Accuracy of immunological criteria for identifying virological failure in children on antiretroviral therapy - The IeDEA Southern Africa Collaboration

Objectives  To determine the diagnostic accuracy of World Health Organization (WHO) 2010 and 2006 as well as United States Department of Health and Human Services (DHHS) 2008 definitions of immunological failure for identifying virological failure (VF) in children on antiretroviral therapy (ART). Methods  Analysis of data from children (<16 years at ART initiation) at South African ART sites at which CD4 count/per cent and HIV-RNA monitoring are performed 6-monthly. Incomplete virological suppression (IVS) was defined as failure to achieve ≥1 HIV-RNA ≤400 copies/ml between 6 and 15 months on ART and viral rebound (VR) as confirmed HIV-RNA ≥5000 copies/ml in a child on ART for ≥18 months who had achieved suppression during the first year on treatment. Results  Among 3115 children [median (interquartile range) age 48 (20-84) months at ART initiation] on treatment for ≥1 year, sensitivity of immunological criteria for IVS was 10%, 6% and 26% for WHO 2006, WHO 2010 and DHHS 2008 criteria, respectively. The corresponding positive predictive values (PPV) were 31%, 20% and 20%. Diagnostic accuracy for VR was determined in 2513 children with ≥18 months of follow-up and virological suppression during the first year on ART with sensitivity of 5% (WHO 2006/2010) and 27% (DHHS 2008). PPV results were 42% (WHO 2010), 43% (WHO 2006) and 20% (DHHS 2008). Conclusion  Current immunological criteria are unable to correctly identify children failing ART virologically. Improved access to viral load testing is needed to reliably identify VF in children.

The role of targeted viral load testing in diagnosing virological failure in children on antiretroviral therapy with immunological failure

Objectives  To determine the improvement in positive predictive value of immunological failure criteria for identifying virological failure in HIV-infected children on antiretroviral therapy (ART) when a single targeted viral load measurement is performed in children identified as having immunological failure. Methods  Analysis of data from children (<16 years at ART initiation) at South African ART sites at which CD4 count/per cent and HIV-RNA monitoring are performed 6-monthly. Immunological failure was defined according to both WHO 2010 and United States Department of Health and Human Services (DHHS) 2008 criteria. Confirmed virological failure was defined as HIV-RNA >5000 copies/ml on two consecutive occasions <365 days apart in a child on ART for ≥18 months. Results  Among 2798 children on ART for ≥18 months [median (IQR) age 50 (21-84) months at ART initiation], the cumulative probability of confirmed virological failure by 42 months on ART was 6.3%. Using targeted viral load after meeting DHHS immunological failure criteria rather than DHHS immunological failure criteria alone increased positive predictive value from 28% to 82%. Targeted viral load improved the positive predictive value of WHO 2010 criteria for identifying confirmed virological failure from 49% to 82%. Conclusion  The addition of a single viral load measurement in children identified as failing immunologically will prevent most switches to second-line treatment in virologically suppressed children.

The eight hours day for wage earning women: United States Supreme Court upholds the California law : List of eight hours laws

National Consumers' League.

Northeastern United States, 1799 : showing township grants and land purchases in New York (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: Map of the middle states of North America : shewing the position of the Geneseo country comprehending the counties of Ontario & Steuben as laid off in townships of six miles squar[e] each, Maverick, sculpt. It was printed by T. & J. Swords for Charles Williamson's Description of the settlement of the Genesee country, in the state of New-York, 1799. Scale [ca. 1:2,250,000]. Partial cadastral map showing large land purchases and township grants in New York State. Covers New York, Pennsylvania, Vermont, Massachusetts, Connecticut, New Jersey, Washington, D.C. and portions of Maryland, Delaware, and West Virginia. The image inside the map neatline is georeferenced to the surface of the earth and fit to the Universal Transverse Mercator (UTM) Zone 18N NAD83 projection. All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map. This map shows features such as roads, drainage, major cities and towns, land purchases, township grants, state boundaries, and more. Includes key to "principal villages in Ontario & Steuben counties." This layer is part of a selection of digitally scanned and georeferenced historic maps from The Harvard Map Collection as part of the Imaging the Urban Environment project. Maps selected for this project represent major urban areas and cities of the world, at various time periods. These maps typically portray both natural and manmade features at a large scale. The selection represents a range of regions, originators, ground condition dates, scales, and purposes.

In the Supreme Court of the United States, October term, 1980, Héctor García, petitioner v. Alton V.M. Gloor ... [et al.], respondents : on writ of certiorari to the United States Court of Appeals for the Fifth Circuit : petition for writ of certiorari /

At head of title: no.

College and university public education in the Caribbean.

"Reprinted by permission from The Caribbean: contemporary education, University of Florida Press, 1960."

Report from Office for Spanish Speaking American Affairs.

Mode of access: Internet.

Factbook, Bureau of Higher Education : summary of program information through fiscal year 1971 /

Cover title.

Career and vocational development of bilingual students /

Supported by the National Institute of Education, U.S. Dept. of Health, Education, and Welfare, under contract no. NIE-C-400-76-0122.

National Bilingual Clearinghouse Conferences, October/November, 1976 /

Summary of six separate conferences.

Foreign agricultural trade of the United States.

Mode of access: Internet.

Review of readiness considerations in the development of the defense budget : report of the Readiness Panel of the Procurement and Military Nuclear Systems Subcommittee of the Committee on Armed Services, House of Representatives, Ninety-sixth Congress, second session.

Mode of access: Internet.

Alcohol and drug abuse in medical education /

"Proceedings of the National Conference on Medical Education in Alcohol and Drug Abuse, jointly sponsored by the Association for Medical Education and Research in Substance Abuse and the Career Teacher Program in Alcohol and Drug Abuse (ADAMHA) November 5-6, 1977, Washington, D.C.": p. 75-131.

An evaluation of cotton dust control systems in the picking and garnetting areas of the Atlanta Federal Penitentiary /

Mode of access: Internet.

Report of workshop on isolation, characterization, and mechanism of action of proteases and antiproteases /

Mode of access: Internet.