li, Patrick CK; Phanuphak, Praphan; Merati, Tuti; Ratanasuwan, Winai; Lee, Christopher KC; Ditangco, Rossana; Mustafa, Mahiran; Singtoroj, Thida; Kiertiburanakul, Sasisopin

    2014-01-01

    Introduction First-line antiretroviral therapy (ART) failure often results from the development of resistance-associated mutations (RAMs). Three patterns, including thymidine analogue mutations (TAMs), 69 Insertion (69Ins) and the Q151M complex, are associated with resistance to multiple-nucleoside reverse transcriptase inhibitors (NRTIs) and may compromise treatment options for second-line ART. Methods We investigated patterns and factors associated with multi-NRTI RAMs at first-line failure in patients from The TREAT Asia Studies to Evaluate Resistance – Monitoring study (TASER-M), and evaluated their impact on virological responses at 12 months after switching to second-line ART. RAMs were compared with the IAS-USA 2013 mutations list. We defined multi-NRTI RAMs as the presence of either Q151M; 69Ins; ≥2 TAMs; or M184V+≥1 TAM. Virological suppression was defined as viral load (VL) <400 copies/ml at 12 months from switch to second-line. Logistic regression was used to analyze (1) factors associated with multi-NRTI RAMs at first-line failure and (2) factors associated with virological suppression after 12 months on second-line. Results A total of 105 patients from 10 sites in Thailand, Hong Kong, Indonesia, Malaysia and Philippines were included. There were 97/105 (92%) patients harbouring ≥1 RAMs at first-line failure, 39/105 with multi-NRTI RAMs: six with Q151M; 24 with ≥2 TAMs; and 32 with M184V+≥1 TAM. Factors associated with multi-NRTI RAMs were CD4 ≤200 cells/µL at genotyping (OR=4.43, 95% CI [1.59–12.37], p=0.004) and ART duration >2 years (OR=6.25, 95% CI [2.39–16.36], p<0.001). Among 87/105 patients with available VL at 12 months after switch to second-line ART, virological suppression was achieved in 85%. The median genotypic susceptibility score (GSS) for the second-line regimen was 2.00. Patients with ART adherence ≥95% were more likely to be virologically suppressed (OR=9.33, 95% CI (2.43–35.81), p=0.001). Measures of patient

  19. Attribution of observed hydrological changes and impacts of future climate change in glacierized mountain catchments in Central Asia

    NASA Astrophysics Data System (ADS)

    Duethmann, Doris; Menz, Christoph; Vorogushyn, Sergiy; Merz, Bruno; Kriegel, David; Bolch, Tobias; Pieczonka, Tino; Farinotti, Daniel; Jiang, Tong; Su, Buda; Güntner, Andreas

    2017-04-01

    High elevation areas in Central Asia currently undergo considerable changes. Trend analyses show that discharge in two headwater catchments of the Tarim River, Northwest China, increased by more than 30% over the past decades. While many studies focus on trend detection, understanding the causes of these changes, i.e. trend attribution, may be even more important. In this study, we first demonstrate the use of a simulation-based approach for attributing the observed streamflow increase to its possible causes. In a second step, we analyze the impact of future climate scenarios for these catchments. Particular attention was given to multiobjective and multivariable calibration, including daily streamflow variability, long-term streamflow changes, annual variability of glacier and regional glacier mass changes. The hydrological model thus allows us to evaluate whether the causes for the observed changes in discharge are also consistent with these data. The hydrological model considers transient reductions in glacier area and lowering of the glacier surface elevation resulting from sustained negative glacier mass balances. For trend attribution, we compare simulations with original and detrended temperature and precipitation series. In the catchment with a lower glacierization, temperature and precipitation increases were both important for the discharge increase. In the catchment with a higher glacier cover, discharge increases are predominantly attributed to temperature increases and related increases of glacier melt, indicating that the increased discharge originates to a considerable extent from loss of glacier storage. A major advantage of the simulation-based attribution approach is seen in the fact that it relies on process-based relationships. The climate impact analysis is based on hundreds of simulations runs that consider different GCMs, emission scenarios and hydrological model parameters. By 2100, projections show a reduction in glacier area by 28 to 89

  20. Assessing gaps in irrigated agricultural productivity through satellite earth observations-A case study of the Fergana Valley, Central Asia

    NASA Astrophysics Data System (ADS)

    Löw, Fabian; Biradar, Chandrashekhar; Fliemann, Elisabeth; Lamers, John P. A.; Conrad, Christopher

    2017-07-01

    Improving crop area and/or crop yields in agricultural regions is one of the foremost scientific challenges for the next decades. This is especially true in irrigated areas because sustainable intensification of irrigated crop production is virtually the sole means to enhance food supply and contribute to meeting food demands of a growing population. Yet, irrigated crop production worldwide is suffering from soil degradation and salinity, reduced soil fertility, and water scarcity rendering the performance of irrigation schemes often below potential. On the other hand, the scope for improving irrigated agricultural productivity remains obscure also due to the lack of spatial data on agricultural production (e.g. crop acreage and yield). To fill this gap, satellite earth observations and a replicable methodology were used to estimate crop yields at the field level for the period 2010/2014 in the Fergana Valley, Central Asia, to understand the response of agricultural productivity to factors related to the irrigation and drainage infrastructure and environment. The results showed that cropping pattern, i.e. the presence or absence of multi-annual crop rotations, and spatial diversity of crops had the most persistent effects on crop yields across observation years suggesting the need for introducing sustainable cropping systems. On the other hand, areas with a lower crop diversity or abundance of crop rotation tended to have lower crop yields, with differences of partly more than one t/ha yield. It is argued that factors related to the infrastructure, for example, the distance of farms to the next settlement or the density of roads, had a persistent effect on crop yield dynamics over time. The improvement potential of cotton and wheat yields were estimated at 5%, compared to crop yields of farms in the direct vicinity of settlements or roads. In this study it is highlighted how remotely sensed estimates of crop production in combination with geospatial technologies

  1. Asia: point of no return?

    PubMed

    1991-09-01

    Perhaps 1 million people in Asia are HIV positive (1% of the world's total). Even many more people are at risk since Asia has 50% of the world's population. Sexual transmission is the main mode of transmission. Yet people in Asia do not want to deal with sexual behavior. Thus high level political commitment is needed such has been done in Thailand which has set up a national AIDS committee. An AIDS expert predicts that by 1995 the number of HIV positive individuals in Asia will surpass the number of HIV positive individuals in all the developed countries. India, Myanmar, and Thailand where prostitution and intravenous (IV) drug use abounds (the Golden Triangle) suffer from the worst AIDS epidemics in the region. International sex tourism contributes greatly to both the heterosexual and homosexual spread of AIDS. In fact, the national AIDS committee in Thailand has begun a campaign to stop sex tourism, but as of September 1991, it had no effect. Further some sex businesses have attempted to stop the spread of AIDS. For example, 2 brothels in central Thailand have implemented a condom only policy for their clients. High rates of sexually transmitted diseases among prostitutes facilitate HIV transmission. This highlights the need for Asian countries to promote condom use. Not all of the Asian countries screen 100% of their blood and blood products. In fact, in India, commercial blood banks do not always screen donated blood since screening eats into their profits. Further unsterile needles are often used in medical facilities such as in India and Viet Nam. Hong Kong sells inexpensive sterile needles over the counter which may account for its low HIV positive rate among drug users. Despite the many problems in Asia which facilitate HIV transmission, tragedy can be averted if governments act at once.

  2. A novel approach to directly observed therapy for tuberculosis in an HIV-endemic area.

    PubMed Central

    Desvarieux, M; Hyppolite, P R; Johnson, W D; Pape, J W

    2001-01-01

    OBJECTIVES: This study evaluated a novel approach to the delivery of directly observed therapy (DOT) for tuberculosis in Haiti. METHODS: A total of 194 patients (152 HIV seropositive, 42 HIV seronegative) received daily unsupervised triple-drug therapy for 4 to 8 weeks, followed by twice-weekly 2-drug therapy for the remainder of the 6-month period. DOT was deferred until initiation of the twice-weekly phase. RESULTS: A total of 169 of 194 patients (87.1%) completed the 6-month course. The program of deferred DOT had an effectiveness of 85%. Overall cost was reduced by approximately 40%. CONCLUSIONS: Flexible approaches to DOT, integrating behavioral knowledge, cost considerations, and practicality may improve completion rates and program effectiveness. PMID:11189809

  3. An observational study of comorbidity and healthcare utilisation among HIV-positive patients aged 50 years and over.

    PubMed

    Patel, Roshani; Moore, Thomas; Cooper, Vanessa; McArdle, Conor; Perry, Nicky; Cheek, Elizabeth; Gainsborough, Nicola; Fisher, Martin

    2016-07-01

    The number of HIV-positive people aged ≥50 years is rising each year. We measured the prevalence of non-infectious illnesses and their risk factors and described healthcare use in this UK population. A cross-sectional, observational study was conducted at an outpatient HIV specialist clinic in south east England. Patients age ≥50 years were invited to complete questionnaires measuring demographics, non-infectious illnesses, medication use, lifestyle and healthcare utilisation. The response rate was 67%. Of 299 participants, 84% reported ≥1 comorbid condition and 61% reported ≥2 (multimorbidity). Most commonly reported were high cholesterol, sexual dysfunction, hypertension and depression. In multivariate analyses, age, number of years HIV-positive and duration of antiretroviral therapy remained significant predictors of comorbidity when controlling for lifestyle factors (exercise, smoking and use of recreational drugs and alcohol). Use of non-HIV healthcare services was associated with increasing comorbidity, a longer duration of HIV and recreational drug use. The majority of HIV-patients aged ≥50 years reported multiple comorbidities and this was associated with polypharmacy and increased use of non-HIV services. Further research examining the quality, safety and patient experience of healthcare is needed to inform development of services to optimally meet the needs of older HIV-positive patients.

  4. Determinants of suicide and accidental or violent death in the Australian HIV Observational Database.

    PubMed

    McManus, Hamish; Petoumenos, Kathy; Franic, Teo; Kelly, Mark D; Watson, Jo; O'Connor, Catherine C; Jeanes, Mark; Hoy, Jennifer; Cooper, David A; Law, Matthew G

    2014-01-01

    Rates of suicide and accidental or violent death remain high in HIV-positive populations despite significantly improved prognosis since the introduction of cART. We conducted a nested case-control study of suicide and accidental or violent death in the Australian HIV Observational Database (AHOD) between January 1999 and March 2012. For each case, 2 controls were matched by clinic, age, sex, mode of exposure and HIV-positive date to adjust for potential confounding by these covariates. Risk of suicide and accidental or violent death was estimated using conditional logistic regression. We included 27 cases (17 suicide and 10 violent/accidental death) and 54 controls. All cases were men who have sex with men (MSM) or MSM/ injecting drug use (IDU) mode of exposure. Increased risk was associated with unemployment (Odds Ratio (OR) 5.86, 95% CI: 1.69-20.37), living alone (OR 3.26, 95% CI: 1.06-10.07), suicidal ideation (OR 6.55, 95% CI: 1.70-25.21), and >2 psychiatric/cognitive risk factors (OR 4.99, 95% CI: 1.17-30.65). CD4 cell count of >500 cells/µL (OR 0.25, 95% CI: 0.07-0.87) and HIV-positive date ≥1990 (1990-1999 (OR 0.31, 95% CI: 0.11-0.89), post-2000 (OR 0.08, 95% CI: 0.01-0.84)) were associated with decreased risk. CD4 cell count ≥500 cells/µL remained a significant predictor of reduced risk (OR 0.15, 95% CI: 0.03-0.70) in a multivariate model adjusted for employment status, accommodation status and HIV-positive date. After adjustment for psychosocial factors, the immunological status of HIV-positive patients contributed to the risk of suicide and accidental or violent death. The number of psychiatric/cognitive diagnoses contributed to the level of risk but many psychosocial factors were not individually significant. These findings indicate a complex interplay of factors associated with risk of suicide and accidental or violent death.

  5. Institutionalizing provider-initiated HIV testing and counselling for children: an observational case study from Zambia.

    PubMed

    Mutanga, Jane N; Raymond, Juliette; Towle, Megan S; Mutembo, Simon; Fubisha, Robert Captain; Lule, Frank; Muhe, Lulu

    2012-01-01

    Provider-initiated testing and counselling (PITC) is a priority strategy for increasing access for HIV-exposed children to prevention measures, and infected children to treatment and care interventions. This article examines efforts to scale-up paediatric PITC at a second-level hospital located in Zambia's Southern Province, and serving a catchment area of 1.2 million people. Our retrospective case study examined best practices and enabling factors for rapid institutionalization of PITC in Livingstone General Hospital. Methods included clinical observations, key informant interviews with programme management, and a desk review of hospital management information systems (HMIS) uptake data following the introduction of PITC. After PITC roll-out, the hospital experienced considerably higher testing uptake. In a 36-month period following PITC institutionalization, of total inpatient children eligible for PITC (n = 5074), 98.5% of children were counselled, and 98.2% were tested. Of children tested (n = 4983), 15.5% were determined HIV-infected; 77.6% of these results were determined by DNA polymerase chain reaction (PCR) testing in children under the age of 18 months. Of children identified as HIV-infected in the hospital's inpatient and outpatient departments (n = 1342), 99.3% were enrolled in HIV care, including initiation on co-trimoxazole prophylaxis. A number of good operational practices and enabling factors in the Livingstone General Hospital experience can inform rapid PITC institutionalization for inpatient and outpatient children. These include the placement of full-time nurse counsellors at key areas of paediatric intake, who interface with patients immediately and conduct testing and counselling. They are reinforced through task-shifting to peer counsellors in the wards. Nurse counsellor capacity to draw specimen for DNA PCR for children under 18 months has significantly enhanced early infant diagnosis. The hospital's bolstered antiretroviral

  6. Institutionalizing Provider-Initiated HIV Testing and Counselling for Children: An Observational Case Study from Zambia

    PubMed Central

    Mutanga, Jane N.; Raymond, Juliette; Towle, Megan S.; Mutembo, Simon; Fubisha, Robert Captain; Lule, Frank; Muhe, Lulu

    2012-01-01

    Background Provider-initiated testing and counselling (PITC) is a priority strategy for increasing access for HIV-exposed children to prevention measures, and infected children to treatment and care interventions. This article examines efforts to scale-up paediatric PITC at a second-level hospital located in Zambia’s Southern Province, and serving a catchment area of 1.2 million people. Methods and Principal Findings Our retrospective case study examined best practices and enabling factors for rapid institutionalization of PITC in Livingstone General Hospital. Methods included clinical observations, key informant interviews with programme management, and a desk review of hospital management information systems (HMIS) uptake data following the introduction of PITC. After PITC roll-out, the hospital experienced considerably higher testing uptake. In a 36-month period following PITC institutionalization, of total inpatient children eligible for PITC (n = 5074), 98.5% of children were counselled, and 98.2% were tested. Of children tested (n = 4983), 15.5% were determined HIV-infected; 77.6% of these results were determined by DNA polymerase chain reaction (PCR) testing in children under the age of 18 months. Of children identified as HIV-infected in the hospital’s inpatient and outpatient departments (n = 1342), 99.3% were enrolled in HIV care, including initiation on co-trimoxazole prophylaxis. A number of good operational practices and enabling factors in the Livingstone General Hospital experience can inform rapid PITC institutionalization for inpatient and outpatient children. These include the placement of full-time nurse counsellors at key areas of paediatric intake, who interface with patients immediately and conduct testing and counselling. They are reinforced through task-shifting to peer counsellors in the wards. Nurse counsellor capacity to draw specimen for DNA PCR for children under 18 months has significantly enhanced early infant

  7. Efficacy and safety of thrice weekly DOTS in tuberculosis patients with and without HIV co-infection: an observational study

    PubMed Central

    2013-01-01

    Background Despite the latest World Health Organization guidelines advocating daily therapy in HIV-TB co-infected individuals, there are few recent studies comparing outcomes of thrice-weekly anti-tuberculosis treatment in HIV-positive and HIV-negative patients with TB. The present study sets out to compare TB treatment outcomes in these two groups in the Indian national programme, which currently involves thrice-weekly therapy for all, regardless of HIV status. Methods HIV-positive and HIV-negative were consecutively screened for enrolment into this prospective observational study, carried out at the All India Institute of Medical Sciences hospital, New Delhi, India, between 2006 and 2010. Patients were given short-course thrice-weekly rifampicin-based therapy, with all HIV-positive patients being started on highly active antiretroviral therapy at least 14 days after commencing TB treatment. Patients were regularly followed-up for 24 months after completion of treatment. Results 150 HIV-positive, 155 HIV-negative patients were enrolled consecutively for the study. Significantly higher treatment success (93.5% vs. 76.7% at end of treatment, p < 0.001) and lower mortality (2.8% vs. 21.6% on follow up, p < 0.001) were observed in HIV-negative patients. No significant difference was found in treatment failure (p = 0.16), sputum smear (p = 0.58) and culture conversion (p = 0.55), and non-serious adverse event incidence (p = 0.851) between the two groups. Low baseline CD4 cell count (<100 cells/ mm3) was the only predictor of mortality in HIV-TB patients (odds ratio 8 · 43, p = 0 · 013). Conclusions Thrice-weekly anti-tuberculosis therapy is more effective in HIV-negative than in HIV-positive patients. However, outcomes in this HIV co-infected cohort were found to be similar to those reported previously with daily therapy, with no safety concerns. This should prompt further study into whether intermittent or daily therapy should be

  8. An effective tool for identifying HIV-1 subtypes B, C, CRF01_AE, their recombinant forms, and dual infections in Southeast Asia by the multi-region subtype specific PCR (MSSP) assay.

    PubMed

    Sakkhachornphop, Supachai; Kijak, Gustavo H; Beyrer, Chris; Razak, Myat Htoo; Sanders-Buell, Eric; Jittiwutikarn, Jaroon; Suriyanon, Vinai; Robb, Merlin L; Kim, Jerome H; Celentano, David D; McCutchan, Francine E; Tovanabutra, Sodsai

    2015-06-01

    The RV144 Thai vaccine trial has been the only vaccine study to show efficacy in preventing HIV infection. Ongoing molecular surveillance of HIV-1 in Southeast Asia is vital for vaccine development and evaluation. In this study a novel tool, the multi-region subtype specific PCR (MSSP) assay, that was able to identify subtypes B, C, CRF01_AE for Thailand, other Southeast Asian countries, India and China is described. The MSSP assay is based on a nested PCR strategy and amplifies eight short regions distributed along the HIV-1 genome using subtype-specific primers. A panel of 41 clinical DNA samples obtained primarily from opiate users in northern Thailand was used to test the assay performance. The MSSP assay provided 73-100% sensitivity and 100% specificity for the three subtypes in each genome region. The assay was then field-tested on 337 sera from HIV infected northern Thai drug users collected between 1999 and 2002. Subtype distribution was CRF01_AE 77.4% (n=261), subtype B 3.3% (n=11), CRF01_AE/B recombinant 12.2% (n=41), CRF01_AE/C recombinant 0.6% (n=2), and non-typeable 6.5% (n=22). The MSSP assay is a simple, cost-effective, and accurate genotyping tool for laboratory settings with limited resources and is sensitive enough to capture the recombinant genomes and dual infections.

  9. Theory, method, and power in drug and HIV-prevention research: a participant-observer's critique.

    PubMed

    Bourgois, P

    1999-12-01

    Why do most substance misuse and HIV-prevention researchers not practice what they preach concerning the complementarity of quantitative and qualitative methods? Why does most of the public health literature fail to address the important intellectual and political debates that substance misuse and HIV infection confronts? Why is the entire field so timid with respect to social science theory? Most drug researchers, and virtually all the anthropologists working on the subject, publicly acknowledge the need to combine quantitative and qualitative methodologies. Surprisingly, however, there are almost no successful examples of substance misuse and HIV prevention research projects that meld quantitative methods with participant-observation approaches organically. While this methodological schism also holds true for most of the social sciences more broadly, in few other fields besides that of substance misuse research is the complementarity of quantitative and qualitative methods more urgently and obviously necessary. On the one hand this methodological dialogue has practical utility for creating better public health interventions that might relieve human suffering; and on the other hand this applied dialogue has the potential for a critical, multidisciplinary, theoretical impact on academia.

  10. Alkalization of yellow sand and its long-term effects on acid rain in East Asia: Observed Evidence and Simulation

    NASA Astrophysics Data System (ADS)

    Wang, Z.; Uno, I.; Akimoto, H.

    2001-05-01

    Acid rain has been one of the serious environmental problems in East Asia for the rapid industrialization in the last two decades. The contour line of pH value less than 5 has come up to the Yellow River region (35 deg N) from the southern China bounded by the Yangtze River (25 deg N) during these ten years. The objective of EANET ( Acid Deposition Moniroring Network in East Asia) is to create a common understanding of the state of the acid deposition problems in East Asia. There are 38 monitoring sites for wet deposition monitoring and data was collected since January 1999. The analysis of datasets in 1999 shows that aerosol has alkalization effects on pH of rain, especially in spring. An Air Quality Prediction Modeling System (AQPMS) was used to investigate the neutralization of acid rain by the yellow-sand in East Asia. The AQPMS includes all the major processes such as emission, advection, diffusion, chemistry, dry deposition, wet deposition and micro-physical processes. A new deflation module for the dust uptake is designed to estimate the dust loading (Wang et. al.,2000). The gas-phase chemical reaction scheme is a slightly modified version of the CBM-IV. Changes in trace species concentrations due to chemical reactions of soluble and reactive gases in in-cloud and below-cloud droplets are computed using a box aqueous chemical model. Numerical simulation was performed for two cases, that is, with and without the neutralization effects of Kosa in 1999. The predicted pH values and sulfate- and nitrate-ion levels of precipitation, together with the surface concentrations of gaseous pollutants, were compared with measured datasets of EANET and a reasonable agreement was obtained. The simulation results of 1999 exhibited a strong neutralization of the precipitation by the yellow-sand in the spring. The aerosol has alkalization effects on pH of rain, which reduces the H+ of rain.

  11. Characteristics and comprehensiveness of adult HIV care and treatment programmes in Asia-Pacific, sub-Saharan Africa and the Americas: results of a site assessment conducted by the International epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration

    PubMed Central

    Duda, Stephany N; Farr, Amanda M; Lindegren, Mary Lou; Blevins, Meridith; Wester, C William; Wools-Kaloustian, Kara; Ekouevi, Didier K; Egger, Matthias; Hemingway-Foday, Jennifer; Cooper, David A; Moore, Richard D; McGowan, Catherine C; Nash, Denis

    2014-01-01

    Introduction HIV care and treatment programmes worldwide are transforming as they push to deliver universal access to essential prevention, care and treatment services to persons living with HIV and their communities. The characteristics and capacity of these HIV programmes affect patient outcomes and quality of care. Despite the importance of ensuring optimal outcomes, few studies have addressed the capacity of HIV programmes to deliver comprehensive care. We sought to describe such capacity in HIV programmes in seven regions worldwide. Methods Staff from 128 sites in 41 countries participating in the International epidemiologic Databases to Evaluate AIDS completed a site survey from 2009 to 2010, including sites in the Asia-Pacific region (n=20), Latin America and the Caribbean (n=7), North America (n=7), Central Africa (n=12), East Africa (n=51), Southern Africa (n=16) and West Africa (n=15). We computed a measure of the comprehensiveness of care based on seven World Health Organization-recommended essential HIV services. Results Most sites reported serving urban (61%; region range (rr): 33–100%) and both adult and paediatric populations (77%; rr: 29–96%). Only 45% of HIV clinics that reported treating children had paediatricians on staff. As for the seven essential services, survey respondents reported that CD4+ cell count testing was available to all but one site, while tuberculosis (TB) screening and community outreach services were available in 80 and 72%, respectively. The remaining four essential services – nutritional support (82%), combination antiretroviral therapy adherence support (88%), prevention of mother-to-child transmission (PMTCT) (94%) and other prevention and clinical management services (97%) – were uniformly available. Approximately half (46%) of sites reported offering all seven services. Newer sites and sites in settings with low rankings on the UN Human Development Index (HDI), especially those in the President's Emergency Plan

  12. Characteristics and comprehensiveness of adult HIV care and treatment programmes in Asia-Pacific, sub-Saharan Africa and the Americas: results of a site assessment conducted by the International epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration.

    PubMed

    Duda, Stephany N; Farr, Amanda M; Lindegren, Mary Lou; Blevins, Meridith; Wester, C William; Wools-Kaloustian, Kara; Ekouevi, Didier K; Egger, Matthias; Hemingway-Foday, Jennifer; Cooper, David A; Moore, Richard D; McGowan, Catherine C; Nash, Denis

    2014-01-01

    HIV care and treatment programmes worldwide are transforming as they push to deliver universal access to essential prevention, care and treatment services to persons living with HIV and their communities. The characteristics and capacity of these HIV programmes affect patient outcomes and quality of care. Despite the importance of ensuring optimal outcomes, few studies have addressed the capacity of HIV programmes to deliver comprehensive care. We sought to describe such capacity in HIV programmes in seven regions worldwide. Staff from 128 sites in 41 countries participating in the International epidemiologic Databases to Evaluate AIDS completed a site survey from 2009 to 2010, including sites in the Asia-Pacific region (n=20), Latin America and the Caribbean (n=7), North America (n=7), Central Africa (n=12), East Africa (n=51), Southern Africa (n=16) and West Africa (n=15). We computed a measure of the comprehensiveness of care based on seven World Health Organization-recommended essential HIV services. Most sites reported serving urban (61%; region range (rr): 33-100%) and both adult and paediatric populations (77%; rr: 29-96%). Only 45% of HIV clinics that reported treating children had paediatricians on staff. As for the seven essential services, survey respondents reported that CD4+ cell count testing was available to all but one site, while tuberculosis (TB) screening and community outreach services were available in 80 and 72%, respectively. The remaining four essential services - nutritional support (82%), combination antiretroviral therapy adherence support (88%), prevention of mother-to-child transmission (PMTCT) (94%) and other prevention and clinical management services (97%) - were uniformly available. Approximately half (46%) of sites reported offering all seven services. Newer sites and sites in settings with low rankings on the UN Human Development Index (HDI), especially those in the President's Emergency Plan for AIDS Relief focus countries

  13. Structural modeling of Vpu from HIV-1 based on solid-state NMR observables

    NASA Astrophysics Data System (ADS)

    Ahn, SeonJoo; Lim, GyuTae; Nam, Seungyoon; Lee, Jinhyuk

    2014-04-01

    Vpu is one of the accessory proteins of HIV-1, and is involved in viral particle release. Viral particle release is enhanced by two proposed functions of Vpu: (i) tetherin interaction and (ii) membrane polarization. Two Vpu functions in viral particle release are still controversial. Here, we investigated the proposed functions by extensive structural modeling of Vpu based on solid-state NMR (Nuclear Magnetic Resonance) observables. We found that Vpu can co-exist in two structural forms: left-handed and right-handed conformation. The co-existence of the two conformations provides a clue to reconcile the controversial issue of its two functions in virus particle release.

  14. Lack of Sexual Minorities' Rights as a Barrier to HIV Prevention Among Men Who Have Sex with Men and Transgender Women in Asia: A Systematic Review.

    PubMed

    Anderson, James E; Kanters, Steve

    2015-03-01

    This study set out to assess the relationship between variation in human rights for sexual minorities in Asian countries and indicators of HIV prevention among men who have sex with men (MSM) and transgender women. To quantitatively measure the relationship between variation in HIV prevention and variation in human rights for sexual minorities, this study developed the Sexual Orientation and Gender Identity (SOGI) Human Rights Index (an original index with scores ranging from 0.0 to 1.0). Subsequently, this study collected 237 epidemiological and behavioral studies from 22 Asian countries and performed a series of meta-analyses in order to calculate national averages for five indicators of HIV prevention: HIV prevalence, inconsistent condom use, recent HIV testing, adequate HIV knowledge, and exposure to HIV prevention services. A change of human rights for sexual minorities from a score of 0.0 to 1.0 as measured by the SOGI Human Rights Index was correlated with a decrease in unprotected anal intercourse by 25.5% (p=0.075), and increases in recent HIV testing by 42.9% (p=0.011), HIV knowledge by 29.5% (p=0.032), and exposure to HIV prevention services by 37.9% (p=0.119). The relationship between HIV prevalence and variation in human rights for sexual minorities was not statistically significant. Our study found correlations between human rights and indicators of HIV prevention, further supporting the need for increased rights among marginalized populations. The paucity of studies from many Asian countries as well as the disparity in how indicators of HIV prevention are measured reveals a need for increased coverage and standardization of MSM serological and behavioral data in order to better inform evidence-based policymaking.

  15. Field Evaluation of Dried Blood Spots for Routine HIV-1 Viral Load and Drug Resistance Monitoring in Patients Receiving Antiretroviral Therapy in Africa and Asia

    PubMed Central

    Monleau, Marjorie; Eymard-Duvernay, Sabrina; Dagnra, Anoumou; Kania, Dramane; Ngo-Giang-Huong, Nicole; Touré-Kane, Coumba; Truong, Lien X. T.; Chaix, Marie-Laure; Delaporte, Eric; Ayouba, Ahidjo; Peeters, Martine

    2014-01-01

    Dried blood spots (DBS) can be used in developing countries to alleviate the logistic constraints of using blood plasma specimens for viral load (VL) and HIV drug resistance (HIVDR) testing, but they should be assessed under field conditions. Between 2009 and 2011, we collected paired plasma-DBS samples from treatment-experienced HIV-1-infected adults in Burkina Faso, Cameroon, Senegal, Togo, Thailand, and Vietnam. The DBS were stored at an ambient temperature for 2 to 4 weeks and subsequently at −20°C before testing. VL testing was performed on the plasma samples and DBS using locally available methods: the Abbott m2000rt HIV-1 test, generic G2 real-time PCR, or the NucliSENS EasyQ version 1.2 test. In the case of virological failure (VF), i.e., a plasma VL of ≥1,000 copies/ml, HIVDR genotyping was performed on paired plasma-DBS samples. Overall, we compared 382 plasma-DBS sample pairs for DBS VL testing accuracy. The sensitivities of the different assays in different laboratories for detecting VF using DBS varied from 75% to 100% for the m2000rt test in labs B, C, and D, 91% to 93% for generic G2 real-time PCR in labs A and F, and 85% for the NucliSENS test in lab E. The specificities varied from 82% to 97% for the m2000rt and NucliSENS tests and reached only 60% for the generic G2 test. The NucliSENS test showed good agreement between plasma and DBS VL but underestimated the DBS VL. The lowest agreement was observed for the generic G2 test. Genotyping was successful for 96/124 (77%) DBS tested, and 75/96 (78%) plasma-DBS pairs had identical HIVDR mutations. Significant discrepancies in resistance interpretations were observed in 9 cases, 6 of which were from the same laboratory. DBS can be successfully used as an alternative to blood plasma samples for routine VL and HIVDR monitoring in African and Asian settings. However, the selection of an adequate VL measurement method and the definition of the VF threshold should be considered, and laboratory

  16. Observation of HIV-1 Nucleocapsid Protein induced TAR DNA melting at the single molecule level

    NASA Astrophysics Data System (ADS)

    Cosa, Gonzalo; Harbron, Elizabeth; O'Connor, Donald; Musier-Forsyth, Karin; Barbara, Paul

    2003-03-01

    Reverse transcription of the HIV-1 RNA genome involves several nucleic acid rearrangement steps, and the HIV-1 nucleocapsid protein (NC) plays a key role in this process. NC is a nucleic acid chaperone protein, which facilitates the formation of the most stable nucleic acid structures. Single molecule fluorescence resonance energy transfer (SM-FRET) measurements enable us to observe the NC-induced conformational fluctuations of a transactivation response region (TAR) DNA hairpin, which is part of the initial product of reverse transcription known as minus-strand strong-stop DNA. SM-FRET studies show that the majority of conformational fluctuations of the fluorescently-labeled TAR DNA hairpin in the presence of NC occur in <100 ms. A single molecule explores a wide range of confomations unpon NC binding, with fluctuations encompassing as many as 40 bases in both arms of the hairpin. No conformational fluctuations are observed with the dye-labeled TAR DNA hairpin in the absence of NC or when a labeled TAR DNA hairpin variant lacking bulges and internal loops is analyzed in the presence of NC. This study represents the first real-time observation of NC-mediated nucleic acid conformational fluctuations, revealing new insights into NC's nucleic acid chaperone activity.

  17. Directly observed therapy for the management of HIV-infected patients in a methadone program.

    PubMed

    Conway, Brian; Prasad, Jennie; Reynolds, Robert; Farley, John; Jones, Michelle; Jutha, Salima; Smith, Nadine; Mead, Annabel; DeVlaming, Stanley

    2004-06-01

    The objective of this prospective, observational clinical study was to evaluate the safety and efficacy of once-daily and twice-daily directly observed therapy (DOT) in human immunodeficiency virus (HIV)-infected patients undergoing methadone treatment. Methadone and highly active antiretroviral therapy (HAART) were dispensed daily as DOT, with patients in the twice-daily HAART group self-administering the second dose. Clinical and laboratory end points were monitored, along with the impact of ongoing cocaine use. We studied 54 patients coinfected with HIV and hepatitis C virus. At baseline, the median virus load was 111,000 copies/mL, and the median CD4+ cell count was 165 cells/mm3. After a median of 24 months, 17 of 29 patients in the once-daily HAART group and 18 of 25 in the twice-daily HAART group had virus loads of <400 copies/mL, regardless of ongoing cocaine use. Thirty-two patients required methadone dose adjustment, which was managed without modification of HAART. Treatment-limiting hepatic toxicity was rare. A DOT program of coadministered methadone and HAART can be implemented with good results, even for patients who continue to use cocaine.

  18. Loss to follow-up in the Australian HIV Observational Database

    PubMed Central

    McManus, Hamish; Petoumenos, Kathy; Brown, Katherine; Baker, David; Russell, Darren; Read, Tim; Smith, Don; Wray, Lynne; Giles, Michelle; Hoy, Jennifer; Carr, Andrew; Law, Matthew

    2015-01-01

    Background Loss to follow-up (LTFU) in HIV-positive cohorts is an important surrogate for interrupted clinical care which can potentially influence the assessment of HIV disease status and outcomes. After preliminary evaluation of LTFU rates and patient characteristics, we evaluated the risk of mortality by LTFU status in a high resource setting. Methods Rates of LTFU were measured in the Australian HIV Observational Database for a range of patient characteristics. Multivariate repeated measures regression methods were used to identify determinants of LTFU. Mortality by LTFU status was ascertained using linkage to the National Death Index. Survival following combination antiretroviral therapy initiation was investigated using the Kaplan-Meier (KM) method and Cox proportional hazards models. Results Of 3,413 patients included in this analysis, 1,632 (47.8%) had at least one episode of LTFU after enrolment. Multivariate predictors of LTFU included viral load (VL)>10,000 copies/ml (Rate ratio (RR) 1.63 (95% confidence interval (CI):1.45–1.84) (ref ≤400)), time under follow-up (per year) (RR 1.03 (95% CI: 1.02–1.04)) and prior LTFU (per episode) (RR 1.15 (95% CI: 1.06–1.24)). KM curves for survival were similar by LTFU status (p=0.484). LTFU was not associated with mortality in Cox proportional hazards models (univariate hazard ratio (HR) 0.93 (95% CI: 0.69–1.26) and multivariate HR 1.04 (95% CI: 0.77–1.43)). Conclusions Increased risk of LTFU was identified amongst patients with potentially higher infectiousness. We did not find significant mortality risk associated with LTFU. This is consistent with timely re-engagement with treatment, possibly via high levels of unreported linkage to other health care providers. PMID:25377928

  19. Directly observed therapy (DOT) for nonadherent HIV-infected youth: lessons learned, challenges ahead.

    PubMed

    Gaur, Aditya H; Belzer, Marvin; Britto, Paula; Garvie, Patricia A; Hu, Chengcheng; Graham, Bobbie; Neely, Michael; McSherry, George; Spector, Stephen A; Flynn, Patricia M

    2010-09-01

    Adherence to medications is critical to optimizing HIV care and is a major challenge in youth. The utility of directly observed therapy (DOT) to improve adherence in youth with HIV remains undefined and prompted this pilot study. Four U.S. sites were selected for this 24-week cooperative group study to assess feasibility and to identify the logistics of providing DOT to HIV-infected youth with demonstrated adherence problems. Once-a-day DOT was provided by DOT facilitators at the participant's choice of a community-based location and DOT tapered over 12 weeks to self-administered therapy based on ongoing adherence assessments. Twenty participants, median age 21 years and median CD4 227 cells/microl, were enrolled. Participants chose their homes for 82% of DOT visits. Compliance with recommended DOT visits was (median) 91%, 91%, and 83% at weeks 4, 8, and 12, respectively. Six participants completed >90% of the study-specified DOT visits and successfully progressed to self-administered therapy (DOT success); only half sustained >90% medication adherence 12 weeks after discontinuing DOT. Participants considered DOT successes were more likely to have higher baseline depression scores (p = 0.046). Via exit surveys participants reported that meeting with the facilitator was easy, DOT increased their motivation to take medications, they felt sad when DOT ended, and 100% would recommend DOT to a friend. In conclusion, this study shows that while community-based DOT is safe, feasible, and as per participant feedback, acceptable to youth, DOT is not for all and the benefits appear short-lived. Depressed youth appear to be one subgroup that would benefit from this intervention. Study findings should help inform the design of larger community-based DOT intervention studies in youth.

  20. Comparing modelled predictions of neonatal mortality impacts using LiST with observed results of community-based intervention trials in South Asia.

    PubMed

    Friberg, Ingrid K; Bhutta, Zulfiqar A; Darmstadt, Gary L; Bang, Abhay; Cousens, Simon; Baqui, Abdullah H; Kumar, Vishwajeet; Walker, Neff; Lawn, Joy E

    2010-04-01

    There is an increasing body of evidence from trials suggesting that major reductions in neonatal mortality are possible through community-based interventions. Since these trials involve packages of varying content, determining how much of the observed mortality reduction is due to specific interventions is problematic. The Lives Saved Tool (LiST) is designed to facilitate programmatic prioritization by modelling mortality reductions related to increasing coverage of specific interventions which may be combined into packages. To assess the validity of LiST outputs, we compared predictions generated by LiST with observed neonatal mortality reductions in trials of packages which met inclusion criteria but were not used as evidence inputs for LiST. Four trials, all from South Asia, met the inclusion criteria. The neonatal mortality rate (NMR) predicted by LiST matched the observed rate very closely in two effectiveness-type trials. LiST predicted NMR reduction was close (absolute difference <5/1000 live births) in a third study. The NMR at the end of the fourth study (Shivgarh, India) was overestimated by 39% or 16/1000 live births. These results suggest that LiST is a reasonably reliable tool for use by policymakers to prioritize interventions to reduce neonatal deaths, at least in South Asia and where empirical data are unavailable. Reasons for the underestimated reduction in one trial likely include the inability of LiST to model all effective interventions.

  1. Comparing modelled predictions of neonatal mortality impacts using LiST with observed results of community-based intervention trials in South Asia

    PubMed Central

    Friberg, Ingrid K; Bhutta, Zulfiqar A; Darmstadt, Gary L; Bang, Abhay; Cousens, Simon; Baqui, Abdullah H; Kumar, Vishwajeet; Walker, Neff; Lawn, Joy E

    2010-01-01

    Background There is an increasing body of evidence from trials suggesting that major reductions in neonatal mortality are possible through community-based interventions. Since these trials involve packages of varying content, determining how much of the observed mortality reduction is due to specific interventions is problematic. The Lives Saved Tool (LiST) is designed to facilitate programmatic prioritization by modelling mortality reductions related to increasing coverage of specific interventions which may be combined into packages. Methods To assess the validity of LiST outputs, we compared predictions generated by LiST with observed neonatal mortality reductions in trials of packages which met inclusion criteria but were not used as evidence inputs for LiST. Results Four trials, all from South Asia, met the inclusion criteria. The neonatal mortality rate (NMR) predicted by LiST matched the observed rate very closely in two effectiveness-type trials. LiST predicted NMR reduction was close (absolute difference <5/1000 live births) in a third study. The NMR at the end of the fourth study (Shivgarh, India) was overestimated by 39% or 16/1000 live births. Conclusions These results suggest that LiST is a reasonably reliable tool for use by policymakers to prioritize interventions to reduce neonatal deaths, at least in South Asia and where empirical data are unavailable. Reasons for the underestimated reduction in one trial likely include the inability of LiST to model all effective interventions. PMID:20348113

  2. [Disseminated infection due to Penicillium marneffei related to HIV infection: first observation in Argentina].

    PubMed

    Santiso, Gabriela; Chediak, Viviana; Maiolo, Elena; Mujica, María T; San Juan, Jorge; Arechavala, Alicia; Negroni, Ricardo

    2011-01-01

    The first case observed in Argentina of AIDS-related human penicillosis is herein presented. The patient was a six- teen year-old young man coming from a rural area of southern China. He was admitted at the F. J. Muñiz Hospital of Buenos Aires city with severe pneumonia and adult respiratory distress. Penicillium marneffei was isolated from bronchoalveolar lavage fuid and was microscopically observed in a skin cytodiagnosis. P. marneffei identification was confirmed by rRNA amplification and its phenotypic characteristics. The patient suffered an advanced HIV infection and also presented several AIDS-related diseases due to CMV, nosocomial bacterial infections and Pneumocystis jirovecii which led to a fatal outcome.

  3. Adverse outcome analyses of observational data: assessing cardiovascular risk in HIV disease.

    PubMed

    Triant, V A; Josephson, F; Rochester, C G; Althoff, K N; Marcus, K; Munk, R; Cooper, C; D'Agostino, R B; Costagliola, D; Sabin, C A; Williams, P L; Hughes, S; Post, W S; Chandra-Strobos, N; Guaraldi, G; Young, S S; Obenchain, R; Bedimo, R; Miller, V; Strobos, J

    2012-02-01

    Clinical decisions are ideally based on randomized trials but must often rely on observational data analyses, which are less straightforward and more influenced by methodology. The authors, from a series of expert roundtables convened by the Forum for Collaborative HIV Research on the use of observational studies to assess cardiovascular disease risk in human immunodeficiency virus infection, recommend that clinicians who review or interpret epidemiological publications consider 7 key statistical issues: (1) clear explanation of confounding and adjustment; (2) handling and impact of missing data; (3) consistency and clinical relevance of outcome measurements and covariate risk factors; (4) multivariate modeling techniques including time-dependent variables; (5) how multiple testing is addressed; (6) distinction between statistical and clinical significance; and (7) need for confirmation from independent databases. Recommendations to permit better understanding of potential methodological limitations include both responsible public access to de-identified source data, where permitted, and exploration of novel statistical methods.

  4. Adverse Outcome Analyses of Observational Data: Assessing Cardiovascular Risk in HIV Disease

    PubMed Central

    Triant, V. A.; Josephson, F.; Rochester, C. G.; Althoff, K. N.; Marcus, K.; Munk, R.; Cooper, C.; D’Agostino, R. B.; Costagliola, D.; Sabin, C. A.; Williams, P. L.; Hughes, S.; Post, W. S.; Chandra-Strobos, N.; Guaraldi, G.; Young, S. S.; Obenchain, R.; Bedimo, R.; Miller, V.

    2012-01-01

    Clinical decisions are ideally based on randomized trials but must often rely on observational data analyses, which are less straightforward and more influenced by methodology. The authors, from a series of expert roundtables convened by the Forum for Collaborative HIV Research on the use of observational studies to assess cardiovascular disease risk in human immunodeficiency virus infection, recommend that clinicians who review or interpret epidemiological publications consider 7 key statistical issues: (1) clear explanation of confounding and adjustment; (2) handling and impact of missing data; (3) consistency and clinical relevance of outcome measurements and covariate risk factors; (4) multivariate modeling techniques including time-dependent variables; (5) how multiple testing is addressed; (6) distinction between statistical and clinical significance; and (7) need for confirmation from independent databases. Recommendations to permit better understanding of potential methodological limitations include both responsible public access to de-identified source data, where permitted, and exploration of novel statistical methods. PMID:22095570

  5. Three-Dimensional Distribution of a Major Desert Dust Outbreak over East Asia in March 2008 Derived from IASI Satellite Observations

    NASA Technical Reports Server (NTRS)

    Cuesta, Juan; Eremenko, Maxim; Flamant, Cyrille; Dufour, Gaelle; Laurent, Benoît; Bergametti, Gilles; Hopfner, Michael; Orphal, Johannes; Zhou, Daniel

    2015-01-01

    We describe the daily evolution of the three-dimensional (3D) structure of a major dust outbreak initiated by an extratropical cyclone over East Asia in early March 2008, using new aerosol retrievals derived from satellite observations of IASI (Infrared Atmospheric Sounding Interferometer). A novel auto-adaptive Tikhonov-Phillips-type approach called AEROIASI is used to retrieve vertical profiles of dust extinction coefficient at 10 microns for most cloud-free IASI pixels, both over land and ocean. The dust vertical distribution derived from AEROIASI is shown to agree remarkably well with along-track transects of Cloud-Aerosol Lidar with Orthogonal Polarization (CALIOP) spaceborne lidar vertical profiles (mean biases less than 110 meters, correlation of 0.95, and precision of 260 meters for mean altitudes of the dust layers). AEROIASI allows the daily characterization of the 3D transport pathways across East Asia of two dust plumes originating from the Gobi and North Chinese deserts. From AEROIASI retrievals, we provide evidence that (i) both dust plumes are transported over the Beijing region and the Yellow Sea as elevated layers above a shallow boundary layer, (ii) as they progress eastward, the dust layers are lifted up by the ascending motions near the core of the extratropical cyclone, and (iii) when being transported over the warm waters of the Japan Sea, turbulent mixing in the deep marine boundary layer leads to high dust concentrations down to the surface. AEROIASI observations and model simulations also show that the progression of the dust plumes across East Asia is tightly related to the advancing cold front of the extratropical cyclone.

  6. Variability of hydrological extreme events in East Asia and their dynamical control: a comparison between observations and two high-resolution global climate models

    NASA Astrophysics Data System (ADS)

    Freychet, N.; Duchez, A.; Wu, C.-H.; Chen, C.-A.; Hsu, H.-H.; Hirschi, J.; Forryan, A.; Sinha, B.; New, A. L.; Graham, T.; Andrews, M. B.; Tu, C.-Y.; Lin, S.-J.

    2017-02-01

    This work investigates the variability of extreme weather events (drought spells, DS15, and daily heavy rainfall, PR99) over East Asia. It particularly focuses on the large scale atmospheric circulation associated with high levels of the occurrence of these extreme events. Two observational datasets (APHRODITE and PERSIANN) are compared with two high-resolution global climate models (HiRAM and HadGEM3-GC2) and an ensemble of other lower resolution climate models from CMIP5. We first evaluate the performance of the high resolution models. They both exhibit good skill in reproducing extreme events, especially when compared with CMIP5 results. Significant differences exist between the two observational datasets, highlighting the difficulty of having a clear estimate of extreme events. The link between the variability of the extremes and the large scale circulation is investigated, on monthly and interannual timescales, using composite and correlation analyses. Both extreme indices DS15 and PR99 are significantly linked to the low level wind intensity over East Asia, i.e. the monsoon circulation. It is also found that DS15 events are strongly linked to the surface temperature over the Siberian region and to the land-sea pressure contrast, while PR99 events are linked to the sea surface temperature anomalies over the West North Pacific. These results illustrate the importance of the monsoon circulation on extremes over East Asia. The dependencies on of the surface temperature over the continent and the sea surface temperature raise the question as to what extent they could affect the occurrence of extremes over tropical regions in future projections.

  7. Three-Dimensional Distribution of a Major Desert Dust Outbreak over East Asia in March 2008 Derived from IASI Satellite Observations

    NASA Technical Reports Server (NTRS)

    Cuesta, Juan; Eremenko, Maxim; Flamant, Cyrille; Dufour, Gaelle; Laurent, Benoît; Bergametti, Gilles; Hopfner, Michael; Orphal, Johannes; Zhou, Daniel

    2015-01-01

    We describe the daily evolution of the three-dimensional (3D) structure of a major dust outbreak initiated by an extratropical cyclone over East Asia in early March 2008, using new aerosol retrievals derived from satellite observations of IASI (Infrared Atmospheric Sounding Interferometer). A novel auto-adaptive Tikhonov-Phillips-type approach called AEROIASI is used to retrieve vertical profiles of dust extinction coefficient at 10 microns for most cloud-free IASI pixels, both over land and ocean. The dust vertical distribution derived from AEROIASI is shown to agree remarkably well with along-track transects of Cloud-Aerosol Lidar with Orthogonal Polarization (CALIOP) spaceborne lidar vertical profiles (mean biases less than 110 meters, correlation of 0.95, and precision of 260 meters for mean altitudes of the dust layers). AEROIASI allows the daily characterization of the 3D transport pathways across East Asia of two dust plumes originating from the Gobi and North Chinese deserts. From AEROIASI retrievals, we provide evidence that (i) both dust plumes are transported over the Beijing region and the Yellow Sea as elevated layers above a shallow boundary layer, (ii) as they progress eastward, the dust layers are lifted up by the ascending motions near the core of the extratropical cyclone, and (iii) when being transported over the warm waters of the Japan Sea, turbulent mixing in the deep marine boundary layer leads to high dust concentrations down to the surface. AEROIASI observations and model simulations also show that the progression of the dust plumes across East Asia is tightly related to the advancing cold front of the extratropical cyclone.

  8. A model for the radiative forcing during ACE-Asia derived from CIRPAS Twin Otter and R/V Ronald H. Brown data and comparison with observations

    NASA Astrophysics Data System (ADS)

    Conant, William C.; Seinfeld, John H.; Wang, Jian; Carmichael, Gregory R.; Tang, Youhua; Uno, Itsushi; Flatau, Piotr J.; Markowicz, Krzysztof M.; Quinn, Patricia K.

    2003-12-01

    Vertical profiles of aerosol size, composition, and hygroscopic behavior from Center for Interdisciplinary Remotely Piloted Aircraft Studies (CIRPAS) Twin Otter and National Oceanic and Atmospheric Administration R/V Ronald H. Brown observations are used to construct a generic optical model of the Asian Pacific Regional Aerosol Characterization Experiment (ACE-Asia) aerosol. The model accounts for sulfate, black carbon, organic carbon, sea salt, and mineral dust. The effects of relative humidity and mixing assumptions (internal versus external, coating of dust by pollutants) are explicitly accounted for. The aerosol model is integrated with a Monte Carlo radiative transfer model to compute direct radiative forcing in the solar spectrum. The predicted regional average surface aerosol forcing efficiency (change in clear-sky radiative flux per unit aerosol optical depth at 500 nm) during the ACE-Asia intensive period is -65 Wm-2 for pure dust and -60 Wm-2 for pure pollution aerosol (clear skies). A three-dimensional atmospheric chemical transport model (Chemical Weather Forecast System (CFORS)) is used with the radiative transfer model to derive regional radiative forcing during ACE-Asia in clear and cloudy skies. Net regional solar direct radiative forcing during the 5-15 April 2001 dust storm period is -3 Wm-2 at the top of the atmosphere and -17 W m-2 at the surface for the region from 20°N to 50°N and 100°E to 150°E when the effects of clouds on the direct forcing are included. The model fluxes and forcing efficiencies are found to be in good agreement with surface radiometric observations made aboard the R.H. Brown. Mean cloud conditions are found to moderate the top of atmosphere (TOA) radiative forcing by a factor of ˜3 compared to clear-sky calculations, but atmospheric absorption by aerosol is not strongly affected by clouds in this study. The regional aerosol effect at the TOA ("climate forcing") of -3 Wm-2 is comparable in magnitude, but of opposite

  9. [Observation on therapeutic effect of acupuncture on complicated facial paralysis in the African patient of HIV/AIDS].

    PubMed

    Zhou, Zhong-Yuan; Dai, Tie-Zhu

    2008-09-01

    To compare therapeutic effects of acupuncture on complicated facial paralysis in the patient with HIV/AIDS and in the patient with no HIV/AIDS. The observation group of 31 cases of facial paralysis with positive HIV/AIDS and the control group of 30 cases of facial paralysis with negative HIV/AIDS were treated with acupuncture at Yifeng (TE 17), Xiaguan (ST 7), Jiache (ST 6), Taiyang (EX-HN 5), Dicang (ST 4), Yuyao (EX-HN 4), Cuanzhu (BL 2), Yingxiang (LI 20), etc. and with individual treatment according to different periods of disease. The difference of therapeutic effects between the two groups were observed. The effective rate was 83.9% in the observation group and 96.7% in the control group, with no significant difference between the two groups; while the cured rate was 9.7% in the observation group and 73.3% in the control group with a very significant difference between the two groups (P < 0.01). Acupuncture with individual treatment has a satisfactory therapeutic effect on complicated facial paralysis in the patient of HIV/AIDS.

  10. A hybrid mobile HIV testing approach for population-wide HIV testing in rural East Africa: an observational study

    PubMed Central

    Chamie, Gabriel; Clark, Tamara D; Kabami, Jane; Kadede, Kevin; Ssemmondo, Emmanuel; Steinfeld, Rachel; Lavoy, Geoff; Kwarisiima, Dalsone; Sang, Norton; Jain, Vivek; Thirumurthy, Harsha; Liegler, Teri; Balzer, Laura B; Petersen, Maya L; Cohen, Craig R; Bukusi, Elizabeth A; Kamya, Moses R; Havlir, Diane V; Charlebois, Edwin D

    2016-01-01

    Background Despite large investments in HIV testing, only 45% of HIV-infected persons in sub-Saharan Africa are estimated to know their status. Optimal methods for maximizing population-level testing remain unknown. We sought to demonstrate the effectiveness at achieving population-wide testing coverage of a hybrid mobile HIV testing approach. Methods From 2013–2014, we enumerated 168,772 adult (≥15 years) residents of 32 communities in Uganda (N=20), and Kenya (N=12) using a door-to-door census. “Stable” residence was defined as living in community for ≥6 months over the past year. In each community we performed 2-week multi-disease community health campaigns (CHC) that included HIV testing, counseling, and referral to care if HIV-infected; CHC non-participants were approached for home-based testing (HBT) over 1–2 months. We determined population HIV testing coverage, and predictors of testing via HBT (vs. CHC) and non-testing. Findings HIV testing was achieved in 89% of stable adult residents (131,307/146,906). HIV prevalence was 9.6% (13,043/136,033 stable and non-stable adults); median CD4+ T-cell count was 514 cells/μL (IQR: 355–703). Among stable adults tested, 43% (56,106/131,307) reported no prior testing. Among HIV-infected adults, 38% (4,932/13,043) were unaware of their status. Among stable CHC attendees, 99.5% (104,635/105,170) accepted HIV testing. Of stable adults tested, 80% (104,635/131,307, range: 60–93%) tested via CHCs. In multivariable analyses of stable adults, predictors of non-testing included male gender (risk ratio [RR]: 1.52, 95% CI: 1.48–1.56), single marital status (RR: 1.70, 95% CI: 1.66–1.75), Kenyan residence (RR: 1.46, 95% CI: 1.41–1.50, vs. Ugandan), and out-of-community migration for ≥1 month in past year (RR: 1.60, 95% CI: 1.53–1.68). Testing was more common among farmers (RR: 0.73, 95% CI: 0.67–0.79) and adults with primary education (RR: 0.84, 95% CI: 0.80–0.89). Interpretation High HIV testing

  11. Data linkage reduces loss to follow-up in an observational HIV cohort study.

    PubMed

    Hill, Teresa; Bansi, Loveleen; Sabin, Caroline; Phillips, Andrew; Dunn, David; Anderson, Jane; Easterbrook, Philippa; Fisher, Martin; Gazzard, Brian; Gilson, Richard; Johnson, Margaret; Leen, Clifford; Orkin, Chloe; Schwenk, Achim; Walsh, John; Winston, Alan; Babiker, Abdel; Delpech, Valerie

    2010-10-01

    To ascertain the degree of loss to follow-up in a cohort and to identify its predictors. Human immunodeficiency virus (HIV)-infected individuals without CD4 cell counts for a year or more were defined as potentially lost to follow-up (LFU). Multivariable Poisson regression models identified the risk factors for potential LFU. Multivariable logistic regression models compared demographic and clinical characteristics of those who returned for care and those permanently LFU. Of 16,595 patients under follow-up, 43.6% were potentially LFU at least once. Of these, 39.8% were considered permanently LFU and 60.2% were seen again after 1 year. Of 9,766 episodes when patients were potentially LFU, 59% resulted in the patient returning for care at the same clinic or at a different clinic. Compared with those permanently LFU, patients returning were more likely to have started highly active antiretroviral therapy, to have higher CD4 counts and viral loads, to be younger, and to have had more CD4 tests before LFU. They were less likely to have had a previous episode of potential LFU. A substantial proportion of patients in the UK Collaborative HIV Cohort study are potentially LFU. Data linkage identifies patients returning for care at different centers. Recognition of factors associated with LFU may help reduce this important source of bias in observational databases. Copyright (c) 2010 Elsevier Inc. All rights reserved.

  12. Heart failure in patients presenting with dyspnoea to the emergency department in the Asia Pacific region: an observational study

    PubMed Central

    Kelly, Anne-Maree; Cullen, Louise; Klim, Sharon; Craig, Simon; Kuan, Win Sen; Jones, Peter; Holdgate, Anna; Lawoko, Charles; Laribi, Said

    2017-01-01

    Objectives To describe demographic features, assessment, management and outcomes of patients who were diagnosed with heart failure after presenting to an emergency department (ED) with a principal symptom of dyspnoea. Design Planned substudy of the prospective, descriptive cohort study: Asia, Australia and New Zealand Dyspnoea in Emergency Departments (AANZDEM). Setting 46 EDs in Australia, New Zealand, Singapore, Hong Kong and Malaysia collected data over 3 72-hour periods in May, August and October 2014. Participants Patients with an ED diagnosis of heart failure. Outcome measures Outcomes included patient epidemiology, investigations ordered, treatment modalities used and patient outcomes (hospital length of stay (LOS) and mortality). Results 455 (14.9%) of the 3044 patients had an ED diagnosis of heart failure. Median age was 79 years, half were male and 62% arrived via ambulance. 392 (86%) patients were admitted to hospital. ED diagnosis was concordant with hospital discharge diagnosis in 81% of cases. Median hospital LOS was 6 days (IQR 4–9) and in-hospital mortality was 5.1%. Natriuretic peptide levels were ordered in 19%, with lung ultrasound (<1%) and echocardiography (2%) uncommonly performed. Treatment modalities included non-invasive ventilation (12%), diuretics (73%), nitrates (25%), antibiotics (16%), inhaled β-agonists (13%) and corticosteroids (6%). Conclusions In the Asia Pacific region, heart failure is a common diagnosis among patients presenting to the ED with a principal symptom of dyspnoea. Admission rates were high and ED diagnostic accuracy was good. Despite the seemingly suboptimal adherence to investigation and treatment guidelines, patient outcomes were favourable compared with other registries. PMID:28246137

  13. Aerosol Radiative Effects observed on the Coast of the Japanese Sea (Tango peninsula) during ACE-Asia

    NASA Astrophysics Data System (ADS)

    Hoeller, R.; Yabe, T.; Tohno, S.; Kasahara, M.

    2001-12-01

    The characterization of the optical properties of the atmospheric aerosol as well as its size-resolved chemical composition is on of the main objectives of ACE-Asia. This is necessary to constrain the radiative forcing by the Asian aerosol, which will become more important as emissions in this area are predicted to increase dramatically. We set up a monitoring station on the coast of the Japanese Sea (Tango Peninsula, Kyoto Prefecture) for the measurements of aerosol optical and chemical properties as well as sky radiation during ACE-Asia in spring 2001. The instrumentation at Tango includes a 3-wavelenght nephelometer (TSI 3563), an OPC (RION KC-01D), a pyrheliometer (EKO MS-53), a 5-wavelength sunphotometer (EKO MS-110A), and a pyranometer (EKO MS-801). The sunphotometer also has a near infrared channel (938 nm) for evaluations of precipitable water; visible channels are used to retrieve aerosol optical depth and Ångström exponents. Filter sampling is performed collocated to the optical measurements for subsequent analysis of elemental and ionic composition of the aerosol. Filters are also analyzed by the integrating plate method for measurements of aerosol absorption coefficients. Size-resolved chemical composition obtained from low-pressure impactor samples are used to calculate aerosol optical properties and compare them to directly measured optical properties. Quality checked parameters are henceforth input into a radiative transfer model (MODTRAN 4.0) to calculate the radiative forcing of the aerosol. This enables us to evaluate which chemical species control the optical properties and radiative forcing of the aerosol. We also compare the radiative impact of clear days with days with heavy dust loadings. >http://aerosol.energy.kyoto- u.ac.jp/~hoeller/ACEmineyama.html

  14. Contemporary changes of water resources, water and land use in Central Asia based on observations and modeling.

    NASA Astrophysics Data System (ADS)

    Shiklomanov, A. I.; Prousevitch, A.; Sokolik, I. N.; Lammers, R. B.

    2015-12-01

    Water is a key agent in Central Asia ultimately determining human well-being, food security, and economic development. There are complex interplays among the natural and anthropogenic drivers effecting the regional hydrological processes and water availability. Analysis of the data combined from regional censuses and remote sensing shows a decline in areas of arable and irrigated lands and a significant decrease in availability of arable and irrigated lands per capita across all Central Asian countries since the middle of 1990thas the result of post-Soviet transformation processes. This change could lead to considerable deterioration in food security and human system sustainability. The change of political situation in the region has also resulted in the escalated problems of water demand between countries in international river basins. We applied the University of New Hampshire - Water Balance Model - Transport from Anthropogenic and Natural Systems (WBM-TrANS) to understand the consequences of changes in climate, water and land use on regional hydrological processes and water availability. The model accounts for sub-pixel land cover types, glacier and snow-pack accumulation/melt across sub-pixel elevation bands, anthropogenic water use (e.g. domestic and industrial consumption, and irrigation for most of existing crop types), hydro-infrastructure for inter-basin water transfer and reservoir/dam regulations. A suite of historical climate re-analysis and temporal extrapolation of MIRCA-2000 crop structure datasets has been used in WBM-TrANS for this project. A preliminary analysis of the model simulations over the last 30 years has shown significant spatial and temporal changes in hydrology and water availability for crops and human across the region due to climatic and anthropogenic causes. We found that regional water availability is mostly impacted by changes in extents and efficiency of crop filed irrigation, especially in highly arid areas of Central Asia

  15. Observations and lessons learnt from more than a decade of water safety planning in South-East Asia.

    PubMed

    Sutherland, David

    2017-09-01

    In many countries of the World Health Organization (WHO) South-East Asia Region, drinking water is not used directly from the tap and faecal contamination of water sources is prevalent. As reflected in Sustainable Development Goal 6, access to safer drinking water is one of the most successful ways of preventing disease. The WHO Water Safety Framework promotes the use of water safety plans (WSPs), which are structured tools that help identify and mitigate potential risks throughout a water-supply system, from the water source to the point of use. WSPs not only help prevent outbreaks of acute and chronic waterborne diseases but also improve water-supply management and performance. During the past 12 years, through the direct and indirect work of a water quality partnership supported by the Australian Government, more than 5000 urban and rural WSPs have been implemented in the region. An impact assessment based on pre- and post-WSP surveys suggests that WSPs have improved system operations and management, infrastructure and performance; leveraged donor funds; increased stakeholder communication and collaboration; increased testing of water quality; and increased monitoring of consumer satisfaction. These achievements, and their sustainability, are being achieved through national legislation and regulatory frameworks for water supply, including quality standards for drinking water; national training tools and extensive training of sector professionals and creation of WSP experts; model WSPs; WSP auditing systems; and the institution of longterm training and support. More than a decade of water safety planning using the WSP approach has shown that supplying safe drinking water at the tap throughout the WHO South-East Asia Region is a realistic goal.

  16. Weight as predictors of clinical progression and treatment failure: results from the TREAT Asia Pediatric HIV Observational Database.

    PubMed

    Kariminia, Azar; Durier, Nicolas; Jourdain, Gonzague; Saghayam, Suneeta; Do, Chau V; Nguyen, Lam Van; Hansudewechakul, Rawiwan; Lumbiganon, Pagakrong; Chokephaibulkit, Kulkanya; Truong, Khanh Huu; Sirisanthana, Virat; Ung, Vibol; Vonthanak, Saphonn; Ananworanich, Jintanat; Nik Yusoff, Nik Khairulddin; Kurniati, Nia; Azahar Razali, Kamarul; Fong, Moy Siew; Nallusamy, Revathy; Wati, Dewi Kumara

    2014-09-01

    To evaluate the value of time-updated weight and height in predicting clinical progression, and immunological and virological failure in children receiving combination antiretroviral therapy (cART). We used Cox regression to analyze data of a cohort of Asian children. A total of 2608 children were included; median age at cART was 5.7 years. Time-updated weight for age z score < -3 was associated with mortality (P < 0.001) independent of CD4% and < -2 was associated with immunological failure (P ≤ 0.03) independent of age at cART. Weight monitoring provides useful data to inform clinical management of children on cART in resource-limited settings.

  17. Regional chemical weather forecasting system CFORS: Model descriptions and analysis of surface observations at Japanese island stations during the ACE-Asia experiment

    NASA Astrophysics Data System (ADS)

    Uno, I.; Carmichael, G. R.; Streets, D. G.; Tang, Y.; Yienger, J. J.; Satake, S.; Wang, Z.; Woo, Jung-Hun; Guttikunda, S.; Uematsu, M.; Matsumoto, K.; Tanimoto, H.; Yoshioka, K.; Iida, T.

    2003-12-01

    The Chemical Weather Forecast System (CFORS) is designed to aid in the design of field experiments and in the interpretation/postanalysis of observed data. The system integrates a regional chemical transport model with a multitracer, online system built within the Regional Atmospheric Modeling System (RAMS) mesoscale model. CFORS was deployed in forecast and postanalysis modes during the NASA Global Tropospheric Experiment (GTE)-Transport and Chemical Evolution over the Pacific (TRACE-P), International Global Atmospheric Chemistry project (IGAC)-International Geosphere-Biosphere Programme (IGBP) Asian Pacific Regional Aerosol Characterization Experiment (ACE-Asia), and National Oceanic and Atmospheric Administration Intercontinental Transport and Chemical Transformation of Anthropogenic Pollution 2002 (ITCT 2K2) field studies. A description of the CFORS model system is presented. The model is used to help interpret the Variability of Maritime Aerosol Properties (VMAP) surface observation data. The CFORS model results help to explain the time variation of both anthropogenic pollutants (sulfate, black carbon, and CO) and natural constituents including radon and mineral dust. Time series and time-height cross-section analysis of gases and aerosols are presented to help identify key processes. Synoptic-scale weather changes are found to play an important role in the continental-scale transport of pollution in the springtime in East Asia. The complex vertical and horizontal structure of pollutants in these outflow events is also presented and discussed.

  18. Assessing the effect of hormonal contraception on HIV acquisition in observational data: challenges and recommended analytic approaches

    PubMed Central

    Polis, Chelsea B.; Westreich, Daniel; Balkus, Jennifer E.; Heffron, Renee

    2014-01-01

    Introduction Determining whether hormonal contraception (HC), particularly the injectable contraceptive depot-medroxyprogesterone acetate (DMPA), increases a woman's risk of HIV acquisition is a priority question for public health. However, assessing the relationship between various HC methods and HIV acquisition with observational data involves substantial analytic design issues and challenges. Studies to date have used inconsistent approaches and generated a body of evidence that is complex and challenging to interpret. Methods In January 2013, USAID and FHI 360 supported a meeting of epidemiologists, statisticians, and content experts to develop recommendations for future observational analyses of HC and HIV acquisition. Results Meeting participants generated recommendations regarding careful definition of exposure groups; handling potential confounders, mediators, and effect modifiers; estimating and addressing the magnitude of measurement error; using multiple methods to account for pregnancy; and exploring the potential for differential exposure to HIV-infected partners. Advantages and disadvantages of various statistical approaches to account for time-varying confounding and estimating total and direct effects were also discussed. Conclusions Implementing these recommendations in future observational HC-HIV acquisition analyses will enhance interpretation of existing studies and strengthen the overall evidence base for this complex and important area. PMID:24088682

  19. AIDS. Grim news for Asia.

    PubMed

    1992-12-04

    While Asia was the last region to be exposed to the global spread of HIV and AIDS, the incidence of HIV infection there is increasing fastest. The Asian Development Bank predicts mortality from AIDS will cause some town and village populations to begin declining by the year 2000. With an estimated 1 million people infected in India, and 400,000 in Thailand, these 2 countries are particularly exposed to the risk of epidemic HIV spread. In 5 years, more people may be affected by AIDS in India than anywhere else in the world. Concern over a growing presence of HIV is also merited for the Philippines, Indonesia, China, and the drug trade's Golden Triangle. The Second International Conference on AIDS in Asia and the Pacific in November 1992 stressed that AIDS no longer affects only homosexual and IV drug using populations. 50% of new infections worldwide in the first half of 1992 were among women, 65% of Thailand's AIDS cases are among heterosexuals, and 3-5% of Thailand's long-haul truck drivers have tested positive for HIV infection. HIV and AIDS robs economies and societies of their best workers. The immediate costs of caring for AIDS patients will pale next to the far greater losses to be realized in private sector economic productivity. Asia's more developed economies will probably be able to survive the epidemic, but small, poor countries like Laos will wilt. Prompt action must be taken to overcome public and religious ignorance and objections to promoting and using condoms throughout the region. For the first time, Beijing has organized an AIDS awareness conference for male homosexuals. Further, Singapore has implemented compulsory testing for lower-income foreign workers. Pakistan has even solicited educational assistance and support from Islamic religious leaders; similar action is being considered in Bangladesh.

  20. Live-cell observation of cytosolic HIV-1 assembly onset reveals RNA-interacting Gag oligomers

    PubMed Central

    Hendrix, Jelle; Baumgärtel, Viola; Schrimpf, Waldemar; Ivanchenko, Sergey; Digman, Michelle A.; Gratton, Enrico; Kräusslich, Hans-Georg; Müller, Barbara

    2015-01-01

    Assembly of the Gag polyprotein into new viral particles in infected cells is a crucial step in the retroviral replication cycle. Currently, little is known about the onset of assembly in the cytosol. In this paper, we analyzed the cytosolic HIV-1 Gag fraction in real time in live cells using advanced fluctuation imaging methods and thereby provide detailed insights into the complex relationship between cytosolic Gag mobility, stoichiometry, and interactions. We show that Gag diffuses as a monomer on the subsecond timescale with severely reduced mobility. Reduction of mobility is associated with basic residues in its nucleocapsid (NC) domain, whereas capsid (CA) and matrix (MA) domains do not contribute significantly. Strikingly, another diffusive Gag species was observed on the seconds timescale that oligomerized in a concentration-dependent manner. Both NC- and CA-mediated interactions strongly assist this process. Our results reveal potential nucleation steps of cytosolic Gag fractions before membrane-assisted Gag assembly. PMID:26283800

  1. NMR observation of HIV-1 gp120 conformational flexibility resulting from V3 truncation.

    PubMed

    Moseri, Adi; Schnur, Einat; Noah, Eran; Zherdev, Yuri; Kessler, Naama; Singhal Sinha, Eshu; Abayev, Meital; Naider, Fred; Scherf, Tali; Anglister, Jacob

    2014-07-01

    The envelope spike of HIV-1, which consists of three external gp120 and three transmembrane gp41 glycoproteins, recognizes its target cells by successively binding to its primary CD4 receptor and a coreceptor molecule. Until recently, atomic-resolution structures were available primarily for monomeric HIV-1 gp120, in which the V1, V2 and V3 variable loops were omitted (gp120core ), in complex with soluble CD4 (sCD4). Differences between the structure of HIV gp120core in complex with sCD4 and the structure of unliganded simian immunodeficiency virus gp120core led to the hypothesis that gp120 undergoes a major conformational change upon sCD4 binding. To investigate the conformational flexibility of gp120, we generated two forms of mutated gp120 amenable for NMR studies: one with V1, V2 and V3 omitted ((mut) gp120core ) and the other containing the V3 region [(mut) gp120core (+V3)]. The TROSY-(1)H-(15)N-HSQC spectra of [(2)H, (13)C, (15)N]Arg-labeled and [(2)H, (13)C, (15)N]Ile-labeled unliganded (mut) gp120core showed many fewer crosspeaks than the expected number, and also many fewer crosspeaks in comparison with the labeled (mut) gp120core bound to the CD4-mimic peptide, CD4M33. This finding suggests that in the unliganded form, (mut) gp120core shows considerable flexibility and motions on the millisecond time scale. In contrast, most of the expected crosspeaks were observed for the unliganded (mut) gp120core (+V3), and only a few changes in chemical shift were observed upon CD4M33 binding. These results indicate that (mut) gp120core (+V3) does not show any significant conformational flexibility in its unliganded form and does not undergo any significant conformational change upon CD4M33 binding, underlining the importance of V3 in stabilizing the gp120core conformation. © 2014 FEBS.

  2. Estimating Trends in the Proportion of Transmitted and Acquired HIV Drug Resistance in a Long Term Observational Cohort in Germany

    PubMed Central

    Schmidt, Daniel; Kollan, Christian; Fätkenheuer, Gerd; Schülter, Eugen; Stellbrink, Hans-Jürgen; Noah, Christian; Jensen, Björn-Erik Ole; Stoll, Matthias; Bogner, Johannes R.; Eberle, Josef; Meixenberger, Karolin; Kücherer, Claudia; Hamouda, Osamah; Bartmeyer, Barbara

    2014-01-01

    Objective We assessed trends in the proportion of transmitted (TDR) and acquired (ADR) HIV drug resistance and associated mutations between 2001 and 2011 in the German ClinSurv-HIV Drug Resistance Study. Method The German ClinSurv-HIV Drug Resistance Study is a subset of the German ClinSurv-HIV Cohort. For the ClinSurv-HIV Drug Resistance Study all available sequences isolated from patients in five study centres of the long term observational ClinSurv-HIV Cohort were included. TDR was estimated using the first viral sequence of antiretroviral treatment (ART) naïve patients. One HIV sequence/patient/year of ART experienced patients was considered to estimate the proportion of ADR. Trends in the proportion of HIV drug resistance were calculated by logistic regression. Results 9,528 patients were included into the analysis. HIV-sequences of antiretroviral naïve and treatment experienced patients were available from 34% (3,267/9,528) of patients. The proportion of TDR over time was stable at 10.4% (95% CI 9.1–11.8; p for trend = 0.6; 2001–2011). The proportion of ADR among all treated patients was 16%, whereas it was high among those with available HIV genotypic resistance test (64%; 1,310/2,049 sequences; 95% CI 62–66) but declined significantly over time (OR 0.8; 95% CI 0.77–0.83; p for trend<0.001; 2001–2011). Viral load monitoring subsequent to resistance testing was performed in the majority of treated patients (96%) and most of them (67%) were treated successfully. Conclusions The proportion of TDR was stable in this study population. ADR declined significantly over time. This decline might have been influenced by broader resistance testing, resistance test guided therapy and the availability of more therapeutic options and not by a decline in the proportion of TDR within the study population. PMID:25148412

  3. Atazanavir and lopinavir profile in pregnant women with HIV: tolerability, activity and pregnancy outcomes in an observational national study.

    PubMed

    Floridia, Marco; Ravizza, Marina; Masuelli, Giulia; Giacomet, Vania; Martinelli, Pasquale; Degli Antoni, Anna; Spinillo, Arsenio; Fiscon, Marta; Francisci, Daniela; Liuzzi, Giuseppina; Pinnetti, Carmela; Marconi, Anna Maria; Tamburrini, Enrica

    2014-05-01

    Atazanavir and lopinavir represent the main HIV protease inhibitors recommended in pregnancy, but comparative data in pregnant women are limited. Women from a national observational study, exposed in pregnancy to either atazanavir or lopinavir, were compared for glucose and lipid profiles, liver function tests, CD4 count, HIV RNA and main pregnancy outcomes. Statistical methods included univariate and multivariable analyses. The study population included 428 pregnancies (lopinavir, 322; atazanavir, 106). The lopinavir group was characterized by higher rates of HIV diagnosis in pregnancy and treatment indication for maternal health, lower CD4 counts, higher HIV RNA levels, less frequent antiretroviral treatment at conception and shorter duration of drug exposure during pregnancy. No differences in pregnancy outcomes, glucose metabolism and weight gain were observed. The two groups also showed in a multivariable analysis similar odds for detectable HIV RNA in the third trimester (adjusted OR 0.85, 95% CI 0.35-2.10, P = 0.730). Total lipid levels were significantly higher in the lopinavir group (median values in the third trimester 239 versus 221 mg/dL for total cholesterol and 226 versus 181 mg/dL for triglycerides; P < 0.001 for both comparisons) and bilirubin levels were significantly higher in the atazanavir group (1.53 versus 0.46 mg/dL, P < 0.001). In this observational study atazanavir and lopinavir showed similar safety and activity in pregnancy, with no differences in the main pregnancy outcomes. Atazanavir use was associated with a better lipid profile and with higher bilirubin levels. Overall, the study findings confirm that these two HIV protease inhibitors represent equally valid alternative options.

  4. Satellite-observed NO2, SO2, and HCHO Vertical Column Densities in East Asia: Recent Changes and Comparisons with Regional Model

    NASA Astrophysics Data System (ADS)

    Kim, H. C.; Lee, P.; Kim, S.; Mok, J.; Yoo, H. L.; Bae, C.; Kim, B. U.; Lim, Y. K.; Woo, J. H.; Park, R.

    2015-12-01

    This study reports the recent changes in tropospheric NO2, SO2, and HCHO vertical column densities (VCD) in East Asia observed from multiple satellites, highlighting especially the annual trend changes of NO2 and SO2 over Beijing-Tianjin-Hebei (BTH) region of China since 2010. Tropospheric VCD data from Global Ozone Monitoring Experiment (GOME), SCanning Imaging Absorption spectroMeter for Atmospheric CHartographY (SCIAMACHY), Ozone Monitoring Instrument (OMI) and GOME-2, retrieved from the Royal Netherlands Meteorological Institute (KNMI) and OMI National Aeronautics and Space Administration (NASA) standard products, are utilized to investigate the annual trends of NO2, SO2, and HCHO VCDs from 2001 to 2015. They are also compared with simulations from Community Multi-scale Air Quality Model (CMAQ) based forecast system by the Integrated Multi-scale Air Quality System for Korea (IMAQS-K) of Ajou University. Until 2011, the changes in NO2 VCD over East Asian countries agree well with the findings of previous research, including the impact of the economic downturn during 2008-2009 and the subsequent quick recovery in China. After peaking in 2011, the NO2 VCD observations from active instruments (OMI and GOME-2) over China started to show a slower decreasing trend, mostly led by the rapid changes in the BTH region in northern China. On the other hand, SO2 started to decline earlier, from 2007, but inclined back from 2010 to 2012, and then back to declining trend since 2012. While satellite observations show dramatic recent changes, the model could not reproduce those changes mostly due to its use of fixed emission inventory. We conclude that rapid update of latest emission inventory is necessary for an accurate forecast of regional air quality in east Asia, especially for upcoming international sports events in PyeongChang (Korea), Tokyo (Japan) and Beijing (China) in 2018, 2020 and 2022, respectively.

  5. Universal definition of loss to follow-up in HIV treatment programs: a statistical analysis of 111 facilities in Africa, Asia, and Latin America.

    PubMed

    Chi, Benjamin H; Yiannoutsos, Constantin T; Westfall, Andrew O; Newman, Jamie E; Zhou, Jialun; Cesar, Carina; Brinkhof, Martin W G; Mwango, Albert; Balestre, Eric; Carriquiry, Gabriela; Sirisanthana, Thira; Mukumbi, Henri; Martin, Jeffrey N; Grimsrud, Anna; Bacon, Melanie; Thiebaut, Rodolphe

    2011-10-01

    Although patient attrition is recognized as a threat to the long-term success of antiretroviral therapy programs worldwide, there is no universal definition for classifying patients as lost to follow-up (LTFU). We analyzed data from health facilities across Africa, Asia, and Latin America to empirically determine a standard LTFU definition. At a set "status classification" date, patients were categorized as either "active" or "LTFU" according to different intervals from time of last clinic encounter. For each threshold, we looked forward 365 d to assess the performance and accuracy of this initial classification. The best-performing definition for LTFU had the lowest proportion of patients misclassified as active or LTFU. Observational data from 111 health facilities-representing 180,718 patients from 19 countries-were included in this study. In the primary analysis, for which data from all facilities were pooled, an interval of 180 d (95% confidence interval [CI]: 173-181 d) since last patient encounter resulted in the fewest misclassifications (7.7%, 95% CI: 7.6%-7.8%). A secondary analysis that gave equal weight to cohorts and to regions generated a similar result (175 d); however, an alternate approach that used inverse weighting for cohorts based on variance and equal weighting for regions produced a slightly lower summary measure (150 d). When examined at the facility level, the best-performing definition varied from 58 to 383 d (mean=150 d), but when a standard definition of 180 d was applied to each facility, only slight increases in misclassification (mean=1.2%, 95% CI: 1.0%-1.5%) were observed. Using this definition, the proportion of patients classified as LTFU by facility ranged from 3.1% to 45.1% (mean=19.9%, 95% CI: 19.1%-21.7%). Based on this evaluation, we recommend the adoption of ≥180 d since the last clinic visit as a standard LTFU definition. Such standardization is an important step to understanding the reasons that underlie patient attrition

  6. Universal Definition of Loss to Follow-Up in HIV Treatment Programs: A Statistical Analysis of 111 Facilities in Africa, Asia, and Latin America

    PubMed Central

    Chi, Benjamin H.; Yiannoutsos, Constantin T.; Westfall, Andrew O.; Newman, Jamie E.; Zhou, Jialun; Cesar, Carina; Brinkhof, Martin W. G.; Mwango, Albert; Balestre, Eric; Carriquiry, Gabriela; Sirisanthana, Thira; Mukumbi, Henri; Martin, Jeffrey N.; Grimsrud, Anna; Bacon, Melanie; Thiebaut, Rodolphe

    2011-01-01

    Background Although patient attrition is recognized as a threat to the long-term success of antiretroviral therapy programs worldwide, there is no universal definition for classifying patients as lost to follow-up (LTFU). We analyzed data from health facilities across Africa, Asia, and Latin America to empirically determine a standard LTFU definition. Methods and Findings At a set “status classification” date, patients were categorized as either “active” or “LTFU” according to different intervals from time of last clinic encounter. For each threshold, we looked forward 365 d to assess the performance and accuracy of this initial classification. The best-performing definition for LTFU had the lowest proportion of patients misclassified as active or LTFU. Observational data from 111 health facilities—representing 180,718 patients from 19 countries—were included in this study. In the primary analysis, for which data from all facilities were pooled, an interval of 180 d (95% confidence interval [CI]: 173–181 d) since last patient encounter resulted in the fewest misclassifications (7.7%, 95% CI: 7.6%–7.8%). A secondary analysis that gave equal weight to cohorts and to regions generated a similar result (175 d); however, an alternate approach that used inverse weighting for cohorts based on variance and equal weighting for regions produced a slightly lower summary measure (150 d). When examined at the facility level, the best-performing definition varied from 58 to 383 d (mean = 150 d), but when a standard definition of 180 d was applied to each facility, only slight increases in misclassification (mean = 1.2%, 95% CI: 1.0%–1.5%) were observed. Using this definition, the proportion of patients classified as LTFU by facility ranged from 3.1% to 45.1% (mean = 19.9%, 95% CI: 19.1%–21.7%). Conclusions Based on this evaluation, we recommend the adoption of ≥180 d since the last clinic visit as a standard LTFU definition. Such

  7. The immunological response to syphilis differs by HIV status; a prospective observational cohort study.

    PubMed

    Kenyon, Chris; Osbak, Kara Krista; Crucitti, Tania; Kestens, Luc

    2017-01-31

    It is not known if there is a difference in the immune response to syphilis between HIV-infected and uninfected individuals. We prospectively recruited all patients with a new diagnosis of syphilis and tested their plasma for IFNα, IFNγ, IL-1β, IL-12p40, IL-12p70, IP-10, MCP-1, MIP-1α, MIP-1β, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10 and IL-17A at baseline pre-treatment and 6 months following therapy. A total of 79 HIV-infected [44 primary/secondary syphilis (PSS) and 35 latent syphilis (LS)] and 12 HIV-uninfected (10 PSS and 2 LS) cases of syphilis and 30 HIV-infected controls were included in the study. At the baseline visit, compared to the control group, concentrations of IL-10 were significantly elevated in the HIV-infected and uninfected groups. The level of IL-10 was significantly higher in the HIV-infected compared to the HIV-uninfected PSS group (25.3 pg/mL (IQR, 4.56-41.76) vs 2.73 pg/mL (IQR, 1.55-9.02), P = 0.0192). In the HIV-infected PSS group (but not the HIV-infected LS or HIV-uninfected PSS groups) the IP-10, MIP-1b, IL-6 and IL-8 were raised compared to the controls. IL-10 levels decreased but did not return to control baseline values by 6 months in HIV infected PSS and LS and HIV uninfected PSS. PSS and LS in HIV-infected individuals is characterized by an increase in inflammatory and anti-inflammatory cytokines such as IL-10. The increase of IL-10 is greater in HIV-infected than uninfected individuals. Further work is required to ascertain if this is part of an immunological profile that correlates with adverse outcomes such as serofast syphilis and neurosyphilis, in HIV-infected individuals.

  8. Collaborative work between the West and Asia.

    PubMed

    Hser, Yih-Ing; Bart, Gavin; Li, Li; Giang, Le Minh

    2013-12-01

    The "Collaborative Work between the West and Asia" session was chaired by Dr. Yih-Ing Hser and had three speakers. The speakers (and their topics) were: Dr. Gavin Bart (Collaborative Addiction Research in Asian Populations Home and Abroad), Dr. Li Li (Implementing Intervention Research Projects in Asia), and Dr. Le Minh Giang (Building Research Infrastructure for International Collaborative Studies on Substance Use Disorder and HIV: The Case of Hanoi Medical University/Vietnam).

  9. Time trends in drug resistant HIV-1 infections in the United Kingdom up to 2009: multicentre observational study.

    PubMed

    Dolling, David; Sabin, Caroline; Delpech, Valerie; Smit, Erasmus; Pozniak, Anton; Asboe, David; Brown, Andrew Leigh; Churchill, Duncan; Williams, Ian; Geretti, Anna Maria; Phillips, Andrew; Mackie, Nicola; Murphy, Gary; Castro, Hannah; Pillay, Deenan; Cane, Patricia; Dunn, David; Dolling, David

    2012-08-21

    To evaluate whether the prevalence of HIV-1 transmitted drug resistance has continued to decline in infections probably acquired within the United Kingdom. Multicentre observational study. All UK public laboratories conducting tests for genotypic HIV resistance as a part of routine care. 14,584 patients infected with HIV-1 subtype B virus, who were first tested for resistance before receiving antiretroviral therapy between January 2002 and December 2009. Prevalence of transmitted drug resistance, defined as one or more resistance mutations from the surveillance list recommended by the World Health Organization. 1654 (11.3%, 95% confidence interval 10.8% to 11.9%) patients had one or more mutations associated with transmitted HIV-1 drug resistance; prevalence was found to decline from 15.5% in 2002 to 9.6% in 2007, followed by a slight increase to 10.9% in 2009 (P=0.21). This later rise was mainly a result of increases in resistance to nucleos(t)ide reverse transcriptase inhibitors (from 5.4% in 2007 to 6.6% in 2009, P=0.24) and protease inhibitors (1.5% to 2.1%, P=0.12). Thymidine analogue mutations, including T215 revertants, remained the most frequent mutations associated with nucleos(t)ide reverse transcriptase inhibitors, despite a considerable fall in stavudine and zidovudine use between 2002 and 2009 (from 29.4% of drug regimens in 2002 to 0.8% in 2009, from 47.9% to 8.8%, respectively). The previously observed decline in the prevalence of transmitted drug resistance in HIV-1 infections probably acquired in the UK seems to have stabilised. The continued high prevalence of thymidine analogue mutations suggests that the source of this resistance may be increasingly from patients who have not undergone antiretroviral therapy and who harbour resistant viruses. Testing of all newly diagnosed HIV-1 positive people should be continued.

  10. Low Birth Weight in Perinatally HIV-Exposed Uninfected Infants: Observations in Urban Settings in Cameroon

    PubMed Central

    Sofeu, Casimir Ledoux; Warszawski, Josiane; Ateba Ndongo, Francis; Penda, Ida Calixte; Tetang Ndiang, Suzie; Guemkam, Georgette; Makwet, Nicaise; Owona, Félicité; Kfutwah, Anfumbom; Tchendjou, Patrice; Texier, Gaëtan; Tchuente, Maurice; Faye, Albert; Tejiokem, Mathurin Cyrille

    2014-01-01

    Background The consequences of maternal HIV infection for fetal growth are controversial. Here, we estimated the frequency of small for gestational age and gender (SGAG) among neonates born to HIV-infected or uninfected mothers and assessed the contribution, if any, of maternal HIV to the risk of SGAG. Methods The data used were obtained from the ANRS-Pediacam cohort in Cameroon. Pairs of newborns, one to a HIV-infected mother and the other to an uninfected mother, were identified during the first week of life, and matched on gender and recruitment site from 2007–2010. SGAG was defined in line with international recommendations as a birth weight Z-score adjusted for gestational age at delivery and gender more than two standard deviations below the mean (−2SD). Considering the matched design, logistic regression modeling was adjusted on site and gender to explore the effect of perinatal HIV exposure on SGAG. Results Among the 4104 mother-infant pairs originally enrolled, no data on birth weight and/or gestational age were available for 108; also, 259 were twins and were excluded. Of the remaining 3737 mother-infant pairs, the frequency of SGAG was 5.3% (95%CI: 4.6–6.0), and was significantly higher among HIV-infected infants (22.4% vs. 6.3%; p<.001) and lower among HIV-unexposed uninfected infants (3.5% vs. 6.3%; p<.001) than among HIV-exposed uninfected infants. Similarly, SGAG was significantly more frequent among HIV-infected infants (aOR: 4.1; 2.0–8.1) and less frequent among HIV-unexposed uninfected infants (aOR: 0.5; 0.4–0.8) than among HIV-exposed uninfected infants. Primiparity (aOR: 1.9; 1.3–2.7) and the presence of any disease during pregnancy (aOR: 1.4; 1.0–2.0) were identified as other contributors to SGAG. Conclusion Maternal HIV infection was independently associated with SGAG for HIV-exposed uninfected infants. This provides further evidence of the need for adapted monitoring of pregnancy in HIV-infected women, especially if they are

  11. [Epidemiology of HIV. Update].

    PubMed

    Dorrucci, Maria

    2010-01-01

    In this decade, the global prevalence of HIV-1 infection stabilized at 0.8% (range: 0.7-0.9%). However, important regional differences in trends and mode of transmission: Sub-Saharan Africa is the most affected by HIV. Since 2001, the number of people with HIV in Eastern Europe and Central Asia increased from 650,000 to 1,5 million in 2007. Overall trends were stable in Central and Western Europe. Heterosexual and homosexual transmission accounts for the largest proportion in these regions. Transmission among injecting drug users has decreased. Similar trends have been observed in Italy: in 2007, there were 1,679 new diagnoses, equivalent to an incidence of 6,0 per 100,000 population. Over the years there has been a progressive increase in the proportion of diagnoses among women and in the median age at diagnosis, as well as changes in the exposure categories (i.e. a decrease in the proportion of injecting drug users and an increase in infections attributed to homosexual and heterosexual contacts). The era of combination antiretroviral therapy (cART) has resulted in a reduction of morbidity and mortality. Before the advent of cART in 1996, the main causes of morbidity and mortality in people with HIV were the opportunistic infections and malignancies AIDS associated.

  12. Assessment of aerosol optics, microphysics, and transport process of biomass-burning haze over northern SE Asia: 7-SEAS AERONET observations

    NASA Astrophysics Data System (ADS)

    Wang, S.; Giles, D. M.; Eck, T. F.; Lin, N.; Tsay, S.; Holben, B. N.

    2013-12-01

    Initiated in 2007, the Seven South East Asian Studies (7-SEAS) is aimed to facilitate an interdisciplinary research on the aerosol environment in SE Asia (SEA) as a whole, promote international collaboration, and further enhance scientific understanding of the impact of biomass burning on clouds, atmospheric radiation, hydrological cycle, and region climates. One of the key measurements proposed in the 7-SEAS is the NASA/AERONET (AErosol RObotic NETwork) observation, which provides helpful information on columnar aerosol optical properties and allows us consistently to examine biomass-burning aerosols across northern SEA from ground-based remote-sensing point of view. In this presentation, we will focus on the two 7-SEAS field deployments, i.e. the 2012 Son La Experiment and the 2013 BASELInE (Biomass-burning Aerosols & Stratocumulus Environment: Lifecycles and Interactions Experiment). We analyze the daytime variation of aerosol by using consistent measurements from 15 of AERONET sites over Indochina, the South China Sea, and Taiwan. Spatiotemporal characteristics of aerosol optical properties (e.g., aerosol optical depth (AOD), fine/coarse mode AOD, single-scattering albedo, asymmetry factor) will be discussed. Strong diurnal variation of aerosol optical properties was observed to be attributed to planetary boundary layer (PBL) dynamics. A comparison between aerosol loading (i.e. AOD) and surface PM2.5 concentration will be presented. Our results demonstrate that smoke aerosols emitted from agriculture burning that under certain meteorological conditions can degrade regional air quality 3000 km from the source region, with additional implications for aerosol radiative forcing and regional climate change over northern SE Asia.

  13. Seasonal change of NMHCs (nonmethanehydrocarbons) and halocarbons from winter to spring in East Asia observed during the PEACE (Pacific Exploration of Asian Continental Emission) aircraft measurement campaigns

    NASA Astrophysics Data System (ADS)

    Shirai, T.; Blake, D. R.; Blake, N. J.; Meinardi, S.; Rowland, F.; Chan, J. C.; Takegawa, N.; Kondo, Y.; Koike, M.; Kita, K.; Kawakami, S.; Ogawa, T.

    2003-12-01

    Recent population growth and rapid economic development in Asia has had a great impact on the amount and composition of gas emissions from Asia. To investigate the impact of these Asian emissions on local and regional air quality and climate, an airborne observation campaign PEACE (the Pacific Exploration of Asian Continental Emission) phases-A and B were conducted in January and April - May 2002, respectively. The concentrations of NMHCs (nonmethanehydrocarbons) and halocarbons were obtained by whole air sampling and subsequent gas chromatography analysis in the laboratory. Quantified onboard the aircraft were CO, CO2, O3, NO, NO2, NOy, H2O, SO2, aerosols, and condensation nuclei. The experiments were conducted along the East Asian coast, with PEACE-A and B representing the local winter and spring weather conditions, respectively. For most of the trace gases whose major atmospheric sink is OH oxidation, observed mixing ratios were much lower during PEACE-B compared to PEACE-A because of the more active photochemistry during spring-time. By contrast, some compounds showed higher mixing ratios in the upper troposphere for PEACE-B than PEACE-A, indicating more effective convection and transport of pollutants from the source regions during the spring-time. For compounds which have biogenic sources, the seasonal variation in the source strengths are indicated. The timescale of the transport in each season was estimated using the ratios of short-lived gases vs. more stable compounds. The results from PEACE are compared to those from the TRACE-P campaign (one of the NASA/GTE projects conducted from February to April 2001 in western Pacific). This comparison highlights the transition from winter to spring, as well as the range of annual trace gas variability in the region.

  14. Mycobacterium genavense in the Netherlands: an opportunistic pathogen in HIV and non-HIV immunocompromised patients. An observational study in 14 cases.

    PubMed

    Hoefsloot, W; van Ingen, J; Peters, E J G; Magis-Escurra, C; Dekhuijzen, P N R; Boeree, M J; van Soolingen, D

    2013-05-01

    Mycobacterium genavense is an opportunistic non-tuberculous mycobacterium previously mostly associated with HIV-infected patients with CD4 counts below 100/μL. In this retrospective observational study of medical charts we studied all Dutch patients in whom M. genavense was detected between January 2002 and January 2010. Of the 14 patients identified, 13 (93%) showed clinically relevant M. genavense disease. All patients with M. genavense disease were severely immunocompromised, including HIV-infected patients, solid organ transplant recipients, those with chronic steroid use in combination with other immune modulating drugs, recipients of chemotherapy for non-Hodgkin lymphoma, and those with immunodeficiency syndromes. Two patients had non-disseminated pulmonary M. genavense disease. Of the 12 patients treated, eight (75%) showed a favourable outcome. Four patients died in this study, three despite treatment for M. genavense disease. We conclude that M. genavense is a clinically relevant pathogen in severely immunocompromised patients that causes predominantly disseminated disease with serious morbidity and mortality. M. genavense is increasingly seen among non-HIV immunocompromised patients.

  15. Observations of barbers' activities in Oyo State Nigeria: implications for HIV/AIDS transmission.

    PubMed

    Salami, Kabiru K; Titiloye, Musibau A; Brieger, William R; Otusanya, Sakiru A

    In Nigeria, most studies concerning HIV/AIDS transmission have looked at the sexual route from both epidemiological and behavioral perspectives. A few have examined the role of blood transfusion and the potential for indigenous surgical practices. None have specifically looked at the transmission of potential barbers. This study distinguished between indigenous barbers who function as surgeons and "modern" barbers who cut hair, and focused on the latter through observations of barbering practices in 77 shops in Igbo-Ora and Apete communities in Oyo State. Igbo-Ora is headquarters of a rural local government, while Apete is a peri-urban community near Ibadan, the state capital. Five barbering sessions were observed in each shop using a checklist during evening hours when shops are busiest. All barbers used clippers to cut hair, either electric or manual. On average, barbers sterilized the clippers in a commercial disinfectant, Jik, or with methylated spirits prior to 4.2 barberings. Sex and age of customer were not associated with wether the clippers were sterilized. Three shop characteristics appeared to influence sterilization behavior. Clippers were more likely to be sterilized if the shop was in Apete, if the shop owner was male, and if the shop had two or more of the following electrical appliances: fan, TV, or radio/cassette layer. There were only two observed cases of the barbers causing a cut, and in both cases the clippers had been sterilized. Overall, 63 (16.3%) of the 385 customers were barbed with non-sterilized clippers. The relatively short time gap between customers implies that the potential for disease transmission exists, though it was not within the scope of this study to study disease transmission itself. In-service training that involves the barbers themselves and addresses both gender and town differences is recommended.

  16. Missed opportunities to offer HIV tests to high-risk groups during general practitioners’ STI-related consultations: an observational study

    PubMed Central

    Joore, I K; Reukers, D F M; Donker, G A; van Sighem, A I; Op de Coul, E L M; Prins, J M; Geerlings, S E; Barth, R E; van Bergen, J E A M; van den Broek, I V

    2016-01-01

    Objectives Prior research has shown that Dutch general practitioners (GPs) do not always offer HIV testing and the number of undiagnosed HIV patients remains high. We aimed to further investigate the frequency and reasons for (not) testing for HIV and the contribution of GPs to the diagnosis of HIV infections in the Netherlands. Design Observational study. Setting (1) Dutch primary care network of 42–45 sentinel practices where report forms during sexually transmitted infection (STI)-related consultations were routinely collected, 2008–2013. (2) Dutch observational cohort with medical data of HIV-positive patients in HIV care, 2008–2013. Outcome measures The proportion of STI-related consultations in patients from high-risk groups tested for HIV, with additional information requested from GPs on HIV testing preconsultation or postconsultation for whom HIV testing was indicated, but not performed. Next, information was collected on the profile of HIV-positive patients entering specialised HIV care following diagnosis by GPs. Results Initially, an HIV test was reported (360/907) in 40% of STI-related consultations in high-risk groups. Additionally, in 26% of consultations an HIV test had been performed in previous or follow-up consultations or at different STI-care facilities. The main reasons for not testing were perceived insignificant risk; ‘too’ recent risk according to GPs or the reluctance of patients. The initiative of the patient was a strong determinant for HIV testing. GPs diagnosed about one third of all newly found cases of HIV. Compared with STI clinics, HIV-positive patients diagnosed in general practice were more likely to be older, female, heterosexual male or sub-Saharan African. Conclusions In one-third of the STI-related consultations of persons from high-risk groups, no HIV test was performed in primary care, which is lower than previously reported. Risk-based testing has intrinsic limitations and implementation of new additional

  17. Cryospheric science: Asia's glacier changes

    NASA Astrophysics Data System (ADS)

    Farinotti, Daniel

    2017-09-01

    Mass changes in High Mountain Asia's glaciers have been under dispute for almost a decade. An analysis of satellite data archives provides an observation-based mass budget for every single glacier in the region.

  18. Fatigue in HIV-Infected People: A Three-Year Observational Study

    PubMed Central

    Barroso, Julie; Leserman, Jane; Harmon, James L.; Hammill, Bradley; Pence, Brian W.

    2015-01-01

    Context HIV-related fatigue remains the most frequent complaint of seropositive patients. Objectives To describe the natural course of fatigue in HIV infection, in a sample (n=128) followed for a three-year period. Methods A longitudinal prospective design was used to determine what factors influenced changes in fatigue intensity and fatigue-related impairment of functioning in a community-dwelling sample of HIV-infected individuals. Participants were followed every six months for a three-year period. At each study visit, we collected data on a large number of physiological and psychosocial markers that have been shown to be related to fatigue in HIV-infected people. At three-month intervals between study visits, we collected data on fatigue via mailed questionnaires. Results Fatigue in HIV infection is largely a result of stressful life events, and is closely tied to the anxiety and depression that accompany such events. Fatigue did not remit spontaneously over the course of the study, indicating the need for interventions to ameliorate this debilitating symptom. Conclusion Intervening to help people who are suffering from HIV-related fatigue to deal with stressful life events may help to ameliorate this debilitating symptom. PMID:25701691

  19. Characteristics of prospective memory deficits in HIV-seropositive substance-dependent individuals: preliminary observations.

    PubMed

    Martin, Eileen M; Nixon, Heather; Pitrak, David L; Weddington, William; Rains, Niles A; Nunnally, Gerald; Grbesic, Silvana; Gonzalez, Raul; Jacobus, Joanna; Bechara, Antoine

    2007-07-01

    The construct of "prospective memory" (PM) refers to a type of episodic memory for a future intention or "remembering what one must do." This function has been proposed as a candidate mechanism underlying behaviors of critical importance in HIV disease, including adherence with medication regimens and continued engagement in risk behavior. We administered tasks of time-based and event-based prospective memory and control tasks of retrospective and working memory to 31 HIV-seropositive and 35 HIV-seronegative substance-dependent individuals (SDIs). We found that compared with HIV- controls HIV+ participants showed deficits in time-based but not event-based PM. Retrospective, but not working, memory performance correlated significantly with time-based PM performance. In addition, performance on the time-based PM task was a significant predictor of scores on a self-report measure of risky sexual and injection practices. These preliminary data provide new and unique findings regarding the components of executive function mediated by prefrontal cortical systems that are impaired among HIV+ SDIs and their relevance to "real-world" behaviors.

  20. Mitigation of variation observed in a peripheral blood mononuclear cell (PBMC) based HIV-1 neutralization assay by donor cell pooling.

    PubMed

    Wieczorek, Lindsay; Brown, Bruce K; Delsarto Macedo, Camila; Wesberry-Schmierer, Maggie; Ngauy, Viseth; Rosa Borges, Andrew; Michael, Nelson L; Marovich, Mary A; Montefiori, David C; Polonis, Victoria R

    2013-12-01

    Cultured primary peripheral blood mononuclear cells (PBMC) represent a potentially physiologic in vitro model of HIV-1 infection, but assessment of antibody-mediated HIV-1 neutralization using PBMC has been hindered by donor variability and lack of a sustainable individual PBMC source. To advance this model for HIV vaccine evaluation, intra- and inter-assay variability were assessed using monoclonal and polyclonal antibodies and PBMC targets from multiple HIV-seronegative donors. Inter-assay variability was introduced by using different PBMC for virus propagation, and more substantially, for assay targets. Neutralization titers varied by as much as 4 logs when using different individual donor PBMC as targets; variability was antibody-specific, with the greatest variation observed using an individual polyclonal plasma. Pooling of multiple PBMC donors significantly reduced median inter-assay variation to the level of intra-assay variation, suggesting a pathway forward for establishing a uniform, sustainable and standardized approach to the assessment of antibody function using a PBMC model.

  1. Assessment of atmospheric acidified pollutants trends observed by EANET in North-East Asia in the first decade of XXI century

    NASA Astrophysics Data System (ADS)

    Gromov, Sergey A.; Trifonova-Yakovleva, Alisa; Gromov, Sergey S.

    2015-04-01

    Owing to rapid development and subsequent enormous increase in energy consumption/fossil fuel use, anthropogenic emissions of sulphur and nitrogen oxides in China and other Asian countries surpass those in North America and Europe since mid-1990s. Consequently, regional air pollution has become an issue for the most of developing countries in North-East Asia. Since 1998, the Acid Deposition Monitoring Network in East Asia (EANET, http://www.eanet.asia/) provides constant monitoring of the air quality and precipitation (including gaseous and particulate phase chemistry) in 13 countries of the region. The measurements are conducted at 45 rural and remote stations using both filter pack sampling techniques and automatic monitoring equipment. In this study we present a comprehensive trend analysis of the long-term (last 15 years) air pollution monitoring data from selected EANET monitoring sites. Using several statistical approaches, we estimate the quality of the data and perform distribution tests, single out special events (detect outliers) and calculate an ensemble of trends (monthly, seasonal, long-term and quartile) and their statistical significance for a suite of observed compounds. Based on this analysis, we further estimate the statistics and overall significance of the observed temporal dynamics for each pollutant. Ultimately we derive more than 20 trend estimates for a total of up to 12 gas-phase and particulate compounds for each station. Our calculations ascertain that about half of the trends (either negative or positive) observed at the EANET stations in Russia, Korea and Japan are significant. Whilst an increase in SO2, HCl, Cl-, NO3 (except for the stations in Russia) concentrations is distinct, small or insignificant trends are reckoned for HNO3-. A marked decrease in K+ content is seen at all regarded stations. We commonly find station-wise correlation for the trends of the remaining compounds, and for several species we conclude a general spatial

  2. Observation of ozone enhancement in the lower troposphere over East Asia from a space-borne ultraviolet spectrometer

    NASA Astrophysics Data System (ADS)

    Hayashida, S.; Liu, X.; Ono, A.; Yang, K.; Chance, K.

    2015-09-01

    We report observations from space using ultraviolet (UV) radiance for significant enhancement of ozone in the lower troposphere over central and eastern China (CEC). The recent retrieval products of the Ozone Monitoring Instrument (OMI) onboard the Earth Observing System (EOS) Aura satellite revealed the spatial and temporal variation of ozone distributions in multiple layers in the troposphere. We compared the OMI-derived ozone over Beijing with airborne measurements by the Measurement of Ozone and Water Vapor by Airbus In-Service Aircraft (MOZAIC) program. The correlation between OMI and MOZAIC ozone in the lower troposphere was reasonable, which assured the reliability of OMI ozone retrievals in the lower troposphere under enhanced ozone conditions. The ozone enhancement was clearly observed over CEC, with Shandong Province as its center, and was most notable in June in any given year. Similar seasonal variations were observed throughout the 9-year OMI measurement period of 2005 to 2013. A considerable part of this ozone enhancement could be attributed to the emissions of ozone precursors from industrial activities and automobiles, and possibly from open crop residue burning (OCRB) after the winter wheat harvest. The ozone distribution presented in this study is also consistent with some model studies. The lower tropospheric ozone distribution is first shown from OMI retrieval in this study, and the results will be useful in clarifying any unknown factors that influence ozone distribution by comparison with model simulations.

  3. A comparison and summary of aerosol optical properties as observed in situ from aircraft, ship, and land during ACE-Asia

    NASA Astrophysics Data System (ADS)

    Doherty, Sarah J.; Quinn, Patricia K.; Jefferson, Anne; Carrico, Christian M.; Anderson, Theodore L.; Hegg, Dean

    2005-02-01

    During the ACE-Asia campaign in March-May 2001, in situ measurements of aerosol optical properties were made from multiple airborne and land- or ship-based platforms. Using a suite of direct interplatform comparisons and a campaign-wide statistical comparison, we test the precision of these measurements, and we determine whether the platforms sampled similar aerosol. Data included in the study are from the National Center for Atmospheric Research C-130 aircraft; the CIRPAS Twin Otter aircraft; the National Oceanographic and Atmospheric Administration (NOAA) ship R.V. Ronald H. Brown; and the Gosan surface station on Jeju Island, located off the southern tip of South Korea. Comparisons were made of total and submicron light scattering at 450, 550, and 700 nm; total and submicron absorption at 550 nm; the Ångström exponent; single scatter albedo of the total aerosol, submicron and supermicron aerosol at 550 nm; hemispheric backscatter fraction at 550 nm; and light scattering hygroscopic growth at 550 nm. For the campaign-wide comparison, the data are broken down by light scattering fine mode fraction since the aerosol in the ACE-Asia study region were a variable mix of pollution, dust, and sea salt. Finally, we calculate how the observed uncertainties in the aerosol optical properties propagate to uncertainties in top-of-atmosphere radiative forcing. Single scatter albedo showed excellent agreement among all platforms other than the Twin Otter, with discrepancies generally <0.02. These data sets combine to give campaign-wide values of single scatter albedo of 0.885 ± 0.023 for the submicron aerosol (i.e. pollution) and 0.957 ± 0.031 for the supermicron aerosol (which, for these data, was predominantly dust). The data also indicated that, as expected, the Low Turbulent Inlet on the C-130 produced enhanced concentrations of coarse mode aerosol. There also may have been significant coarse mode particle losses on the other platforms. These effects combined to produce

  4. Observation of ozone enhancement in the lower troposphere over East Asia from a space-borne ultraviolet spectrometer

    NASA Astrophysics Data System (ADS)

    Hayashida, S.; Liu, X.; Ono, A.; Yang, K.; Chance, K.

    2015-01-01

    We report observations from space using ultraviolet (UV) radiance for significant enhancement of ozone in the lower troposphere over Central and Eastern China (CEC). The recent retrieval products of the Ozone Monitoring Instrument (OMI) onboard the Earth Observing System (EOS)/Aura satellite revealed the spatial and temporal variation of ozone distributions in multiple layers in the troposphere. We compared the OMI-derived ozone over Beijing with airborne measurements by the Measurement of Ozone and Water Vapor by Airbus In-Service Aircraft (MOZAIC) program. The correlation between OMI and MOZAIC ozone in the lower troposphere was reasonable, which assured the reliability of OMI ozone retrievals in the lower troposphere under enhanced ozone conditions. The ozone enhancement was clearly observed over CEC, with Shandong Province as its center, and most notable in June in any given year. Similar seasonal variations were observed throughout the nine-year OMI measurement period of 2005 to 2013. The ozone enhancement in June was associated with the enhancement of carbon monoxide (CO) and hotspots, which is consistent with previous studies of in-situ measurements such those made by the MTX2006 campaign. A considerable part of this ozone enhancement could be attributed to the emissions of ozone precursors from open crop residue burning (OCRB) after the winter wheat harvest, in addition to emissions from industrial activities and automobiles. The ozone distribution presented in this study is also consistent with some model studies that apply emissions from OCRB. The lower tropospheric ozone distribution is first shown from OMI retrieval in this study, and the results will be useful in clarifying any unknown factors that influence ozone distribution by comparison with model simulations.

  5. Long-term observations of black carbon mass concentrations at Fukue Island, western Japan, during 2009-2015: constraining wet removal rates and emission strengths from East Asia

    NASA Astrophysics Data System (ADS)

    Kanaya, Yugo; Pan, Xiaole; Miyakawa, Takuma; Komazaki, Yuichi; Taketani, Fumikazu; Uno, Itsushi; Kondo, Yutaka

    2016-08-01

    Long-term (2009-2015) observations of atmospheric black carbon (BC) mass concentrations were performed using a continuous soot-monitoring system (COSMOS) at Fukue Island, western Japan, to provide information on wet removal rate constraints and the emission strengths of important source regions in East Asia (China and others). The annual average mass concentration was 0.36 µg m-3, with distinct seasonality; high concentrations were recorded during autumn, winter, and spring and were caused by Asian continental outflows, which reached Fukue Island in 6-46 h. The observed data were categorized into two classes, i.e., with and without a wet removal effect, using the accumulated precipitation along a backward trajectory (APT) for the last 3 days as an index. Statistical analysis of the observed ΔBC / ΔCO ratios was performed to obtain information on the emission ratios (from data with zero APT only) and wet removal rates (including data with nonzero APTs). The estimated emission ratios (5.2-6.9 ng m-3 ppb-1) varied over the six air mass origin areas; the higher ratios for south-central East China (30-35° N) than for north-central East China (35-40° N) indicated the relative importance of domestic emissions and/or biomass burning sectors. The significantly higher BC / CO emission ratios adopted in the bottom-up Regional Emission inventory in Asia (REAS) version 2 (8.3-23 ng m-3 ppb-1) over central East China and Korea needed to be reduced at least by factors of 1.3 and 2.8 for central East China and Korea, respectively, but the ratio for Japan was reasonable. The wintertime enhancement of the BC emission from China, predicted by REAS2, was verified for air masses from south-central East China but not for those from north-central East China. Wet removal of BC was clearly identified as a decrease in the ΔBC / ΔCO ratio against APT. The transport efficiency (TE), defined as the ratio of the ΔBC / ΔCO ratio with precipitation to that without precipitation, was

  6. Recent cancer incidence trends in an observational clinical cohort of HIV-infected patients in the US, 2000 to 2011.

    PubMed

    Yanik, Elizabeth L; Tamburro, Kristen; Eron, Joseph J; Damania, Blossom; Napravnik, Sonia; Dittmer, Dirk P

    2013-05-24

    In HIV-infected populations in developed countries, the most recent published cancer incidence trend analyses are only updated through 2008. We assessed changes in the distribution of cancer types and incidence trends among HIV-infected patients in North Carolina up until 2011. We linked the University of North Carolina Center for AIDS Research HIV Clinical Cohort, an observational clinical cohort of 3141 HIV-infected patients, with the North Carolina Cancer registry. Cancer incidence rates were estimated across calendar years from 2000 to 2011. The distribution of cancer types was described. Incidence trends were assessed with linear regression. Across 15,022 person-years of follow-up, 202 cancers were identified (incidence rate per 100,000 person-years [IR]: 1345; 95% confidence interval [CI]: 1166, 1544). The majority of cancers were virus-related (61%), including Kaposi sarcoma (N = 32) (IR: 213; 95%CI: 146, 301), non-Hodgkin lymphoma (N = 34) (IR: 226; 95%CI: 157, 316), and anal cancer (N = 16) (IR: 107; 95%CI: 61, 173). Non-Hodgkin lymphoma was observed to decrease from 2000 to 2011 (decline of 15 cases per 100,000 person-years per calendar year, 95%CI: -27, -3). No other changes in incidence or changes in incidence trends were observed for other cancers (all P > 0.20). We observed a substantial burden of a variety of cancers in this population in the last decade. Kaposi sarcoma and non-Hodgkin lymphoma were consistently two of the greatest contributors to cancer burden across calendar time. Cancer rates appeared stable across calendar years, except for non-Hodgkin lymphoma, which appeared to decrease throughout the study period.

  7. Relationship between column aerosol optical properties and surface aerosol gravimetric concentrations during the Distributed Regional Aerosol Gridded Observation Network - Northeast ASIA 2012 campaign

    NASA Astrophysics Data System (ADS)

    Jeong, U.; Kim, J.; Seo, S.; Choi, M.; Kim, W. V.; Holben, B. N.; Lee, S.; Kim, J.

    2012-12-01

    One of the main objectives of Distributed Regional Aerosol Gridded Observation Network (DRAGON) campaign in Deriving Information on Surface conditions from Column and Vertically Resolved Observations Relevant to Air Quality (DISCOVER-AQ) mission is to understand the relationship between the column optical properties of the atmosphere and the surface level air quality in terms of aerosols and gases. This study aims to identify the important parameters that affecting the relationship between those variables during the DRAGON - northeast Asia 2012 campaign. Column aerosol optical properties from ten Cimel sun photometers at DRAGON sites in Seoul, MODIS (Moderate Resolution Imaging Spectroradiometer), and GOCI (Geostationary Ocean Color Imager) and particulate matter (PM10) sampling from 40 NIER (National Institute of Environmental Research of South Korea) measurement sites in Seoul during the period of 1st March - 31th May 2012 were employed in this study. The key parameters in relationship between aerosol optical depth (AOD) and PM are reported to be aerosol vertical profile and hygroscopicity of the aerosols. The meteorological conditions including relative humidity, surface temperature, and wind speed that could affect those parameters were investigated.

  8. Regional modeling of tropospheric NO2 vertical column density over East Asia during the period 2000-2010: comparison with multisatellite observations

    NASA Astrophysics Data System (ADS)

    Itahashi, S.; Uno, I.; Irie, H.; Kurokawa, J.-I.; Ohara, T.

    2014-04-01

    Satellite observations of the tropospheric NO2 vertical column density (VCD) are closely correlated to, and thus can be used to estimate, surface NOx emissions. In this study, the NO2 VCD simulated by a regional chemical transport model with emissions data from the updated Regional Emission inventory in ASia (REAS) version 2.1 were validated through comparison with multisatellite observations during the period 2000-2010. Rapid growth in NO2 VCD (~11% year-1) driven by the expansion of anthropogenic NOx emissions was identified above the central eastern China (CEC) region, except for the period during the economic downturn. In contrast, slightly decreasing trends (~2% year-1) were identified above Japan accompanied by a decline in anthropogenic emissions. To systematically compare the modeled NO2 VCD, we estimated sampling bias and the effect of applying the averaging kernel information, with particular focus on the SCanning Imaging Absorption spectroMeter for Atmospheric CHartographY (SCIAMACHY) data. Using the updated REAS, the modeled NO2 VCD reasonably reproduced annual trends observed by multisatellites, suggesting that the rate of increase of NOx emissions estimated by the updated REAS inventory would be robust. Province-scale revision of emissions above CEC is needed to further refine emission inventories. Based on the close linear relationship between modeled and observed NO2 VCD and anthropogenic NOx emissions, NOx emissions in 2009 and 2010, which were not covered by the updated REAS inventory, were estimated. NOx emissions from anthropogenic sources in China in 2009 and 2010 were determined to be 26.4 and 28.5 Tg year-1, respectively, indicating that NOx emissions increased more than twofold between 2000 and 2010. This increase reflected the strong growth of anthropogenic emissions in China following the rapid recovery from the economic downturn from late 2008 until mid-2009. Our method consists of simple estimations from satellite observations and

  9. North-south asymmetry of the equatorial ionospheric anomaly observed in East Asia during the SUNDIAL-87 campaign

    NASA Astrophysics Data System (ADS)

    Walker, G. O.; Li, T. Y. Y.; Soegijo, J.; Kikuchi, T.; Huang, Y. N.; Badillo, V.; Szuszczewicz, E. P.

    1991-06-01

    The asymmetry of the equatorial ionospheric anomaly (EIA) has been investigated using results obtained at a chain of East Asian ionosonde stations (at longitude 120 deg E) during the SUNDIAL-87 campaign, 29 May-7 June 1987. Predominant daily features were a more rapid build-up of the southern (winter) EIA crest in the morning and a more rapid decay of this same crest, starting in the mid-afternoon, than the northern crest. These observations have been explained by the effect of the daytime summer-winter hemisphere-directed winds.

  10. Timing of cART initiation in Male and Female Migrants Living with HIV in Western Europe: an observational cohort study (1997-2013).

    PubMed

    2017-01-21

    We evaluate differences in timing of cART (combined Antiretroviral Treatment) initiation by geographical origin in male and female HIV-positive subjects in COHERE, a large European Collaboration of HIV Cohorts. We included individuals recruited in Western-Europe between January1997-March2013, with known geographical origin and ≥1CD4 cell count measurement while cART-naïve. Timing of cART was assessed through modified time-to-event methods where a scale of CD4 counts was used instead of time, with cART being the outcome. We estimated the median CD4 at cART initiation (estimated CD4 levels at which the probability of starting cART is 50%) using Kaplan-Meier and adjusted Hazard Ratios of cART initiation using Cox regression. Of 151674 individuals, 110 592(72.9%) were men. Median (95% CI) CD4 count falls far below 250 cells/mm in all groups, and was lowest in Sub-Saharan African [SSA:161(158-167)] and Caribbean men [CRB:161(150-174)], and in Asian women [ASIA/OC:185(165-197)]. The adjusted probability of cART initiation among men was lower in migrants compared to natives, but differences depended on initial CD4 count. For example in the group with >500 CD4 at recruitment, they were 45%(36-53%), 30%(17-40%) and 25%(19-30%) lower for CRB, Eastern European (EE) and SSA men, respectively. In women, no meaningful differences were observed between natives and most migrant groups. However, SSA women had a 31% (24-38%) higher probability of cART initiation when recruited at a CD4>500 cells/mm and 9%(4-14%) lower when recruited at CD4<100 cells/mm. Most migrant men initiate cART at lower CD4 count than natives whereas this does not hold for migrant women.

  11. Cutaneous HIV-associated Kaposi sarcoma: a potential setting for management by clinical observation.

    PubMed

    Beatrous, Surget V; Grisoli, Stratton B; Riahi, Ryan R; Cohen, Philip R

    2017-06-15

    Kaposi sarcoma (KS) is a malignancy of viral etiology whose course ranges from cutaneous limited lesions to fulminant disease with multi-organ involvement. Four clinical variants of the disease exist: classic, endemic, iatrogenic, and epidemic. Iatrogenic and epidemic variants of Kaposi sarcoma develop in the setting of immune suppression. Transplant recipients who develop iatrogenic KS typically demonstrate improvement of lesions following de-escalation of immunosuppressive therapy. Similarly, HIV-infected patients who begin highly active antiretroviral therapy (HAART) experience immune reconstitution, which can induce KS regression. We describe two patients with varying clinical outcomes of cutaneous-limited HIV-associated KS after immune reconstitution with HAART. We propose that immune reconstitution with HAART, followed by clinical and radiographic surveillance for disease progression, may be an appropriate initial management strategy for limited cutaneous HIV-associated KS. In patients with more extensive disease at presentation or failure of HAART alone, antineoplastic therapy should be instituted.

  12. Trend analysis of satellite-observed tropospheric NO2 vertical column densities over East Asia for 2005-2014

    NASA Astrophysics Data System (ADS)

    Muto, T.; Irie, H.; Itahashi, S.

    2015-12-01

    Nitrogen dioxide (NO2) plays a central role in the troposphere as a toxic substance for the respiratory system and a precursor for ozone and aerosols. Furthermore, the OH concentration is dependent on the NO2 concentration. While trend analysis for tropospheric NO2 concentrations in several specific regions all over the world was made in literature for period until 2011, the latest trends after 2011 have not been reported yet. The time period after 2011 is of interest, because it corresponds to the 12th 5-year-plan regulating NOx emissions in China and the period with the power substitution of thermal power generation for the nuclear power generation in Japan. In this study, we first compared satellite-observed tropospheric NO2 VCDs (Vertical Column Densities) with those observed by ground-based Multi-Axis Differential Optical Absorption Spectroscopy (MAX-DOAS) instruments installed at Chiba University in order to clarify whether or not there is degradation in OMI and GOME-2 NO2 VCDs data after 2011. We concluded that there is no significant degradation in OMI and GOME-2 data, since the comparison results are similar to those reported by previous validation studies. Based on the results, tropospheric NO2 VCD trends over Central Eastern China (CEC; 30-40°N, 110.0-123.0°E) and Japan (JPN; 33.5-37.0°N, 133.0-141.0°E) regions were estimated using the regression analysis for annual mean values. Although an increase in NO2 VCDs occurred at a rate of 6%(8%) per year in OMI (GOME-2) data from 2005(2007) to 2011 over CEC, we found a decrease at a rate of 10%(11%) per year from 2011 to 2014. This reduction may be a result from the regulation of NOx emissions from coal fired power generation, iron foundry, cement plant, etc., and installation of the denitrification units during the period of 12th 5-year-plan. For JPN, both OMI and GOME-2 data sets showed that the NO2 VCDs decreased at a rate of 4% per year before 2011. The decreasing trends continued until 2014, with a

  13. Surface ozone and carbon monoxide levels observed at Oki, Japan: regional air pollution trends in East Asia.

    PubMed

    Sikder, Helena Akhter; Suthawaree, Jeeranut; Kato, Shungo; Kajii, Yoshizumi

    2011-03-01

    Simultaneous ground-based measurements of ozone and carbon monoxide were performed at Oki, Japan, from January 2001 to September 2002 in order to investigate the O(3) and CO characteristics and their distributions. The observations revealed that O(3) and CO concentrations were maximum in springtime and minimum in the summer. The monthly averaged concentrations of O(3) and CO were 60 and 234 ppb in spring and 23 and 106 ppb in summer, respectively. Based on direction, 5-day isentropic backward trajectory analysis was carried out to determine the transport path of air masses, preceding their arrival at Oki. Comparison between classified results from present work and results from the year 1994-1996 was carried out. The O(3) and CO concentration results of classified air masses in our analysis show similar concentration trends to previous findings; highest in the WNW/W, lowest in N/NE and medium levels in NW. Moreover, O(3) levels are higher and CO levels are lower in the present study in all categories. Copyright © 2010 Elsevier Ltd. All rights reserved.

  14. Heterosexual transmission of HIV.

    PubMed

    Johnson, A M; Laga, M

    1988-01-01

    Recent developments concerning heterosexual transmission of HIV (review of 1988 literature only) suggest improved understanding of the pattern of spread and role of risk behaviors and biological cofactors in its transmission. 3 distinct patterns if HIV infection are known: heterosexual spread in sub-Saharan Africa and the Caribbean, spread primarily among homosexuals and injecting drug users in Europe, North American and much of Latin America and Australia, and both homosexual and heterosexual transmission in Asia, the Pacific, the Middle East and Eastern Europe, where prevalence is low. In Africa an estimated 80% of cases are acquired heterosexually. Important risk factors are number of sex partners, sex with prostitutes, being a prostitute, being a sex partner of an infected person, and having a history of other sexually transmitted diseases. Prevalence rates have risen rapidly in Zaire and Kenya. In Africa, acquisition of HIV is related to sexual activity only. In contrast, in the U.S., heterosexual cases make up only 4% of all cases, and in Europe only 6%. Data on types of sexual transmission of HIV are mounting, in aggregate suggestive of a marked heterogeneity in infectivity and possibly susceptibility between individuals. Among couples where the man is positive, in some places individuals appear to be highly infective, notably those from Kinshasa, Zaire and Haiti, while other series of discordant couples the receptive partner remained seronegative for several years. Transmission from women to men appears to be less efficient than from men to women, as has been observed with other STDs such as gonorrhea. Biological cofactors implicated in enhanced HIV transmission appear to be advanced CDC Stage IV AIDS disease, with low T-helper lymphocyte counts and high antigenemia; concomitant STDS, especially those with genital ulceration; lack of circumcision; oral contraceptive use; practice of anal intercourse; inconsistent or no use of condoms. Theoretical models for

  15. Mercury in the atmosphere around Japan, Korea, and China as observed during the 2001 ACE-Asia field campaign: Measurements, distributions, sources, and implications

    NASA Astrophysics Data System (ADS)

    Friedli, Hans R.; Radke, Lawrence F.; Prescott, Ryan; Li, Pan; Woo, Jung-Hun; Carmichael, Gregory R.

    2004-10-01

    We report on mercury in the atmosphere of east Asia (Japan, Korea, and China) as measured from sea level to ˜7000 m during 16 research flights in the National Science Foundation (NSF)/National Center for Atmospheric Research (NCAR) C-130 aircraft during the Asian Pacific Regional Aerosol Characterization Experiment (ACE-Asia) campaign (http://saga.pmel.noaa.gov/aceasia/). The air at all altitudes contained concentrations of atmospheric mercury above the global background. The atmosphere was highly stratified with plumes originating from massive dust storms carried out of China, from local industrial pollution, from volcanoes, and, less well defined, from biomass burning. Most often the air masses were mixtures, e.g., dust layers contained anthropogenic emissions or volcanic plumes were embedded in anthropogenic pollution; thus the total data set showed no significant correlations of gaseous mercury with the most common anthropogenic pollutants in the area (CO and SO2), but good correlations were observed for identifiable plumes. Highest mixing ratios for gaseous elemental mercury (GEM) were found in industrial plumes exiting China (˜6.3 ng/m3), Korea (˜3 ng/m3), and Japan (˜3 ng/m3). The core of the plume from Miyake Jima volcano contained ˜3.7 ng/m3 of GEM. Crustal mercury was also present, emitted and subsequently deposited during the outbreak of the spring dust storms. Some of the nondust aerosols contained soluble mercury in highly variable ratios with the gas-phase mercury contained in the same plume. Preliminary estimates for the export from China are 5-15 t of crustal mercury during the dust storms, ˜150 t/yr of gas-phase mercury from biomass/biofuel combustion, and ˜600 t/yr from industrial sources, mostly from coal combustion. Gaseous mercury is a useful tracer for industrial, volcanic, and biomass-burning sources, but in most cases, robust plume identification required one or more cotracers. Because of the inertness of GEM and the ease of its

  16. Impact of Aerosols on Shortwave and Photosynthetically Active Radiation Balance over Sub-tropical Region in South Asia: Observational and Modeling Approach

    NASA Astrophysics Data System (ADS)

    Subba, T.; Pathak, B.

    2016-12-01

    surface dimming is observed in west-Asia followed by IGP and west-India. Surface radiative reduction over NER is comparable to south-India standing on the third place which is still higher than that of the Himalayan and Oceanic regions.

  17. Safety, tolerability, and efficacy of metformin extended-release oral antidiabetic therapy in patients with type 2 diabetes: an observational trial in Asia.

    PubMed

    Kim, Chul-Hee; Han, Kyung-Ah; Oh, Han-Jin; Tan, Kevin Eng-Kiat; Sothiratnam, Radhakrishna; Tjokroprawiro, Askandar; Klein, Marcus

    2012-12-01

    The aim of the present prospective observational study was to assess the tolerability and antihyperglycemic efficacy of metformin extended-release (MXR) in the routine treatment of patients with type 2 diabetes mellitus (T2DM) from six Asian countries. Data from 3556 patients treated with once-daily MXR for 12 weeks, or until discontinuation, were analyzed. Treatment with MXR was well tolerated, with 97.4% of patients completing 12 weeks of treatment. Only 3.3% of patients experienced one or more gastrointestinal (GI) side-effects and only 0.7% of patients discontinued for this reason (primary endpoint). The incidence of GI side-effects and related discontinuations appeared to be considerably lower during short-term MXR therapy than during previous treatment (mean 2.71 years' duration), most commonly with immediate-release metformin. A 12-week course of MXR therapy also reduced HbA1c and fasting glucose levels from baseline. The present study provides new insights into the incidence of GI side-effects with MXR in Asian patients with T2DM and on the tolerability of MXR in non-Caucasian populations. Specifically, these data indicate that once-daily MXR not only improves measures of glycemic control in Asian patients with T2DM, but also has a favorable GI tolerability profile that may help promote enhanced adherence to oral antidiabetic therapy. © 2012 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

  18. An International Observational Prospective Survey Assessing the Control of Atrial Fibrillation in Asia-Pacific: Results of the Record-AFAP Registry

    PubMed Central

    Amerena, John; Chen, Shih-Ann; Sriratanasathavorn, Charn; Cho, Jeong-Gwan; Dejia, Huang; Omar, Razali; Fat, Tse Hung; King, Anthony

    2015-01-01

    A prospective 1-year observational survey was designed to assess the management and control of atrial fibrillation (AF) in eight countries within the Asia-Pacific region. Patients (N = 2,604) with recently diagnosed AF or a history of AF ≤1 year were included. Clinicians chose the treatment strategy (rhythm or rate control) according to their standard practice and medical discretion. The primary endpoint was therapeutic success. At baseline, rhythm- and rate-control strategies were applied to 35.7% and 64.3% of patients, respectively. At 12 months, therapeutic success was 43.2% overall. Being assigned to rhythm-control strategy at baseline was associated with a higher therapeutic success (46.5% vs 41.4%; P = 0.0214) and a lower incidence of clinical outcomes (10.4% vs 17.1% P < 0.0001). Patients assigned to rate-control strategies at baseline had higher cardiovascular morbidities (history of heart failure or valvular heart disease). Cardiovascular outcomes may be less dependent on the choice of treatment strategy than cardiovascular comorbidities. PMID:26279634

  19. Detection of HIV type 1 env subtypes A, B, C, and E in Asia using dried blood spots: a new surveillance tool for molecular epidemiology.

    PubMed

    Cassol, S; Weniger, B G; Babu, P G; Salminen, M O; Zheng, X; Htoon, M T; Delaney, A; O'Shaughnessy, M; Ou, C Y

    1996-10-10

    Global surveillance of HIV-1 subtypes for genetic characterization is hampered by the biohazard of processing and the difficulties of shipping whole blood or cells from many developing country regions. We developed a technique for the direct automated sequencing of viral DNA from dried blood spot (DBS) specimens collected on absorbent paper, which can be mailed unrefrigerated in sturdy paper envelopes with low biohazard risk. DBS were collected nonrandomly from HIV-1-infected, mostly asymptomatic, patients in five Asian countries in 1991, and shipped via airmail or hand carried without refrigeration to Bangkok, and then transshipped to North America for processing. After more than 2 years of storage, including 6 months at ambient temperatures, proviral DNA in the DBS was amplified by nested PCR, and a 389-nucleotide segment of the C2-V3 env gene region was sequenced, from which 287 base pairs were aligned and subtyped by phylogenetic analysis with neighbor-joining and other methods. From southern India, there were 25 infections with subtype C and 2 with subtype A. From Myanmar (Burma), we identified the first subtype E infection, as well as six subtype BB, a distinct cluster within subtype B that was first discovered in Thailand and that has now appeared in China, Malaysia, and Japan. From southwest China, one BB was identified, while a "classical" B typical of North American and European strains was found in Indonesia. From Thailand, five DBS of ambiguous serotype were identified as three B, one BB, and one E. A blinded control serotype E specimen was correctly identified, but a serotype BB control was not tested. Most HIV-1 in southern India appears to be env subtype C, with rare A, as others have reported in western and northern India. The subtypes BB and E in Myanmar, and the BB in China, suggest epidemiological linkage with these subtypes in neighboring Thailand. DBS are a practical, economical technique for conducting large-scale molecular epidemiological

  20. Continuous generation and two-dimensional structure of equatorial plasma bubbles observed by high-density GPS receivers in Southeast Asia

    NASA Astrophysics Data System (ADS)

    Buhari, S. M.; Abdullah, M.; Hasbi, A. M.; Otsuka, Y.; Yokoyama, T.; Nishioka, M.; Tsugawa, T.

    2014-12-01

    High-density GPS receivers located in Southeast Asia (SEA) were utilized to study the two-dimensional structure of ionospheric plasma irregularities in the equatorial region. The longitudinal and latitudinal variations of tens of kilometer-scale irregularities associated with equatorial plasma bubbles (EPBs) were investigated using two-dimensional maps of the rate of total electron content change index (ROTI) from 127 GPS receivers with an average spacing of about 50-100 km. The longitudinal variations of the two-dimensional maps of GPS ROTI measurement on 5 April 2011 revealed that 16 striations of EPBs were generated continuously around the passage of the solar terminator. The separation distance between the subsequent onset locations varied from 100 to 550 km with 10 min intervals. The lifetimes of the EPBs observed by GPS ROTI measurement were between 50 min and over 7 h. The EPBs propagated 440-3000 km toward the east with velocities of 83-162 m s-1. The longitudinal variations of EPBs by GPS ROTI keogram coincided with the depletions of 630 nm emission observed using the airglow imager. Six EPBs were observed by GPS ROTI along the meridian of Equatorial Atmosphere Radar (EAR), while only three EPBs were detected by the EAR. The high-density GPS receivers in SEA have an advantage of providing time continuous descriptions of latitudinal/longitudinal variations of EPBs with both high spatial resolution and broad geographical coverage. The spatial periodicity of the EPBs could be associated with a wavelength of the quasiperiodic structures on the bottomside of the F region which initiate the Rayleigh-Taylor instability.

  1. Southeast Asia

    NASA Technical Reports Server (NTRS)

    2002-01-01

    Home to beautiful jungles, booming industry, and age-old temples, Southeast Asia has become a confluence of ancient and modern life. This true-color image of mainland Southeast Asia was acquired on November 30, 2001, by the Moderate-resolution Imaging Spectroradiometer (MODIS), flying aboard NASA's Terra spacecraft. The body of water in the upper righthand corner of the image is the Gulf of Tonkin. East and southeast of the gulf are the dark green jungles of Vietnam, Laos, and Cambodia. The light brown Mekong River winds its way through the center of the Cambodian jungle and into southern Vietnam. The dark blue patch to the left of the river at the bottom of the image is the Tonle Sap. Literally translated to mean 'Great Lake,' the Tonle Sap is the largest freshwater lake in Southeast Asia. During the rainy season from May to October, the lake will more than double in size growing from its wintertime extent of 3,000 square kilometers to over 7,500 square kilometers. North of the lake, approximately in the center of the image, is a saucer-shaped patch of reddish brown land known as the Khorat Plateau. Situated 90 to 200 meters above sea level in eastern Thailand, the dry plateau is mostly covered with farmland and savanna-type grasses and shrubs. Moving south again, the large body of light blue water at the bottom central portion of the image is the Gulf of Thailand. By switching to the full resolution image (250 meters per pixel) and following the Gulf of Thailand to its northernmost extent, one can see a pinkish beige patch of terrain covered by a faint latticework of fine lines. These are likely to be the network of roads that crisscross Bangkok and its surrounding suburbs and fertile farmland. The narrow strip of land to the east of the Gulf of Thailand is the Malay Peninsula. The body of water to the left of the peninsula is the Gulf of Martaban, which borders Myanmar (Burma). At the far upper lefthand corner of the image, the water has turned light brown from

  2. Southeast Asia

    NASA Technical Reports Server (NTRS)

    2002-01-01

    Home to beautiful jungles, booming industry, and age-old temples, Southeast Asia has become a confluence of ancient and modern life. This true-color image of mainland Southeast Asia was acquired on November 30, 2001, by the Moderate-resolution Imaging Spectroradiometer (MODIS), flying aboard NASA's Terra spacecraft. The body of water in the upper righthand corner of the image is the Gulf of Tonkin. East and southeast of the gulf are the dark green jungles of Vietnam, Laos, and Cambodia. The light brown Mekong River winds its way through the center of the Cambodian jungle and into southern Vietnam. The dark blue patch to the left of the river at the bottom of the image is the Tonle Sap. Literally translated to mean 'Great Lake,' the Tonle Sap is the largest freshwater lake in Southeast Asia. During the rainy season from May to October, the lake will more than double in size growing from its wintertime extent of 3,000 square kilometers to over 7,500 square kilometers. North of the lake, approximately in the center of the image, is a saucer-shaped patch of reddish brown land known as the Khorat Plateau. Situated 90 to 200 meters above sea level in eastern Thailand, the dry plateau is mostly covered with farmland and savanna-type grasses and shrubs. Moving south again, the large body of light blue water at the bottom central portion of the image is the Gulf of Thailand. By switching to the full resolution image (250 meters per pixel) and following the Gulf of Thailand to its northernmost extent, one can see a pinkish beige patch of terrain covered by a faint latticework of fine lines. These are likely to be the network of roads that crisscross Bangkok and its surrounding suburbs and fertile farmland. The narrow strip of land to the east of the Gulf of Thailand is the Malay Peninsula. The body of water to the left of the peninsula is the Gulf of Martaban, which borders Myanmar (Burma). At the far upper lefthand corner of the image, the water has turned light brown from

  3. Studying Peculiarities of Ionospheric Response to the 2015 March 17-19 Geomagnetic Storm in East Asia: Observations and Simulation

    NASA Astrophysics Data System (ADS)

    Romanova, Elena; Zherebtsov, Gelii; Polekh, Nelya; Wang, Xiao; Wang, Guojun; Zolotukhina, Nina; Shi, Jiankui

    2016-07-01

    We report results of the research into effects of the strong geomagnetic storm in the ionosphere of high, middle, and low latitudes on March 17-19, 2015. The research relies on measurements made at the network of ionospheric stations located near the 120°E meridian. The analysis of experimental data has revealed that at the beginning of the main storm phase the equatorial wall of the main ionospheric trough (MIT) shifted towards geographic latitudes 58-60°N, which caused negative disturbances in subauroral latitudes and positive disturbances in middle latitudes. Further displacement of the MIT equatorial wall towards a geographic latitude of 52° N led to a decrease in the F2-layer critical frequency (foF2) up to 2 MHz in middle latitudes during evening and night hours, and to the appearance of sporadic layers in these latitudes due to energetic particle precipitation. Such phenomena are largely specific to the subauroral ionosphere. During the recovery storm phase on March 18, 2015 during daylight hours, negative disturbances were recorded at all the stations. Since prolonged negative disturbances are usually associated with a reduction in the ratio of concentrations of atomic oxygen and molecular nitrogen [O]/[N2] which is transported by disturbed thermospheric wind from auroral latitudes to middle and low ones, we analyzed measurements of [O]/[N2], made by GUVI (Global Ultraviolet Imager, http://guvi.jhuapl.edu/site/gallery/guvi-galleryl3on2.shtml), during this storm. The storm appeared to be characterized by very low values of [O]/[N2] which were recorded in the longitude sector 60 - 150°E up to 15°N on March 18. The discovered peculiarities of the ionospheric response to the storm were interpreted using a theoretical model of ionosphere-plasmosphere coupling developed at ISTP SB RAS. The simulation showed that the displacement of MIT equatorial wall resulted in foF2 variations similar to those observed during the main storm phase in subauroral and middle

  4. The role of community-based nurses in harm reduction for HIV prevention: a South East and South Asia case study.

    PubMed

    Limbu, Bobby

    2008-06-01

    International studies have explored the use of community-based nurses for harm reduction programs and HIV prevention. However, none have explored this role within the countries of Nepal, Myanmar, and China where the legal and political environment may adversely affect uptake of services by people who use injection drugs. Based on experiences as a nurse and harm reduction technical adviser for the development of community-based nursing initiatives in Nepal, Myanmar and China, I review some of the strengths and challenges associated with harm reduction programs in these countries. Community-based nurses play an important role in increasing the access and uptake of public health services by people who inject drugs. Within the context of harm reduction programs, community-based nurses develop a unique trust with people who inject drugs by providing non-discriminatory health care. Nurses act as information bridges between communities of people who use injection drugs, law enforcement, political and health care stakeholders. In doing so, they facilitate timely policy and programmatic responses. However, community-based nurses are prone to burnout due to long working hours and a limited pool of human resources. Community-based nurses have proven essential to the effective implementation of harm reduction program for HIV prevention in Nepal, Myanmar and China. Increased attention and support to these health care professionals have the potential to strengthen existing programs targeting people who inject drugs.

  5. Maternal characteristics during pregnancy and risk factors for positive HIV RNA at delivery: a single-cohort observational study (Brescia, Northern Italy).

    PubMed

    Izzo, Ilaria; Forleo, Maria A; Casari, Salvatore; Quiros-Roldan, Eugenia; Magoni, Michele; Carosi, Giampiero; Torti, Carlo

    2011-02-21

    Detectable HIV RNA in mothers at delivery is an important risk factor for HIV transmission to newborns. Our hypothesis was that, in migrant women, the risk of detectable HIV RNA at delivery is greater owing to late HIV diagnosis. Therefore, we examined pregnant women by regional provenance and measured variables that could be associated with detectable HIV RNA at delivery. A observational retrospective study was conducted from January 1999 to May 2008. Univariate and multivariable regression analyses (generalized linear models) were used, with detectable HIV RNA at delivery as dependent variable. The overall population comprised 154 women (46.8% migrants). Presentation was later in migrant women than Italians, as assessed by CD4-T-cell count at first contact (mean 417/mm³ versus 545/mm³, respectively; p = 0.003). Likewise, HIV diagnosis was made before pregnancy and HAART was already prescribed at the time of pregnancy in more Italians (91% and 75%, respectively) than migrants (61% and 42.8%, respectively). A subgroup of women with available HIV RNA close to term (i.e., ≤30 days before labour) was studied for risk factors of detectable HIV RNA (≥50 copies/ml) at delivery. Among 93 women, 25 (26.9%) had detectable HIV RNA. A trend toward an association between non-Italian nationality and detectable HIV RNA at delivery was demonstrated by univariate analysis (relative risk, RR = 1.86; p = 0.099). However, by multivariable regression analysis, the following factors appeared to be more important: lack of stable (i.e., ≥14 days) antiretroviral therapy at the time of HIV RNA testing (RR = 4.3; p < 0.0001), and higher CD4+ T-cell count at pregnancy (per 50/mm³, RR = 0.94; p = 0.038). These results reinforce the importance of extensive screening for HIV infection, earlier initiation of antiretroviral therapy and stricter monitoring of pregnant women to reduce the risk of detectable HIV RNA at delivery. Public health interventions should be particularly targeted to

  6. Maternal characteristics during pregnancy and risk factors for positive HIV RNA at delivery: a single-cohort observational study (Brescia, Northern Italy)

    PubMed Central

    2011-01-01

    Background Detectable HIV RNA in mothers at delivery is an important risk factor for HIV transmission to newborns. Our hypothesis was that, in migrant women, the risk of detectable HIV RNA at delivery is greater owing to late HIV diagnosis. Therefore, we examined pregnant women by regional provenance and measured variables that could be associated with detectable HIV RNA at delivery. Methods A observational retrospective study was conducted from January 1999 to May 2008. Univariate and multivariable regression analyses (generalized linear models) were used, with detectable HIV RNA at delivery as dependent variable. Results The overall population comprised 154 women (46.8% migrants). Presentation was later in migrant women than Italians, as assessed by CD4-T-cell count at first contact (mean 417/mm3 versus 545/mm3, respectively; p = 0.003). Likewise, HIV diagnosis was made before pregnancy and HAART was already prescribed at the time of pregnancy in more Italians (91% and 75%, respectively) than migrants (61% and 42.8%, respectively). A subgroup of women with available HIV RNA close to term (i.e., ≤30 days before labour) was studied for risk factors of detectable HIV RNA (≥50 copies/ml) at delivery. Among 93 women, 25 (26.9%) had detectable HIV RNA. A trend toward an association between non-Italian nationality and detectable HIV RNA at delivery was demonstrated by univariate analysis (relative risk, RR = 1.86; p = 0.099). However, by multivariable regression analysis, the following factors appeared to be more important: lack of stable (i.e., ≥14 days) antiretroviral therapy at the time of HIV RNA testing (RR = 4.3; p < 0.0001), and higher CD4+ T-cell count at pregnancy (per 50/mm3, RR = 0.94; p = 0.038). Conclusions These results reinforce the importance of extensive screening for HIV infection, earlier initiation of antiretroviral therapy and stricter monitoring of pregnant women to reduce the risk of detectable HIV RNA at delivery. Public health

  7. Household survey of HIV incidence in Rwanda: a national observational cohort study.

    PubMed

    Nsanzimana, Sabin; Remera, Eric; Kanters, Steve; Mulindabigwi, Augustin; Suthar, Amitabh B; Uwizihiwe, Jean Paul; Mwumvaneza, Mutagoma; Mills, Edward J; Bucher, Heiner C

    2017-10-01

    In Rwanda, HIV prevalence among adults aged 15-49 years has been stable at 3% since 2005. The aim of this study was to characterise HIV incidence across Rwanda. We did a nationally representative, prospective HIV incidence survey for the period of 2013-14, which used two-stage sampling. We randomly selected 492 villages in the first sampling stage and 14 households per village in the second stage. Participants completed a questionnaire and 14 140 people were tested for HIV. 13 728 participants were HIV negative, and were enrolled in the incidence cohort. Participants were retested and surveyed again after 12 months. Weights were calculated as the inverse of the probability to select the villages and the households. The study period was from Nov 5, 2013, to Nov 15, 2014. Among 14 222 respondents from 6792 households, 14 140 were tested for HIV and 13 728 were HIV negative. Of 12 593 people who participated in the endpoint data collection activities, 5965 (47·4%) were men and the mean age was 30 years (SD 10·8). 11 237 (89·2%) participants lived in rural areas, 4826 (38·3%) were single, and 7140 (56·7%) were married or cohabitating. During the year, 35 participants had seroconversion, including 13 men and 22 women, resulting in an overall incidence of 0·27 per 100 person-years (95% CI 0·18-0·35). Incidence was 0·21 per 100 person-years (0·10-0·32) in men and 0·32 per 100 person-years (0·19-0·45) in women. Our findings suggested multiple breakouts, with multiple seroconversions occurring in three villages and two households. Incidence was higher in adults aged 36-45 years (0·37 per 100 person-years, 0·12-0·62; adjusted hazard ratio [aHR] 4·49, 95% CI 1·30-14·70) relative to those aged 16-25, higher in western province (0·57 per 100 person-years, 0·31-0·87; aHR 5·90, 1·33-25·28) relative to the northern province, and higher in urban areas (0·65 per 100 person-years, 0·23-1·07; aHR 3·10, 1·28-6·99) than in rural areas. The

  8. Long-term observations of black carbon mass concentrations at Fukue Island, western Japan, during 2009-2015: Evaluating bottom-up emission inventories for East Asia

    NASA Astrophysics Data System (ADS)

    Kanaya, Y.; PAN, X.; Miyakawa, T.; Komazaki, Y.; Taketani, F.; Uno, I.; Kondo, Y.

    2016-12-01

    Long-term (2009-2015) observations of atmospheric black carbon (BC) mass concentrations were performed using a continuous soot-monitoring system (COSMOS) at Fukue Island, western Japan, to provide information on wet removal rate constraints and the emission strengths of important source regions in East Asia (China and others). Here we focus on the analysis of spatio-temporal variations in the BC/CO emission ratio. For the analysis, we only used the observed ΔBC/ΔCO ratio when precipitation did not occur along the backward trajectories for 72 hours. Backward trajectory analysis was also used to classify the air mass origin areas. For individual origin areas, cases with BC concentrations in the highest 25% range, with maximum relative humidity along the trajectory over the previous three days in the lowest 25% range, and with the traveling times in the shortest 25% range were critically selected for the analysis. The observed tendencies that the average ΔBC/ΔCO ratio was higher for the air masses from south Central East China (S-CEC, 7.6 ng m-3 ppb-1) than that from North-CEC (6.4 ng m-3 ppb-1) and that the ratio was higher in winter than spring in S-CEC suggested stronger influence from domestic sector in S-CEC. The REAS2 bottom up emission inventory qualitatively captured these features; quantitatively however, the emission ratios were overestimated at least by a factor of 1.3. For Korea, the observed ΔBC/ΔCO ratio (8.4 ng m-3 ppb-1) was significantly overpredicted by REAS2 (23.2 ng m-3 ppb-1), pointing to the necessity of revising the emission database. The large discrepancy seems originating from too high BC/CO emission ratios assumed for industry and transportation sectors in emission inventory studies (e.g., 42 and 27 ng m-3 ppb-1 for REAS2). The results were similar for MEIC and CAPSS, emission inventories developed in China and Korea, respectively. On the other hand, the observed ratio for Japan (6.7 ng m-3 ppb-1) only differed slightly ( 10%) from the

  9. Asbestos in Asia.

    PubMed

    Leong, Su Lyn; Zainudin, Rizka; Kazan-Allen, Laurie; Robinson, Bruce W

    2015-05-01

    Asbestos is a global killer. Despite lessons learned in the developed world on the use of asbestos and its hazardous pulmonary consequences, its use continues to increase in Asia. Although some countries such as Japan, Korea and Singapore have curtailed the use of this mineral, there are numerous countries in Asia that continue to mine, import and use this fibre, particularly China, which is one of the largest consumers in the world. Numerous factors ranging from political and economic to the lack of understanding of asbestos and the management of asbestos-related lung disease are keys to this observed trend. Awareness of these factors combined with early intervention may prevent the predicted Asian 'tsunami' of asbestos diseases. © 2015 Asian Pacific Society of Respirology.

  10. Infant feeding practices at routine PMTCT sites, South Africa: results of a prospective observational study amongst HIV exposed and unexposed infants - birth to 9 months

    PubMed Central

    2012-01-01

    Background We sought to investigate infant feeding practices amongst HIV-positive and -negative mothers (0-9 months postpartum) and describe the association between infant feeding practices and HIV-free survival. Methods Infant feeding data from a prospective observational cohort study conducted at three (of 18) purposively-selected routine South African PMTCT sites, 2002-2003, were analysed. Infant feeding data (previous 4 days) were gathered during home visits at 3, 5, 7, 9, 12, 16, 20, 24, 28, 32 and 36 weeks postpartum. Four feeding groups were of interest, namely exclusive breastfeeding, mixed breastfeeding, exclusive formula feeding and mixed formula feeding. Cox proportional hazards models were fitted to investigate associations between feeding practices (0-12 weeks) and infant HIV-free survival. Results Six hundred and sixty five HIV-positive and 218 HIV-negative women were recruited antenatally and followed-up until 36 weeks postpartum. Amongst mothers who breastfed between 3 weeks and 6 months postpartum, significantly more HIV-positive mothers practiced exclusive breastfeeding compared with HIV-negative: at 3 weeks 130 (42%) versus 33 (17%) (p < 0.01); this dropped to 17 (11%) versus 1 (0.7%) by four months postpartum. Amongst mothers practicing mixed breastfeeding between 3 weeks and 6 months postpartum, significantly more HIV-negative mothers used commercially available breast milk substitutes (p < 0.02) and use of these peaked between 9 and 12 weeks. The probability of postnatal HIV or death was lowest amongst infants living in the best resourced site who avoided breastfeeding, and highest amongst infants living in the rural site who stopped breastfeeding early (mean and standard deviations: 10.7% ± 3% versus 46% ± 11%). Conclusions Although feeding practices were poor amongst HIV-positive and -negative mothers, HIV-positive mothers undertake safer infant feeding practices, possibly due to counseling provided through the routine PMTCT programme. The

  11. Temporal and spatial distribution of tropospheric NO2 over arid areas of Central Asia by OMI Satellite observations: Evidence for a strong contribution of soil biogenic nitric oxide

    NASA Astrophysics Data System (ADS)

    Mamtimin, Buhalqem; Qi, Yue; Beirle, Steffen; Wagner, Thomas; Meixner, Franz X.

    2013-04-01

    We present results observations of tropospheric NO2 carried out by Ozone Monitoring Instrument (OMI) over the Central Asian arid areas from 2005 to 2011. We selected 8 oases (Ruoqiang, Milan, Waxxari, Qiemo, Minfeng, Shache, Awati and Kuche) in Taklimakan desert (part of the great Central Asian deserts). For these, spatial distributions, seasonal variations, and trends of tropospheric NO2 Vertical Column Densities (VCDs) retrieved are discussed. In the Taklimakan desert, oases are the centers of all human activities and the economy of the selected oases are dominated by oasis agriculture. Irrigation and fertilization favor the microbial production of nitric oxide in soils, which after emission is converted to NO2 by ozone. Consequently, tropospheric NO2-VCDs are a good proxy for biogenic NO emissions from soils. For contrast, we examined also the NO2-VCDs in the area of the growing megacity Urumqi (43.85°N, 87.62°E), which is known as an anthropogenic highly polluted city in the Central Asian deserts. For 2005-2011, all selected oases are hot spots of NO/NO2 in the Taklimakan desert. Higher NO2-VCDs were observed during growing seasons over all 8 oases. NO2-VCDs observed in summer generally increased from 2005 to 2011. NO2-VCDs over Urumqi were generally at least 1 order of magnitude higher than those over the oases. In contrast to the oases, wintertime NO2-VCDs over Urumqi are higher than in summer. We evaluated governmental statistical agricultural data of the 8 oasis, and compared the trends with corresponding summertime NO2-VCDs. Inter-annual trends of NO2-VCDs over the oases show similar patterns to those of N-fertilizer application and sown (and irrigated) areas. Highest NO2-VCDs observed in summer for agriculturally dominated oases are a strong indication that soil biogenic NO emission is the main contributor to the tropospheric NO2 over all 8 oases, while in Urumqi fossil fuel combustion, particularly during winter, is the main source for NO/NO2. With

  12. New directions in hydro-climatic histories: observational data recovery, proxy records and the atmospheric circulation reconstructions over the earth (ACRE) initiative in Southeast Asia

    NASA Astrophysics Data System (ADS)

    Williamson, Fiona; Allan, Rob; Switzer, Adam D.; Chan, Johnny C. L.; Wasson, Robert James; D'Arrigo, Rosanne; Gartner, Richard

    2015-12-01

    The value of historic observational weather data for reconstructing long-term climate patterns and the detailed analysis of extreme weather events has long been recognized (Le Roy Ladurie, 1972; Lamb, 1977). In some regions however, observational data has not been kept regularly over time, or its preservation and archiving has not been considered a priority by governmental agencies. This has been a particular problem in Southeast Asia where there has been no systematic country-by-country method of keeping or preserving such data, the keeping of data only reaches back a few decades, or where instability has threatened the survival of historic records. As a result, past observational data are fragmentary, scattered, or even absent altogether. The further we go back in time, the more obvious the gaps. Observational data can be complimented however by historical documentary or proxy records of extreme events such as floods, droughts and other climatic anomalies. This review article highlights recent initiatives in sourcing, recovering, and preserving historical weather data and the potential for integrating the same with proxy (and other) records. In so doing, it focuses on regional initiatives for data research and recovery - particularly the work of the international Atmospheric Circulation Reconstructions over the Earth's (ACRE) Southeast Asian regional arm (ACRE SEA) - and the latter's role in bringing together disparate, but interrelated, projects working within this region. The overarching goal of the ACRE SEA initiative is to connect regional efforts and to build capacity within Southeast Asian institutions, agencies and National Meteorological and Hydrological Services (NMHS) to improve and extend historical instrumental, documentary and proxy databases of Southeast Asian hydroclimate, in order to contribute to the generation of high-quality, high-resolution historical hydroclimatic reconstructions (reanalyses) and, to build linkages with humanities researchers

  13. Aerosol properties computed from aircraft-based observations during the ACE- Asia campaign. 2; A case study of lidar ratio closure and aerosol radiative effects

    NASA Technical Reports Server (NTRS)

    Kuzmanoski, Maja; Box, M. A.; Schmid, B.; Box, G. P.; Wang, J.; Russell, P. B.; Bates, D.; Jonsson, H. H.; Welton, Ellsworth J.; Flagan, R. C.

    2005-01-01

    For a vertical profile with three distinct layers (marine boundary, pollution and dust), observed during the ACE-Asia campaign, we carried out a comparison between the modeled lidar ratio vertical profile and that obtained from collocated airborne NASA AATS-14 sunphotometer and shipborne Micro-Pulse Lidar (MPL) measurements. Vertically resolved lidar ratio was calculated from two size distribution vertical profiles - one obtained by inversion of sunphotometer-derived extinction spectra, and one measured in-situ - combined with the same refractive index model based on aerosol chemical composition. The aerosol model implies single scattering albedos of 0.78 - 0.81 and 0.93 - 0.96 at 0.523 microns (the wavelength of the lidar measurements), in the pollution and dust layers, respectively. The lidar ratios calculated from the two size distribution profiles have close values in the dust layer; they are however, significantly lower than the lidar ratios derived from combined lidar and sunphotometer measurements, most probably due to the use of a simple nonspherical model with a single particle shape in our calculations. In the pollution layer, the two size distribution profiles yield generally different lidar ratios. The retrieved size distributions yield a lidar ratio which is in better agreement with that derived from lidar/sunphotometer measurements in this layer, with still large differences at certain altitudes (the largest relative difference was 46%). We explain these differences by non-uniqueness of the result of the size distribution retrieval and lack of information on vertical variability of particle refractive index. Radiative transfer calculations for this profile showed significant atmospheric radiative forcing, which occurred mainly in the pollution layer. We demonstrate that if the extinction profile is known then information on the vertical structure of absorption and asymmetry parameter is not significant for estimating forcing at TOA and the surface

  14. A multicenter observational study of the potential benefits of initiating combination antiretroviral therapy during acute HIV infection.

    PubMed

    Hecht, Frederick M; Wang, Lei; Collier, Ann; Little, Susan; Markowitz, Martin; Margolick, Joseph; Kilby, J Michael; Daar, Eric; Conway, Brian; Holte, Sarah

    2006-09-15

    Uncontrolled studies have suggested a benefit, after treatment discontinuation, of initiating highly active antiretroviral therapy (HAART) during primary human immunodeficiency virus (HIV) infection. We assessed whether initiation of HAART within 2 weeks of (acute treatment) or between 2 weeks and 6 months after (early treatment) HIV seroconversion was associated with improvements in the viral load and the CD4+ T cell count after discontinuation of treatment in an observational cohort. Subjects from the multicenter Acute Infection and Early Disease Research Program cohort were enrolled in the present study within 6 months of HIV seroconversion and self-selected whether to initiate HAART. Subjects who received acute (n=13) or early (n=45) treatment received HAART for at least 12 weeks and then subsequently stopped treatment, whereas untreated subjects (n=337) declined treatment. HIV RNA levels and CD4+ T cell counts at 24, 48, and 72 weeks after treatment cessation in the 2 treatment groups were compared with those noted in the untreated group during the same periods of observation after enrollment. The acute treatment group had lower mean HIV RNA levels at 24 weeks without therapy (-0.48 log(10) copies/mL [95% confidence interval {CI}, -0.82 to -0.13 log(10) copies/mL]) and higher mean CD4+ T cell counts (112 cells/ mu L [95% CI, 20-205 cells/ microL]), compared with the untreated group at 24 weeks. The differences in the laboratory values for the acute treatment group versus the untreated group at 72 weeks without therapy were as follows: for the HIV RNA level, -0.35 log(10) copies/mL (95% CI, -0.91 to 0.21 log(10) copies/mL) and, for the CD4 T+ cell count, 112 cells/ microL (95% CI, -15 to 213 cells/ microL). The early treatment group had lower HIV RNA levels at 24 weeks than did the untreated group, but differences were no longer apparent by week 48; CD4+ T cell counts were higher in the early treatment group at week 24 (116 cells/ microL [95% CI, 75-157 cells

  15. Do High-Risk Young Adults Use the HIV Self-Test Appropriately? Observations from a Think-Aloud Study

    PubMed Central

    Schnall, Rebecca; John, Rita Marie; Carballo-Dieguez, Alex

    2015-01-01

    Purpose The purpose of this study was to understand high-risk young adults’ use of the rapid HIV self-test. Background The highest rate of new human immunodeficiency virus (HIV) infections occurs in people between 15-24 years. Improving identification of young people infected with HIV is a critical public health priority. The first rapid HIV self-testing kit was approved in the US in 2012. Despite the product’s promise, its use by untrained young adults is not well-understood. Methods We conducted a mixed methods study using surveys, a think-aloud protocol, observations and in-depth interviews. A systematic checklist was developed to assess participants’ use of the test. A total of 21 racial and/or ethnic minority young adults aged 18-24 participated in this study. Analysis of our interview data was guided by the Theory of Reasoned Action (TRA). Results Participants completed the initial procedures of the test with a mean time of 8:36 minutes (range of 2:04′ – 16:33′). On a 14-point checklist, participants had a mean score of 10.8 (SD 2.26, range 3-14). In the qualitative analysis of the participants’ interviews, guided by the theoretical constructs of the TRA, the following themes emerged: “Did I use it correctly?”, “Can I trust the results?” (Attitude); “How will my partner react?”, “What will people think?” (Subjective Norm); “Quick, Easy and Blood Free,” and “Avoids the hassle of dealing with the healthcare system” (Behavioral Intention). Conclusions & Implications This study provided evidence of the usefulness of the test perceived by young adults, especially in light of their concerns about lack of privacy in medical settings. Since many participants did not follow all of the instructions while using the test, it is not evident that young adults can correctly use the HIV self-test. Development of instructions manuals that are understandable and guide proper use of medical devices is a great need, especially in the context

  16. Clinical efficacy and safety of a novel tetravalent dengue vaccine in healthy children in Asia: a phase 3, randomised, observer-masked, placebo-controlled trial.

    PubMed

    Capeding, Maria Rosario; Tran, Ngoc Huu; Hadinegoro, Sri Rezeki S; Ismail, Hussain Imam H J Muhammad; Chotpitayasunondh, Tawee; Chua, Mary Noreen; Luong, Chan Quang; Rusmil, Kusnandi; Wirawan, Dewa Nyoman; Nallusamy, Revathy; Pitisuttithum, Punnee; Thisyakorn, Usa; Yoon, In-Kyu; van der Vliet, Diane; Langevin, Edith; Laot, Thelma; Hutagalung, Yanee; Frago, Carina; Boaz, Mark; Wartel, T Anh; Tornieporth, Nadia G; Saville, Melanie; Bouckenooghe, Alain

    2014-10-11

    An estimated 100 million people have symptomatic dengue infection every year. This is the first report of a phase 3 vaccine efficacy trial of a candidate dengue vaccine. We aimed to assess the efficacy of the CYD dengue vaccine against symptomatic, virologically confirmed dengue in children. We did an observer-masked, randomised controlled, multicentre, phase 3 trial in five countries in the Asia-Pacific region. Between June 3, and Dec 1, 2011, healthy children aged 2-14 years were randomly assigned (2:1), by computer-generated permuted blocks of six with an interactive voice or web response system, to receive three injections of a recombinant, live, attenuated, tetravalent dengue vaccine (CYD-TDV), or placebo, at months 0, 6, and 12. Randomisation was stratified by age and site. Participants were followed up until month 25. Trial staff responsible for the preparation and administration of injections were unmasked to group allocation, but were not included in the follow-up of the participants; allocation was concealed from the study sponsor, investigators, and parents and guardians. Our primary objective was to assess protective efficacy against symptomatic, virologically confirmed dengue, irrespective of disease severity or serotype, that took place more than 28 days after the third injection. The primary endpoint was for the lower bound of the 95% CI of vaccine efficacy to be greater than 25%. Analysis was by intention to treat and per procotol. This trial is registered with ClinicalTrials.gov, number NCT01373281. We randomly assigned 10,275 children to receive either vaccine (n=6851) or placebo (n=3424), of whom 6710 (98%) and 3350 (98%), respectively, were included in the primary analysis. 250 cases of virologically confirmed dengue took place more than 28 days after the third injection (117 [47%] in the vaccine group and 133 [53%] in the control group). The primary endpoint was achieved with 56·5% (95% CI 43·8-66·4) efficacy. We recorded 647 serious adverse

  17. Global Dispersal Pattern of HIV Type 1 Subtype CRF01_AE: A Genetic Trace of Human Mobility Related to Heterosexual Sexual Activities Centralized in Southeast Asia.

    PubMed

    Angelis, Konstantinos; Albert, Jan; Mamais, Ioannis; Magiorkinis, Gkikas; Hatzakis, Angelos; Hamouda, Osamah; Struck, Daniel; Vercauteren, Jurgen; Wensing, Annemarie M J; Alexiev, Ivailo; Åsjö, Birgitta; Balotta, Claudia; Camacho, Ricardo J; Coughlan, Suzie; Griskevicius, Algirdas; Grossman, Zehava; Horban, Andrzej; Kostrikis, Leondios G; Lepej, Snjezana; Liitsola, Kirsi; Linka, Marek; Nielsen, Claus; Otelea, Dan; Paredes, Roger; Poljak, Mario; Puchhammer-Stöckl, Elisabeth; Schmit, Jean-Claude; Sönnerborg, Anders; Staneková, Danica; Stanojevic, Maja; Boucher, Charles A B; Kaplan, Lauren; Vandamme, Anne-Mieke; Paraskevis, Dimitrios

    2015-06-01

    Human immunodeficiency virus type 1 (HIV-1) subtype CRF01_AE originated in Africa and then passed to Thailand, where it established a major epidemic. Despite the global presence of CRF01_AE, little is known about its subsequent dispersal pattern. We assembled a global data set of 2736 CRF01_AE sequences by pooling sequences from public databases and patient-cohort studies. We estimated viral dispersal patterns, using statistical phylogeographic analysis run over bootstrap trees estimated by the maximum likelihood method. We show that Thailand has been the source of viral dispersal to most areas worldwide, including 17 of 20 sampled countries in Europe. Japan, Singapore, Vietnam, and other Asian countries have played a secondary role in the viral dissemination. In contrast, China and Taiwan have mainly imported strains from neighboring Asian countries, North America, and Africa without any significant viral exportation. The central role of Thailand in the global spread of CRF01_AE can be probably explained by the popularity of Thailand as a vacation destination characterized by sex tourism and by Thai emigration to the Western world. Our study highlights the unique case of CRF01_AE, the only globally distributed non-B clade whose global dispersal did not originate in Africa. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  18. Short-term risk of anaemia following initiation of combination antiretroviral treatment in HIV-infected patients in countries in sub-Saharan Africa, Asia-Pacific, and central and South America

    PubMed Central

    2012-01-01

    Background The objective was to examine the short-term risk and predictors of anaemia following initiation of combination antiretroviral therapy (cART) in HIV-infected patients from the Western Africa, Eastern Africa, Southern Africa, Central Africa, Asian-Pacific, and Caribbean and Central and South America regions of the International Epidemiologic Databases to Evaluate AIDS (IeDEA) collaboration. Methods Anaemia was defined as haemoglobin of < 10 g/dL. Patients were included if they started cART with three or more drugs, had prior haemoglobin of > = 10 g/dL, and had one or more follow-up haemoglobin tests. Factors associated with anaemia up to 12 months were examined using Cox proportional hazards models and stratified by IeDEA region. Results Between 1998 and 2008, 19,947 patients initiated cART with baseline and follow-up haemoglobin tests (7358, 7289, 2853, 471, 1550 and 426 in the Western Africa, Eastern Africa, Southern Africa, Central Africa, Asian-Pacific, and Caribbean and Central and South America regions, respectively). At initiation, anaemia was found in 45% of Western Africa patients, 29% of Eastern Africa patients, 21% of Southern Africa patients, 36% of Central Africa patients, 15% of patients in Asian-Pacific and 14% of patients in Caribbean and Central and South America. Among patients with haemoglobin of > = 10 g/dL at baseline (13,445), the risks of anaemia were 18.2, 6.6, 9.7, 22.9, 11.8 and 19.5 per 100 person-years in the Western Africa, Eastern Africa, Southern Africa, Central Africa, Asian, and Caribbean and Central and South America regions, respectively. Factors associated with anaemia were female sex, low baseline haemoglobin level, low baseline CD4 count, more advanced disease stage, and initial cART containing zidovudine. Conclusions In data from 34 cohorts of HIV-infected patients from sub-Saharan Africa, Central and South America, and Asia, the risk of anaemia within 12 months of initiating cART was moderate. Routine haemoglobin

  19. Short-term risk of anaemia following initiation of combination antiretroviral treatment in HIV-infected patients in countries in sub-Saharan Africa, Asia-Pacific, and central and South America.

    PubMed

    Zhou, Jialun; Jaquet, Antoine; Bissagnene, Emmanuel; Musick, Beverly; Wools-Kaloustian, Kara; Maxwell, Nicola; Boulle, Andrew; Wehbe, Firas; Masys, Daniel; Iriondo-Perez, Jeniffer; Hemingway-Foday, Jay; Law, Matthew

    2012-01-30

    The objective was to examine the short-term risk and predictors of anaemia following initiation of combination antiretroviral therapy (cART) in HIV-infected patients from the Western Africa, Eastern Africa, Southern Africa, Central Africa, Asian-Pacific, and Caribbean and Central and South America regions of the International Epidemiologic Databases to Evaluate AIDS (IeDEA) collaboration. Anaemia was defined as haemoglobin of < 10 g/dL. Patients were included if they started cART with three or more drugs, had prior haemoglobin of > = 10 g/dL, and had one or more follow-up haemoglobin tests. Factors associated with anaemia up to 12 months were examined using Cox proportional hazards models and stratified by IeDEA region. Between 1998 and 2008, 19,947 patients initiated cART with baseline and follow-up haemoglobin tests (7358, 7289, 2853, 471, 1550 and 426 in the Western Africa, Eastern Africa, Southern Africa, Central Africa, Asian-Pacific, and Caribbean and Central and South America regions, respectively). At initiation, anaemia was found in 45% of Western Africa patients, 29% of Eastern Africa patients, 21% of Southern Africa patients, 36% of Central Africa patients, 15% of patients in Asian-Pacific and 14% of patients in Caribbean and Central and South America. Among patients with haemoglobin of > = 10 g/dL at baseline (13,445), the risks of anaemia were 18.2, 6.6, 9.7, 22.9, 11.8 and 19.5 per 100 person-years in the Western Africa, Eastern Africa, Southern Africa, Central Africa, Asian, and Caribbean and Central and South America regions, respectively. Factors associated with anaemia were female sex, low baseline haemoglobin level, low baseline CD4 count, more advanced disease stage, and initial cART containing zidovudine. In data from 34 cohorts of HIV-infected patients from sub-Saharan Africa, Central and South America, and Asia, the risk of anaemia within 12 months of initiating cART was moderate. Routine haemoglobin monitoring was recommended in patients at

  20. Understanding patterns of variability in tropospheric ozone over Europe and eastern Asia in 2005-2009 using TES observations and the TM5 chemistry transport model

    NASA Astrophysics Data System (ADS)

    Verstraeten, W. W.; van Geel, M. H. A.; Boersma, K. F.

    2012-04-01

    TM5 runs at the global scale returned r values of 0.97 for the lower troposphere (LT, surface - 500 hPa) and 0.98 for the higher troposphere (UT, < 500 hPa). At the 464 hPa level, on average, the percentage difference in ozone concentrations between TES and TM5 is 15% which is in line with earlier reported comparisons between TES v2 and sonde data. Generally, at the global scale, the TES-TM5 overestimations at the 468 hPa level were located at higher latitudes, whereas underestimations were observed at lower latitudes. In January the absolute differences in ozone concentration between TES and TM5 at the 464 hPa level are smaller compared to July. At the regional scale at 464 hPa, TES v4 time series (2005-2010) show an increasing trend of ozone concentrations in eastern Asia (NE China) in addition to reported increasing concentrations of NOx with higher differences between TES and TM5 in July compared to January. For Europe, no clear-cut trends in time series of ozone concentrations were observed. For better understanding the increases and/or decreases in tropospheric ozone in some parts of the world different TM5 model runs with varying anthropogenic emissions will be run in future research.

  1. The Continuous Generation of Equatorial Plasma Bubbles during the Passage of the Solar Terminator, Observed with a Densely-Clustered Network of GPS Receivers in Southeast Asia.

    NASA Astrophysics Data System (ADS)

    Buhari, S. M.; Tsunoda, R. T.; Abdullah, M.; Hasbi, A. M.; Otsuka, Y.; Yokoyama, T.; Nishioka, M.; Tsugawa, T.

    2014-12-01

    Equatorial plasma bubbles (EPBs) are three-dimensional structures of depleted plasma density that are often observed in the nighttime equatorial ionosphere. They are initiated near the magnetic dip equator, in the bottomside of the F layer, and develop with time, upward in altitude and poleward in latitude (into both hemispheres), taking the form of longitudinally-narrow, vertically-extended wedges that penetrate deep into the topside of the F layer. Moreover, these structures drift zonally as they evolve in time. Much of what is not yet known about EPBs stems from our inability (1) to capture spatial descriptions of these structures, and (2) to monitor their evolution as a function of time. An objective of this presentation is to report the existence and availability of total electron content (TEC) data from densely-clustered networks of GPS receivers that are capable of providing time-continuous descriptions of EPBs with both high spatial resolution and broad geographical coverage. The networks include the Malaysia Real-Time Kinematics GNSS Network (MyRTKnet), Sumatera GPS Array (SUGAR) network and International GNSS Service (IGS) located in Southeast Asia (SEA). These networks contain 127 GPS receivers with average spacing of about 50 to 100 km. With the ability to resolve space-time ambiguities, we are able to follow the temporal evolution of EPB structures over an extended longitude sector (90 to 120 degrees, East longitude). We will present results from a case study (April 5, 2011) in which 16 EPBs were detected in longitude and tracked in time. We show, for the first time, that the births of 10 out of 16 observed EPBs coincided with the time of passage of the solar terminator across the longitude of birth. The distance between birth locations varied between 100 and 550 km with 10-minute interval. These EPBs were found to persist for 50 minutes to 7 hours, while drifting eastward at a speed of 92 to 150 ms-1. The finding that as many as 16 EPBs can be

  2. HIV in Europe.

    PubMed

    Põder, Airi; Haldre, Madli

    2014-01-01

    In 2011, the estimated number of people living with HIV in Europe and Central Asia was 2.3 million. This is more than twice the 2001 figure. At the same time, approximately 50% of the infected people may not know their HIV status. The Europe/Central Asia region is one of only two regions in which HIV infections continue to increase. The estimated prevalence rate in the west and center of the region, however, has remained stable at 0.2%. The HIV epidemics in Eastern Europe and Central Asia are typically driven by unsafe drug injection and by onward transmission to the sexual partners of people who inject drugs. In the western part of the region, the epidemic remains concentrated among men who have sex with men and migrants from countries with generalized epidemics. Means of preventing and fighting HIV should, first and foremost, be directed to those parts of the population that are most exposed to the risk of the infection. Proceeding from the data presented, recommendations are given for ways of decreasing HIV prevalence in the region, such as promoting dialogue and awareness among multistakeholders, including policy makers, donors, and population groups most exposed to the infection. © 2013 Elsevier Inc. All rights reserved.

  3. Community-based treatment of advanced HIV disease: introducing DOT-HAART (directly observed therapy with highly active antiretroviral therapy).

    PubMed Central

    Farmer, P.; Léandre, F.; Mukherjee, J.; Gupta, R.; Tarter, L.; Kim, J. Y.

    2001-01-01

    In 2000, acquired immunodeficiency syndrome (AIDS) overtook tuberculosis (TB) as the world's leading infectious cause of adult deaths. In affluent countries, however, AIDS mortality has dropped sharply, largely because of the use of highly active antiretroviral therapy (HAART). Antiretroviral agents are not yet considered essential medications by international public health experts and are not widely used in the poor countries where human immunodeficiency virus (HIV) takes its greatest toll. Arguments against the use of HAART have mainly been based on the high cost of medications and the lack of the infrastructure necessary for using them wisely. We re- examine these arguments in the setting of rising AIDS mortality in developing countries and falling drug prices, and describe a small community-based treatment programme based on lessons gained in TB control. With the collaboration of Haitian community health workers experienced in the delivery of home-based and directly observed treatment for TB, an AIDS-prevention project was expanded to deliver HAART to a subset of HIV patients deemed most likely to benefit. The inclusion criteria and preliminary results are presented. We conclude that directly observed therapy (DOT) with HAART, "DOT-HAART", can be delivered effectively in poor settings if there is an uninterrupted supply of high-quality drugs. PMID:11799447

  4. The Relationship Between Individual Characteristics and Interest in Using a Mobile Phone App for HIV Self-Management: Observational Cohort Study of People Living With HIV.

    PubMed

    Lucero, Robert James; Frimpong, Jemima A; Fehlberg, Elizabeth A; Bjarnadottir, Ragnhildur I; Weaver, Michael T; Cook, Christa; Modave, Francois; Rathore, Mobeen H; Morano, Jamie P; Ibanez, Gladys; Cook, Robert L

    2017-07-27

    The human immunodeficiency virus (HIV) continues to be a major health issue in the United States, and an estimated 1.2 million people in the United States are living with HIV. As part of Healthy People 2020, the Office of Disease Prevention and Health Promotion has targeted the persistent demographic and geographic disparities in HIV prevalence and management. Preliminary evidence suggests that mobile health technology (smartphone apps) may be a promising way to support HIV self-management among vulnerable populations of people living with HIV (PLWH) who lack access to appropriate health care services. This study examines the association between individual characteristics of PLWH and level of interest in using a free mobile phone app for HIV self-management. This study was conducted using cross-sectional survey data collected in the Florida Cohort Study between 2014 and 2016 (N=766). Associations between individual characteristics of PLWH and level of interest in using a free mobile phone app for HIV self-management were examined using bivariate analysis and logistic regression. Overall, 85.5% (655/766) of respondents were interested in using a free mobile phone app that supports HIV self-management. Participants expressed the highest interest in app functions that facilitate communication with health care providers (568/740, 76.8%) or help to identify relevant health care services (556/745 74.6%). Age (OR 0.959, 95% CI 0.936-0.982), education (OR 1.281, 95% CI 1.027-1.598) and disability or inability to work (OR 0.296, 95% CI 0.145-0.606) were all significantly associated with being interested in using a free mobile phone app for HIV self-management. This study indicates that a majority of PLWH are interested in using a free mobile phone app to self-manage their condition. The findings can inform the development of mobile phone apps that support effective HIV self-management.

  5. HIV: evolution of a pandemic.

    PubMed Central

    Hankins, C

    1995-01-01

    Although the prevalence of AIDS is still relatively low in many countries in Asia and the Pacific Rim, the rate of HIV transmission in this region continues to rise inexorably and will surpass that of sub-Saharan Africa by 1997. The challenge of mobilizing governments and communities to counter this largely invisible threat was the theme of the Third International Conference on AIDS in Asia and the Pacific, held in Chiang Mai, Thailand, in September 1995. Thailand has led the way with bold and far-reaching HIV prevention programs. Nevertheless, the long-term consequences of existing HIV infection in Thailand and elsewhere in Asia will be severe. Moreover, these repercussions will be felt globally as productivity is undermined, health care costs soar and purchasing power weakens. Supporting programs for HIV prevention and care abroad is thus an urgent matter of economic and political self-interest as well as a humanitarian imperative. PMID:7489554

  6. Improved virologic suppression with HIV subspecialty care in a large prison system using telemedicine: an observational study with historical controls.

    PubMed

    Young, Jeremy D; Patel, Mahesh; Badowski, Melissa; Mackesy-Amiti, Mary Ellen; Vaughn, Pyrai; Shicker, Louis; Puisis, Michael; Ouellet, Lawrence J

    2014-07-01

    Correctional populations have an elevated human immunodeficiency virus (HIV) prevalence, yet many individuals lack access to subspecialty care. Our study showed that HIV-infected inmates had significantly greater virologic suppression and higher CD4 T-lymphocyte counts when managed by a multidisciplinary team of subspecialists conducting clinics via telemedicine. In other studies, these outcomes have been associated with reductions on HIV-related morbidity and mortality, as well as HIV transmission.

  7. Heterosexual risk of HIV-1 infection per sexual act: a systematic review and meta-analysis of observational studies

    PubMed Central

    Boily, Marie-Claude; Baggaley, Rebecca F; Wang, Lei; Masse, Benoit; White, Richard G; Hayes, Richard; Alary, Michel

    2015-01-01

    We conducted a systematic review and meta-analysis of observational studies of the risk of HIV-1 transmission per heterosexual contact. The search to September 2008 identified 43 publications based on 25 different study populations. Pooled female-to-male (0·0004,95%CI=0·0001-0·0014) and male-to-female (0·0008,CI=0·0006-0·0011) transmission estimates in developed countries reflected a low risk of infection in the absence of antiretrovirals. Developing country female-to-male (0·0038,CI=0·0013-0·0110) and male-to-female (0·0030,CI=0·0014-0·0063) estimates in absence of commercial sex(CS) work were higher. In meta-regression analysis, the infectivity across estimates in absence of CS work was significantly associated with gender, setting, the interaction between setting and gender and HIV prevalence. The pooled receptive anal intercourse estimate was much higher (0·017,CI=0·003-0·089). Estimates for the early and late phase of HIV infection were 9·2(CI=4·5-18·8) and 7·3(CI=4·5-11·9)-fold larger than for the asymptomatic phase, respectively. After adjusting for CS exposure, presence or history of genital ulcers in either couple member increased per-act infectivity 5·3(CI=1·4-19·5)-fold compared to no sexually transmitted infection. Study estimates among non-circumcised men were at least twice those among circumcised men. Developing country estimates were more heterogeneous than developed country estimates, which indicates poorer study quality, greater heterogeneity in risk factors or under-reporting of high-risk behaviour. Efforts are needed to better understand these differences and quantify infectivity in developing countries. PMID:19179227

  8. Heterosexual risk of HIV-1 infection per sexual act: systematic review and meta-analysis of observational studies.

    PubMed

    Boily, Marie-Claude; Baggaley, Rebecca F; Wang, Lei; Masse, Benoit; White, Richard G; Hayes, Richard J; Alary, Michel

    2009-02-01

    We did a systematic review and meta-analysis of observational studies of the risk of HIV-1 transmission per heterosexual contact. 43 publications comprising 25 different study populations were identified. Pooled female-to-male (0.04% per act [95% CI 0.01-0.14]) and male-to-female (0.08% per act [95% CI 0.06-0.11]) transmission estimates in high-income countries indicated a low risk of infection in the absence of antiretrovirals. Low-income country female-to-male (0.38% per act [95% CI 0.13-1.10]) and male-to-female (0.30% per act [95% CI 0.14-0.63]) estimates in the absence of commercial sex exposure (CSE) were higher. In meta-regression analysis, the infectivity across estimates in the absence of CSE was significantly associated with sex, setting, the interaction between setting and sex, and antenatal HIV prevalence. The pooled receptive anal intercourse estimate was much higher (1.7% per act [95% CI 0.3-8.9]). Estimates for the early and late phases of HIV infection were 9.2 (95% CI 4.5-18.8) and 7.3 (95% CI 4.5-11.9) times larger, respectively, than for the asymptomatic phase. After adjusting for CSE, presence or history of genital ulcers in either couple member increased per-act infectivity 5.3 (95% CI 1.4-19.5) times versus no sexually transmitted infection. Study estimates among non-circumcised men were at least twice those among circumcised men. Low-income country estimates were more heterogeneous than high-income country estimates, which indicates poorer study quality, greater heterogeneity of risk factors, or under-reporting of high-risk behaviour. Efforts are needed to better understand these differences and to quantify infectivity in low-income countries.

  9. Drug problem in southeast and southwest Asia.

    PubMed

    Kulsudjarit, Kongpetch

    2004-10-01

    In 2002, the drug problem in Southeast and Southwest Asia was serious, particularly in the production of opium and heroin in Afghanistan, Myanmar, and Laos, the three largest producers of illicit opium in the world. The increasing illicit manufacture of ATS, particularly methamphetamine, in Southeast Asia, mainly in China and Myanmar, was also a major concern. Some reports indicated that ephedrine, used for illicitly producing methamphetamine in Southeast Asia, is diverted and smuggled out of China and India, whereas caffeine, the adulterant used for producing methamphetamine tablets, is mainly smuggled into Myanmar through its border with Thailand. Seizure data showed a dramatic increase in trafficking in MDMA through Southeast Asia. In terms of the drug epidemic, in 2002, cannabis remained overall the main drug of abuse in all of the countries of Southeast and Southwest Asia. Opiates, mainly opium and heroin, were also the drugs of choice except in Thailand, where opiate abuse declined, but ATS was the main drug of abuse due to its low cost and availability. A significant increase in ATS abuse, amphetamine, methamphetamine, and MDMA among the youth who smoked, sniffed, and inhaled them was reported in Cambodia, China, Indonesia, Laos, Myanmar, the Philippines, and Thailand. Injecting drug use among opiate abusers has been identified as the prime cause of the rapid spread of HIV/AIDS in Southeast and Southwest Asia.

  10. Immune recovery of middle-aged HIV patients following antiretroviral therapy: An observational cohort study.

    PubMed

    Wong, Ngai Sze; Chan, Kenny Chi Wai; Cheung, Edward Ka Hin; Wong, Ka Hing; Lee, Shui Shan

    2017-07-01

    In HIV-infected persons, age is negatively associated with optimal CD4 recovery following antiretroviral therapy. Our understanding of the situation in older adults, especially the middle-aged is, however, limited. We undertook to examine the latter's pattern of CD4/CD8 recovery following antiretroviral therapy.Retrospective clinical cohort data of HIV patients diagnosed between 1985 and 2014 in Hong Kong were collected. They were categorized by age at treatment initiation, viz., young adults (age 18-49), middle-aged (age 50-64), and elderly (≥65 years' old). Predictors of immune recovery (CD4 count, CD8 count, CD4/CD8 ratio) over time were examined using multivariable linear generalized estimating equations.A total of 2754 patients (aged ≥18) have been on antiretroviral therapy, with baseline characteristics similar between middle-aged and the elderly. Late diagnosis, defined as progression to AIDS within 3 months of HIV diagnosis, was less common in middle-aged (odds ratio = 0.58, 95% confidence interval = 0.37-0.91). Among Chinese patients who have been on treatment for ≥4 years (n = 913), 80.6%, 14.6%, and 4.8% were young adults, middle-aged, and elderly respectively. Late treatment initiation, defined as AIDS diagnosis or CD4 count ≤100 cells/μL before treatment, was common in middle-aged and elderly, the former however had faster CD4 recovery (3.95 vs. 3.36 cells/μL/month), but slower CD8 decline (-1.76 vs. -4.34 cells/μL/month) and CD4/CD8 normalization (0.009 vs. 0.0101/month).As a transitional age group, the immune recovery of middle-aged patients lagged behind young adults largely because of late treatment initiation. Following adoption of early and non-CD4-guided treatment initiation, their long-term clinical outcome is expected to improve.

  11. Long-term MAX-DOAS network observations of NO2 in Russia and Asia (MADRAS) during the period 2007-2012: instrumentation, elucidation of climatology, and comparisons with OMI satellite observations and global model simulations

    NASA Astrophysics Data System (ADS)

    Kanaya, Y.; Irie, H.; Takashima, H.; Iwabuchi, H.; Akimoto, H.; Sudo, K.; Gu, M.; Chong, J.; Kim, Y. J.; Lee, H.; Li, A.; Si, F.; Xu, J.; Xie, P.-H.; Liu, W.-Q.; Dzhola, A.; Postylyakov, O.; Ivanov, V.; Grechko, E.; Terpugova, S.; Panchenko, M.

    2014-08-01

    We conducted long-term network observations using standardized Multi-Axis Differential optical absorption spectroscopy (MAX-DOAS) instruments in Russia and ASia (MADRAS) from 2007 onwards and made the first synthetic data analysis. At seven locations (Cape Hedo, Fukue and Yokosuka in Japan, Hefei in China, Gwangju in Korea, and Tomsk and Zvenigorod in Russia) with different levels of pollution, we obtained 80 927 retrievals of tropospheric NO2 vertical column density (TropoNO2VCD) and aerosol optical depth (AOD). In the technique, the optimal estimation of the TropoNO2VCD and its profile was performed using aerosol information derived from O4 absorbances simultaneously observed at 460-490 nm. This large data set was used to analyze NO2 climatology systematically, including temporal variations from the seasonal to the diurnal scale. The results were compared with Ozone Monitoring Instrument (OMI) satellite observations and global model simulations. Two NO2 retrievals of OMI satellite data (NASA ver. 2.1 and Dutch OMI NO2 (DOMINO) ver. 2.0) generally showed close correlations with those derived from MAX-DOAS observations, but had low biases of up to ~50%. The bias was distinct when NO2 was abundantly present near the surface and when the AOD was high, suggesting a possibility of incomplete accounting of NO2 near the surface under relatively high aerosol conditions for the satellite observations. Except for constant biases, the satellite observations showed nearly perfect seasonal agreement with MAX-DOAS observations, suggesting that the analysis of seasonal features of the satellite data were robust. Weekend reduction in the TropoNO2VCD found at Yokosuka and Gwangju was absent at Hefei, implying that the major sources had different weekly variation patterns. While the TropoNO2VCD generally decreased during the midday hours, it increased exceptionally at urban/suburban locations (Yokosuka, Gwangju, and Hefei) during winter. A global chemical transport model, MIROC

  12. Country watch: South-East Asia.

    PubMed

    Bagasao, T M

    1996-01-01

    Nongovernmental organizations (NGO) and community-based groups working on HIV/AIDS in Thailand, Sri Lanka, the Philippines, Malaysia, and other countries participated in a February 1991 workshop during which they recognized that human rights are inextricably linked with HIV prevention, the provision of services, and improving the quality of life of people living with HIV/AIDS and other vulnerable, marginalized groups. They also noted how rarely environments were supportive with respect to either legal structures or sociocultural norms. The groups resolved to act as a watchdog, an advocacy and lobbying group to monitor legislation, provide public information, and empower people with HIV/AIDS as visible and active partners. Meeting again in 1993 to assess progress, the groups found few gains in addressing human rights violations such as the denial of medical services to people with HIV/AIDS and the deportation of HIV-positive migrant workers. The Asia Pacific Council of AIDS Service Organizations (APCASO) responded by developing a pilot documentation, monitoring, and reporting system in the region to record HIV-related human rights violations. That system is described.

  13. Long-term MAX-DOAS network observations of NO2 in Russia and Asia (MADRAS) during 2007-2012: instrumentation, elucidation of climatology, and comparisons with OMI satellite observations and global model simulations

    NASA Astrophysics Data System (ADS)

    Kanaya, Y.; Irie, H.; Takashima, H.; Iwabuchi, H.; Akimoto, H.; Sudo, K.; Gu, M.; Chong, J.; Kim, Y. J.; Lee, H.; Li, A.; Si, F.; Xu, J.; Xie, P.-H.; Liu, W.-Q.; Dzhola, A.; Postylyakov, O.; Ivanov, V.; Grechko, E.; Terpugova, S.; Panchenko, M.

    2014-01-01

    We conducted long-term network observations using standardized Multi-Axis Differential optical absorption spectroscopy (MAX-DOAS) instruments in Russia and ASia (MADRAS) from 2007 onwards. At seven locations (Cape Hedo, Fukue, and Yokosuka in Japan, Hefei in China, Gwangju in Korea, and Tomsk and Zvenigorod in Russia) with different levels of pollution, we obtained 80 927 retrievals of tropospheric NO2 vertical column density (TropoNO2VCD) and aerosol optical depth (AOD). In the technique, the optimal estimation of the TropoNO2VCD and its profile was performed using aerosol information derived from O4 absorbances simultaneously observed at 460-490 nm. This large data set was used to analyze NO2 climatology systematically, including temporal variations from the seasonal to the diurnal scale. The results were compared with Ozone Monitoring Instrument (OMI) satellite observations and global model simulations. Two NO2 retrievals of OMI satellite data (NASA ver. 2.1 and Dutch OMI NO2 (DOMINO) ver. 2.0) generally showed close correlations with those derived from MAX-DOAS observations, but had low biases of ~50%. The bias was distinct when NO2 was abundantly present near the surface and when the AOD was high, suggesting that the aerosol shielding effect could be important, especially for clean sites where the difference could not be attributed to the spatial inhomogeneity. Except for constant biases, the satellite observations showed nearly perfect seasonal agreement with MAX-DOAS observations, suggesting that the analysis of seasonal features of the satellite data were robust. The prevailing seasonal patterns with a wintertime maximum implied the dominance of anthropogenic emissions around our sites. The presence of weekend reductions at Yokosuka and Gwangju suggested the dominance of emissions from diesel vehicles, with significant weekly cycles, whereas the absence of such a reduction at Hefei suggested the importance of other sources. A global chemical transport model

  14. Insecticide resistance status in the whitefly, Bemisia tabaci genetic groups Asia-I, Asia-II-1 and Asia-II-7 on the Indian subcontinent

    PubMed Central

    Naveen, N. C.; Chaubey, Rahul; Kumar, Dinesh; Rebijith, K. B.; Rajagopal, Raman; Subrahmanyam, B.; Subramanian, S.

    2017-01-01

    The present study is a summary of the current level of the insecticide resistance to selected organophosphates, pyrethroids, and neonicotinoids in seven Indian field populations of Bemisia tabaci genetic groups Asia-I, Asia-II-1, and Asia-II-7. Susceptibility of these populations was varied with Asia-II-7 being the most susceptible, while Asia-I and Asia-II-1 populations were showing significant resistance to these insecticides. The variability of the LC50 values was 7x for imidacloprid and thiamethoxam, 5x for monocrotophos and 3x for cypermethrin among the Asia-I, while, they were 7x for cypermethrin, 6x for deltamethrin and 5x for imidacloprid within the Asia-II-1 populations. When compared with the most susceptible, PUSA population (Asia-II-7), a substantial increase in resistant ratios was observed in both the populations of Asia-I and Asia-II-1. Comparative analysis during 2010–13 revealed a decline in susceptibility in Asia-I and Asia-II-1 populations of B. tabaci to the tested organophosphate, pyrethroid, and neonicotinoid insecticides. Evidence of potential control failure was detected using probit analysis estimates for cypermethrin, deltamethrin, monocrotophos and imidacloprid. Our results update resistance status of B. tabaci in India. The implications of insecticide resistance management of B. tabaci on Indian subcontinent are discussed. PMID:28098188

  15. Accuracy in HIV Rapid Testing among Laboratory and Non-laboratory Personnel in Zambia: Observations from the National HIV Proficiency Testing System

    PubMed Central

    Mwangala, Sheila; Musonda, Kunda G.; Monze, Mwaka; Musukwa, Katoba K.; Fylkesnes, Knut

    2016-01-01

    Background Despite rapid task-shifting and scale-up of HIV testing services in high HIV prevalence countries, studies evaluating accuracy remain limited. This study aimed to assess overall accuracy level and factors associated with accuracy in HIV rapid testing in Zambia. Methods Accuracy was investigated among rural and urban HIV testing sites participating in two annual national HIV proficiency testing (PT) exercises conducted in 2009 (n = 282 sites) and 2010 (n = 488 sites). Testers included lay counselors, nurses, laboratory personnel and others. PT panels of five dry tube specimens (DTS) were issued to testing sites by the national reference laboratory (NRL). Site accuracy level was assessed by comparison of reported results to the expected results. Non-parametric rank tests and multiple linear regression models were used to assess variation in accuracy between PT cycles and between tester groups, and to examine factors associated with accuracy respectively. Results Overall accuracy level was 93.1% (95% CI: 91.2–94.9) in 2009 and 96.9% (95% CI: 96.1–97.8) in 2010. Differences in accuracy were seen between the tester groups in 2009 with laboratory personnel being more accurate than non-laboratory personnel, while in 2010 no differences were seen. In both PT exercises, lay counselors and nurses had more difficulties interpreting results, with more occurrences of false-negative, false-positive and indeterminate results. Having received the standard HIV rapid testing training and adherence to the national HIV testing algorithm were positively associated with accuracy. Conclusion The study showed an improvement in tester group and overall accuracy from the first PT exercise to the next. Average number of incorrect test results per 1000 tests performed was reduced from 69 to 31. Further improvement is needed, however, and the national HIV proficiency testing system seems to be an important tool in this regard, which should be continued and needs to be urgently

  16. Shifts in drug-taking threaten Asia.

    PubMed

    Gammelgaard, J

    1992-05-01

    Infection with the human immunodeficiency virus (HIV) is spreading rapidly among injection drug users (IDUs), particularly in countries of the Golden Triangle where Myanmar (Burma), Thailand, and Laos converge and the pure heroin China White is refined. Thailand, Myanmar, Hong Kong, Malaysia, Singapore, the southern provinces of China, and the northeastern states of Mizoram, Manipur and Nagaland in India are affected. Infection has reached 50% and more in some groups of IDUs in these countries. In Thailand, 63% of the 23,845 known cases of HIV infection are among an estimated 400,000 IDUs. It is estimated that Myanmar has 160,000 IDUs, of whom half are infected with HIV, and among 85,000 IDUs tested, 85% were infected. The Myanmar sector of the Golden Triangle produces double the amount of the mid-1980s, more than 2000 tons of raw opium a year impaction northeastern India and China's southwest Yunnan province. The HIV infection rate among IDUs tested in Manipur was 50% in 1991, and 40% of an estimated 10,000 IDUs in neighboring Nagaland carry the virus. In China 398 of the 493 registered HIV cases are among IDUs in Yunnan. In Malaysia, there are nearly 4000 cases of HIV infection, approximately 80% of which are IDUs. The epidemic of heroin injection swept over Asia in the last decade, since Afghanistan, Pakistan, and Iran were major heroin producers. An estimated is 10 of Karachi's 8 million population uses drugs. Criminal syndicates in Pakistan, Afghanistan, and India control production, manufacture and wholesale distribution of heroin using sophisticated systems. Addiction is punishable in only a few countries, as most countries distinguish between the selling of drugs and consumption. WHO placed the interdiction of IDUs and HIV in Asia on its agenda at a meeting in Thailand, in October 1991, to prevent a shift toward drug injecting in countries where drugs are still largely inhaled.

  17. Understanding how adherence goals promote adherence behaviours: a repeated measure observational study with HIV seropositive patients

    PubMed Central

    2012-01-01

    Background The extent to which patients follow treatments as prescribed is pivotal to treatment success. An exceptionally high level (> 95%) of HIV medication adherence is required to suppress viral replication and protect the immune system and a similarly high level (> 80%) of adherence has also been suggested in order to benefit from prescribed exercise programmes. However, in clinical practice, adherence to both often falls below the desirable level. This project aims to investigate a wide range of psychological and personality factors that may lead to adherence/non-adherence to medical treatment and exercise programmes. Methods HIV positive patients who are referred to the physiotherapist-led 10-week exercise programme as part of the standard care are continuously recruited. Data on social cognitive variables (attitude, intention, subjective norms, self-efficacy, and outcome beliefs) about the goal and specific behaviours, selected personality factors, perceived quality of life, physical activity, self-reported adherence and physical assessment are collected at baseline, at the end of the exercise programme and again 3 months later. The project incorporates objective measures of both exercise (attendance log and improvement in physical measures such as improved fitness level, weight loss, improved circumferential anthropometric measures) and medication adherence (verified by non-invasive hair analysis). Discussion The novelty of this project comes from two key aspects, complemented with objective information on exercise and medication adherence. The project assesses beliefs about both the underlying goal such as following prescribed treatment; and about the specific behaviours such as undertaking the exercise or taking the medication, using both implicit and explicit assessments of patients’ beliefs and attitudes. We predict that i) the way people think about the underlying goal of their treatments explains medication and exercise behaviours over and above

  18. Alterations in the Fecal Microbiota of Patients with HIV-1 Infection: An Observational Study in A Chinese Population

    PubMed Central

    Ling, Zongxin; Jin, Changzhong; Xie, Tiansheng; Cheng, Yiwen; Li, Lanjuan; Wu, Nanping

    2016-01-01

    The available evidence suggests that alterations in gut microbiota may be tightly linked to the increase in microbial translocation and systemic inflammation in patients with human immunodeficiency virus 1 (HIV-1) infection. We profiled the fecal microbiota as a proxy of gut microbiota by parallel barcoded 454-pyrosequencing in 67 HIV-1-infected patients (32 receiving highly active antiretroviral therapy [HAART] and 35 HAART naïve) and 16 healthy controls from a Chinese population. We showed that α-diversity indices did not differ significantly between the healthy control and HIV-1-infected patients. The ratio of Firmicutes/Bacteroidetes increased significantly in HIV-1-infected patients. Several key bacterial phylotypes, including Prevotella, were prevalent in HIV-1-infected patients; whereas Phascolarctobacterium, Clostridium XIVb, Dialister and Megamonas were significantly correlated with systemic inflammatory cytokines. After short-term, effective HAART, the viral loads of HIV-1 were reduced; however, the diversity and composition of the fecal microbiota were not completely restored. and the dysbiosis remained among HIV-1-infected subjects undergoing HAART. Our detailed analysis demonstrated that dysbiosis of fecal microbiota might play an active role in HIV-1 infection. Thus, new insights may be provided into therapeutics that target the microbiota to attenuate the progression of HIV disease and to reduce the risk of gut-linked disease in HIV-1-infected patients. PMID:27477587

  19. Identifying Perceived Barriers along the HIV Care Continuum: Findings from Providers, Peer Educators, and Observations of Provider-Patient Interactions in Ethiopia.

    PubMed

    Kulkarni, Sarah; Hoffman, Susie; Gadisa, Tsigereda; Melaku, Zenebe; Fantehun, Mesganaw; Yigzaw, Muluneh; El-Sadr, Wafaa; Remien, Robert; Tymejczyk, Olga; Nash, Denis; Elul, Batya

    2016-07-01

    Increasing the proportion of HIV-positive individuals who link promptly to and are retained in care remains challenging in sub-Saharan Africa, but little evidence is available from the provider perspective. In 4 Ethiopian health facilities, we (1) interviewed providers and peer educators about their perceptions of service delivery- and patient-level barriers and (2) observed provider-patient interactions to characterize content and interpersonal aspects of counseling. In interviews, providers and peer educators demonstrated empathy and identified nonacceptance of HIV status, anticipated stigma from unintended disclosure, and fear of antiretroviral therapy as patient barriers, and brusque counseling and insufficient counseling at provider-initiated testing sites as service delivery-related. However, observations from the same clinics showed that providers often failed to elicit patients' barriers to retention, making it unlikely these would be addressed during counseling. Training is needed to improve interpersonal aspects of counseling and ensure providers elicit and address barriers to HIV care experienced by patients.

  20. MICS-Asia II: Impact of global emissions on regional air quality in Asia

    NASA Astrophysics Data System (ADS)

    Holloway, Tracey; Sakurai, Tatsuya; Han, Zhiwei; Ehlers, Susanna; Spak, Scott N.; Horowitz, Larry W.; Carmichael, Gregory R.; Streets, David G.; Hozumi, Y.; Ueda, Hiromasa; Park, S. U.; Fung, Christopher; Kajino, M.; Thongboonchoo, Narisara; Engardt, Magnuz; Bennet, Cecilia; Hayami, Hiroshi; Sartelet, Karine; Wang, Zifa; Matsuda, K.; Amann, Markus

    This study quantifies the seasonality and geographic variability of global pollutant inflow to Asia. Asia is often looked to as a major source of intercontinental air pollution transport with rising emissions and efficient pollutant export processes. However, the degree to which foreign emissions have been imported to Asia has not been thoroughly examined. The Model Inter-Comparison Study for Asia (MICS-Asia) is an international collaboration to study air pollution transport and chemistry in Asia. Using the global atmospheric chemistry Model of Ozone and Related Tracers (MOZART v. 2.4), and comparing results with a suite of regional models participating in MICS-Asia, we find that imported O 3 contributes significantly throughout Asia. The choice of upper boundary condition is found to be particularly important for O 3, even for surface concentrations. Both North America and Europe contribute to ground-level O 3 concentrations throughout the region, though the seasonality of these two sources varies. North American contributions peak at over 10% of monthly mean O 3 during winter months in East Asia, compared to Europe's spring- and autumn-maxima (5-8%). In comparison to observed data from the Acid Deposition Monitoring Network in East Asia (EANET), MOZART concentrations for O 3 generally fall within the range of the MICS models, but MOZART is unable to capture the fine spatial variability of shorter-lived species as well as the regional models.

  1. Heterogeneity of the HIV epidemic: an observational epidemiologic study of agrarian, trading, and fishing communities in Rakai, Uganda

    PubMed Central

    Chang, Larry W; Grabowski, Mary K; Ssekubugu, Robert; Nalugoda, Fred; Kigozi, Godfrey; Nantume, Betty; Lessler, Justin; Moore, Sean M; Quinn, Thomas C; Reynolds, Steven J; Gray, Ronald H; Serwadda, David; Wawer, Maria J

    2016-01-01

    Summary Background Understanding the extent to which HIV burden differs across communities and the drivers of local disparities is critical for an effective and targeted HIV response. We assessed community-level variations in HIV prevalence, risk factors, and treatment and prevention service uptake in Rakai, Uganda. Methods The Rakai Community Cohort Study (RCCS) is an open, population-based cohort surveying persons aged 15–49 in 40 communities. Participants are HIV tested and interviewed to obtain sociodemographic, behavioral, and health information. RCCS data from August 2011 to May 2013 were used to classify communities as agrarian (n=27), trading (n=9), or lakeside fishing sites (n=4). HIV prevalence was mapped using Bayesian methods, and variability across and within community classifications was characterized. Differences in HIV risk factors and uptake of antiretroviral therapy and male circumcision between community types were assessed. Findings 17,119 individuals were included; 9215 (54%) were female. 9931 participants resided in agrarian, 3318 in trading, and 3870 in fishing communities. There was large variation in HIV prevalence, ranging from 9% to 43% across communities. Fishing communities had a higher median HIV prevalence (41%, range: 37–43%) compared to trading (17%, range: 11–22%) and agrarian communities (14%, range: 9–26%); ART and male circumcision coverage were significantly lower in fishing communities. Self-reported risk behaviors were significantly higher in men compared to women and in fishing communities compared to other community types. Interpretation There is substantial heterogeneity in HIV prevalence, risk factors, and service uptake across communities within one region of Uganda. These findings underscore the need for local surveillance and have important implications for the design of targeted HIV responses. In particular, the extremely high HIV burden and risk behaviors, and low use of combination HIV prevention in fishing

  2. Prevalence of HIV infection among people with disabilities: a population-based observational study in Yaoundé, Cameroon (HandiVIH).

    PubMed

    De Beaudrap, Pierre; Beninguisse, Gervais; Pasquier, Estelle; Tchoumkeu, Alice; Touko, Adonis; Essomba, Frida; Brus, Aude; Aderemi, Toyin Janet; Hanass-Hancock, Jill; Eide, Arne Henning; Mac-Seing, Muriel; Mont, Daniel

    2017-04-01

    In resource-limited settings, people with disabilities have been left behind in the response to HIV. In the HandiVIH study, we estimate and compare HIV prevalence and associated risk factors between people with and without disabilities. In this cross-sectional, population-based, observational study, we used two-phase random sampling to recruit adults with disabilities and a control group matched for age, sex, and residential location from households of the general population. We used the Washington Group Short Set of Questions on Disability to identify people with disabilities. We administered an HIV test and a life-course history interview to participants. The primary outcome was the prevalence of HIV among participants with and without disabilities. Between Oct 2, 2014, and Nov 30, 2015, we recruited 807 people with disabilities and 807 participants without disabilities from Yaoundé, Cameroon. 28 of 716 people in the control population had a positive HIV test result (crude prevalence 3·9%, 95% CI 2·9-5·3) compared with 50 of 739 people with disabilities (6·8%, 5·0-8·6; conditional odds ratio [OR] 1·7; p=0·04). Women with disabilities were more often involved in paid sexual relationships than were women without disabilities (2·5% vs 0·5%, p=0·05). People with disabilities were also at increased risk of sexual violence than were women without disabilities (11·0% vs 7·5%, OR 1·5; p=0·01). Sexual violence and sex work were strongly associated with increased risk of HIV infection among participants with disabilities but not among controls (OR 3·0, 95% CI 1·6-5·6 for sexual violence and 12·3, 4·4-34·6 for sex work). Analyses were done in men and women. The higher prevalence of HIV infection in people with disabilities than people without disabilities reflects a higher exposure to HIV infection as well as the presence of disability-associated HIV infection. The susceptibility of people with disabilities to HIV infection seems to be shaped by social

  3. Clinical Predictors of Immune Reconstitution following Combination Antiretroviral Therapy in Patients from the Australian HIV Observational Database

    PubMed Central

    Rajasuriar, Reena; Gouillou, Maelenn; Spelman, Tim; Read, Tim; Hoy, Jennifer; Law, Matthew; Cameron, Paul U.; Petoumenos, Kathy; Lewin, Sharon R.

    2011-01-01

    Background A small but significant number of patients do not achieve CD4 T-cell counts >500cells/µl despite years of suppressive cART. These patients remain at risk of AIDS and non-AIDS defining illnesses. The aim of this study was to identify clinical factors associated with CD4 T-cell recovery following long-term cART. Methods Patients with the following inclusion criteria were selected from the Australian HIV Observational Database (AHOD): cART as their first regimen initiated at CD4 T-cell count <500cells/µl, HIV RNA<500copies/ml after 6 months of cART and sustained for at least 12 months. The Cox proportional hazards model was used to identify determinants associated with time to achieve CD4 T-cell counts >500cells/µl and >200cells/µl. Results 501 patients were eligible for inclusion from AHOD (n = 2853). The median (IQR) age and baseline CD4 T-cell counts were 39 (32–47) years and 236 (130–350) cells/µl, respectively. A major strength of this study is the long follow-up duration, median (IQR) = 6.5(3–10) years. Most patients (80%) achieved CD4 T-cell counts >500cells/µl, but in 8%, this took >5 years. Among the patients who failed to reach a CD4 T-cell count >500cells/µl, 16% received cART for >10 years. In a multivariate analysis, faster time to achieve a CD4 T-cell count >500cells/µl was associated with higher baseline CD4 T-cell counts (p<0.001), younger age (p = 0.019) and treatment initiation with a protease inhibitor (PI)-based regimen (vs. non-nucleoside reverse transcriptase inhibitor, NNRTI; p = 0.043). Factors associated with achieving CD4 T-cell counts >200cells/µl included higher baseline CD4 T-cell count (p<0.001), not having a prior AIDS-defining illness (p = 0.018) and higher baseline HIV RNA (p<0.001). Conclusion The time taken to achieve a CD4 T-cell count >500cells/µl despite long-term cART is prolonged in a subset of patients in AHOD. Starting cART early with a PI-based regimen (vs. NNRTI-based regimen

  4. Viral hepatitis and human immunodeficiency virus co-infections in Asia

    PubMed Central

    Utsumi, Takako; Lusida, Maria I

    2015-01-01

    Hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) affect many people in Asian countries, although there are geographic differences. Both HBV and HIV (HBV/HIV) and HCV/HIV co-infections are highly prevalent in Asia. Hetero- and homosexual, injection drug use, and geographic area are strong predictors of HBV, HCV, and HIV serostatus. In HBV endemic regions, the prevalence and genotype distribution of HBV/HIV co-infection is almost comparable with that in the general population. In Japan, where HBV has low endemicity, the prevalence of HBV/HIV co-infection is approximately 10-fold higher than that in the general population, and HBV Ae is the most common subgenotype among HIV infected individuals. Highly active antiretroviral therapy (HAART) is an effective treatment for HIV/Acquired Immune Deficiency Syndrome. Lamivudine, a component of HAART, is an effective treatment for HBV, HIV, and HBV/HIV co-infection; however, cost, emerging drug resistance, antiretroviral-associated liver toxicity and liver-related morbidity due to HCV progression are particular concerns. HCV/HIV co-infection may accelerate the clinical progression of both HCV and HIV. The high prevalence of HBV/HIV and HCV/HIV co-infections in Asia underscores the need to improve prevention and control measures, as fewer evidence-based prevention strategies are available (compared with Western countries). In this review, the most recent publications on the prevalence of HBV/HIV and HCV/HIV co-infections and related issues, such as therapy and problems in Asia, are updated and summarized. PMID:25964874

  5. Viral hepatitis and human immunodeficiency virus co-infections in Asia.

    PubMed

    Utsumi, Takako; Lusida, Maria I

    2015-05-12

    Hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) affect many people in Asian countries, although there are geographic differences. Both HBV and HIV (HBV/HIV) and HCV/HIV co-infections are highly prevalent in Asia. Hetero- and homosexual, injection drug use, and geographic area are strong predictors of HBV, HCV, and HIV serostatus. In HBV endemic regions, the prevalence and genotype distribution of HBV/HIV co-infection is almost comparable with that in the general population. In Japan, where HBV has low endemicity, the prevalence of HBV/HIV co-infection is approximately 10-fold higher than that in the general population, and HBV Ae is the most common subgenotype among HIV infected individuals. Highly active antiretroviral therapy (HAART) is an effective treatment for HIV/Acquired Immune Deficiency Syndrome. Lamivudine, a component of HAART, is an effective treatment for HBV, HIV, and HBV/HIV co-infection; however, cost, emerging drug resistance, antiretroviral-associated liver toxicity and liver-related morbidity due to HCV progression are particular concerns. HCV/HIV co-infection may accelerate the clinical progression of both HCV and HIV. The high prevalence of HBV/HIV and HCV/HIV co-infections in Asia underscores the need to improve prevention and control measures, as fewer evidence-based prevention strategies are available (compared with Western countries). In this review, the most recent publications on the prevalence of HBV/HIV and HCV/HIV co-infections and related issues, such as therapy and problems in Asia, are updated and summarized.

  6. Trends in the burden of HIV mortality after roll-out of antiretroviral therapy in KwaZulu-Natal, South Africa: an observational community cohort study.

    PubMed

    Reniers, Georges; Blom, Sylvia; Calvert, Clara; Martin-Onraet, Alexandra; Herbst, Abraham J; Eaton, Jeffrey W; Bor, Jacob; Slaymaker, Emma; Li, Zehang R; Clark, Samuel J; Bärnighausen, Till; Zaba, Basia; Hosegood, Victoria

    2017-03-01

    Antiretroviral therapy (ART) substantially decreases morbidity and mortality in people living with HIV. In this study, we describe population-level trends in the adult life expectancy and trends in the residual burden of HIV mortality after the roll-out of a public sector ART programme in KwaZulu-Natal, South Africa, one of the populations with the most severe HIV epidemics in the world. Data come from the Africa Centre Demographic Information System (ACDIS), an observational community cohort study in the uMkhanyakude district in northern KwaZulu-Natal, South Africa. We used non-parametric survival analysis methods to estimate gains in the population-wide life expectancy at age 15 years since the introduction of ART, and the shortfall of the population-wide adult life expectancy compared with that of the HIV-negative population (ie, the life expectancy deficit). Life expectancy gains and deficits were further disaggregated by age and cause of death with demographic decomposition methods. Covering the calendar years 2001 through to 2014, we obtained information on 93 903 adults who jointly contribute 535 42 8 person-years of observation to the analyses and 9992 deaths. Since the roll-out of ART in 2004, adult life expectancy increased by 15·2 years for men (95% CI 12·4-17·8) and 17·2 years for women (14·5-20·2). Reductions in pulmonary tuberculosis and HIV-related mortality account for 79·7% of the total life expectancy gains in men (8·4 adult life-years), and 90·7% in women (12·8 adult life-years). For men, 9·5% is the result of a decline in external injuries. By 2014, the life expectancy deficit had decreased to 1·2 years for men (-2·9 to 5·8) and to 5·3 years for women (2·6-7·8). In 2011-14, pulmonary tuberculosis and HIV were responsible for 84·9% of the life expectancy deficit in men and 80·8% in women. The burden of HIV on adult mortality in this population is rapidly shrinking, but remains large for women, despite their better

  7. Quality of life improvement in HIV-1 patients treated with raltegravir in a real-life observational study: RACING.

    PubMed

    Spire, Bruno; Nait-Ighil, Lella; Pugliese, Pascal; Poizot-Martin, Isabelle; Jullien, Vincent; Marcelin, Anne-Geneviève; Billaud, Eric

    2017-01-01

    Good efficacy and safety of raltegravir in person living with HIV was demonstrated in clinical trials over five years, but real-life data, particularly about quality of life (QoL), are lacking. QoL was evaluated over time in adult patients first treated or switched to regimens containing raltegravir in an observational cohort study. Patient QoL was evaluated using the Fatigue Impact Scale (FIS) and the HIV Symptom Index (HSI). Data were collected at baseline and at 1, 3, 6, 12, 18, and 24 months. Baseline FIS and HSI subscores were compared with the scores at each visit using the paired Wilcoxon test. The impact of time, sociodemographic and medical variables upon patient-perceived fatigue and symptoms was also assessed using mixed multivariate models. From baseline, all FIS and HSI subscores improved significantly after one month of treatment. In addition, psychosocial FIS subscores and both the frequency of bothersome symptoms and HSI subscores improved significantly at each visit. Physical FIS subscores also improved significantly, except at month 18, whereas both cognitive and total FIS subscores improved only after 6 months and 24 months, respectively. In multivariate analysis, employment was independently associated over time with improved improvement in both FIS and HSI subscores. Patient QoL improved significantly over a 24-month period of treatment with a raltegravir-containing regimen. FIS and HSI are sensitive tools to measure the impact of new antiretroviral combinations on a patient's perception of QoL.

  8. Factors which influence treatment initiation for pulmonary non-tuberculous mycobacterium infection in HIV negative patients; a multicentre observational study.

    PubMed

    Rawson, Timothy M; Abbara, Aula; Kranzer, Katharina; Ritchie, Andrew; Milburn, James; Brown, Tim; Adeboyeku, David; Buckley, Jim; Davidson, Robert N; Berry, Matthew; Kon, Onn Min; John, Laurence

    2016-11-01

    Clinical, radiological and microbiological criteria inform diagnosis of pulmonary Non-Tuberculous Mycobacteria (NTM) disease and treatment decisions. This multicentre, review aims to characterise NTM disease meeting ATS/IDSA criteria and define factors associated with initiation of treatment. Sputum samples growing NTM from 5 London hospitals between 2010 and 2014 were identified. Data for HIV-negative individuals meeting ATS/IDSA guidelines for pulmonary NTM disease were extracted. Associations between clinical variables and treatment decision were investigated using Chi-squared, Fishers-exact or Mann Whitney tests. Factors associated with treatment in univariate analysis (p < 0.150) were included in a multivariate logistic regression model. NTM were identified from 817 individuals' sputum samples. 108 met ATS/IDSA criteria. 42/108 (39%) were initiated on treatment. Median age was 68 (56-78) in the cohort. On multivariate analysis, factors significantly associated with treatment of pulmonary NTM infection were: Cavitation on HRCT (OR: 6.49; 95% CI: 2.36-17.81), presenting with night sweats (OR 4.18; 95% CI: 1.08-16.13), and presenting with weight loss (OR 3.02; 95% CI: 1.15-7.93). Of those treated, 18(43%) have completed treatment, 9(21%) remain on treatment, 10(24%) stopped due to side effects, 5(12%) died during treatment. Mortality was 31% (n = 13) in treated versus 21% (n = 14) in the non-treated cohort. Subgroup analysis of individual NTM species did not observe any differences in treatment initiation or outcomes between groups. Decision to treat pulmonary NTM infection requires clinical judgement when interpreting clinical guidelines. Factors independently associated with decision to treat in this HIV-negative cohort include cavitation on HRCT and presenting with night sweats or weight loss. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. Asia needs political commitment to fight AIDS.

    PubMed

    1997-06-02

    Delegates from China, Cambodia, Indonesia, Malaysia, Burma, Thailand, and Vietnam to a Joint UN Program on HIV/AIDS (UNAIDS) workshop in Bangkok urged their governments to give priority to the prevention of HIV and AIDS. There are already approximately 3 million people infected with HIV in Asia. Their numbers should increase by 1-2 million by the year 2000. However, devoid of any prevention measures, 2-5 million more people could instead become infected over the same period. Thailand, where many people have adopted condom use and the patronage of brothels and prostitutes has declined, was noted as a success story at the workshop in preventing the further spread of HIV. The level of risky sexual behavior in Thailand has declined to such an extent that HIV case projections made in 1991 for the year 2000 have been revised to a lower number. An estimated more than 100,000 people are infected with HIV in Indonesia, a country in which the epidemic may grow to 2.5 million cases by 2000 unless successful prevention programs are implemented.

  10. JPRS Report East Asia Southeast Asia

    DTIC Science & Technology

    1987-06-17

    aqua EAST EUROPE gold SOVIET UNION salmon EAST ASIA yellow NEAR EAST £ SOUTH ASIA. ..blue LATIN AMERICA pink WEST EUROPE ivory AFRICA (SUB...established with a view to improving technical knowledge. Then unified accounting was set up, particularly on behalf of the cadres who go out to...has reduced their number from 23 to 11, etc. In terms of management, through accounting and financial planning, it is possible to ascertain the

  11. JPRS Report, East Asia Southeast Asia

    DTIC Science & Technology

    1990-06-14

    JPRS-SEA-90-017 14 JUNE 1990 JPRS Report— East Asia Southeast Asia REPRODUCED BY U.S. DEPARTMENT OF COMMERCE NATIONAL TECHNICAL INFORMATION ...Rangoon THE WORKING PEOPLE’S DAILY in English 31 Mar 90 pp 12, 4, 6 [Excerpts] Yangon, 30 March—The Information Com- mittee of the State Law and Order...is found that rooms for tourists are insufficient. Hence, the Ministry of Trade is making arrangements for building new hotels in Yangon, Mandalay

  12. JPRS Report: East Asia, Southeast Asia.

    DTIC Science & Technology

    1991-02-13

    are a number of knowledgeable and well-educated people who don’t dare give their views. They are afraid of being branded as bad. They are afraid...exempts the eldest sons of war dead families), the children of Class-1 and Class-2 disabled veterans and Class-1 ill soldiers, and people with blood...19980515 091 East Asia Southeast Asia JPRS-SEA-91-003 CONTENTS 13 February 1991 BURMA Report on Border Area Development [THE WORKING PEOPLES DAILY

  13. Harm reduction history, response, and current trends in Asia.

    PubMed

    Thomson, Nicholas

    2013-12-01

    HIV epidemics in Asia have been initially driven through injecting drug use and the use of shared needles and syringes. Molecular epidemiological work has shown that where there is heroin trafficking and use, so too is there HIV. Given the often strict enforcement of national anti-narcotic laws, harm reduction responses to HIV infections driven by injecting drug use have been historically slow. As it became clear that preventing HIV meant embracing harm reduction, many countries in the region have adopted harm reduction as part of their national AIDS strategy and increasingly as part of their national drug strategy. Initial successes have proven that harm reduction, as it pertains to HIV among IDUs, can and does work in Asia. These initial successes have led to more comprehensive scale-up of other essential components of HIV prevention among IDUs, including increased availability of opiate substitution programs. Still, multiple challenges remain as overall coverage of services in the region remains poor. Changes in the availability and patterns of use of drugs, including the exponential increase in the use of amphetamine-type stimulants, is providing ongoing challenges to both the law enforcement and public health sectors. This paper reflects on the history of harm reduction in Asia and the shifting trends forcing policy makers to adapt and expand harm reduction strategies to include an ever widening approach to criminal justice, policing, public health, and human rights.

  14. Theoretical Foundations of Research Focused on HIV Prevention Among Substance-involved Women: A Review of Observational and Intervention Studies

    PubMed Central

    Auerbach, Judith D.; Smith, Laramie R.

    2016-01-01

    Although substance use continues to be a significant component of HIV risk among women worldwide, to date relatively little attention has been paid in research, services, or policy to substance-involved women (SIW). HIV acquisition for SIW stems from transmission risks directly related to substance use, as well as risks associated with sexual activity where power to negotiate risk and safety are influenced by dynamics of male partnerships, sex work, and criminalization (of both drug use and sex work), among other things. As such, HIV risk for such women resides as much in the environment—physical, social, cultural, economic, and political--in which drug use occurs as it does from transmission-related behaviors of individual women. To reduce HIV infections among SIW, it is important to specify the interaction of individual- and environmental-level factors, including, but not limited to those related to women's own substance use, that can and ought to be changed. This involves theorizing about the interplay of gender, substance use, and HIV risk and incorporating that theoretical understanding into intervention design and evaluation. A review of the published literature focused on HIV prevention among SIW revealed a general lack of theoretical and conceptual foundation specific to the gender-related and environmental drivers of HIV in this population. Greater theoretical linkages to intersectionality and syndemics approaches are recommended to better identify and target relevant mechanisms by which the interplay of gender dynamics and substance use potentiate the likelihood of HIV acquisition and transmission among SIW. PMID:25978481

  15. Adjunctive Corticosteroids for Pneumocystis jirovecii Pneumonia in Non-HIV-infected Patients: A Systematic Review and Meta-analysis of Observational Studies.

    PubMed

    Fujikura, Yuji; Manabe, Toshie; Kawana, Akihiko; Kohno, Shigeru

    2017-02-01

    The clinical benefits of adjunctive corticosteroids for Pneumocystis jirovecii (P. jirovecii) pneumonia in patients not infected with the human immunodeficiency virus (HIV) has not been evaluated by meta-analysis. We conducted a systematic review of published studies describing the effects of adjunctive corticosteroids on outcome in non-HIV P. jirovecii pneumonia patients. Two investigators independently searched the PubMed and Cochrane databases for eligible articles written in English. A meta-analysis was performed using a random-effects model for measuring mortality as the primary outcome, and the need for intubation or mechanical ventilation as the secondary outcome. Seven observational studies were eligible. In these studies, adjunctive corticosteroids did not affect mortality in non-HIV patients (odds ratio [OR] 1.26; 95% CI 0.60-2.67) and there was no beneficial effect in patients with severe hypoxemia (PaO2<70mmHg) (OR 0.90; 95% CI 0.44-1.83). No significant effect on the secondary outcome was observed (OR 1.34; 95% CI 0.44-4.11). Although the studies were observational, meta-analysis showed that adjunctive corticosteroids did not improve the outcome of P. jirovecii pneumonia in non-HIV patients. The results warrant a randomized controlled trial. Copyright © 2016 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Sex trafficking in South Asia.

    PubMed

    Huda, S

    2006-09-01

    Economic and social inequalities and political conflicts have led to the movement of persons within each country and across the borders in South Asia. Globalization has encouraged free mobility of capital, technology, experts and sex tourism. Illiteracy, dependency, violence, social stigma, cultural stereotypes, gender disparity and endemic poverty, among other factors, place women and children in powerless, non-negotiable situations that have contributed to the emergence and breeding of the cavernous problem of sex trafficking in the entire region. This alarming spread of sex trafficking has fuelled the spread of HIV infection in South Asia, posing a unique and serious threat to community health, poverty alleviation and other crucial aspects of human development. Although the SAARC (South Asian Association for Regional Cooperation) Convention on Trafficking in Women and Children has been an important breakthrough, most of the countries in the region do not have anti-trafficking legislation or means to protect the victims. Countries of the region should make a concerted effort to treat trafficking victims as "victims" of human rights violations in all anti-trafficking strategies and actions.

  17. Central Asia Active Fault Database

    NASA Astrophysics Data System (ADS)

    Mohadjer, Solmaz; Ehlers, Todd A.; Kakar, Najibullah

    2014-05-01

    The ongoing collision of the Indian subcontinent with Asia controls active tectonics and seismicity in Central Asia. This motion is accommodated by faults that have historically caused devastating earthquakes and continue to pose serious threats to the population at risk. Despite international and regional efforts to assess seismic hazards in Central Asia, little attention has been given to development of a comprehensive database for active faults in the region. To address this issue and to better understand the distribution and level of seismic hazard in Central Asia, we are developing a publically available database for active faults of Central Asia (including but not limited to Afghanistan, Tajikistan, Kyrgyzstan, northern Pakistan and western China) using ArcGIS. The database is designed to allow users to store, map and query important fault parameters such as fault location, displacement history, rate of movement, and other data relevant to seismic hazard studies including fault trench locations, geochronology constraints, and seismic studies. Data sources integrated into the database include previously published maps and scientific investigations as well as strain rate measurements and historic and recent seismicity. In addition, high resolution Quickbird, Spot, and Aster imagery are used for selected features to locate and measure offset of landforms associated with Quaternary faulting. These features are individually digitized and linked to attribute tables that provide a description for each feature. Preliminary observations include inconsistent and sometimes inaccurate information for faults documented in different studies. For example, the Darvaz-Karakul fault which roughly defines the western margin of the Pamir, has been mapped with differences in location of up to 12 kilometers. The sense of motion for this fault ranges from unknown to thrust and strike-slip in three different studies despite documented left-lateral displacements of Holocene and late

  18. Validation of an Algorithm to Identify Antiretroviral-Naïve Status at Time of Entry into a Large, Observational Cohort of HIV-infected Patients

    PubMed Central

    Gandhi, Neel R.; Tate, Janet P.; Rodriguez-Barradas, Maria C.; Rimland, David; Goetz, Matthew Bidwell; Gibert, Cynthia; Brown, Sheldon T.; Mattocks, Kristin; Justice, Amy C.

    2013-01-01

    Purpose Large, observational HIV cohorts play an important role in answering questions which are difficult to study in randomized trials; however, they often lack detailed information regarding previous antiretroviral treatment (ART). Knowledge of ART treatment history is important when ascertaining the long-term impact of medications, co-morbidities, or adverse reactions on HIV outcomes. Methods We performed a retrospective study to validate a prediction algorithm for identifying ART-naïve patients using the Veterans Aging Cohort Study’s Virtual Cohort—an observational cohort of 40,594 HIV-infected veterans nationwide. Medical records for 3070 HIV-infected patients were reviewed to determine history of combination ART treatment. An algorithm using Virtual Cohort laboratory data was used to predict ART treatment status and compared to medical record review. Results Among 3070 patients’ medical records reviewed, 1223 were eligible for analysis. Of these, 990 (81%) were ART naïve at cohort entry based on medical record review. The prediction algorithm’s sensitivity was 86%, specificity 47%, positive predictive value (PPV) 87% and negative predictive value 45%, using a viral load threshold of <400 copies/ml. Sensitivity analysis revealed that PPV would be maximized by increasing the viral load threshold, whereas sensitivity would be maximized by lowering the viral load threshold. Conclusions A prediction algorithm using available laboratory data can be used to accurately identify ART-naïve patients in large, observational HIV cohorts. Use of this algorithm will allow investigators to accurately limit analyses to ART-naïve patients when studying the contribution of ART to outcomes and adverse events. PMID:23836591

  19. Weight as predictors of clinical progression and treatment failure: Results from the TREAT Asia Pediatric HIV Observational Database (TApHOD)

    PubMed Central

    Kariminia, Azar; Durier, Nicolas; Jourdain, Gonzague; Saghayam, Suneeta; Do, Chau V.; Van Nguyên, Lam; Hansudewechakul, Rawiwan; Lumbiganon, Pagakrong; Chokephaibulkit, Kulkanya; Truong, Khanh Huu; Sirisanthana, Virat; Ung, Vibol; Vonthanak, Saphonn; Ananworanich, Jintanat; Yusoff, Nik Khairulddin N.; Kurniati, Nia; Razali, Kamarul Azahar; Fong, Moy Siew; Nallusamy, Revathy; Wati, Dewi Kumara

    2014-01-01

    Objective To evaluate the value of time-updated weight and height in predicting clinical progression, immunological and virological failure in children receiving combination antiretroviral therapy (cART). Methods We used Cox regression to analyse data of a cohort of Asian children. Results 2608 children were included; median age at cART was 5.7 years. Time-updated weight for age Z score <−3 was associated with mortality (P < 0.001) independent of CD4%; and <−2 was associated with immunological failure (P ≤ 0.03) independent of age at cART. Conclusion Weight monitoring provides useful data to inform clinical management of children on cART in resource-limited settings. PMID:24872132

  20. Initial Antituberculous Regimen with Better Drug Penetration into Cerebrospinal Fluid Reduces Mortality in HIV Infected Patients with Tuberculous Meningitis: Data from an HIV Observational Cohort Study

    PubMed Central

    Midde, Manoranjan; Pakam, Raghavakalyan; Naik, Praveen Kumar

    2013-01-01

    Tuberculous meningitis (TM) is the deadliest form of tuberculosis. Nearly two-thirds of HIV infected patients with TM die, and most deaths occur within one month. Current treatment of TM involves the use of drugs with poor penetration into the cerebro-spinal fluid (CSF). In this study, we present the mortality before and after implementing a new antituberculous regimen (ATR) with a higher drug penetration in CSF than the standard ATR during the initial treatment of TM in an HIV cohort study. The new ATR included levofloxacin, ethionamide, pyrazinamide, and a double dose of rifampicin and isoniazid and was given for a median of 7 days (interquartile range 6–9). The new ATR was associated with an absolute 21.5% (95% confidence interval (CI), 7.3–35.7) reduction in mortality at 12 months. In multivariable analysis, independent factors associated with mortality were the use of the standard ATR versus the new ATR (hazard ratio 2.05; 95% CI, 1.2–3.5), not being on antiretroviral therapy, low CD4 lymphocyte counts, and low serum albumin levels. Our findings suggest that an intensified initial ATR, which likely results in higher concentrations of active drugs in CSF, has a beneficial effect on the survival of HIV-related TM. PMID:23997952

  1. Association between HIV replication and serum leptin levels: an observational study of a cohort of HIV-1-infected South African women

    PubMed Central

    2010-01-01

    Background Advanced HIV infection can result in lipoatrophy and wasting, even in the absence of ongoing opportunistic infections, suggesting that HIV may directly affect adipose tissue amount and distribution. Methods We assessed the relationship of fat (measured using anthropometry, DEXA, MRI scans) or markers related to glucose and lipid metabolism with viral load in a cross-sectional sample of 83 antiretroviral-naïve HIV-1-infected South African women. A multivariable linear model was fitted to log10VL to assess the combined effect of these variables. Results In addition to higher T cell activation, women with viral load greater than the population median had lower waist circumference, body mass index and subcutaneous abdominal fat, as well as lower serum leptin. We demonstrate that leptin serum levels are inversely associated with viral replication, independent of the amount of adipose tissue. This association is maintained after adjusting for multiple variables associated with disease progression (i.e., cellular activation and innate immunity effector levels). Conclusions Our results demonstrate that serum leptin levels are inversely associated with viral replication, independent of disease progression: we postulate that leptin may affect viral replication. PMID:20822522

  2. Temporal trends in HIV-1 incidence and risk behaviours in men who have sex with men in Bangkok, Thailand, 2006-13: an observational study.

    PubMed

    van Griensven, Frits; Holtz, Timothy H; Thienkrua, Warunee; Chonwattana, Wannee; Wimonsate, Wipas; Chaikummao, Supaporn; Varangrat, Anchalee; Chemnasiri, Tareerat; Sukwicha, Wichuda; Curlin, Marcel E; Samandari, Taraz; Chitwarakorn, Anupong; Mock, Philip A

    2015-02-01

    HIV-1 incidence in men who have sex with men (MSM) is often difficult to estimate. We therefore assessed temporal trends in HIV-1 incidence and behavioural risk factors in MSM in Bangkok, Thailand, from 2006 to 2013. In this observational study, we used data for clients attending the Silom Community Clinic for voluntary counselling and testing (VCT) services and from the Bangkok MSM Cohort Study (BMCS) to investigate trends in HIV incidence per 100 person-years per quarter in both cohorts. During VCT, basic demographic data were gathered at registration. However, no behavioural risk data were gathered. In the BMCS, we gathered demographic and behavioural data at baseline and at regular study visits using audio computer-assisted self-interviewing. Questions were included about potential risk factors such as drug use, sexual practices, and how often condoms were used. We also analysed behavioural risk factors in the BMCS cohort, using a restricted cubic spline function for time. From 2006 to 2013, 8176 MSM came for VCT; 1999 (24%) clients were initially seronegative and returned for another test. 235 (12%) individuals seroconverted. The overall HIV-1 incidence was 5.5 per 100 person-years (95% CI 4.8-6.3), with an increasing trend (adjusted p=0.02). In the BMCS, 1372 people were seronegative at baseline; 1259 (92%) had more than one follow-up test and 238 (17%) seroconverted. The overall HIV-1 incidence was 5.3 per 100 person-years (95% CI 4.7-6.1), with an increase and then a decline (inverted U-shaped curve, p=0.0001). Individuals aged 21 years and younger were at significantly higher risk of HIV infection than were those aged 30 years and older in the in the VCT (rate ratio 2.29, 95% CI 1.88-2.78, p<0.0001) and BMCS cohorts (1.99, 1.50-2.65, p<0.0001). Overall, drug use (p=0.03), drug use to enhance sex (p=0.0006), use of drugs for erectile dysfunction (p<0.0001), and 100% condom use (p<0.0001) increased over time, whereas the proportion of individuals reporting

  3. Clinical impact of altered T-cell homeostasis in treated HIV patients enrolled in a large observational cohort.

    PubMed

    Ndumbi, Patricia; Gillis, Jennifer; Raboud, Janet M; Cooper, Curtis; Hogg, Robert S; Montaner, Julio S G; Burchell, Ann N; Loutfy, Mona R; Machouf, Nima; Klein, Marina B; Tsoukas, Chris M

    2013-11-28

    We investigated the probability of transitioning in or out of the CD3⁺ T-cell homeostatic range during antiretroviral therapy, and we assessed the clinical impact of lost T-cell homeostasis (TCH) on AIDS-defining illnesses (ADIs) or death. Within the Canadian Observational Cohort (CANOC), we studied 4463 antiretroviral therapy (ART)-naive HIV-positive patients initiating combination ART (cART) between 2000 and 2010. CD3⁺ trajectories were estimated using a four state Markov model. CD3⁺ T-cel percentage states were classified as follows: very low (<50%), low (50-64%), normal (65-85%), and high (>85%). Covariates associated with transitioning between states were examined. The association between CD3⁺ T-cell percentage states and time to ADI/death from cART initiation was determined using Cox proportional hazards models. A total of 4463 patients were followed for a median of 3 years. Two thousand, five hundred and eight (56%) patients never transitioned from their baseline CD3⁺ T-cell percentage state; 85% of these had normal TCH. In multivariable analysis, individuals with time-updated low CD4⁺ cell count, time-updated detectable viral load, older age, and hepatitis C virus (HCV) coinfection were less likely to maintain TCH. In the multivariable proportional hazards model, both very low and high CD3⁺ T-cell percentages were associated with increased risk of ADI/death [adjusted hazard ratio=1.91 (95% confidence interval, CI: 1.27-2.89) and hazard ratio=1.49 (95% CI: 1.13-1.96), respectively]. Patients with very low or high CD3⁺ T-cell percentages are at risk for ADIs/death. To our knowledge, this is the first study linking altered TCH and morbidity/mortality in cART-treated HIV-positive patients.

  4. Counseling to reduce high-risk sexual behavior in HIV care: a multi-center, direct observation study.

    PubMed

    Flickinger, Tabor E; Berry, Stephen; Korthuis, P Todd; Saha, Somnath; Laws, M Barton; Sharp, Victoria; Moore, Richard D; Beach, Mary Catherine

    2013-07-01

    A key opportunity to reduce HIV transmission lies with healthcare providers counseling HIV-infected patients about safer sex. We audio-recorded and transcribed clinical encounters between 45 healthcare providers and 417 of their HIV-infected patients at four outpatient sites in the United States. We used logistic regressions to evaluate associations between patient and provider characteristics, and the occurrence of discussion (any talk about sex) and counseling (advice about safer sex). Of the 417 encounters, discussion of sex occurred in 187 (45% of encounters, 95% CI: 40-50%). Counseling occurred for 49% (95% CI: 35-63%) of patients reporting unsafe sex. Discussion of sex was more likely with younger or less-educated patients and with less cultural difference between patient and provider, while counseling was associated with greater provider mindfulness and lower provider empathy. These findings suggest targets to improve communication regarding sexual risk reduction in HIV care.

  5. Validation of the on-line aerosol retrieval and error characterization algorithm from the OMI Near-UV observations during the DRAGON-NE Asia 2012 campaign

    NASA Astrophysics Data System (ADS)

    Jeong, U.; Ahn, C.; Kim, J.; Bhartia, P. K.; Torres, O.; Spurr, R. J. D.; Liu, X.; Chance, K.; Holben, B. N.

    2014-12-01

    One of the representative advantages of using ultraviolet channel to retrieve aerosol optical property is that the results are less affected by the uncertainty of surface reflectance database. The retrieved aerosol products have relatively uniform quality at both land and ocean except the ice-snow surface. The near UV technique of aerosol remote sensing has additional merit that it has long period database since TOMS (Total Ozone Mapping Spectrometer) including aerosol absorption properties. Thus the retrieved product using the near UV technique using TOMS and OMI (Ozone Monitoring Instrument) measurement is quite appropriate for climatological research. For such purposes, assessment of accuracy of the retrieved product is essential to evaluate the radiative forcing of the aerosols. In this study, the error characterizations of the near UV technique using OMI measurements have been performed with the optimal estimation method during the DRAGON-NE Asia 2012 campaign. In order to avoid the interpolation error, we developed the on-line retrieval scheme based on the traditional near UV method. The retrieval noise and smoothing error of retrieved AOT (Aerosol Optical Thickness) were compared with the biases between 380 nm AOT from AERONET and retrieved 388 nm AOT. They showed positive correlations which infer the possibility of the estimated errors using the optimal estimation method to be used to evaluate the error of retrieved products. Forward model parameter errors were analyzed separately which depends on the quality of the used database, thus can be reduced by improving the database.

  6. Unification of South Asia

    DTIC Science & Technology

    1994-06-03

    time. Even protest movements that sprang from its fold, like Jainism and Buddhism, remained part of the Hindu fold. These protestant religions were more...Asia: for example, Jainism , Buddhism, Sikhism and Christians. The Hindus are the descendants of the Aryans, nomadic people of Central Asia who

  7. AED in Asia

    ERIC Educational Resources Information Center

    Academy for Educational Development, 2004

    2004-01-01

    Founded in 1961, the Academy for Educational Development (AED) is an independent, nonprofit, charitable organization that operates development programs in the United States and throughout the world. This directory presents an overview of AED endeavors in Asia. AED's work in Asia has centered on institution-building, taking advantage of its…

  8. Heterogeneity of the HIV epidemic in agrarian, trading, and fishing communities in Rakai, Uganda: an observational epidemiological study.

    PubMed

    Chang, Larry W; Grabowski, Mary K; Ssekubugu, Robert; Nalugoda, Fred; Kigozi, Godfrey; Nantume, Betty; Lessler, Justin; Moore, Sean M; Quinn, Thomas C; Reynolds, Steven J; Gray, Ronald H; Serwadda, David; Wawer, Maria J

    2016-08-01

    Understanding the extent to which HIV burden differs across communities and the drivers of local disparities is crucial for an effective and targeted HIV response. We assessed community-level variations in HIV prevalence, risk factors, and treatment and prevention service uptake in Rakai, Uganda. The Rakai Community Cohort Study (RCCS) is an open, population-based cohort of people aged 15-49 years in 40 communities. Participants are HIV tested and interviewed to obtain sociodemographic, behavioural, and health information. RCCS data from Aug 10, 2011, to May 30, 2013, were used to classify communities as agrarian (n=27), trading (n=9), or lakeside fishing sites (n=4). We mapped HIV prevalence with Bayesian methods, and characterised variability across and within community classifications. We also assessed differences in HIV risk factors and uptake of antiretroviral therapy and male circumcision between community types. 17 119 individuals were included, 9215 (54%) of whom were female. 9931 participants resided in agrarian, 3318 in trading, and 3870 in fishing communities. Median HIV prevalence was higher in fishing communities (42%, range 38-43) than in trading (17%, 11-21) and agrarian communities (14%, 9-26). Antiretroviral therapy use was significantly lower in both men and women in fishing communities than in trading (age-adjusted prevalence risk ratio in men 0·64, 95% CI 0·44-0·97; women 0·53, 0·42-0·66) and agrarian communities (men 0·55, 0·42-0·72; women 0·65, 0·54-0·79), as was circumcision coverage among men (vs trading 0·48, 0·42-0·55; vs agrarian 0·64, 0·56-0·72). Self-reported risk behaviours were significantly higher in men than in women and in fishing communities than in other community types. Substantial heterogeneity in HIV prevalence, risk factors, and service uptake in Rakai, Uganda, emphasises the need for local surveillance and the design of targeted HIV responses. High HIV burden, risk behaviours, and low use of combination

  9. Asia-MIP: Multi Model-data Synthesis of Terrestrial Carbon Cycles in Asia

    NASA Astrophysics Data System (ADS)

    Ichii, K.; Kondo, M.; Ito, A.; Kang, M.; Sasai, T.; SATO, H.; Ueyama, M.; Kobayashi, H.; Saigusa, N.; Kim, J.

    2013-12-01

    Asia, which is characterized by monsoon climate and intense human activities, is one of the prominent understudied regions in terms of terrestrial carbon budgets and mechanisms of carbon exchange. To better understand terrestrial carbon cycle in Asia, we initiated multi-model and data intercomparison project in Asia (Asia-MIP). We analyzed outputs from multiple approaches: satellite-based observations (AVHRR and MODIS) and related products, empirically upscaled estimations (Support Vector Regression) using eddy-covariance observation network in Asia (AsiaFlux, CarboEastAsia, FLUXNET), ~10 terrestrial biosphere models (e.g. BEAMS, Biome-BGC, LPJ, SEIB-DGVM, TRIFFID, VISIT models), and atmospheric inversion analysis (e.g. TransCom models). We focused on the two difference temporal coverage: long-term (30 years; 1982-2011) and decadal (10 years; 2001-2010; data intensive period) scales. The regions of covering Siberia, Far East Asia, East Asia, Southeast Asia and South Asia (60-80E, 10S-80N), was analyzed in this study for assessing the magnitudes, interannual variability, and key driving factors of carbon cycles. We will report the progress of synthesis effort to quantify terrestrial carbon budget in Asia. First, we analyzed the recent trends in Gross Primary Productivities (GPP) using satellite-based observation (AVHRR) and multiple terrestrial biosphere models. We found both model outputs and satellite-based observation consistently show an increasing trend in GPP in most of the regions in Asia. Mechanisms of the GPP increase were analyzed using models, and changes in temperature and precipitation play dominant roles in GPP increase in boreal and temperate regions, whereas changes in atmospheric CO2 and precipitation are important in tropical regions. However, their relative contributions were different. Second, in the decadal analysis (2001-2010), we found that the negative GPP and carbon uptake anomalies in 2003 summer in Far East Asia is one of the largest

  10. Psychological Factors, Beliefs About Medication, and Adherence of Youth with HIV-1 in a Multisite Directly Observed Therapy (DOT) Pilot Study

    PubMed Central

    Garvie, Patricia A.; Flynn, Patricia M.; Belzer, Marvin; Britto, Paula; Hu, Chengcheng; Graham, Bobbie; Neely, Michael; McSherry, George D.; Spector, Stephen A.; Gaur, Aditya H.

    2010-01-01

    Introduction Examine psychological functioning and beliefs about medicine in adolescents with HIV-1 on HAART in a community-based directly observed therapy (DOT) pilot feasibility study. Methods Youth with behaviorally-acquired HIV (n=20; 65% female; median age 21 years) with adherence problems, received once-daily DOT. Youth were assessed at baseline, week 12 (post-DOT) and week 24 (follow-up). Results Baseline to week 12 comparisons: 55% of youth reported clinical depressive symptoms compared to 27% at week 12 with sustained improvements at week 24. Substance use: Borderline clinical range (Tscore=68), with clinical but statistically non-significant improvement (Tscore=61). Hopelessness scores reflected optimism for the future. Coping strategies showed significantly decreased Cognitive Avoidance (p=0.02), Emotional Discharge (p=0.004), and Acceptance/Resignation (“nothing I can do,” p=0.004); Positive Reappraisal and Seeking Support emerged. Aside from depressive symptoms, week 12 improvements were not sustained at week 24. DOT adherence was predicted by higher baseline depression (p=0.05), Beliefs About Medicine (p=0.006) and Perceived Threat of illness scores (p=0.03). Discussion Youth with behaviorally-acquired HIV and adherence problems who participated in a community-based DOT intervention reported clinically improved depressive symptoms, and temporarily reduced substance use and negative coping strategies. Depressive symptoms, Beliefs About Medicine and viewing HIV as a threat predicted better DOT adherence. PMID:21575827

  11. The Number and Complexity of Pure and Recombinant HIV-1 Strains Observed within Incident Infections during the HIV and Malaria Cohort Study Conducted in Kericho, Kenya, from 2003 to 2006.

    PubMed

    Billings, Erik; Sanders-Buell, Eric; Bose, Meera; Bradfield, Andrea; Lei, Esther; Kijak, Gustavo H; Arroyo, Miguel A; Kibaya, Rukia M; Scott, Paul T; Wasunna, Monique K; Sawe, Frederick K; Shaffer, Douglas N; Birx, Deborah L; McCutchan, Francine E; Michael, Nelson L; Robb, Merlin L; Kim, Jerome H; Tovanabutra, Sodsai

    2015-01-01

    Characterization of HIV-1 subtype diversity in regions where vaccine trials are conducted is critical for vaccine development and testing. This study describes the molecular epidemiology of HIV-1 within a tea-plantation community cohort in Kericho, Kenya. Sixty-three incident infections were ascertained in the HIV and Malaria Cohort Study conducted in Kericho from 2003 to 2006. HIV-1 strains from 58 of those individuals were full genome characterized and compared to two previous Kenyan studies describing 41 prevalent infections from a blood bank survey (1999-2000) and 21 infections from a higher-risk cohort containing a mix of incident and prevalent infections (2006). Among the 58 strains from the community cohort, 43.1% were pure subtypes (36.2% A1, 5.2% C, and 1.7% G) and 56.9% were inter-subtype recombinants (29.3% A1D, 8.6% A1CD, 6.9% A1A2D, 5.2% A1C, 3.4% A1A2CD, and 3.4% A2D). This diversity and the resulting genetic distance between the observed strains will need to be addressed when vaccine immunogens are chosen. In consideration of current vaccine development efforts, the strains from these three studies were compared to five candidate vaccines (each of which are viral vectored, carrying inserts corresponding to parts of gag, pol, and envelope), which have been developed for possible use in sub-Saharan Africa. The sequence comparison between the observed strains and the candidate vaccines indicates that in the presence of diverse recombinants, a bivalent vaccine is more likely to provide T-cell epitope coverage than monovalent vaccines even when the inserts of the bivalent vaccine are not subtype-matched to the local epidemic.

  12. The Number and Complexity of Pure and Recombinant HIV-1 Strains Observed within Incident Infections during the HIV and Malaria Cohort Study Conducted in Kericho, Kenya, from 2003 to 2006

    PubMed Central

    Billings, Erik; Sanders-Buell, Eric; Bose, Meera; Bradfield, Andrea; Lei, Esther; Kijak, Gustavo H.; Arroyo, Miguel A.; Kibaya, Rukia M.; Scott, Paul T.; Wasunna, Monique K.; Sawe, Frederick K.; Shaffer, Douglas N.; Birx, Deborah L.; McCutchan, Francine E.; Michael, Nelson L.; Robb, Merlin L.; Kim, Jerome H.; Tovanabutra, Sodsai

    2015-01-01

    Characterization of HIV-1 subtype diversity in regions where vaccine trials are conducted is critical for vaccine development and testing. This study describes the molecular epidemiology of HIV-1 within a tea-plantation community cohort in Kericho, Kenya. Sixty-three incident infections were ascertained in the HIV and Malaria Cohort Study conducted in Kericho from 2003 to 2006. HIV-1 strains from 58 of those individuals were full genome characterized and compared to two previous Kenyan studies describing 41 prevalent infections from a blood bank survey (1999–2000) and 21 infections from a higher-risk cohort containing a mix of incident and prevalent infections (2006). Among the 58 strains from the community cohort, 43.1% were pure subtypes (36.2% A1, 5.2% C, and 1.7% G) and 56.9% were inter-subtype recombinants (29.3% A1D, 8.6% A1CD, 6.9% A1A2D, 5.2% A1C, 3.4% A1A2CD, and 3.4% A2D). This diversity and the resulting genetic distance between the observed strains will need to be addressed when vaccine immunogens are chosen. In consideration of current vaccine development efforts, the strains from these three studies were compared to five candidate vaccines (each of which are viral vectored, carrying inserts corresponding to parts of gag, pol, and envelope), which have been developed for possible use in sub-Saharan Africa. The sequence comparison between the observed strains and the candidate vaccines indicates that in the presence of diverse recombinants, a bivalent vaccine is more likely to provide T-cell epitope coverage than monovalent vaccines even when the inserts of the bivalent vaccine are not subtype-matched to the local epidemic. PMID:26287814

  13. The relationship between economic characteristics and health-related quality of life in newly diagnosed cancer patients in Southeast Asia: results from an observational study.

    PubMed

    Kimman, Merel; Jan, Stephen; Monaghan, Helen; Woodward, Mark

    2015-04-01

    We investigate whether cancer patients' economic characteristics are independent determinants of health-related quality of life (HRQoL) in low- and middle-income settings to identify priorities for health policy and research. A cross-sectional survey of 9,513 cancer patients from Southeast Asia provided data on demographics, economic status and HRQoL. HRQoL was measured using the EORTC QLQ-C30 and EQ-5D. Information on cancer site and stage was collected using the patients' medical records. Multiple linear regression analysis estimated the relative impact of economic characteristics (i.e. health insurance, employment status, household income and economic hardship) on HRQoL. All economic characteristics were significant independent determinants of HRQoL, when we controlled for demographic and clinical characteristics. Economic hardship was found to be most important. The adjusted mean differences in HRQoL scores between patients who had experienced economic hardship in the year before diagnosis compared to patients who did not were -5.6, -6.7, -7.3 and -0.06, respectively, for global health, physical function, emotional function and the EQ-5D index (all p values <0.001). Subgroup analyses showed that this significant result for economic hardship as a predictor of poor HRQoL was consistent across all age groups, for males and females, and across all levels of education. Living in poor economic circumstances before a cancer diagnosis is associated with greatly impaired HRQoL after diagnosis. There is wide scope for research on innovative interventions that provide low-cost and targeted support aimed to improve health outcomes of disadvantaged cancer patients in low- and middle-income settings.

  14. Neurology in Asia.

    PubMed

    Tan, Chong-Tin

    2015-02-10

    Asia is important as it accounts for more than half of the world population. The majority of Asian countries fall into the middle income category. As for cultural traditions, Asia is highly varied, with many languages spoken. The pattern of neurologic diseases in Asia is largely similar to the West, with some disease features being specific to Asia. Whereas Asia constitutes 60% of the world's population, it contains only 20% of the world's neurologists. This disparity is particularly evident in South and South East Asia. As for neurologic care, it is highly variable depending on whether it is an urban or rural setting, the level of economic development, and the system of health care financing. To help remedy the shortage of neurologists, most counties with larger populations have established training programs in neurology. These programs are diverse, with many areas of concern. There are regional organizations serving as a vehicle for networking in neurology and various subspecialties, as well as an official journal (Neurology Asia). The Asian Epilepsy Academy, with its emphasis on workshops in various locations, EEG certification examination, and fellowships, may provide a template of effective regional networking for improving neurology care in the region.

  15. Bacteremia as a Cause of Fever in Ambulatory, HIV-Infected Mozambican Adults: Results and Policy Implications from a Prospective Observational Study

    PubMed Central

    Moon, Troy D.; Silva, Wilson P.; Buene, Manuel; Morais, Luís; Valverde, Emilio; Vermund, Sten H.; Brentlinger, Paula E.

    2013-01-01

    Fever is typically treated empirically in rural Mozambique. We examined the distribution and antimicrobial susceptibility patterns of bacterial pathogens isolated from blood-culture specimens, and clinical characteristics of ambulatory HIV-infected febrile patients with and without bacteremia. This analysis was nested within a larger prospective observational study to evaluate the performance of new Mozambican guidelines for fever and anemia in HIV-infected adults (clinical trial registration NCT01681914, www.clinicaltrials.gov); the guidelines were designed to be used by non-physician clinicians who attended ambulatory HIV-infected patients in very resource-constrained peripheral health units. In 2012 (April-September), we recruited 258 HIV-infected adults with documented fever or history of recent fever in three sites within Zambézia Province, Mozambique. Although febrile patients were routinely tested for malaria, blood culture capacity was unavailable in Zambézia prior to study initiation. We confirmed bacteremia in 39 (15.1%) of 258 patients. The predominant organisms were non-typhoid Salmonella, nearly all resistant to multiple first-line antibiotics (ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole). Features most associated with bacteremia included higher temperature, lower CD4+ T-lymphocyte count, lower hemoglobin, and headache. Introduction of blood cultures allowed us to: 1) confirm bacteremia in a substantial proportion of patients; 2) tailor specific antimicrobial therapy for confirmed bacteremia based on known susceptibilities; 3) make informed choices of presumptive antibiotics for patients with suspected bacteremia; and 4) construct a preliminary clinical profile to help clinicians determine who would most likely benefit from presumptive bacteremia treatment. Our findings demonstrate that in resource-limited settings, there is urgent need to expand local microbiologic capacity to better identify and treat cases of bacteremia in HIV

  16. Bacteremia as a cause of fever in ambulatory, HIV-infected Mozambican adults: results and policy implications from a prospective observational study.

    PubMed

    Moon, Troy D; Silva, Wilson P; Buene, Manuel; Morais, Luís; Valverde, Emilio; Vermund, Sten H; Brentlinger, Paula E

    2013-01-01

    Fever is typically treated empirically in rural Mozambique. We examined the distribution and antimicrobial susceptibility patterns of bacterial pathogens isolated from blood-culture specimens, and clinical characteristics of ambulatory HIV-infected febrile patients with and without bacteremia. This analysis was nested within a larger prospective observational study to evaluate the performance of new Mozambican guidelines for fever and anemia in HIV-infected adults (clinical trial registration NCT01681914, www.clinicaltrials.gov); the guidelines were designed to be used by non-physician clinicians who attended ambulatory HIV-infected patients in very resource-constrained peripheral health units. In 2012 (April-September), we recruited 258 HIV-infected adults with documented fever or history of recent fever in three sites within Zambézia Province, Mozambique. Although febrile patients were routinely tested for malaria, blood culture capacity was unavailable in Zambézia prior to study initiation. We confirmed bacteremia in 39 (15.1%) of 258 patients. The predominant organisms were non-typhoid Salmonella, nearly all resistant to multiple first-line antibiotics (ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole). Features most associated with bacteremia included higher temperature, lower CD4+ T-lymphocyte count, lower hemoglobin, and headache. Introduction of blood cultures allowed us to: 1) confirm bacteremia in a substantial proportion of patients; 2) tailor specific antimicrobial therapy for confirmed bacteremia based on known susceptibilities; 3) make informed choices of presumptive antibiotics for patients with suspected bacteremia; and 4) construct a preliminary clinical profile to help clinicians determine who would most likely benefit from presumptive bacteremia treatment. Our findings demonstrate that in resource-limited settings, there is urgent need to expand local microbiologic capacity to better identify and treat cases of bacteremia in HIV

  17. Evaluation of Microscopic Observation Drug Susceptibility (MODS) and the string test for rapid diagnosis of pulmonary tuberculosis in HIV/AIDS patients in Bolivia.

    PubMed

    Lora, Meredith H; Reimer-McAtee, Melissa J; Gilman, Robert H; Lozano, Daniel; Saravia, Ruth; Pajuelo, Monica; Bern, Caryn; Castro, Rosario; Espinoza, Magaly; Vallejo, Maya; Solano, Marco; Challapa, Roxana; Torrico, Faustino

    2015-06-06

    Tuberculosis (TB) is the most common opportunistic infection and the leading cause of death in HIV-positive people worldwide. Diagnosing TB is difficult, and is more challenging in resource-scarce settings where culture-based diagnostic methods rely on poorly sensitive smear microscopy by Ziehl-Neelsen stain (ZN). We performed a cross-sectional study examining the diagnostic utility of Microscopic Observation Drug Susceptibility liquid culture (MODS) versus traditional Ziehl-Neelsen staining (ZN) and Lowenstein Jensen culture (LJ) of pulmonary tuberculosis (TB) and multidrug-resistant tuberculosis (MDRTB) in HIV-infected patients in Bolivia. For sputum scarce individuals we assessed the value of the string test and induced sputum for TB diagnosis. The presence of Mycobacterium tuberculosis (Mtb) in the sputum of 107 HIV-positive patients was evaluated by ZN, LJ, and MODS. Gastric secretion samples obtained by the string test were evaluated by MODS in 102 patients. The TB-HIV co-infection rate of HIV patients with respiratory symptoms by sputum sample was 45 % (48/107); 46/48 (96 %) were positive by MODS, 38/48 (79 %) by LJ, and 30/48 (63 %) by ZN. The rate of MDRTB was 9 % (4/48). Median time to positive culture was 10 days by MODS versus 34 days by LJ (p < 0.0001). In smear-negative patients, MODS detected TB in 17/18 patients, compared to 11/18 by LJ (94.4 % vs 61.0 %, p = 0.03 %). In patients unable to produce a sputum sample without induction, the string test cultured by MODS yielded Mtb in of 9/11 (82 %) TB positive patients compared to 11/11 (100 %) with induced sputum. Of the 10 patients unable to produce a sputum sample, 4 were TB-positive by string test. MODS was faster and had a higher Mtb detection yield compared to LJ, with a greater difference in yield between the two in smear-negative patients. The string test is a valuable diagnostic technique for HIV sputum-scarce or sputum-absent patients, and should be considered as an alternative test to induced

  18. Lack of Effectiveness of Antiretroviral Therapy in Preventing HIV Infection in Serodiscordant Couples in Uganda: An Observational Study

    PubMed Central

    Birungi, Josephine; Min, Jeong Eun; Muldoon, Katherine A.; Kaleebu, Pontiano; King, Rachel; Khanakwa, Sarah; Nyonyintono, Maureen; Chen, YaLin; Mills, Edward J.; Lyagoba, Fred; Ragonnet-Cronin, Manon; Wangisi, Jonathan; Lourenco, Lillian; Moore, David M.

    2015-01-01

    Background We examined the real-world effectiveness of ART as an HIV prevention tool among HIV serodiscordant couples in a programmatic setting in a low-income country. Methods We enrolled individuals from HIV serodiscordant couples aged ≥18 years of age in Jinja, Uganda from June 2009 – June 2011. In one group of couples the HIV positive partner was receiving ART as they met clinical eligibility criteria (a CD4 cell count ≤250 cells/ μL or WHO Stage III/IV disease). In the second group the infected partner was not yet ART-eligible. We measured HIV incidence by testing the uninfected partner every three months. We conducted genetic linkage studies to determine the source of new infections in seroconverting participants. Results A total of 586 couples were enrolled of which 249 (42%) of the HIV positive participants were receiving ART at enrollment, and an additional 99 (17%) initiated ART during the study. The median duration of follow-up was 1.5 years. We found 9 new infections among partners of participants who had been receiving ART for at least three months and 8 new infections in partners of participants who had not received ART or received it for less than three months, for incidence rates of 2.09 per 100 person-years (PYRs) and 2.30 per 100 PYRs, respectively. The incidence rate ratio for ART-use was 0.91 (95% confidence interval 0.31-2.70; p=0.999). The hazard ratio for HIV seroconversion associated with ART-use by the positive partner was 1.07 (95% CI 0.41-2.80). A total of 5/7 (71%) of the transmissions on ART and 6/7 (86%) of those not on ART were genetically linked. Conclusion Overall HIV incidence was low in comparison to previous studies of serodiscordant couples. However, ART-use was not associated with a reduced risk of HIV transmission in this study. PMID:26171777

  19. Preventing HIV among adolescents with oral PrEP: observations and challenges in the United States and South Africa

    PubMed Central

    Hosek, Sybil; Celum, Connie; Wilson, Craig M; Kapogiannis, Bill; Delany-Moretlwe, Sinead; Bekker, Linda-Gail

    2016-01-01

    Introduction Adolescents and young adults aged <25 are a key population in the HIV epidemic, with very high HIV incidence rates in many geographic settings and a large number who have limited access to prevention services. Thus, any biomedical HIV prevention approach should prepare licensure and implementation strategies for young populations. Oral pre-exposure prophylaxis (PrEP) is the first antiretroviral-based prevention intervention with proven efficacy across many settings and populations, and regulatory and policy approvals at global and national levels are occurring rapidly. We discuss available data from studies in the United States and South Africa on the use of oral PrEP for HIV prevention in adolescent minors, along with some of the implementation challenges. Discussion Ongoing studies in the United States and South Africa among youth under the age of 18 should provide the safety data needed by the end of 2016 to contribute to licensure of Truvada as daily PrEP in adolescents. The challenges of completing these studies as well as foreseeable broader challenges highlighted by this work are presented. Adherence to daily PrEP is a greater challenge for younger populations, and poor adherence was associated with decreased efficacy in all PrEP trials. Individual-level barriers include limited familiarity with antiretroviral-based prevention, stigma, product storage, and social support. Structural challenges include healthcare financing for PrEP, clinician acceptability and comfort with PrEP delivery, and the limited youth-friendly health services available. These challenges are discussed in the context of the work done to date in the United States and South Africa, but will likely be magnified in the setting of limited resources in many other countries that are heavily impacted by HIV. Conclusions Adolescent populations are particularly vulnerable to HIV, and oral PrEP in these populations is likely to have an impact on population-level HIV incidence. The

  20. HIV Transmission

    MedlinePlus

    ... Abroad Treatment Basic Statistics Get Tested Find an HIV testing site near you. Enter ZIP code or city Follow HIV/AIDS CDC HIV CDC HIV/AIDS See RSS | ... on HIV Syndicated Content Website Feedback HIV/AIDS HIV Transmission Language: English (US) Español (Spanish) Recommend ...

  1. Terrorism in Southeast Asia

    DTIC Science & Technology

    2003-11-18

    Asia , particularly those in the Philippines, Indonesia, Malaysia , and, to a lesser extent, Thailand, that are known or alleged to have ties to the...Southeast Asia ,” Heritage Lectures, No.773, Delivered December 13, 2002, [http://www.heritage.org (continued...) Malaysia Malaysia’s former Prime...Relations. CRS Report RS20572. Indonesian Separatist Movement in Aceh. CRS Issue Brief IB97004. Japan-U.S. Relations. CRS-32 Figure 1. Southeast Asia Maps CRS-33 Figure 2. Indonesia CRS-34 Figure 3. Malaysia

  2. Zika virus in Asia.

    PubMed

    Duong, Veasna; Dussart, Philippe; Buchy, Philippe

    2017-01-01

    Zika virus (ZIKV) is an emerging mosquito-borne virus that was first isolated from a sentinel rhesus monkey in the Zika Forest in Uganda in 1947. In Asia, the virus was isolated in Malaysia from Aedes aegypti mosquitoes in 1966, and the first human infections were reported in 1977 in Central Java, Indonesia. In this review, all reported cases of ZIKV infection in Asia as of September 1, 2016 are summarized and some of the hypotheses that could currently explain the apparently low incidence of Zika cases in Asia are explored.

  3. Diagnosis of Photochemical Ozone Production Rates and Limiting Factors based on Observation-based Modeling Approach over East Asia: Impact of Radical Chemistry Mechanism and Ozone-Control Implications

    NASA Astrophysics Data System (ADS)

    Kanaya, Y.

    2015-12-01

    Growth of tropospheric ozone, causing health and climate impacts, is concerned over East Asia, because emissions of precursors have dramatically increased. Photochemical production rates of ozone and limiting factors, primarily studied for urban locations, have been poorly assessed within a perspective of regional-scale air pollution over East Asia. We performed comprehensive observations of ozone precursors at several locations with regional representativeness and made such assessment based on the observation-based modeling approach. Here, diagnosis at Fukue Island (32.75°N, 128.68°E) remotely located in western Japan (May 2009) is highlighted, where the highest 10% of hourly ozone concentrations reached 72‒118 ppb during May influenced by Asian continental outflow. The average in-situ ozone production rate was estimated to be 6.8 ppb per day, suggesting that in-travel production was still active, while larger buildup must have occurred beforehand. Information on the chemical status of the air mass arriving in Japan is important, because it affects how further ozone production occurs after precursor addition from Japanese domestic emissions. The main limiting factor of ozone production was usually NOx, suggesting that domestic NOx emission control is important in reducing further ozone production and the incidence of warning issuance (>120 ppb). VOCs also increased the ozone production rate, and occasionally (14% of time) became dominant. This analysis implies that the VOC reduction legislation recently enacted should be effective. The uncertainty in the radical chemistry mechanism governing ozone production had a non-negligible impact, but the main conclusion relevant to policy was not altered. When chain termination was augmented by HO2-H2O + NO/NO2 reactions and by heterogeneous loss of HO2 on aerosol particle surfaces, the daily ozone production rate decreased by <24%, and the fraction of hours when the VOC-limited condition occurred varied from 14% to 13

  4. Examining the signs and symptoms experienced by individuals with suspected acute coronary syndrome in the Asia-Pacific region: a prospective observational study.

    PubMed

    Greenslade, Jaimi H; Cullen, Louise; Parsonage, William; Reid, Christopher M; Body, Richard; Richards, Mark; Hawkins, Tracey; Lim, Swee Han; Than, Martin

    2012-12-01

    This study examines whether symptoms reported by patients presenting with possible acute coronary syndrome vary across different ethnic backgrounds. We also assess the predictive value of individual symptoms according to ethnic background. The study used prospectively collected data on adult patients presenting with suspected acute coronary syndrome to 12 emergency departments in the Asia-Pacific region. Trained research nurses collected data on ethnicity, type of pain, and associated symptoms, using a customized case report form. The primary endpoint was acute coronary syndrome within 30 days of presentation, as adjudicated by cardiologists using standardized guidelines. Logistic regression analyses assessed the relationship between ethnicity and symptom type and the predictive value of symptom type for acute coronary syndrome. Acute coronary syndrome was diagnosed in 358 (19.2%) of the 1,868 patients recruited. In comparison with white patients, Chinese patients were less likely to report atypical pain (odds ratio [OR]=0.26; 95% confidence interval [CI] 0.2 to 0.34), exertional pain (OR=0.41; 95% CI 0.32 to 0.53), pleuritic pain (OR=0.26; 95% CI 0.19 to 0.35), pain on palpation (OR=0.31; 95% CI 0.2 to 0.49), nausea (OR=0.52; 95% CI 0.42 to 0.67), diaphoresis (OR=0.41; 95% CI 0.33 to 0.51), and shortness of breath (OR=0.59; 95% CI 0.48 to 0.73). The comparison of white with other ethnic groups yielded similar results. The predictive value of symptoms was similarly poor across different ethnic groups, with the notable exception of India, where typical pain was predictive of acute coronary syndrome (OR 8.82; 95% CI 2.19 to 35.48). There are cross-cultural differences in symptoms reported by patients with suspected acute coronary syndrome. Such differences are not likely to be clinically relevant because the majority of symptoms display limited diagnostic value for acute coronary syndrome. Copyright © 2012. Published by Mosby, Inc.

  5. [Epidemiology of HIV].

    PubMed

    Ledergerber, Bruno; Battegay, Manuel

    2014-08-01

    Globally, an estimated 35 million people were living with HIV in 2012; of these, 69 % in sub-Saharan Africa. There were 2.3 million new HIV infections globally and 1.6 million AIDS deaths in 2012. As a result of large roll-out programs with integrated voluntary counselling and testing and prevention programs in resource limited settings, sexual transmission of HIV decreased substantially over the last years. However, the world is not on track to reduced HIV transmission among people who inject drugs. Especially in Eastern Europe and Asia prevention coverage for people who inject drugs remains low. In addition, effective prevention among these people is undermined by stigmatisation, discrimination, punitive policy frameworks and law enforcement practices, which discourage people from seeking the health and social services they need. Antiretroviral coverage among pregnant women living with HIV reached 62 % in 2012 resulting in a reduction of newly infected children by 35 % from 2009. In 2012, 9.7 million people in low and middle-income countries received antiretroviral therapy, representing 61 % of all who were eligible under the 2010 WHO HIV treatment guidelines. Under the 2013 guidelines, this represents only 34 % of the 28.3 million people eligible in 2013. A new concept to curb the HIV epidemic is "Test and Treat" which involves population-wide HIV tests with immediate initiation of antiretroviral therapy among all HIV infected individuals. However, there are concerns regarding the sustainability of such treatment programs for decades due to lost to follow up and insufficient adherence and the danger of a large increase of resistant HIV which jeopardize the effectiveness of affordable treatments.

  6. Sentinel Asia step 2 utilization for disaster management in Malaysia

    NASA Astrophysics Data System (ADS)

    Moslin, S. I.; Wahap, N. A.; Han, O. W.

    2014-02-01

    With the installation of Wideband InterNetworking engineering test and Demonstration Satellite (WINDS) communication system in the National Space Centre, Banting; officially Malaysia is one of the twelve Sentinel Asia Step2 System Regional Servers in the Asia Pacific region. The system will be dedicated to receive and deliver images of disaster struck areas observed by Asia Pacific earth observation satellites by request of the Sentinel Asia members via WINDS satellite or 'Kizuna'. Sentinel Asia is an initiative of collaboration between space agencies and disaster management agencies, applying remote sensing and web-GIS technologies to assist disaster management in Asia Pacific. When a disaster occurred, participating members will make an Emergency Observation Request (EOR) to the Asian Disaster Reduction Centre (ADRC). Subsequently, the Data Provider Node (DPN) will execute the emergency observation using the participating earth observation satellites. The requested images then will be processed and analysed and later it will be uploaded on the Sentinel Asia website to be utilised for disaster management and mitigation by the requestor and any other international agencies related to the disaster. Although the occurrences of large scale natural disasters are statistically seldom in Malaysia, but we can never be sure with the unpredictable earth climate nowadays. This paper will demonstrate the advantage of using Sentinel Asia Step2 for local disaster management. Case study will be from the recent local disaster occurrences. In addition, this paper also will recommend a local disaster management support system by using the Sentinel Asia Step2 facilities in ANGKASA.

  7. A hybrid mobile approach for population-wide HIV testing in rural east Africa: an observational study.

    PubMed

    Chamie, Gabriel; Clark, Tamara D; Kabami, Jane; Kadede, Kevin; Ssemmondo, Emmanuel; Steinfeld, Rachel; Lavoy, Geoff; Kwarisiima, Dalsone; Sang, Norton; Jain, Vivek; Thirumurthy, Harsha; Liegler, Teri; Balzer, Laura B; Petersen, Maya L; Cohen, Craig R; Bukusi, Elizabeth A; Kamya, Moses R; Havlir, Diane V; Charlebois, Edwin D

    2016-03-01

    Despite large investments in HIV testing, only an estimated 45% of HIV-infected people in sub-Saharan Africa know their HIV status. Optimum methods for maximising population-level testing remain unknown. We sought to show the effectiveness of a hybrid mobile HIV testing approach at achieving population-wide testing coverage. We enumerated adult (≥15 years) residents of 32 communities in Uganda (n=20) and Kenya (n=12) using a door-to-door census. Stable residence was defined as living in the community for at least 6 months in the past year. In each community, we did 2 week multiple-disease community health campaigns (CHCs) that included HIV testing, counselling, and referral to care if HIV infected; people who did not participate in the CHCs were approached for home-based testing (HBT) for 1-2 months within the 1-6 months after the CHC. We measured population HIV testing coverage and predictors of testing via HBT rather than CHC and non-testing. From April 2, 2013, to June 8, 2014, 168,772 adult residents were enumerated in the door-to-door census. HIV testing was achieved in 131,307 (89%) of 146,906 adults with stable residence. 13,043 of 136,033 (9·6%, 95% CI 9·4-9·8) adults with and without stable residence had HIV; median CD4 count was 514 cells per μL (IQR 355-703). Among 131,307 adults with stable residence tested, 56,106 (43%) reported no previous testing. Among 13,043 HIV-infected adults, 4932 (38%) were unaware of their status. Among 105,170 CHC attendees with stable residence 104,635 (99%) accepted HIV testing. Of 131,307 adults with stable residence tested, 104,635 (80%; range 60-93% across communities) tested via CHCs. In multivariable analyses of adults with stable residence, predictors of non-testing included being male (risk ratio [RR] 1·52, 95% CI 1·48-1·56), single marital status (1·70, 1·66-1·75), age 30-39 years (1·58, 1·52-1·65 vs 15-19 years), residence in Kenya (1·46, 1·41-1·50), and migration out of the community for at least

  8. Pass Over Southeastern Asia

    NASA Image and Video Library

    This video over Southeastern Asia was taken by the crew of Expedition 29 aboard the International Space Station. This sequence of shots was taken on Oct. 7, 2011, from 12:41:10 to 12:50:46 GMT, on ...

  9. Identifying Perceived Barriers along the HIV Care Continuum: Findings from Providers, Peer Educators, and Observations of Provider–Patient Interactions in Ethiopia

    PubMed Central

    Kulkarni, Sarah; Hoffman, Susie; Gadisa, Tsigereda; Melaku, Zenebe; Fantehun, Mesganaw; Yigzaw, Muluneh; El-Sadr, Wafaa; Remien, Robert; Tymejczyk, Olga; Nash, Denis; Elul, Batya

    2015-01-01

    Increasing the proportion of HIV-positive individuals who link promptly to and are retained in care remains challenging in sub- Saharan Africa, but little evidence is available from the provider perspective. In 4 Ethiopian health facilities, we (1) interviewed providers and peer educators about their perceptions of service delivery- and patient-level barriers and (2) observed provider–patient interactions to characterize content and interpersonal aspects of counseling. In interviews, providers and peer educators demonstrated empathy and identified nonacceptance of HIV status, anticipated stigma from unintended disclosure, and fear of antiretroviral therapy as patient barriers, and brusque counseling and insufficient counseling at provider-initiated testing sites as service delivery-related. However, observations from the same clinics showed that providers often failed to elicit patients’ barriers to retention, making it unlikely these would be addressed during counseling. Training is needed to improve interpersonal aspects of counseling and ensure providers elicit and address barriers to HIV care experienced by patients. PMID:26173944

  10. Management of fever in ambulatory HIV-infected adults in resource-limited settings: prospective observational evaluation of a new Mozambican guideline.

    PubMed

    Brentlinger, Paula E; Silva, Wilson P; Buene, Manuel; Morais, Luis; Valverde, Emilio; Vermund, Sten H; Moon, Troy D

    2014-11-01

    A new Mozambican guideline for management of fever in HIV-infected adults requires malaria testing and systematic consideration of specific alternative diagnoses (eg, tuberculosis and bacterial infections) in addition to malaria. We conducted a prospective observational study of the guideline's performance. Of 258 HIV-infected subjects with axillary temperature ≥37.5° C or history of fever, 76.0% improved, 13.6% died or were hospitalized, and 10.5% were lost to follow-up. In multivariate analyses, factors associated with adverse outcomes were bacterial blood stream infection, syndromically diagnosed tuberculosis, lower CD4 T-lymphocyte count, no antiretroviral therapy, lower body mass index, lower hemoglobin, and nonprescription of antibiotics.

  11. Southeast Asia Report

    DTIC Science & Technology

    1984-04-12

    South - East Asia unloading dollars in the expectation that the US currency will fall still further. In Tokyo, the US dollar closed at 222.10 yen after a...consideration of the fact that South - East Asia, despite the concept of Zone of Peace, Freedom and Neutrality (ZOPFAN), is still a zone of...at McMurdo and South Pole, I accepted in microseconds and waited some months with impatience. Christchurch, in New Zealand’s South Island, is the US

  12. JPRS Report, East Asia, Southeast Asia

    DTIC Science & Technology

    1993-01-15

    Louangphachit [PASASON 18 Nov] ...., 21 MALAYSIA ECONOMIC Proton To Start Plant in Chile [BERITA HARIAN 14 Nov] 22 THAILAND MILITARY Opinion...Minister of Defense and Security] L.B. Murdani said that sociocultural problems are latent throughout the Asia Pacific area, including Southeast...can learn that the country disintegrated because of sociocultural problems and not because of military, sociopolitical, or socioeconomic issues. He

  13. JPRS Report, East Asia, Southeast Asia

    DTIC Science & Technology

    1987-07-23

    interests of socialism and peace and stability in the region and the world over." /12913 CSO: 4209/663 PEOPLE’S REPUBLIC OF KAMPUCHEA KAMPUCHEA...will be further strengthened and developed for the social development of each country and for peace and stability in the region and the world. [Text...contributed to the safeguarding of peace and stability in Indochina, Southeast Asia and the world. We are very proud of these successes and consider

  14. JPRS Report, East Asia, Southeast Asia

    DTIC Science & Technology

    2007-11-02

    Economic Management 7 PASASON Sees Need for Enterprises To Adopt Capitalist Expertise 7 MALAYSIA Mahathir Hands Over $100,000 to PLO 9 Libyan...Diplomats in Malaysia Spearhead Asia-Pacific ’Offensive’ 9 Mahathir Warns Japanese Investors About ’Western Media Distortion’ 10 Negotiations To...9604 JPRS-SEA-88-033 10 August 1988 FIJI Study of Nation’s Leadership 42130148a Kuala Lumpur UTUSAN MALAYSIA in Malay 2 Jun 88 p 6 [Article by

  15. JPRS Report, East Asia, Southeast Asia.

    DTIC Science & Technology

    2007-11-02

    facilities, facilities which have proven to be reliable and far less expensive. And to sweeten the pot the Soviet Union also offered to let...interior of Sichuan Province, and this facility has even launched a U.S. artificial satellite. The AsiaSat 1 satellite was launched there recently...rockets to launch its artificial satellites. Its concern has been that sophisticated satellite technology will fall into the hands of an enemy. JPRS

  16. Effectiveness, safety, durability and immune recovery in a retrospective, multicentre, observational cohort of ART-experienced, HIV-1-infected patients receiving maraviroc.

    PubMed

    Dentone, C; Sterrantino, G; Signori, A; Cenderello, G; Guerra, M; De Leo, P; Bartolacci, V; Mantia, E; Orofino, G; Giacomini, M; Bruzzone, B; Francisci, D; Di Biagio, A

    2017-10-01

    The aim of this retrospective, multicentre, observational study was to assess the durability, safety, immune recovery and effectiveness on viral suppression of antiretroviral therapy (ART) in a maraviroc (MVC)-based cohort. We collected clinical, demographical, immunological and virological parameters of adult HIV patients who were infected by CCR5-tropic virus and started an ART regimen containing MVC from 2005 to 2012. We created a longitudinal mixed model to assess the change over time of data. We enrolled 126 drug-experienced patients; the median duration of MVC treatment was 25 months. The probability of stopping ART at one year was 13.3%, and at three years was 27.3%. Statistically significant changes were observed for CD4+ cell count increase ( p < 0.001), HIV-RNA decrease ( p < 0.001) and total cholesterol decrease ( p = 0.005). Ninety-four patients (79.7%) had CD4 ≥ 200 cells/mm(3) at baseline while nine of them reached this threshold at nine months (7.6%), 17 (13%) after nine months and six (5%) remained below 200 cells/mm(3) at the end of the study. Overall, 114 patients (90.5%) achieved an HIV-RNA ≤ 50 cp/ml. A majority of patients maintained CD4 cell counts of ≥ 200 cells/mm(3) and achieved an undetectable HIV viral load within three months. MVC-containing regimens are safe and appear to be a feasible therapeutic option for ART.

  17. Syphilis and Hepatitis B Co-infection among HIV-Infected, Sex-Trafficked Women and Girls, Nepal

    PubMed Central

    Decker, Michele R.; Gupta, Jhumka; Dharmadhikari, Ashwin; Seage, George R.; Raj, Anita

    2008-01-01

    Sex trafficking may play a major role in spread of HIV across South Asia. We investigated co-infection with HIV and other sexually transmitted diseases among 246 sex-trafficked women and girls from Nepal. Those who were HIV positive were more likely than those who were HIV negative to be infected with syphilis and/or hepatitis B. PMID:18507905

  18. Monsoon-driven transport of atmospheric mercury to the South China Sea from the Chinese mainland and Southeast Asia-Observation of gaseous elemental mercury at a background station in South China.

    PubMed

    Liu, Ming; Chen, Laiguo; Xie, Donghai; Sun, Jiaren; He, Qiusheng; Cai, Limei; Gao, Zhiqiang; Zhang, Yiqiang

    2016-11-01

    Concentrations of gaseous elemental mercury (GEM) were continuously monitored from May 2011 to May 2012 at the Wuzhishan State Atmosphere Background Monitoring Station (109°29'30.2″ E, 18°50'11.0″ N) located in Hainan Island. This station is an ideal site for monitoring long-range transport of atmospheric pollutants from mainland China and Southeast Asia to South China Sea. Annual average GEM concentration was 1.58 ± 0.71 ng m(-3) during the monitoring period, which was close to background values in the Northern Hemisphere. GEM concentrations showed a clear seasonal variation with relatively higher levels in autumn (1.86 ± 0.55 ng m(-3)) and winter (1.80 ± 0.62 ng m(-3)) and lower levels in spring (1.16 ± 0.45 ng m(-3)) and summer (1.43 ± 0.46 ng m(-3)). Long-range atmospheric transport dominated by monsoons was a dominant factor influencing the seasonal variations of GEM. The GEM diel trends were related to the wind speed and long-range atmospheric mercury transport. We observed 30 pollution episodes throughout the monitoring period. The analysis of wind direction and backward trajectory suggested that elevated GEM concentrations at the monitoring site were primarily related to the outflows of atmospheric Hg from mainland China and the Indochina peninsula. The △GEM/△CO values also suggested that GEM was significantly affected by the long-range transport from the anthropogenic sources and biomass burning in Asia and Indochina peninsula.

  19. Observations on two cases of apparent submandibular gland cysts in HIV positive patients: MR and CT findings

    SciTech Connect

    Gottesman, R.I.; Som, P.M.; Mester, J.; Silvers, A.R.

    1996-05-01

    To present two cases of probable lymphoepithelial cysts of the submandibular glands in patients who were human immunodeficiency virus (HIV) positive and who also had lymphoepithelial cysts of the parotid glands. Computed tomography and MRI of two HIV positive patients with lymphoepithelial cysts of the parotid glands and cysts in tile submandibular glands were correlated with the histories and the possible presence of other known causes of submandibular gland multiple cysts. Because of the present treatment philosophy regarding HIV positive patients with major salivary gland cysts, surgical resection of these glands was not performed. All other known causes of multiple submandibular gland cysts were excluded by either history or laboratory data. Computed tomography and MRI on two patients with known HIV infection and bilateral parotid lymphoepithelial cysts are presented. Both patients also had bilateral multiple submandibular gland cysts and no evidence of obstructive glandular diseases autoimmune disease, or other organ system cysts. These cases of presumed submandibular gland lymphoepithelial cysts are rare in the literature. They are presented in the hope that other radiologists will be stimulated to document the occurrence of this entity. 22 refs., 2 figs.

  20. Is Central Asia really exsiccating?

    NASA Astrophysics Data System (ADS)

    Aizen, V. B.; Aizen, E. M.; Surazakov, A. B.

    2008-12-01

    At the end of 20th and the beginning of 21st century central Asia oases suffered from serious drought caused lack of water for agriculture, economy growth and population increase. However, people of this region always experienced lack of water for irrigation and fought a war over the rights to control river streams. The drying up of central Asian rivers is not a new phenomenon according to the ancient manuscripts. Thus, lets see about what has happened with the past century climate and water resources of central Asia using the long-term observational data. We analyzed data from more than 200 meteorological stations and stream gauges over the central Asia in elevation range from 25 m. b.s.l. to 4,000 m. a.s.l. to understand the last 100 years variability in climate and water resources, examining changes in the extreme and mean monthly air temperatures, precipitation and river runoff. The evaluation of seasonal snow and glacier's covered areas between 1970th and 2007th in central Asia derived from AVHRR, MODIS, Hexagon KH-9, Landsat ETM and ASTER data exhibit 15% reduction of the seasonal snow covered area and 10.1% of the glacier area. It has been found that during last twenty years the duration of snowmelt, from the date of maximum snow cover to date of its disappearance, reduced by 30 days and in 2007 was equal to 138 days in the central Asian mountains. The decrease of seasonal snow cover is not a linear process. The further decrease may be accelerated due to increase of rainfall instead of snowfall in early spring months at high elevations, and consequently a lesser heat expenditure for the snowmelt. The growth in summer air temperatures, especially observable since the 1970th, accompanied by increase of evapotranspiration and precipitation, notably in summer and autumn, and at high elevations over 3,000 m, and at the western peripheral mountain ridges. Average difference in the means of annual air temperatures for the two thirty-year periods before and after

  1. Mortality in HIV-infected women, heterosexual men, and men who have sex with men in Rio de Janeiro, Brazil: an observational cohort study.

    PubMed

    Coelho, Lara; Grinsztejn, Beatriz; Castilho, Jessica L; De Boni, Raquel; Quintana, Marcel S B; Campos, Dayse P; Ribeiro, Sayonara R; Pacheco, Antonio G; Veloso, Valdilea G; Luz, Paula M

    2016-10-01

    Mortality in HIV-infected individuals might differ by sex and mode of HIV acquisition. We aimed to study mortality in HIV-infected women, heterosexual men, and men who have sex with men (MSM) in a cohort from Rio de Janeiro, Brazil. In this observational cohort study, we included HIV-infected women, heterosexual men, and MSM (aged ≥18 years) from the Instituto Nacional de Infectologia Evandro Chagas database who were enrolled between Jan 1, 2000, and Oct 30, 2011, and who had at least 60 days of follow-up. Causes of deaths, defined with the Coding of Death in HIV protocol, were documented. Cox proportional hazards models accounting for competing risks were used to explore risk factors for AIDS-related and non-AIDS-related deaths. We had 10 142 person-years of follow-up from 2224 individuals: 817 (37%) women, 554 (25%) heterosexual men, and 853 (38%) MSM. Of 103 deaths occurred, 64 were AIDS related, 31 were non-AIDS related, and eight were of unknown causes. In unadjusted analyses, compared with women, the hazard of AIDS-related deaths was higher for heterosexual men (hazard ratio [HR] 3·52, 95% CI 1·30-9·08; p=0·009) and for MSM (2·30, 0·89-5·94; p=0·084). After adjustment for age, CD4 cell counts, last HIV viral load, antiretroviral therapy use, and AIDS-defining infection, AIDS-defining malignant disease, and hospital admission during follow-up, the excess risk of AIDS-related death decreased for heterosexual men (adjusted HR 1·99, 0·75-5·25; p=0·163) but was unchanged for MSM (2·24, 0·82-6·11; p=0·114). Non-AIDS-related mortality did not differ by group. Compared with women, increased risk of AIDS-related death in heterosexual men was partly mitigated by risk factors for AIDS mortality, whereas the excess risk in MSM was unchanged. Further study of reasons for disparity in AIDS-related mortality by mode of transmission is needed. US National Institutes of Health, Brazilian National Council of Technological and Scientific Development (CNPq

  2. Scaling up paediatric HIV care with an integrated, family-centred approach: an observational case study from Uganda.

    PubMed

    Luyirika, Emmanuel; Towle, Megan S; Achan, Joyce; Muhangi, Justus; Senyimba, Catherine; Lule, Frank; Muhe, Lulu

    2013-01-01

    Family-centred HIV care models have emerged as an approach to better target children and their caregivers for HIV testing and care, and further provide integrated health services for the family unit's range of care needs. While there is significant international interest in family-centred approaches, there is a dearth of research on operational experiences in implementation and scale-up. Our retrospective case study examined best practices and enabling factors during scale-up of family-centred care in ten health facilities and ten community clinics supported by a non-governmental organization, Mildmay, in Central Uganda. Methods included key informant interviews with programme management and families, and a desk review of hospital management information systems (HMIS) uptake data. In the 84 months following the scale-up of the family-centred approach in HIV care, Mildmay experienced a 50-fold increase of family units registered in HIV care, a 40-fold increase of children enrolled in HIV care, and nearly universal coverage of paediatric cotrimoxazole prophylaxis. The Mildmay experience emphasizes the importance of streamlining care to maximize paediatric capture. This includes integrated service provision, incentivizing care-seeking as a family, creating child-friendly service environments, and minimizing missed paediatric testing opportunities by institutionalizing early infant diagnosis and provider-initiated testing and counselling. Task-shifting towards nurse-led clinics with community outreach support enabled rapid scale-up, as did an active management structure that allowed for real-time review and corrective action. The Mildmay experience suggests that family-centred approaches are operationally feasible, produce strong coverage outcomes, and can be well-managed during rapid scale-up.

  3. Durability of response to vaccination against viral hepatitis A in HIV-infected patients: a 5-year observation.

    PubMed

    Jabłonowska, E; Kuydowicz, J

    2014-09-01

    The aim of this study was to estimate the prevalence of total antibodies to hepatitis A virus (anti-HAV-T) in the group of HIV-positive adults in Lodz region of Poland, and to evaluate the response and long-term immunity after vaccination against hepatitis A virus. In the group of 234 HIV-infected patients, 72 persons (30.8%) were anti-HAV-T positive (>20 IU/L). In multivariate analysis, two independent factors associated with the presence of anti-HAV-T were identified: the age of patients (OR = 1.07) and the presence of antibodies to hepatitis C virus (OR = 2.87). Vaccination was completed in 83 patients. Good response (anti-HAV-T >20 IU/L one month after the booster dose) was obtained in 79.5% of patients. In patients with CD4 >200 cells/µL in multivariate analysis only presence of antibodies to hepatitis C virus was a prognostic factor for the response to vaccination (OR = 0.13). Among responders available for the follow-up, 82% (50 out of 61) had detectable anti-HAV-T at 1 year and 75.5% (37 out of 49) at 5 years. Our results demonstrate that most of the studied HIV-positive patients were susceptible to hepatitis A virus infection. Most HIV-infected adults with high CD4 counts had a durable response even up to 5 years after vaccination. Patients with a HIV/hepatitis C virus coinfection displayed a worse response to vaccination. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  4. The current status of Zika virus in Southeast Asia

    PubMed Central

    2016-01-01

    OBJECTIVES: Zika virus currently poses a global threat and is a major public health issue throughout Latin America and the Caribbean. However, Zika virus infections in humans have also been observed in other regions, including Southeast Asia, where arboviral diseases are very common. In this study, we summarize the current status of Zika virus in Southeast Asia. This review aims to provide an overview of the current situation and also to suggest ways of adequately managing the emergence of Zika virus in Southeast Asia. METHODS: The literature searching for the reports on Zika virus in Southeast Asia was done using standard database PubMed and the re-analysis and summarization on the reports was done. RESULTS: A limited number of reports have addressed Zika virus disease in Southeast Asia, but it is has been confirmed that a problem already exists. Individual case reports and outbreaks of Zika virus have been confirmed in Southeast Asia. Several reports have also described patients becoming infected after visiting Southeast Asia. In addition, the concurrent circulation of Zika virus with other arboviruses has been confirmed. CONCLUSIONS: As a tropical region with a high prevalence of arboviral diseases, the emergence of Zika virus in Southeast Asia is a major concern. It is essential for local medical personnel to recognize this disease. Given the status of Southeast Asia as a globally important tourist destination, continuous updates on the status of Zika virus in Southeast Asia are required and should be incorporated into global health advisories regarding travel. PMID:27336445

  5. The current status of Zika virus in Southeast Asia.

    PubMed

    Wiwanitkit, Viroj

    2016-01-01

    Zika virus currently poses a global threat and is a major public health issue throughout Latin America and the Caribbean. However, Zika virus infections in humans have also been observed in other regions, including Southeast Asia, where arboviral diseases are very common. In this study, we summarize the current status of Zika virus in Southeast Asia. This review aims to provide an overview of the current situation and also to suggest ways of adequately managing the emergence of Zika virus in Southeast Asia. The literature searching for the reports on Zika virus in Southeast Asia was done using standard database PubMed and the re-analysis and summarization on the reports was done. A limited number of reports have addressed Zika virus disease in Southeast Asia, but it is has been confirmed that a problem already exists. Individual case reports and outbreaks of Zika virus have been confirmed in Southeast Asia. Several reports have also described patients becoming infected after visiting Southeast Asia. In addition, the concurrent circulation of Zika virus with other arboviruses has been confirmed. As a tropical region with a high prevalence of arboviral diseases, the emergence of Zika virus in Southeast Asia is a major concern. It is essential for local medical personnel to recognize this disease. Given the status of Southeast Asia as a globally important tourist destination, continuous updates on the status of Zika virus in Southeast Asia are required and should be incorporated into global health advisories regarding travel.

  6. Retention in Care of Adult HIV Patients Initiating Antiretroviral Therapy in Tigray, Ethiopia: A Prospective Observational Cohort Study

    PubMed Central

    Bucciardini, Raffaella; Fragola, Vincenzo; Abegaz, Teshome; Lucattini, Stefano; Halifom, Atakilt; Tadesse, Eskedar; Berhe, Micheal; Pugliese, Katherina; Binelli, Andrea; De Castro, Paola; Terlizzi, Roberta; Fucili, Luca; Di Gregorio, Massimiliano; Mirra, Marco; Olivieri, Erika; Teklu, Tsigemariam; Zegeye, Teame; Haile, Amanuel; Vella, Stefano; Abraham, Loko; Godefay, Hagos

    2015-01-01

    Introduction Although Ethiopia has been scaling up the antiretroviral therapy (ART) services, low retention in care of patients remains one of the main obstacles to treatment success. We report data on retention in care and its associated determinants in Tigray, Ethiopia. Methods We used data from the CASA project, a prospective observational and multi-site study of a cohort of HIV-infected patients who initiated ART for the first time in Tigray. Four participating health facilities (HFs) located in the South of Tigray were considered for this study. Patients were followed for one year after ART initiation. The main outcome measure was represented by the current retention in care, defined as the proportion of patients who were alive and receiving ART at the same HF one year after ART initiation. Patients who started ART between January 1, 2013 and December 31, 2013 were included in this analysis. Patients were followed for one year after ART initiation. The determinants of retention were analysed using univariate and multivariate Cox Proportional Hazards model with robust sandwich estimates to account for within HF correlation. Results The four participating HFs in Tigray were able to retain overall 85.1% of their patients after one year from starting ART. Loss to follow-up (5.5%) and transfers to other HF (6.6) were the main determinant of attrition. A multivariate analysis shows that the factors significantly associated with retention were the type of HF, gender and active TB. Alamata health center was the HF with the highest attrition rate (HR 2.99, 95% CI: 2.77–3.23). Active TB (HR 1.72, 95% CI: 1.23–2.41) and gender (HR 1.64, 95% CI: 1.10–2.56) were also significantly associated with attrition. Conclusions Although Ethiopia has significantly improved access to the ART program, achieving and maintaining a satisfactory long-term retention rate is a future goal. This is difficult because of different retention rates among HFs. Moreover specific

  7. An observational case series of HIV-positive patients treated with open reduction internal fixation for a closed lower extremity fracture.

    PubMed

    Hao, Jiandong; Herbert, Benoit; Quispe, Juan C; Cuellar, Derly O; Chadayammuri, Vivek; Kim, Ji Wan; Young, Heather; Hake, Mark E; Hammerberg, Mark E; Hak, David J; Mauffrey, Cyril

    2015-07-01

    The purpose of this study was to investigate the influence of immune deficiency status of HIV-positive patients on postoperative complication such as surgical site infection and nonunions. Retrospective observational cohort study: Level III. Level I trauma center. Consecutive adult HIV-positive patients with closed fractures who underwent operative treatment between January 1, 2001 and December 31, 2012. postoperative complication including infection and fracture nonunion. A total of 42 HIV-positive patients with closed fractures who underwent surgical fracture fixation were identified during the 12-year study time window. Of these, 18 patients were excluded due to incomplete medical records (n = 16) or open fractures (n = 2). The remaining 24 patients with closed fracture treated surgically (19 males and 5 females; mean age 45.1 ± 10.5 years; age range 20-67 years) were included in the study. Within a 6-month period from the time of injury, 16 patients had a CD4+ cell count >200 and five patients had a CD4+ cell count <200 (CD4+ cell count was not available in three patients). Twenty-two patients (91.6 %) were on antiretroviral therapy at the time of injury. Only one patient, with associated end-stage renal failure and diabetes mellitus, developed a postoperative infection (4.2 %). All patients achieved fracture union within 180 days postoperatively, without the need for surgical revisions. Our study suggests that HIV infection does not seem to correlate with a higher risk for the development of postoperative complication related to surgical site infection and fracture nonunions after operative fixation of closed fractures.

  8. Tobacco control in Asia.

    PubMed

    Mackay, Judith; Ritthiphakdee, Bungon; Reddy, K Srinath

    2013-05-04

    For the purpose of this article, Asia refers to WHO's combined South-East Asia and Western Pacific regions and thus includes Australia and New Zealand. Asia has the highest number of tobacco users and is the prime target of transnational tobacco companies. The future of global tobacco control rests in this region and the challenges are clear. China, India, and Indonesia are key markets and Asia is a frontrunner in tobacco control measures, such as plain packaging of cigarettes. Some countries in Asia have a long history of tobacco control activities beginning in the 1970s, and WHO's Western Pacific Region is still the only region where all countries have ratified WHO's Framework Convention on Tobacco Control. We reviewed the history, research, epidemiology, tobacco control action, obstacles, and potential responses and solutions to the tobacco epidemic in this region. Levels of development, systems of government, and population size are very different between countries, with population size ranging from 1500 to 1·3 billion, but similarities exist in aspects of the tobacco epidemic, harms caused, obstacles faced, and tobacco control actions needed. Copyright © 2013 Elsevier Ltd. All rights reserved.

  9. Pediatric acquired immunodeficiency syndrome in Asia: mother-to-child transmission.

    PubMed

    Pancharoen, Chitsanu; Thisyakorn, Usa

    2002-05-01

    At least 6 million people in the Asia-Pacific region have human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS). The numbers of HIV-infected women and children are increasing at an alarming rate. Important components of infection control that need to be addressed if mother-to-child transmission of HIV is to be prevented successfully include voluntary and confidential counseling and testing, family planning, obstetric care, use of antiretroviral agents, and availability of alternatives to breast-feeding. Many services can aid in the prevention of mother-to-child transmission of HIV and the care of HIV-infected mothers and their children. Each country needs to take into account the features of HIV and AIDS epidemiology that are peculiar to it, its infrastructure, and the resources that are available. Providing services in a stepwise manner can help prevent mother-to-child transmission of HIV.

  10. High rates of lifetime and recent violence observed among harder-to-reach women living with HIV.

    PubMed

    Borwein, Alexandra; Salters, Kate A; Palmer, Alexis K; Miller, Cari L; Duncan, Katrina C; Chan, Keith; Montaner, Julio S G; Hogg, Robert S

    2014-01-01

    This study examined the prevalence and correlates associated with lifetime and recent violence among a sample of harder-to-reach human immunodeficiency virus (HIV)-positive women living in British Columbia (BC), Canada. Interviewer-led surveys with 1000 participants gathered quantitative data on social, economic, and structural characteristics such as housing status, relationship status, family structure, history of drug use, and sexual behavior. Logistic regression analysis modeled associations between independent variables and experiences of violence at baseline. Cox regression analyses with time-dependent covariates determined correlates of lifetime and recent violence among HIV-positive women. Of the 249 women in the study, an overwhelming proportion of women (81%) reported experiences of violence in their lifetime. Among those, 22% reported recent experiences of violence, and 56% of the women reported more than five violent episodes in their lifetime. Lifetime violence was independently associated with HIV-related stigma (adjusted odds ratio [AOR] = 2.18, 95% confidence interval [CI] = 1.14-5.70), previous tobacco use (AOR = 2.79, 95% CI = 1.10-7.07), ever having a drinking problem (AOR = 2.82, 95% CI = 1.28-6.23), and ever having received care for a mental health condition (AOR = 2.42, 95% CI = 1.06-5.52). Recent violence was associated with the current illicit drug use (AOR = 2.60, 95% CI = 1.14-5.90), and currently residing in unstable housing (AOR = 2.75, 95% CI = 1.31-5.78). This study underscores the need to consider potential experiences of historical and current violence as part of comprehensive care for women living with HIV.

  11. A participant observation study using actors at 30 publicly funded HIV counseling and testing sites in Pennsylvania.

    PubMed Central

    Silvestre, A J; Gehl, M B; Encandela, J; Schelzel, G

    2000-01-01

    OBJECTIVES: This study was designed to augment an evaluation of Pennsylvania publicly funded HIV counseling and testing sites, particularly of the staff-client interaction. METHODS: Actors were trained as research assistants and sent to 30 randomly chosen sites to be tested and counseled for HIV disease. Instruments based on Centers for Disease Control and Prevention (CDC) guidelines were designed and used to evaluate them. RESULTS: Data were generated that identified the range of compliance with CDC guidelines and state policy. Among the findings were that 10 of 30 sites required signed consents despite a state policy allowing anonymous testing. Only 17% of providers developed a written risk reduction plan, even though 69% of all sites surveyed by mail asserted that such plans were developed. Only 2 of 5 HIV-positive actors were offered partner notification services, even though 100% of sites visited by an interviewer claimed to offer such services. CONCLUSIONS: The findings suggest that although evaluation methods such as mail surveys and site visits are useful for evaluating the existence of appropriate policies and protocols and gathering baseline data, they might not be sufficient for assessing actual staff-client interaction. PMID:10897188

  12. Fever of unknown origin in patients with HIV infection in Thailand: an observational study and review of the literature.

    PubMed

    Kitkungvan, Danai; Apisarnthanarak, Anucha; Plengpart, Panarat; Mundy, Linda M

    2008-04-01

    Fever of unknown origin (FUO) is a common presentation for patients with advanced human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS). We prospectively followed 72 patients, consecutively admitted to a Thai regional hospital with FUO and HIV infection to identify aetiologies and mortality in the era of available antiretroviral therapy (ART). Aetiologies of FUO were identified in 67 patients (93%), of whom 61(85%) had an infectious aetiology. The most common infectious aetiologies were Mycobacterium tuberculosis (n=30; 42%), Cryptococcus neoformans (n=17; 24%), Pneumocystis jiroveci (n=9; 13%), Toxoplasma gondii (n=5; 7%), and salmonella bacteraemia (n=5; 7%). Nineteen patients (26%) had co-infection with two or more pathogens. The median CD4 count was 120 cells/mm(3) (range, 1-581 cells/mm(3)), and the all-cause mortality was 22% (n=16). By multivariate analysis, inadequate antimicrobial treatment was the sole predictor of mortality (aOR=4.9; 95% CI=1.2-21.9; P=0.02). Overall, 58 of 72 patients (81%) had an opportunistic infection suggesting that guideline use of ART and prophylactic strategies remain unmet needs that will benefit individuals and populations with HIV/AIDS in Thailand.

  13. Epilepsy: Asia versus Africa.

    PubMed

    Bhalla, Devender; Tchalla, Achille Edem; Marin, Benoît; Ngoungou, Edgard Brice; Tan, Chong Tin; Preux, Pierre-Marie

    2014-09-01

    Is epilepsy truly an "African ailment"? We aimed to determine this, since international health agencies often refer to epilepsy as an African disease and the scientific literature has spoken the same tone. Various published materials, mainly reports, articles, were used to gather Asian and African evidence on various aspects of epilepsy and many of its risk and associated factors. Our results suggest that in no way can epilepsy be considered as an African ailment and such characterization is most likely based on popular beliefs rather than scientific evidence. In comparison to Africa, Asia has a 5.0% greater burden from all diseases, and is 17.0% more affected from neuropsychiatric disorders (that include epilepsy). Given that more countries in Asia are transitioning, there may be large demographic and lifestyle changes in the near future. However these changes are nowhere close to those expected in Africa. Moreover, 23 million Asians have epilepsy in comparison to 3.3 million Africans and 1.2 million sub-Saharan Africans. In comparison to Africa, Asia has more untreated patients, 55.0% more additional epilepsy cases every year, because of its larger population, with greater treatment cost and possibly higher premature mortality. Of several associated factors discussed herein, many have more importance for Asia than Africa. The current state of epilepsy in Asia is far less than ideal and there is an urgent need to recognize and accept the importance of epilepsy in Asia. In no way can epilepsy be considered as an African ailment. This is most likely based on popular beliefs rather than scientific evidence. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here.

  14. Integration of remote sensing data and surface observations to estimate the impact of the Russian wildfires over Europe and Asia during August 2010

    NASA Astrophysics Data System (ADS)

    Mei, L.; Xue, Y.; de Leeuw, G.; Guang, J.; Wang, Y.; Li, Y.; Xu, H.; Yang, L.; Hou, T.; He, X.; Wu, C.; Dong, J.; Chen, Z.

    2011-12-01

    A series of wildfires broke out in Western Russia starting in late July of 2010. Harmful particulates and gases released into the local Russian atmosphere have been reported, as have possible negative consequences for the global atmosphere. In this study, an extremely hazy area and its transport trajectory on Russian wildfires were analysed using aerosol optical depth (AOD) images retrieved via the synergy method from Moderate Resolution Imaging Spectroradiometer (MODIS) data. In addition, we used trace gases (NO2 and SO2) and CO2 products measured using Ozone Monitoring Instrument (OMI) data, vertical distribution of AOD data retrieved from Cloud-Aerosol Lidar and Infrared Pathfinder Satellite Observation (CALIPSO) data, the mass trajectory analyses, synoptic maps from a HYSPLIT model simulation and ground-based data, including AERONET (both AOD and Ångström exponent) data and PM2.5. First, an Optimal Smoothing (OS) scheme was used to develop more precise and reliable AOD data based on multiple competing predictions made using several AOD retrieval models; then, integrated AOD and PM2.5 data were related using a chemical transport model (GEOS-Chem), and the integrated AOD and visibility data were related using the 6S radiative transfer code. The results show that the PM2.5 concentration is enhanced by a factor of 3-5 as determined from both satellite and in situ observations with peak daily mean concentrations of approximately 500 μg m3. Also, the visibility in many parts of Russia, for instance in Moscow, was less than 100 m; in some areas, the visibility was less than 50 m. Additionally, the possible impact on neighbouring countries due to long-transport was analysed for 31 July and 15 August 2010. A comparison of the satellite aerosol products and ground observations from the neighbouring countries suggests that wildfires in Western Russian had little impact on most european and asian countries, the exceptions being Finland, Estonia, Ukraine and Kyrgyzstan

  15. Knowledge, Perceptions and Attitudes of Youths in India Regarding HIV/AIDS: A Review of Current Literature

    ERIC Educational Resources Information Center

    Banerjee, Priya; Mattle, Courtney

    2005-01-01

    The HIV/AIDS pandemic is steadily increasing in severity throughout the developing world. Recently, Southeast Asia has become a rising concern for health care professionals in the field of infectious disease (UNAIDS, 2004). Most of Southeast Asia is experiencing surging prevalence and incidence rates of HIV infection. One particular country of…

  16. Integration of remote sensing data and surface observations to estimate the impact of the russian wildfires over Europe and Asia during August 2010

    NASA Astrophysics Data System (ADS)

    Mei, L.; Xue, Y.; de Leeuw, G.; Guang, J.; Wang, Y.; Li, Y.; Xu, H.; Yang, L.; Hou, T.; He, X.; Wu, C.; Dong, J.; Chen, Z.

    2011-08-01

    A series of wildfires broke out in western Russia starting in late July of 2010. Harmful particulates and gases released into the local Russian atmosphere have been reported, as have possible negative consequences for the global atmosphere. In this study, an extremely hazy area and its transport trajectory on Russian wildfires were analysed using aerosol optical depth (AOD) images retrieved via the synergy method from Moderate Resolution Imaging Spectroradiometer (MODIS) data. In addition, we used trace gases (NO2 and SO2) and CO2 products measured using Ozone Monitoring Instrument (OMI) data, vertical distribution of AOD data retrieved from Cloud-Aerosol Lidar and Infrared Pathfinder Satellite Observation (CALIPSO) data, the mass trajectory analyses, synoptic maps from a HYSPLIT model simulation and ground-based data, including AERONET (both AOD and Ångström exponent) data and PM2.5. First, an Optimal Smoothing (OS) scheme was used to develop more precise and reliable AOD data based on multiple competing predictions made using several AOD retrieval models; then, integrated AOD and PM2.5 data were related using a chemical transport model (GEOS-Chem), and the integrated AOD and visibility data were related using a 6S model. The results show that the PM2.5 concentration is 3-5 times the normal amount based on both satellite data and in situ values with peak daily mean concentrations of approximately 500 μg m-3. Also, the visibility of many parts of Russia, even Moscow, was less than 100 m; in some areas, the visibility was less than 50 m. Additionally, the possible impact on neighbouring countries due to the long-transport effect was also analysed during 31 July and 15 August 2010. A comparison of the satellite aerosol products and ground observations from the neighbouring countries suggests that wildfires in western Russian have had little impact on most European and Asian countries, the exceptions being Finland, Estonia, Ukraine and Kyrgyzstan. However, a

  17. Safety, tolerability, and efficacy of metformin extended-release oral antidiabetic therapy in patients with type 2 diabetes: An observational trial in Asia

    PubMed Central

    Kim, Chul-Hee; Han, Kyung-Ah; Oh, Han-Jin; Tan, Kevin Eng-Kiat; Sothiratnam, Radhakrishna; Tjokroprawiro, Askandar; Klein, Marcus

    2012-01-01

    Background The aim of the present prospective observational study was to assess the tolerability and antihyperglycemic efficacy of metformin extended-release (MXR) in the routine treatment of patients with type 2 diabetes mellitus (T2DM) from six Asian countries. Methods Data from 3556 patients treated with once-daily MXR for 12 weeks, or until discontinuation, were analyzed. Results Treatment with MXR was well tolerated, with 97.4% of patients completing 12 weeks of treatment. Only 3.3% of patients experienced one or more gastrointestinal (GI) side-effects and only 0.7% of patients discontinued for this reason (primary endpoint). The incidence of GI side-effects and related discontinuations appeared to be considerably lower during short-term MXR therapy than during previous treatment (mean 2.71 years’ duration), most commonly with immediate-release metformin. A 12-week course of MXR therapy also reduced HbA1c and fasting glucose levels from baseline. Conclusions The present study provides new insights into the incidence of GI side-effects with MXR in Asian patients with T2DM and on the tolerability of MXR in non-Caucasian populations. Specifically, these data indicate that once-daily MXR not only improves measures of glycemic control in Asian patients with T2DM, but also has a favorable GI tolerability profile that may help promote enhanced adherence to oral antidiabetic therapy. PMID:22742083

  18. On large-scale transport of dust storms and anthropogenic dust-falls over east Asia observed in central Korea in 2009

    NASA Astrophysics Data System (ADS)

    Chung, Y. S.; Kim, Hak-Sung; Chun, Youngsin

    2014-05-01

    Dust air pollution has been routinely monitored in central Korea for the last two decades. In 2009, there were eight typical episodes of significant dust loadings in the air: four were caused by dust storms from deserts in Mongolia and Northern China, while the remaining were typical cases of anthropogenic air pollution masses arriving from the Yellow Sea and East China. These natural dust loadings occurred with cool northwesterly airflows in the forward side of an intense anticyclone coming from Mongolia and Siberia. The mean concentrations of the four natural dustfall cases for TSP, PM10 and PM2.5 were 632, 480 and 100 μg m-3, respectively. In contrast, the anthropogenic dust-pollution episodes occurred with the warm westerly and southwesterly airflows in the rear side of an anticyclone. This produced a favorable atmospheric and chemical condition for the build-up of anthropogenic dust air pollution in the Yellow Sea. The mean concentrations of the four anthropogenic dust loadings for TSP, PM10 and PM2.5 were 224, 187 and 137 μg m-3, respectively. The contents of fine dust loadings of PM2.5 were comparatively high in the cases of anthropogenic air pollution. High atmospheric concentrations of fine particles in the atmosphere cause poor visibility and constitute a health hazard. Satellite observations clearly showed the movement of dust-pollution masses from Mongolia and Northern China and from the Yellow Sea and East China that caused these dust pollution episodes in Korea.

  19. Mortality among HIV-infected women, heterosexual men, and men who have sex with men: insights from an observational cohort study

    PubMed Central

    Coelho, Lara; Grinsztejn, Beatriz; Castilho, Jessica L.; De Boni, Raquel; Quintana, Marcel S. B.; Campos, Dayse P.; Ribeiro, Sayonara R.; Pacheco, Antonio G.; Veloso, Valdilea G.; Luz, Paula M.

    2016-01-01

    Background Mortality among HIV-infected individuals may differ by sex and mode of HIV acquisition. We studied mortality among women, heterosexual men, and men who have sex with men (MSM) in a cohort from Rio de Janeiro, Brazil. Methods HIV-infected adults followed at Instituto Nacional de Infectologia Evandro Chagas from 2000–2011 were included. Cox proportional hazards models accounting for competing risks were used to explore risk factors for AIDS and non-AIDS related deaths. Findings 2224 individuals were included (36·7%[817/2224] women, 24·9%[554/2224] heterosexual men, and 38·4%[853/2224] MSM). Throughout the study period, 103 deaths occurred: 64 due to AIDS-related causes, 31 due to non-AIDS related causes and 8 of unknown causes. In unadjusted analyses, compared to women, hazard of AIDS-related deaths was higher for heterosexual men (hazard ratio [HR] 3·52, 95% confidence interval [95%CI] 1·30–9·08) and for MSM (HR 2·30, 95%CI 0·89–5·94). After adjusting for confounders, excess risk of AIDS-related death observed for heterosexual men was attenuated (aHR 1·99, 95%CI 0·75–5·25, p-value=0.163), but unchanged for MSM (aHR 2·24, 95%CI 0·82–6·11, p-value=0.114). Non-AIDS related mortality did not differ by group. Interpretation Compared to women, increased risk of AIDS-related death among heterosexual men was partially mitigated by risk factors for AIDS mortality while excess risk observed among MSM was unchanged. Further study of reasons for AIDS-related mortality disparity by mode of transmission is needed. PMID:27658875

  20. Efficacy of etravirine combined with darunavir or other ritonavir-boosted protease inhibitors in HIV-1-infected patients: an observational study using pooled European cohort data.

    PubMed

    Vingerhoets, J; Calvez, V; Flandre, P; Marcelin, A-G; Ceccherini-Silberstein, F; Perno, C-F; Mercedes Santoro, M; Bateson, R; Nelson, M; Cozzi-Lepri, A; Grarup, J; Lundgren, J; Incardona, F; Kaiser, R; Sonnerborg, A; Clotet, B; Paredes, R; Günthard, H F; Ledergerber, B; Hoogstoel, A; Nijs, S; Tambuyzer, L; Lavreys, L; Opsomer, M

    2015-05-01

    This observational study in antiretroviral treatment-experienced, HIV-1-infected adults explored the efficacy of etravirine plus darunavir/ritonavir (DRV group; n = 999) vs. etravirine plus an alternative boosted protease inhibitor (other PI group; n = 116) using pooled European cohort data. Two international (EuroSIDA; EUResist Network) and five national (France, Italy, Spain, Switzerland and UK) cohorts provided data (collected in 2007-2012). Stratum-adjusted (for confounding factors) Mantel-Haenszel differences in virological responses (viral load < 50 HIV-1 RNA copies/mL) and odds ratios (ORs) with 95% confidence intervals (CIs) were derived. Baseline characteristics were balanced between groups except for previous use of antiretrovirals (≥ 10: 63% in the DRV group vs. 49% in the other PI group), including previous use of at least three PIs (64% vs. 53%, respectively) and mean number of PI resistance mutations (2.3 vs. 1.9, respectively). Week 24 responses were 73% vs. 75% (observed) and 49% vs. 43% (missing = failure), respectively. Week 48 responses were 75% vs. 73% and 32% vs. 30%, respectively. All 95% CIs around unadjusted and adjusted differences encompassed 0 (difference in responses) or 1 (ORs). While ORs by cohort indicated heterogeneity in response, for pooled data the difference between unadjusted and adjusted for cohort ORs was small. These data do not indicate a difference in response between the DRV and other PI groups, although caution should be applied given the small size of the other PI group and the lack of randomization. This suggests that the efficacy and virology results from DUET can be extrapolated to a regimen of etravirine with a boosted PI other than darunavir/ritonavir. © 2015 British HIV Association.

  1. Peritoneal dialysis in Asia.

    PubMed

    Cheng, I K

    1996-01-01

    The socioeconomic status of Asian countries is diverse, and government reimbursement policies for treatment of patients suffering from end-stage renal disease (ESRD) vary greatly from one country to another. Both of these factors have a major impact not only on the choice of treatment for ESRD but also on the utilization of peritoneal dialysis (PD) in this region. Based on the data collected from 11 representative Asian countries, several observations can be made. First, the treatment rates for ESRD in these countries correlated closely with their gross domestic product (GDP) per capita income. Second, the PD utilization rate appeared to have a biphasic relationship with the GDP per capita income and treatment rate, in that countries with the highest and the lowest treatment rates tended to have lower PD utilization rates, whereas countries with modest treatment rates tended to have higher PD utilization rates. The reason for low PD utilization in countries with the highest treatment rates differs from that in countries with low treatment rates. In the former, because of full government reimbursement, there is little physician incentive to introduce PD as an alternative form of ESRD treatment to in-center hemodialysis (HD), whereas in the latter, the complet