Whole-Genome Sequence of the Soil Bacterium Micrococcus sp. KBS0714.

We present here a draft genome assembly of Micrococcus sp. KBS0714, which was isolated from agricultural soil. The genome provides insight into the strategies that Micrococcus spp. use to contend with environmental stressors such as desiccation and starvation in environmental and host-associated ecosystems.

Access to therapy in the Multicenter AIDS Cohort Study, 1989-1992.

The study aims were (i) to describe secular trends in the utilization of antiretrovirals, antivirals, Pneumocystis carinii pneumonia (PCP) prophylaxis, and antifungal prophylaxis and (ii) to determine whether factors such as clinical status, health services utilization, insurance status, income, education and race were associated with access to therapy. Data on utilization of therapy, health services utilization, income and insurance status were collected semiannually from October 1990 through March 1992 from 1415 homosexual/bisexual HIV-1 seropositive men in the Multicenter AIDS Cohort Study (MACS). Prevalence of therapy use according to level of immunosuppression was determined at each study visit. Clinical AIDS was defined using the 1987 CDC definition. Factors associated with use of antiretroviral therapy and PCP prophylaxis were assessed using multiple logistic regression with robust variance techniques to adjust variance estimates and significance levels for within-person correlations of drug use over time. Prevalence of zidovudine use remained relatively constant throughout the study period. In contrast, use of didanosine (21-34%), acyclovir (23-34%) and dideoxycytidine (zalcitabine) (8-25%) increased in participants with clinical AIDS. Similar trends were seen for combination antiretroviral therapy, trimethoprim-sulfamethoxazole, dapsone, ketoconazole and fluconazole. However, reported use of aerosolized pentamidine fell. After adjusting for CD4+ lymphocyte count and HIV-1 symptoms, previous HIV-related hospitalization (OR = 1.52; 95% CI = 1.22-1.91), outpatient visit (OR = 2.83; 95% CI = 2.12-3.78), having insurance (OR = 1.32; 95% CI = 1.01-1.75), college education (OR = 1.42; 95% CI = 1.13-1.80) and white race (OR = 1.58; 95% CI = 1.21-2.07) were all associated with being on antiretroviral therapy in persons without clinical AIDS. In persons with clinical AIDS, having insurance (OR = 2.89; 95% CI = 1.04-8.02) and a previous outpatient visit (OR = 11.69; 95% CI = 1.77-77.30) were the significant variables. Factors significantly associated with being on PCP prophylaxis in multivariate models were previous hospitalization, previous outpatient visit, and college education (for subjects without clinical AIDS.

Proteinuria and its assessment in normal and hypertensive pregnancy.

OBJECTIVES: The purposes of this study were (1) to determine 24-hour urinary protein excretion rates in normal human pregnancy and (2) to assess the reliability of assessment of proteinuria by dipstick measurement. STUDY DESIGN: At 17 to 20 and 33 to 36 weeks of pregnancy, 174 normal volunteers collected a 24-hour urine sample; the volume and the protein and creatinine concentrations were measured. The result for protein was compared with dipstick analysis of an early morning midstream urine sample collected at the conclusion of the 24-hour period. Sixty-eight consecutive inpatients admitted to the antenatal ward with hypertension and positive urine dipstick tests for protein underwent the same procedure. The interobserver variability in dipstick analyses of urine samples of known protein content was assessed with the aid of 66 volunteers from the hospital staff. RESULTS: The upper 95% confidence limit of the normal population was less than 200 mg per 24 hours, at both stages of pregnancy investigated. In these women and in the hypertensive inpatients a high proportion of false-positive and false-negative results was found with dipstick analyses. Interobserver variation in assessment of proteinuria by dipstick was high, with an 18% false-positive rate and a false-negative rate approaching 40% for samples with 30 mg/dl. Even in the presence of 100 mg/dl the false-negative rate was 7%, whereas the concentration of protein was significantly underestimated in 20% of samples with 500 mg/dl. CONCLUSION: Dipstick urinalysis cannot be relied on either to detect or to exclude the presence of proteinuria in pregnant women.

Predictors of the risk of development of acquired immunodeficiency syndrome within 24 months among gay men seropositive for human immunodeficiency virus type 1: a report from the Multicenter AIDS Cohort Study.

The natural history of infection with human immunodeficiency virus type 1 (HIV-1) is characterized by a relentless decline in CD4-positive lymphocytes and the ultimate development of acquired immunodeficiency syndrome (AIDS). However, variables other than the CD4-positive lymphocyte level contribute to the measurement of risk for AIDS and can be used as predictors of AIDS onset. This study was undertaken to identify factors that, independently of the CD4-positive lymphocyte level, would predict the risk of AIDS over 24 months in a cohort of HIV-1 seropositive homosexual men receiving no antiretroviral therapy. Demographic, clinical, and laboratory data from 1,325 white, HIV-1 seropositive participants in the Multicenter AIDS Cohort Study who have been studied for 4 years were analyzed with univariate and multivariate methods. To control for stage of infection, the baseline percentage of CD4-positive lymphocytes (a known marker of disease progression), and the decline of CD4-positive cells during the first 6 months of observation were used as continuous variables. The variables that were independently associated with an increased risk of developing AIDS were: low baseline CD4 percentage, decline in the CD4 percentage during the first 6 months of follow-up, the presence of serum immunoglobulin A at baseline, decrease in hemoglobin during the first 6 months of follow-up, incident fatigue, and the interaction of decline in the CD4 percentage and incident thrush. While low CD4 percentage and other variables have been previously described as prognostic markers, decline in the CD4 percentage and the interaction of that decline and incident thrush have not previously been described as being of prognostic importance. These variables and the analytic method for estimating prognosis may prove useful for selecting and evaluating antiretroviral therapy, instituting prophylactic measures against certain opportunistic infections, and recruitment into clinical trials. Because study participants received no antiretroviral prophylaxis during the period under analysis, the method could be used to estimate the prognosis for those receiving investigational treatment were they to remain untreated, effectively making any participant in a clinical trial his own untreated control.

Zidovudine use in AIDS-free HIV-1-seropositive homosexual men in the Multicenter AIDS Cohort Study (MACS), 1987-1989.

Zidovudine use data were examined in the Multicenter AIDS Cohort Study to determine (i) if the proportion of pre-AIDS participants (i.e., CD4+ cells less than 200/mm3 or AIDS-related complex) taking zidovudine is high enough to explain a slower than expected rise in AIDS incidence in U.S. homosexual men since mid-1987; (ii) which factors are associated with starting zidovudine and clinical trials of zidovudine; and (iii) if pre-AIDS patients, as a group, are being undertreated. Data on zidovudine use, clinical trial participation, and sociodemographic, clinical, and hematologic variables were collected every 6 months from 1,195 AIDS-free HIV-1-seropositive homosexual men from April 1987 to September 1989. Overall prevalence of zidovudine use rose from 3.6% in mid-1987 (visit 7) to 23% in mid-1989 (visit 11). Of those with less than 200 CD4+ lymphocytes/mm3, the prevalence of zidovudine use rose from 23% (24% if those taking zidovudine or placebo as part of a clinical trial are included) at visit 7 to 58% (69%) at visit 11. Of those with ARC, 20% (23%) were using zidovudine at visit 7 and 55% (65%) at visit 11. Although numbers were small, the advanced ARC participants (CD4+ cells less than 200/mm3 and two or more symptoms) reported the highest treatment rates (50, 78, 80, 60, and 74% at visits 7-11, respectively). By September 1989, 42% (31%) of those with CD4+ lymphocyte levels less than 200/mm3 were still not receiving zidovudine, suggesting that many high-risk, pre-AIDS individuals are being undertreated. To explore this finding further, we examined a range of sociodemographic, hematologic, and clinical variables to determine which factors best predicted initiation of zidovudine therapy outside of clinical trials. In multivariate analyses, CD4+ lymphocyte number was the most consistent predictor of initiation of therapy over all four study visits. For each 100 cells/mm3 deficit, the odds ratios were 2.3 (95% C.I. of 1.7-3.1) at visit 7 and 1.7% (95% C.I. of 1.4-2.0) at visit 11. Symptom status and education level were also associated with starting zidovudine, but not at all visits. The relatively low predictive power of the clinical variables raises and the possibility that nonclinical factors not measured in the MACS (drug cost, third-party insurance restrictions, and individual preferences) may play an important role in predicting zidovudine use. Finally, comparisons were made between seropositive participants starting clinical trials of zidovudine and the rest of the study population. No important differences were found in demographic or major clinical variables between clinical trial participants and zidovudine nonusers in this study.