Outcomes of Nigeria's HIV/AIDS Treatment Program for Patients Initiated on Antiretroviral Treatment between 2004-2012

BackgroundThe Nigerian Antiretroviral therapy (ART) program started in 2004 and now ranks among the largest in Africa. However, nationally representative data on outcomes have not been reported.MethodsWe evaluated retrospective cohort data from a nationally representative sample of adults aged ≥15 years who initiated ART during 2004 to 2012. Data were abstracted from 3,496 patient records at 35 sites selected using probability-proportional-to-size (PPS) sampling. Analyses were weighted and controlled for the complex survey design. The main outcome measures were mortality, loss to follow-up (LTFU), and retention (the proportion alive and on ART). Potential predictors of attrition were assessed using competing risk regression models.ResultsAt ART initiation, 66.4 percent (%) were females, median age was 33 years, median weight 56 kg, median CD4 count 161 cells/mm³, and 47.1% had stage III/IV disease. The percentage of patients retained at 12, 24, 36 and 48 months was 81.2%, 74.4%, 67.2%, and 61.7%, respectively. Over 10,088 person-years of ART, mortality, LTFU, and overall attrition (mortality, LTFU, and treatment stop) rates were 1.1 (95% confidence interval (CI): 0.7–1.8), 12.3 (95%CI: 8.9–17.0), and 13.9 (95% CI: 10.4–18.5) per 100 person-years (py) respectively. Highest attrition rates of 55.4/100py were witnessed in the first 3 months on ART. Predictors of LTFU included: lower-than-secondary level education (reference: Tertiary), care in North-East and South-South regions (reference: North-Central), presence of moderate/severe anemia, symptomatic functional status, and baseline weight <45kg. Predictor of mortality was WHO stage higher than stage I. Male sex, severe anemia, and care in a small clinic were associated with both mortality and LTFU.ConclusionModerate/Advanced HIV disease was predictive of attrition; earlier ART initiation could improve program outcomes. Retention interventions targeting men and those with lower levels of education are needed. Further research to understand geographic and clinic size variations with outcome is warranted.     

From lab to field, new approaches to phenotyping root system architecture

Plant root system architecture (RSA) is plastic and dynamic, allowing plants to respond to their environment in order to optimize acquisition of important soil resources. A number of RSA traits are known to be correlated with improved crop performance. There is increasing recognition that future gains in productivity, especially under low input conditions, can be achieved through optimization of RSA. However, realization of this goal has been hampered by low resolution and low throughput approaches for characterizing RSA. To overcome these limitations, new methods are being developed to facilitate high throughput and high content RSA phenotyping. Here we summarize laboratory and field approaches for phenotyping RSA, drawing particular attention to recent advances in plant imaging and analysis. Improvements in phenotyping will facilitate the genetic analysis of RSA and aid in the identification of the genetic loci underlying useful agronomic traits.     

Phytochrome chromophore biosynthesis. Treatment of tetrapyrrole-deficient Avena explants with natural and non-natural bilatrienes leads to formation of spectrally active holoproteins

Etiolated Avena seedlings grown in the presence of 4-amino-5-hexynoic acid, an inhibitor of 5-aminolevulinic acid synthesis in plants, contain less than 10% of the spectrally detectable levels of phytochrome found in untreated seedlings (Elich, T.D., and Lagarias, J.C. (1988) Plant Physiol. 88, 747-751). In this study, incubation of explants from such seedlings with [14C]biliverdin IX alpha led to rapid covalent incorporation of radiolabel into a single 124-kDa polypeptide in soluble protein extracts. Immunoprecipitation experiments confirmed that this protein was phytochrome. Parallel experiments were performed with four unlabeled linear tetrapyrroles, the naturally occurring biliverdin IX alpha isomer, two non-natural isomers, biliverdin XIII alpha and biliverdin III alpha, and phycocyanobilin-the cleaved prosthetic group of the light-harvesting antenna protein C-phycocyanin. In all cases, except for the III alpha isomer of biliverdin, a time-dependent recovery of photoreversible phytochrome was observed. The newly formed phytochrome obtained after incubation with biliverdin IX alpha exhibited spectral characteristics identical with those of the native protein. In contrast, the spectral properties of phytochromes formed during incubation with biliverdin XIII alpha and phycocyanobilin differed significantly from those of the native chromoprotein. These results indicate that biliverdin IX alpha is an intermediate in the biosynthesis of the phytochrome chromophore and that phytochromes with prosthetic groups derived from bilatrienes having non-natural D-ring substituents are photochromic.     

A mechanism for the potent inhibition of eukaryotic acetyl-coenzyme A carboxylase by soraphen A, a macrocyclic polyketide natural product

Acetyl-coenzyme A carboxylases (ACCs) have crucial roles in fatty acid metabolism. Soraphen A, a macrocyclic polyketide natural product, is a nanomolar inhibitor against the biotin carboxylase (BC) domain of human, yeast, and other eukaryotic ACCs. Here we report the crystal structures of the yeast BC domain, alone and in complex with soraphen A. Soraphen has extensive interactions with an allosteric site, about 25 A from the active site. The specificity of soraphen is explained by large structural differences between the eukaryotic and prokaryotic BC in its binding site, confirmed by our studies on the effects of single-site mutations in this binding site. Unexpectedly, our structures suggest that soraphen may bind in the BC dimer interface and inhibit the BC activity by disrupting the oligomerization of this domain. Observations from native gel electrophoresis confirm this structural insight. The structural information provides a foundation for structure-based design of new inhibitors against these enzymes.     

Feed intake and dietary composition of iron (Fe), copper (Cu), vitamin E,and tannic acid of five captive black rhinoceros (Diceros bicornis) in a UK collection

The black rhinoceros (Diceros bicornis) is a critically endangered species facing multiple anthropogenic pressures in its natural home range across Africa. Black rhinoceros are difficult to maintain ex situ and subject to diseases that are linked with captive dietary factors. Hemochromatosis is of particular concern, as it is a common finding at necropsy of captive adults, and has been linked to excessive dietary iron intake. This intake study investigates the select nutrient composition of the diets offered to and consumed by five captive black rhinoceros in a UK zoo to evaluate, ensure adequacy, and/or make adjustments if necessary. Alfalfa hay, pellets and six browse species offered were analyzed for iron (Fe), copper (Cu), vitamin E, and tannic acid content. Intakes were quantified and evaluated against levels found in wild diets and the currently available feeding guidelines for black rhinoceros. Diets eaten by five individual rhinoceros (1.4%–2.3% of bodyweight dry matter [DM] intake), comprising 68%–82% hay, 6%–13% pellets, and 13%–27% browse, contained 76–98 mg/kg Fe (on a DM basis), fell within the ranges of plants eaten by free‐ranging rhinoceros (45–140 mg/kg DM), as well as values recommended for captive‐fed browsing rhinoceros (50–100 mg/kg DM). Consumed diets were found to be marginal to adequate in Cu (9–11 mg/kg DM) compared with the recommended 10 mg/kg DM; dietary vitamin E ranged from 54 to 79 IU/kg DM, and tannic acid measured 13–14 g/kg DM. Commercial pellets were the primary contributor of dietary Fe, Cu, and vitamin E, containing up to 10 times more of each of those nutrients than the forages. Native browses were important sources of lower Fe ingredients, as well as appropriate levels of dietary Cu and vitamin E (dependent on species). Interestingly, pellets (23 g/kg) and alfalfa hay (14 g/kg) contained higher concentrations of tannic acid compared with any of the browses fed (4–13 g/kg). All nutritional parameters evaluated were close to recommended dietary levels, diets resembled values consumed in the wild, and the animals remained clinically healthy throughout the study. Overall, diets were considered nutritionally adequate for captive feeding of black rhinoceros; evaluating the nutrient composition of all ingredients, including browse plants in diets, provides important information for achieving optimal nutrient balance.     

High-throughput imaging and analysis of root system architecture in Brachypodium distachyon under differential nutrient availability

Nitrogen (N) and phosphorus (P) deficiency are primary constraints for plant productivity, and root system architecture (RSA) plays a vital role in the acquisition of these nutrients. The genetic determinants of RSA are poorly understood, primarily owing to the complexity of crop genomes and the lack of sufficient RSA phenotyping methods. The objective of this study was to characterize the RSA of two Brachypodium distachyon accessions under different nutrient availability. To do so, we used a high-throughput plant growth and imaging platform, and developed software that quantified 19 different RSA traits. We found significant differences in RSA between two Brachypodium accessions grown on nutrient-rich, low-N and low-P conditions. More specifically, one accession maintained axile root growth under low N, while the other accession maintained lateral root growth under low P. These traits resemble the RSA of crops adapted to low-N and -P conditions, respectively. Furthermore, we found that a number of these traits were highly heritable. This work lays the foundation for future identification of important genetic components of RSA traits under nutrient limitation using a mapping population derived from these two accessions.     

Phytochrome Chromophore Biosynthesis : Both 5-Aminolevulinic Acid and Biliverdin Overcome Inhibition by Gabaculine in Etiolated Avena sativa L. Seedlings

Etiolated Avena sativa L. seedlings grown in the presence of gabaculine (5-amino-1,3-cyclohexadienylcarboxylic acid) contained reduced levels of phytochrome as shown by spectrophotometric and immunochemical assays. Photochromic phytochrome levels in gabaculine-grown plants were estimated to be 20% of control plants, while immunoblot analysis showed that the phytochrome protein moiety was present at approximately 50% of control levels. Gabaculine-grown seedlings administered either 5-aminolevulinic acid or biliverdin exhibited a rapid increase of spectrophotometrically detectable phytochrome. Phytochrome concentrations estimated immunochemically did not similarly increase throughout treatment with either compound. Similar experiments with 5-amino[4-¹⁴C] levulinic acid showed radiolabeling of phytochrome with kinetics that paralleled the spectrally detected increase. These results are consistent with (a) the intermediacy of both 5-aminolevulinic acid and biliverdin in the biosynthetic pathway of the phytochrome chromophore and (b) the lack of coordinate regulation of chromophore and apoprotein synthesis in Avena seedlings.