Suicide in HIV-Infected Individuals and the General Population in Switzerland, 1988-2008

Objective High rates of suicide have been described in HIV-infected patients, but it is unclear to what extent the introduction of highly active antiretroviral therapy (HAART) has affected suicide rates. The authors examined time trends and predictors of suicide in the pre-HAART (1988—1995) and HAART (1996—2008) eras in HIV-infected patients and the general population in Switzerland. Method The authors analyzed data from the Swiss HIV Cohort Study and the Swiss National Cohort, a longitudinal study of mortality in the Swiss general population. The authors calculated standardized mortality ratios comparing HIV-infected patients with the general population and used Poisson regression to identify risk factors for suicide. Results From 1988 to 2008, 15,275 patients were followed in the Swiss HIV Cohort Study for a median duration of 4.7 years. Of these, 150 died by suicide (rate 158.4 per 100,000 person-years). In men, standardized mortality ratios declined from 13.7 (95% CI=11.0—17.0) in the pre-HAART era to 3.5 (95% CI=2.5—4.8) in the late HAART era. In women, ratios declined from 11.6 (95% CI=6.4—20.9) to 5.7 (95% CI=3.2—10.3). In both periods, suicide rates tended to be higher in older patients, in men, in injection drug users, and in patients with advanced clinical stage of HIV illness. An increase in CD4 cell counts was associated with a reduced risk of suicide. Conclusions Suicide rates decreased significantly with the introduction of HAART, but they remain above the rate observed in the general population, and risk factors for suicide remain similar. HIV-infected patients remain an important target group for suicide prevention.

Gilbert syndrome and the development of antiretroviral therapy-associated hyperbilirubinemia

BACKGROUND: Unconjugated hyperbilirubinemia results from Gilbert syndrome and from antiretroviral therapy (ART) containing protease inhibitors. An understanding of the interaction between genetic predisposition and ART may help to identify individuals at highest risk for developing jaundice. METHODS: We quantified the contribution of UGT1A1*28 and ART to hyperbilirubinemia by longitudinally modeling 1386 total bilirubin levels in 96 human immunodeficiency virus (HIV)-infected individuals during a median of 6 years. RESULTS: The estimated average bilirubin level was 8.8 micromol/L (0.51 mg/dL). Atazanavir increased bilirubin levels by 15 mu mol/L (0.87 mg/dL), and indinavir increased bilirubin levels by 8 micromol/L (0.46 mg/dL). Ritonavir, lopinavir, saquinavir, and nelfinavir had no or minimal effect on bilirubin levels. Homozygous UGT1A1*28 increased bilirubin levels by 5.2 micromol/L (0.3 mg/dL). As a consequence, 67% of individuals homozygous for UGT1A1*28 and receiving atazanavir or indinavir had > or =2 episodes of hyperbilirubinemia in the jaundice range (>43 micromol/L [>2.5 mg/dL]), versus 7% of those with the common allele and not receiving either of those protease inhibitors (P<.001). Efavirenz resulted in decreased bilirubin levels, which is consistent with the induction of UDP-glucuronosyltransferase 1A1. CONCLUSIONS: Genotyping for UGT1A1*28 before initiation of ART would identify HIV-infected individuals at risk for hyperbilirubinemia and decrease episodes of jaundice.

An analysis of the Galveston Hurricane using the 20CR data set

The Twentieth Century Reanalysis (20CR) is an atmospheric dataset consisting of 56 ensemble members, which covers the entire globe and reaches back to 1871. To assess the suitability of this dataset for studying past extremes, we analysed a prominent extreme event, namely the Galveston Hurricane, which made landfall in September 1900 in Texas, USA. The ensemble mean of 20CR shows a track of the pressure minimum with a small standard deviation among the 56 ensemble members in the area of the Gulf of Mexico. However, there are systematic differences between the assimilated “Best Track” from the International Best Track Archive for Climate Stewardship (IBTrACS) and the ensemble mean track in 20CR. East of the Strait of Florida, the tracks derived from 20CR are located systematically northeast of the assimilated track while in the Gulf of Mexico, the 20CR tracks are systematically shifted to the southwest compared to the IBTrACS position. The hurricane can also be observed in the wind field, which shows a cyclonic rotation and a relatively calm zone in the centre of the hurricane. The 20CR data reproduce the pressure gradient and cyclonic wind field. Regarding the amplitude of the wind speeds, the ensemble mean values from 20CR are significantly lower than the wind speeds known from measurements.

The Samoa Hurricane, 15-16 March 1889

Analysing historical weather extremes such as the tropical cyclone in Samoa in March 1889 could add to our understanding of extreme events. However, up to now the availability of suitable data was limiting the analysis of historical extremes, particularly in remote regions. The new “Twentieth Century Reanalysis” (20CR), which provides six-hourly, three-dimensional data for the entire globe back to 1871, might provide the means to study this and other early events. While its suitability for studying historical extremes has been analysed for events in the northern extratropics (see other papers in this volume), the representation of tropical cyclones, especially in early times, remains unknown. The aim of this paper is to study to the hurricane that struck Samoa on 15-16 March 1889. We analyse the event in 20CR as well as in contemporary observations. We find that the event is not reproduced in the ensemble mean of 20CR, nor is it within the ensemble spread. We argue that this is due to the paucity of data assimilated into 20CR. A preliminary compilation of historical observations from ships for that period, in contrast, provides a relatively consistent picture of the event. This shows that more observations would be available and implies that future versions of surface-based reanalyses might profit from digitizing further observations in the tropical region.

Investigating the sensitivity of hurricane intensity and trajectory to sea surface temperatures using the regional model WRF

The influence of sea surface temperature (SST) anomalies on the hurricane characteristics are investigated in a set of sensitivity experiments employing the Weather Research and Forecasting (WRF) model. The idealised experiments are performed for the case of Hurricane Katrina in 2005. The first set of sensitivity experiments with basin-wide changes of the SST magnitude shows that the intensity goes along with changes in the SST, i.e., an increase in SST leads to an intensification of Katrina. Additionally, the trajectory is shifted to the west (east), with increasing (decreasing) SSTs. The main reason is a strengthening of the background flow. The second set of experiments investigates the influence of Loop Current eddies idealised by localised SST anomalies. The intensity of Hurricane Katrina is enhanced with increasing SSTs close to the core of a tropical cyclone. Negative nearby SST anomalies reduce the intensity. The trajectory only changes if positive SST anomalies are located west or north of the hurricane centre. In this case the hurricane is attracted by the SST anomaly which causes an additional moisture source and increased vertical winds.