Immunodeficiency at the start of combination antiretroviral therapy in low-, middle-, and high-income countries

OBJECTIVE To describe the CD4 cell count at the start of combination antiretroviral therapy (cART) in low-income (LIC), lower middle-income (LMIC), upper middle-income (UMIC), and high-income (HIC) countries. METHODS Patients aged 16 years or older starting cART in a clinic participating in a multicohort collaboration spanning 6 continents (International epidemiological Databases to Evaluate AIDS and ART Cohort Collaboration) were eligible. Multilevel linear regression models were adjusted for age, gender, and calendar year; missing CD4 counts were imputed. RESULTS In total, 379,865 patients from 9 LIC, 4 LMIC, 4 UMIC, and 6 HIC were included. In LIC, the median CD4 cell count at cART initiation increased by 83% from 80 to 145 cells/μL between 2002 and 2009. Corresponding increases in LMIC, UMIC, and HIC were from 87 to 155 cells/μL (76% increase), 88 to 135 cells/μL (53%), and 209 to 274 cells/μL (31%). In 2009, compared with LIC, median counts were 13 cells/μL [95% confidence interval (CI): -56 to +30] lower in LMIC, 22 cells/μL (-62 to +18) lower in UMIC, and 112 cells/μL (+75 to +149) higher in HIC. They were 23 cells/μL (95% CI: +18 to +28 cells/μL) higher in women than men. Median counts were 88 cells/μL (95% CI: +35 to +141 cells/μL) higher in countries with an estimated national cART coverage >80%, compared with countries with <40% coverage. CONCLUSIONS Median CD4 cell counts at the start of cART increased 2000-2009 but remained below 200 cells/μL in LIC and MIC and below 300 cells/μL in HIC. Earlier start of cART will require substantial efforts and resources globally.

Dynamics of Shifting Cultivation Landscapes in Northern Lao PDR Between 2000 and 2009 Based on an Analysis of MODIS Time Series and Landsat Images

The rotational nature of shifting cultivation poses several challenges to its detection by remote sensing. Consequently, there is a lack of spatial data on the dynamics of shifting cultivation landscapes on a regional, i.e. sub-national, or national level. We present an approach based on a time series of Landsat and MODIS data and landscape metrics to delineate the dynamics of shifting cultivation landscapes. Our results reveal that shifting cultivation is a land use system still widely and dynamically utilized in northern Laos. While there is an overall reduction in the areas dominated by shifting cultivation, some regions also show an expansion. A review of relevant reports and articles indicates that policies tend to lead to a reduction while market forces can result in both expansion and reduction. For a better understanding of the different factors affecting shifting cultivation landscapes in Laos, further research should focus on spatially explicit analyses.

Snow variability in the Swiss Alps 1864-2009

We present a climate analysis of nine unique Swiss Alpine new snow series that have been newly digitized. The stations cover different altitudes (450–1860 m asl) and all time series cover more than 100 years (one from 1864 to 2009). In addition, data from 71 stations for the last 50–80 years for new snow and snow depth are analysed to get a more complete picture of the Swiss Alpine snow variability. Important snow climate indicators such as new snow sums (NSS), maximum new snow (MAXNS) and days with snowfall (DWSF) are calculated and variability and trends analysed. Series of days with snow pack (DWSP) ≥ 1 cm are reconstructed with useful quality for six stations using the daily new snow, local temperature and precipitation data. Our results reveal large decadal variability with phases of low and high values for NSS, DWSF and DWSP. For most stations NSS, DWSF and DWSP show the lowest values recorded and unprecedented negative trends in the late 1980s and 1990s. For MAXNS, however, no clear trends and smaller decadal variability are found but very large MAXNS values (>60 cm) are missing since the year 2000. The fraction of NSS and DWSP in different seasons (autumn, winter and spring) has changed only slightly over the ∼150 year record. Some decreases most likely attributable to temperature changes in the last 50 years are found for spring, especially for NSS at low stations. Both the NSS and DWSP snow indicators show a trend reversal in most recent years (since 2000), especially at low and medium altitudes. This is consistent with the recent ‘plateauing’ (i.e. slight relative decrease) of mean winter temperature in Switzerland and illustrates how important decadal variability is in understanding the trends in key snow indicators.