Late Diagnosis and Entry to Care after Diagnosis of Human Immunodeficiency Virus Infection: A Country Comparison

Background

Testing for HIV infection and entry to care are the first steps in the continuum of care that benefit individual health and may reduce onward transmission of HIV. We determined the percentage of people with HIV who were diagnosed late and the percentage linked into care overall and by demographic and risk characteristics by country.

Methods

Data were analyzed from national HIV surveillance systems. Six countries, where available, provided data on two late diagnosis indicators (AIDS diagnosis within 3 months of HIV diagnosis, and AIDS diagnosis within 12 months before HIV diagnosis) and linkage to care (≥1 CD4 or viral load test result within 3 months of HIV diagnosis) for people diagnosed with HIV in 2009 or 2010 (most recent year data were available).

Principal Findings

The percentage of people presenting with late stage disease at HIV diagnosis varied by country, overall with a range from 28.7% (United States) to 8.8% (Canada), and by transmission categories. The percentage of people diagnosed with AIDS who had their initial HIV diagnosis within 12 months before AIDS diagnosis varied little among countries, except the percentages were somewhat lower in Spain and the United States. Overall, the majority of people diagnosed with HIV were linked to HIV care within 3 months of diagnosis (more than 70%), but varied by age and transmission category.

Conclusions

Differences in patterns of late presentation at HIV diagnosis among countries may reflect differences in screening practices by providers, public health agencies, and people with HIV. The percentage of people who received assessments of immune status and viral load within 3 months of diagnosis was generally high.     

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Characterization of Pallid Sturgeon (Scaphirhynchus albus) Spawning Habitat in the Lower Missouri River

Acipenseriformes (sturgeons and paddlefish) globally have declined throughout their range due to river fragmentation, habitat loss, overfishing, and degradation of water quality. In North America, pallid sturgeon (Scaphirhynchus albus) populations have experienced poor to no recruitment, or substantial levels of hybridization with the closely related shovelnose sturgeon (S. platorynchus). The Lower Missouri River is the only portion of the species’ range where successful reproduction and recruitment of genetically pure pallid sturgeon have been documented. This paper documents spawning habitat and behavior on the Lower Missouri River, which comprises over 1,300 km of unfragmented river habitat. The objective of this study was to determine spawning locations and describe habitat characteristics and environmental conditions (depth, water velocity, substrate, discharge, temperature, and turbidity) on the Lower Missouri River. We measured habitat characteristics for spawning events of ten telemetry-tagged female pallid sturgeon from 2008–2013 that occurred in discrete reaches distributed over hundreds of kilometers. These results show pallid sturgeon select deep and fast areas in or near the navigation channel along outside revetted banks for spawning. These habitats are deeper and faster than nearby river habitats within the surrounding river reach. Spawning patches have a mean depth of 6.6 m and a mean depth-averaged water-column velocity of 1.4 m per second. Substrates in spawning patches consist of coarse bank revetment, gravel, sand, and bedrock. Results indicate habitat used by pallid sturgeon for spawning is more common and widespread in the present-day channelized Lower Missouri River relative to the sparse and disperse coarse substrates available prior to channelization. Understanding the spawning habitats currently utilized on the Lower Missouri River and if they are functioning properly is important for improving habitat remediation measures aimed at increasing reproductive success. Recovery efforts for pallid sturgeon on the Missouri River, if successful, can provide guidance to sturgeon recovery on other river systems; particularly large, regulated, and channelized rivers.     

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Translational control of coronaviruses

Coronaviruses represent a large family of enveloped RNA viruses that infect a large spectrum of animals. In humans, the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is responsible for the current COVID-19 pandemic and is genetically related to SARS-CoV and Middle East respiratory syndrome-related coronavirus (MERS-CoV), which caused outbreaks in 2002 and 2012, respectively. All viruses described to date entirely rely on the protein synthesis machinery of the host cells to produce proteins required for their replication and spread. As such, virus often need to control the cellular translational apparatus to avoid the first line of the cellular defense intended to limit the viral propagation. Thus, coronaviruses have developed remarkable strategies to hijack the host translational machinery in order to favor viral protein production. In this review, we will describe some of these strategies and will highlight the role of viral proteins and RNAs in this process.     

Improvement in cyst recovery and molecular detection of Giardia duodenalis from stool samples

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Mediator subunit MED1 modulates intranuclear dynamics of the thyroid hormone receptor

The thyroid hormone receptors (TRs) mediate thyroid hormone (T₃)-dependent gene expression. The nuclear import and export signals that direct TR shuttling are well characterized, but little is known about factors modulating nuclear retention. We used fluorescence-based nucleocytoplasmic scoring and fluorescence recovery after photobleaching in transfected cells to investigate whether Mediator subunits MED1 and MED13 play a role in nuclear retention of TR. When MED1 was overexpressed, there was a striking shift towards a greater nuclear localization of TRβ1 and the oncoprotein v-ErbA, subtypes with cytosolic populations at steady-state, and TRβ1 intranuclear mobility was reduced. For TRα1, there was no observable change in its predominantly nuclear distribution pattern or mobility. Consistent with a role for MED1 in nuclear retention, the cytosolic TRα1 and TRβ1 population were significantly greater in MED1^−/− cells, compared with MED1^+/+ cells. Exposure to T₃ and epidermal growth factor, which induces MED1 phosphorylation, also altered TR intranuclear dynamics. Overexpression of miR-208a, which downregulates MED13, led to a more cytosolic distribution of nuclear-localized TRα1; however, overexpression of MED13 had no effect on TRβ1 localization. The known binding site of MED1 overlaps with a transactivation domain and nuclear export signal in helix 12 of TR's ligand-binding domain (LBD). Coimmunoprecipitation assays demonstrated that TR's LBD interacts directly with exportins 5 and 7, suggesting that binding of exportins and MED1 to TR may be mutually exclusive. Collectively, our data provide evidence that MED1 promotes nuclear retention of TR, and highlight the dual functionality of helix 12 in TR transactivation and nuclear export.     

Population Structure and Genetic Diversity in Sweet Cassava Accessions in Paraná and Santa Catarina,Brazil

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