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1.
Glob Chang Biol ; 30(5): e17334, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38780465

RESUMO

The crises of climate change and biodiversity loss are interlinked and must be addressed jointly. A proposed solution for reducing reliance on fossil fuels, and thus mitigating climate change, is the transition from conventional combustion-engine to electric vehicles. This transition currently requires additional mineral resources, such as nickel and cobalt used in car batteries, presently obtained from land-based mines. Most options to meet this demand are associated with some biodiversity loss. One proposal is to mine the deep seabed, a vast, relatively pristine and mostly unexplored region of our planet. Few comparisons of environmental impacts of solely expanding land-based mining versus extending mining to the deep seabed for the additional resources exist and for biodiversity only qualitative. Here, we present a framework that facilitates a holistic comparison of relative ecosystem impacts by mining, using empirical data from relevant environmental metrics. This framework (Environmental Impact Wheel) includes a suite of physicochemical and biological components, rather than a few selected metrics, surrogates, or proxies. It is modified from the "recovery wheel" presented in the International Standards for the Practice of Ecological Restoration to address impacts rather than recovery. The wheel includes six attributes (physical condition, community composition, structural diversity, ecosystem function, external exchanges and absence of threats). Each has 3-5 sub attributes, in turn measured with several indicators. The framework includes five steps: (1) identifying geographic scope; (2) identifying relevant spatiotemporal scales; (3) selecting relevant indicators for each sub-attribute; (4) aggregating changes in indicators to scores; and (5) generating Environmental Impact Wheels for targeted comparisons. To move forward comparisons of land-based with deep seabed mining, thresholds of the indicators that reflect the range in severity of environmental impacts are needed. Indicators should be based on clearly articulated environmental goals, with objectives and targets that are specific, measurable, achievable, relevant, and time bound.


Assuntos
Mineração , Biodiversidade , Ecossistema , Meio Ambiente , Conservação dos Recursos Naturais , Mudança Climática
3.
Meat Sci ; 193: 108923, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36063774

RESUMO

Carcass value is a complex relationship with varying contributions between eating quality (MSA Index) and lean cut yield (LCY%). Bone-out data from 112 Bos taurus steer carcasses, grain finished for 100 days with a hormonal growth promotant were analyzed. Carcass values were calculated using 1) flat cut prices, 2) cut prices weighted for MSA grades, and 3) cut prices weighted for MSA grades for four high value primals. To extend the range in eating quality, analyses were re-run assuming no HGP implants. When all cuts were valued according to eating quality grade, the impact of the MSA Index and LCY% varied in their importance in determining carcass value. However, if only four high value cuts were harvested, carcass value was largely a function of LCY%. The importance of eating quality and carcass yield in determining carcass value was dependent upon the type of cattle, the cuts being harvested and the grade premiums/discounts realized.


Assuntos
Composição Corporal , Carne , Animais , Bovinos
4.
J Bone Joint Surg Am ; 103(17): 1620-1627, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-33848100

RESUMO

BACKGROUND: Improved knowledge of in vivo function of the collateral ligaments is essential for enhancing rehabilitation and guiding surgical reconstruction as well as soft-tissue balancing in total knee arthroplasty. The aim of this study was to quantify in vivo elongation patterns of the collateral ligaments throughout complete cycles of functional activities. METHODS: Knee kinematics were measured using radiographic images captured with a mobile fluoroscope while healthy subjects performed level walking, downhill walking, and stair descent. The registered in vivo tibiofemoral kinematics were then used to drive subject-specific multibody knee models to track collateral ligament elongation. RESULTS: The elongation patterns of the medial collateral ligament varied distinctly among its bundles, ranging from lengthening of the anterior fibers to shortening of the posterior bundle with increases in the knee flexion angle. The elongation patterns of the lateral collateral ligament varied considerably among subjects. It showed an average 4% shortening with increasing flexion until 60% to 70% of the gait cycle, and then recovered during the terminal-swing phase until reaching its reference length (defined at heel strike). CONCLUSIONS: The observed nonuniform elongation of the medial collateral ligament bundles suggests that single-bundle reconstruction techniques may not fully restore healthy ligament function. Moreover, the observed ligament elongation patterns indicate greater varus than valgus laxity in the loaded knee. CLINICAL RELEVANCE: Through providing key knowledge about the in vivo elongation patterns of the collateral ligaments throughout complete cycles of functional activities, this study offers in vivo evidence for benchmarking ligament reconstruction and soft-tissue balancing in total knee arthroplasty.


Assuntos
Artroplastia do Joelho/reabilitação , Ligamentos Colaterais/fisiologia , Articulação do Joelho/fisiologia , Benchmarking , Fenômenos Biomecânicos , Feminino , Humanos , Masculino , Adulto Jovem
6.
Clin Radiol ; 76(5): 333-341, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33461746

RESUMO

AIM: To establish the diagnostic accuracy of the Liver Imaging Reporting and Data System (LI-RADS) for hepatocellular carcinoma (HCC) and compare its performance to that of international criteria from European Assofor the Study of the Liver (EASL), Japan Society of Hepatology (JSH), Asian Pacific Association for the Study of the Liver (APASL), and Organ Procurement and Transplantation Network (OPTN), and to the reporting radiologist's overall opinion regarding the probability of a nodule being a HCC by correlating with a histological diagnosis from whole liver explants. MATERIALS AND METHODS: The present single-centre, retrospective review selected participants based on the following criteria: adults (≥18 years) listed for liver transplantation in 2014/2015, with liver cirrhosis at the time of magnetic resonance imaging (MRI) with hepatocyte specific contrast agent, and at least one liver lesion ≥10 mm on MRI with histology from subsequent liver explant for comparison. Each lesion was assessed against international criteria and given a "radiologist opinion" score of 1-5 (1 = definitely benign, 5 = definitely HCC). RESULTS: Total 268 patient records were reviewed, with 105 eligible lesions identified from 47 patients. Median lesion size was 15.5 mm (range 10-68 mm). Sensitivity (%), specificity (%), and positive predictive value (PPV; %) for LI-RADS LR5 was 45, 89, and 89, for LI-RADS LR4+5 + TIV was 61, 80, and 86, for EASL was 44, 86 and 86, for JSH/APASL was 64, 81, and 87, for OPTN was 36, 90, and 88, and for "radiologist impression" of probably or definitely HCC was 79, 79, and 88 respectively. CONCLUSIONS: MRI has moderate sensitivity and good specificity for the diagnosis of HCC with considerable variation depending on criteria used. OPTN criteria have the best specificity, but low sensitivity. "Radiologist opinion" gives highest overall accuracy with increases in sensitivity and reduction in specificity when compared to the imaging criteria.


Assuntos
Carcinoma Hepatocelular/diagnóstico por imagem , Gadolínio DTPA , Aumento da Imagem/métodos , Cirrose Hepática/complicações , Neoplasias Hepáticas/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Sistemas de Informação em Radiologia , Adulto , Idoso , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/patologia , Meios de Contraste , Feminino , Humanos , Fígado/diagnóstico por imagem , Fígado/patologia , Cirrose Hepática/patologia , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade
8.
Ann Biomed Eng ; 48(4): 1396-1406, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31974870

RESUMO

This study aimed to quantify the elongation patterns of the collateral ligaments following TKA during functional activities of daily living. Using mobile video-fluoroscopy to capture radiographic images of the knee in a group of six patients, each with an ultra-congruent knee implant, tibiofemoral kinematics were reconstructed throughout complete cycles of level gait, downhill walking, stair descent, and squat activities. Kinematic data were then used to drive subject-specific multibody knee models to estimate length-change patterns of the LCL as well as three bundles of the MCL. In addition, a sensitivity analysis examined the role of the attachment site in the elongation patterns. Our data indicate a slackening of the LCL but non-uniform length-change patterns across the MCL bundles (ranging from lengthening of the anterior fibers to shortening of the posterior fibers) with increasing knee flexion angle. Near-isometric behavior of the intermediate fibers was observed throughout the entire cycle of the studied activities. These length-change patterns were found to be largely consistent across different activities. Importantly, length-change patterns were critically sensitive to the location of the femoral attachment points relative to the femoral component. Thus, in TKA with ultra-congruent implants, implantation of the femoral component may critically govern post-operative ligament function.


Assuntos
Atividades Cotidianas , Artroplastia do Joelho , Ligamentos Colaterais/fisiologia , Idoso , Fenômenos Biomecânicos , Fêmur/fisiologia , Humanos , Joelho/diagnóstico por imagem , Joelho/fisiologia , Prótese do Joelho , Pessoa de Meia-Idade , Movimento/fisiologia , Tíbia/fisiologia
9.
J Dev Orig Health Dis ; 11(2): 168-187, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31204632

RESUMO

In lifecourse studies that encompass the adolescent period, the assessment of pubertal status is important, but can be challenging. We aimed to identify current methods for pubertal assessment and assess their appropriateness for population-based research by combining a review of the literature with the views of experts in the field. We searched bibliographic databases, extracted data and assessed study quality to inform a workshop with 21 experts. Acceptability of different approaches was explored with a panel of ten adolescents. We screened 11,935 abstracts, assessed 157 articles and summarised results from 38 articles. Combining these with the opinions of experts, self-assessment was found to be a practical method for use in studies where agreement with the gold standard of clinical assessment by physical examination to within one Tanner stage was acceptable. Serial measures of height and foot size accurately indicated timing of the pubertal growth spurt and age at peak height velocity, and were seen as feasible within longitudinal studies. Hormonal and radiological methods did not offer a practical means of assessing pubertal status. Assessment of voice maturation was promising, but needed validation. Young people thought that self-assessment, foot size and voice assessments were acceptable, and preferred an assessor of the same sex for clinical assessment. This review thus informs researchers working in lifecourse and adolescent health, and identifies future directions in order to improve validity of the methods.


Assuntos
Desenvolvimento do Adolescente/fisiologia , Prova Pericial , Puberdade Tardia/diagnóstico , Puberdade Precoce/diagnóstico , Puberdade/fisiologia , Adolescente , Saúde do Adolescente , Autoavaliação Diagnóstica , Humanos , Puberdade/psicologia , Puberdade Tardia/fisiopatologia , Puberdade Precoce/fisiopatologia
10.
Epidemiol Infect ; 147: e300, 2019 11 12.
Artigo em Inglês | MEDLINE | ID: mdl-31711553

RESUMO

An outbreak of 18 cases of hepatitis A virus infection across five Canadian provinces was investigated. Case onsets occurred between October 2017 and May 2018. A retrospective matched case-control study was conducted to identify the likely source of the outbreak. Three matched controls were recruited for each case using a previously established control bank, supplemented by landline and cell phone call lists. Univariate and multivariate matched analyses were conducted to identify a potential outbreak source. Seventy-two per cent of controls were recruited through the control bank, and required on average 25.5 calls per recruited control; 20% of controls were recruited through a landline sample and 8% of controls were recruited through a cell phone sample, requiring an average of 847.3 and 331.7 calls per recruited control, respectively. Results of the analysis pointed to shrimp/prawns (odds ratio (OR) 15.75, p = 0.01) and blackberries (OR 7.21, p = 0.02) as foods of interest, however, an outbreak source could not be confirmed. The control bank proved to be a more efficient method for control recruitment than random call lists. Expanding the control bank size and using alternative methods, such as online surveys, may prove beneficial for increasing the timeliness of a case-control study during an outbreak investigation.


Assuntos
Surtos de Doenças , Hepatite A/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Canadá/epidemiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Microbiologia de Alimentos , Hepatite A/transmissão , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
11.
J Evol Biol ; 31(4): 516-529, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29322640

RESUMO

Much of the variation among insects is derived from the different ways that chitin has been moulded to form rigid structures, both internal and external. In this study, we identify a highly conserved expression pattern in an insect-only gene family, the Osiris genes, that is essential for development, but also plays a significant role in phenotypic plasticity and in immunity/toxicity responses. The majority of Osiris genes exist in a highly syntenic cluster, and the cluster itself appears to have arisen very early in the evolution of insects. We used developmental gene expression in the fruit fly, Drosophila melanogaster, the bumble bee, Bombus terrestris, the harvester ant, Pogonomyrmex barbatus, and the wood ant, Formica exsecta, to compare patterns of Osiris gene expression both during development and between alternate caste phenotypes in the polymorphic social insects. Developmental gene expression of Osiris genes is highly conserved across species and correlated with gene location and evolutionary history. The social insect castes are highly divergent in pupal Osiris gene expression. Sets of co-expressed genes that include Osiris genes are enriched in gene ontology terms related to chitin/cuticle and peptidase activity. Osiris genes are essential for cuticle formation in both embryos and pupae, and genes co-expressed with Osiris genes affect wing development. Additionally, Osiris genes and those co-expressed seem to play a conserved role in insect toxicology defences and digestion. Given their role in development, plasticity, and protection, we propose that the Osiris genes play a central role in insect adaptive evolution.


Assuntos
Regulação da Expressão Gênica no Desenvolvimento , Genes de Insetos , Himenópteros/fisiologia , Família Multigênica , Exoesqueleto/metabolismo , Animais , Drosophila melanogaster , Feminino , Masculino , Filogenia
12.
Mar Genomics ; 37: 1-17, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28970064

RESUMO

The biodiversity, ecosystem services and climate variability of the Antarctic continent and the Southern Ocean are major components of the whole Earth system. Antarctic ecosystems are driven more strongly by the physical environment than many other marine and terrestrial ecosystems. As a consequence, to understand ecological functioning, cross-disciplinary studies are especially important in Antarctic research. The conceptual study presented here is based on a workshop initiated by the Research Programme Antarctic Thresholds - Ecosystem Resilience and Adaptation of the Scientific Committee on Antarctic Research, which focussed on challenges in identifying and applying cross-disciplinary approaches in the Antarctic. Novel ideas and first steps in their implementation were clustered into eight themes. These ranged from scale problems, through risk maps, and organism/ecosystem responses to multiple environmental changes and evolutionary processes. Scaling models and data across different spatial and temporal scales were identified as an overarching challenge. Approaches to bridge gaps in Antarctic research programmes included multi-disciplinary monitoring, linking biomolecular findings and simulated physical environments, as well as integrative ecological modelling. The results of advanced cross-disciplinary approaches can contribute significantly to our knowledge of Antarctic and global ecosystem functioning, the consequences of climate change, and to global assessments that ultimately benefit humankind.


Assuntos
Organismos Aquáticos/fisiologia , Ecossistema , Pesquisa Interdisciplinar , Regiões Antárticas , Biodiversidade , Mudança Climática , Congressos como Assunto , Ecologia , Genômica
13.
J Child Orthop ; 11(6): 472-478, 2017 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-29263761

RESUMO

PURPOSE: The distal femoral extension osteotomy (DFEO) is often used in the treatment of crouch gait to help compensate for knee flexion contractures. The effects of DFEO on skeletal and muscle lengths are incompletely understood, but are important to consider in planning concomitant surgeries such as patellar tendon advancement (PTA). Therefore, the purpose of this study was to quantify the changes in femur, quadriceps, and hamstring lengths with DFEO, and to determine the sensitivity to surgical factors such as wedge location and magnitude. METHODS: A musculoskeletal model with six degrees of freedom tibiofemoral and patellofemoral joints was used for analysis. A wedge was removed from the distal femur and the remaining bone segments were plated together to simulate the DFEO. After simulating the knee's post-operative equilibrium, the surgically-induced changes in muscle and bone lengths were analysed. RESULTS: Relative to the pre-operative state, DFEO stretches the hamstrings while shortening the femur and quadriceps. A more posterior wedge apex location (i.e. creation of a cuneiform wedge) diminished the stretch of the hamstrings, but induced greater shortening of the femur and quadriceps. More proximal wedge locations necessitated greater translation of the distal fragment to maintain the knee joint axis. CONCLUSION: Reduced quadriceps length after DFEO shown in this study is consistent with the need for simultaneous PTA. The induced hamstring stretch also may represent a potential mechanism for post-operative nerve palsies. Overall, the numerical results provide a firmer basis for planning the specifics of DFEO such that desired muscle lengths and joint alignment are achieved.

14.
J Anim Sci ; 95(3): 1396-1406, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28380506

RESUMO

Ammonium urate nephrolithiasis frequently develops in common bottlenose dolphins () managed under human care but is rare in free-ranging common bottlenose dolphins. In other species, the dietary cation-anion difference (DCAD) can affect ammonium urate urolith formation by increasing proton excretion as ammonium ions. Therefore, differences in diet between the 2 dolphin populations could affect urolith formation, but the DCAD of most species consumed by free-ranging and managed dolphins is unknown. To compare the nutrient composition of diets consumed by free-ranging and managed bottlenose dolphins, samples ( = 5) of the 8 species of fish commonly consumed by free-ranging bottlenose dolphins in Sarasota Bay, FL, and the 7 species of fish and squid commonly fed to managed bottlenose dolphins were analyzed for nutrient content. Metabolizable energy was calculated using Atwater factors; the DCAD was calculated using 4 equations commonly used in people and animals that use different absorption coefficients. The nutrient composition of individual species was used to predict the DCAD of 2 model diets typically fed to managed common bottlenose dolphins and a model diet typically consumed by common bottlenose dolphins in Sarasota Bay. To mimic differences in postmortem handling of fish for the 2 populations of bottlenose dolphins, "free-ranging" samples were immediately frozen at -80°C and minimally thawed before analysis, whereas "managed" samples were frozen for 6 to 9 mo at -18°C and completely thawed. "Free-ranging" species contained more Ca and P and less Na and Cl than "managed" fish and squid species. As a consequence, the DCAD of both model managed dolphin diets obtained using 3 of the 4 equations was much more negative than the DCAD of the model free-ranging bottlenose dolphin diet ( < 0.05). The results imply that managed bottlenose dolphins must excrete more protons in urine than free-ranging bottlenose dolphins, which will promote nephrolith formation. The nutrient composition of the free-ranging bottlenose dolphin diet, determined for the first time here, can be used as a guide for feeding managed bottlenose dolphins, but research in vivo is warranted to determine whether adding more cations to the diet will prevent urolith formation in managed dolphins.


Assuntos
Compostos de Amônio/urina , Ânions/metabolismo , Golfinho Nariz-de-Garrafa/fisiologia , Cátions/metabolismo , Nefrolitíase/veterinária , Ácido Úrico/urina , Ração Animal/análise , Fenômenos Fisiológicos da Nutrição Animal , Animais , Animais Selvagens , Animais de Zoológico , Dieta/veterinária , Metabolismo Energético , Feminino , Peixes , Humanos , Masculino , Nefrolitíase/urina
16.
Appl Phys B ; 123(8): 225, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-32025104

RESUMO

The use of an Yb:YAG thin-slab architecture for amplification of a radially polarised beam at 1030 nm is investigated and shown to be a promising route for power scaling. The detrimental impact of the Gouy phase shift on radial polarisation purity is considered and a simple scheme for effective phase shift management to restore polarisation purity is presented. Preliminary experiments based on a double-pass amplifier configuration yielded an output beam with a high radial polarisation extinction ratio of 15 dB and no degradation in polarisation purity despite the non- axial symmetry of amplifier gain medium. At 50 W of launched pump power a small-signal gain of 7.5 dB was obtained for a 25 mW input, whilst 4.4 dB gain was obtained for a 1.45 W input. The prospects for further power scaling are discussed.

17.
J Chromatogr Sep Tech ; 7(5)2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27904786

RESUMO

Bottlenose dolphins managed under human care, human beings and Dalmatian dogs are prone to forming urate uroliths. Limiting dietary purine intake limits urate urolith formation in people and dogs because purines are metabolized to uric acid, which is excreted in urine. Managed dolphins develop ammonium urate nephroliths, whereas free-ranging dolphins do not. Free-ranging dolphins consume live fish, whereas managed dolphins consume different species that have been stored frozen and thawed. Differences in the purine content of fish consumed by dolphins under human care versus in the wild may be responsible for the difference in urolith prevalence. Commercially available purine assays measure only four purines, but reported changes in purines during frozen storage suggest that a wider range of metabolites should be measured when comparing fresh and stored fish. A method using high performance liquid chromatography with tandem mass spectrometry was developed to quantify eight purine metabolites in whole fish and squid commonly consumed by dolphins. The coefficient of variation within and among days was sometimes high for purines present in small amounts but was acceptable (≤ 25%) for guanine, hypoxanthine, and inosine, which were present in high concentrations. This expanded assay identified a total purine content up to 2.5 times greater than the total that would be quantified if only four purines were measured. Assuming additional purines are absorbed, these results suggest that additional purine metabolites should be measured to better understand the associated risk when fish or other purine-rich foods are consumed by people or animals prone to developing uroliths.

18.
Acta Neurol Scand ; 134(4): 271-6, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26626018

RESUMO

BACKGROUND: Parkin related Parkinson's disease (PD) is differentiated from idiopathic PD by absent or sparse Lewy bodies, and preserved olfaction. The significance of single Parkin mutations in the pathogenesis of PD is debated. OBJECTIVES: To assess olfaction results according to Parkin mutation status. To compare the prevalence of Parkin single heterozygous mutations in patients diagnosed with PD to the rate in healthy controls in order to establish whether these single mutations could be a risk factor for developing PD. METHODS: Parkin gene mutation testing was performed in young onset PD (diagnosed <50 years old) to identify three groups: Parkin homozygous or compound heterozygote mutation carriers, Parkin single heterozygote mutation carriers, and non-carriers of Parkin mutations. Olfaction was tested using the 40-item British version of the University of Pennsylvania smell identification test (UPSIT). RESULTS: Of 344 young onset PD cases tested, 8 (2.3%) were Parkin compound heterozygotes and 13 (3.8%) were Parkin single heterozygotes. Olfaction results were available in 282 cases (eight compound heterozygotes, nine single heterozygotes, and 265 non-carriers). In Parkin compound heterozygotes, the median UPSIT score was 33, interquartile range (IQR) 28.5-36.5, which was significantly better than in single Parkin heterozygotes (median 19, IQR 18-28) and non-carriers (median score 22, IQR 16-28) (ANOVA P < 0.001). These differences persisted after adjusting for age, disease duration, gender, and smoking (P < 0.001). There was no significant difference in UPSIT scores between single heterozygotes and non-carriers (P = 0.90). CONCLUSIONS: Patients with Parkin compound heterozygous mutations have relatively preserved olfaction compared to Parkin single heterozygotes and non-carriers. The prevalence of Parkin single heterozygosity is similar to the 3.7% rate reported in healthy controls.


Assuntos
Doença de Parkinson/genética , Doença de Parkinson/psicologia , Olfato/genética , Ubiquitina-Proteína Ligases/genética , Adulto , Idade de Início , Idoso , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/genética , Estudos de Coortes , DNA/genética , Feminino , Frequência do Gene , Genótipo , Heterozigoto , Humanos , Masculino , Pessoa de Meia-Idade , Mutação/genética , Testes Neuropsicológicos , Doença de Parkinson/epidemiologia , Prevalência
19.
Can Commun Dis Rep ; 42(2): 37-44, 2016 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-29770002

RESUMO

BACKGROUND: Among individuals with genital herpes simplex virus (HSV), co-infection with human immunodeficiency virus (HIV) has been shown to increase the frequency and severity of HSV symptoms, HSV shedding, and risk of HSV transmission. OBJECTIVE: To assess whether suppressive antivirual therapy for genital HSV in an HIV-positive populatation prevents HSV transmission to a susceptible partner. METHODS: A systematic search of the literature was conducted using MEDLINE and EMBASE databases to identify randomized controlled trials published between January 2005 and June 2015. Inclusion criteria were trials written in English or French utilizing suppressive antiviral therapies for HSV. Studies had to report on outcomes related to HSV transmission from HIV-positive populations. Surrogate markers of HSV transmission risk, such as HSV detection and viral load, were also included. Articles underwent a risk of bias assessment, and those with low risk of bias underwent data extraction to complete a narrative synthesis. RESULTS: This review identified thirteen papers. Only one study directly measured transmission of HSV. The overall transmission rate was <10%, and suppressive antiviral therapy had no significant protective effect (9% transmission rate in the acyclovir group vs. 6% in the placebo group; hazard ratio [HR]: 1.35, 95% CI: 0.83-2.20). The remaining 12 papers addressed surrogate markers of transmission risk: HSV detection and viral load. Suppressive acyclovir appears to be effective in reducing HSV detection among HIV-positive populations, but it does not appear to reduce viral load. Suppressive valacyclovir may be effective in reducing HSV detection and viral load among HIV-positive patients who are antiretroviral therapy (ART)-naïve, but its effect appears to be nullified among those concurrently on ART. CONCLUSION: Based on current evidence, suppressive antiviral therapy may reduce HSV detection and viral load, but its impact on HSV transmission is unclear. Clinicians should caution HIV-positive patients with HSV that suppressive therapy may not reduce risk of HSV transmission to susceptible partners.

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