NOVEL SIMPLEXVIRUS (SIMPLEXVIRUS DOLICHOTINEALPHA1) ASSOCIATED WITH FATALITY IN FOUR PATAGONIAN MARA (DOLICHOTIS PATAGONUM).

Four of seven Patagonian maras (Dolichotis patagonum) at a zoological institution developed acute neurologic signs that progressed to tetraparesis and death. All affected were young adult females (10 mon-5 yr old) that presented over 11 d. Clinical signs were rapidly progressive and unresponsive to supportive therapies. Two of the four individuals were found deceased 4 d after hospitalization. Two individuals were euthanized due to poor prognosis and decline after 6 and 8 d, respectively. Simultaneously, an additional mara developed mild and self-resolving clinical signs, including a kyphotic gait and paraparesis. On gross examination, there were widespread petechiae and ecchymoses of the skeletal muscle, myocardium, skin, pericardium, urinary bladder mucosa, and spinal cord. On histopathology, all animals had necrotizing myelitis and rhombencephalitis, with intranuclear viral inclusions in three individuals. Electron microscopy confirmed herpesviral replication and assembly complexes in neurons and oligodendrocytes. Consensus PCR performed on spinal cord, brainstem, or cerebellum revealed a novel Simplexvirus most closely related to Simplexvirus leporidalpha 4. The virus was amplified and sequenced and is referred to as Simplexvirus dolichotinealpha1. It is unknown whether this virus is endemic in Patagonian mara or whether it represents an aberrant host species. Clinicians should be aware of this virus and its potential to cause severe, rapidly progressive, life-threatening disease in this species.

MAMMARY GLAND ADENOCARCINOMA IN FOUR INDIAN CRESTED PORCUPINES (HYSTRIX INDICA).

Neoplasia in porcupines is rarely reported in the literature, and the prevalence is unknown. A retrospective review of records from a private zoo diagnostic pathology service found four cases of mammary adenocarcinoma in Indian crested porcupines (Hystrix indica) from four separate zoological institutions. All cases presented in geriatric females (14-19 yr of age) as freely movable subcutaneous masses within the mammary chain. None of the individuals had additional clinical signs, radiographic, or hematologic changes at initial presentation. All cases were managed with surgical excision in the form of either an excisional biopsy or a partial mastectomy. Histologic examination diagnosed all tumors with anaplasia and moderate to high numbers of mitotic figures. Two cases required subsequent surgeries for management of local recurrence in the years following initial diagnosis. One case is 19 months postsurgical removal without evidence of metastasis or local recurrence. Two of the cases were euthanized after diagnosis of inoperable metastases to the lungs and spinal cord, including one previously treated with an oral nonsteroidal antiestrogen medication, tamoxifen. The third case was euthanized due to degenerative mobility changes and renal dysfunction and had no evidence of metastasis. The average survival time from initial surgical excision to euthanasia for the three applicable cases was 33 months. These cases suggest that surgical excision alone may result in temporary management of mammary adenocarcinoma in this species. Metastasis can occur, and routine screening with advanced imaging may aid in early detection of these lesions.

RETROSPECTIVE ANALYSIS OF MORTALITY CAUSES IN MANAGED KIRK'S DIK-DIKS (MADOQUA KIRKII) IN NORTH AMERICA FROM 1988 to 2019.

Kirk's dik-diks (Madoqua kirkii) are the most common dik-dik species managed in North American zoological institutions, but their numbers are declining at a concerning rate, with less than 40 individuals currently housed in accredited institutions. This retrospective study reports the causes of mortality in Kirk's dik-diks in North American zoological institutions from 1988 to 2019. Out of 15 institutions accredited by the Association of Zoos and Aquariums (AZA) currently housing Kirk's dik-diks, nine contributed to this study (60% participation). Eighty-four necropsy records were reviewed to determine the primary affected body system and etiological cause of death across and within age categories. Neonatal death (prior to 1 mon of age) was most common (38.1%), followed by death in adults (29.8%), geriatric animals (19.0%), and juveniles (13.1%). As a whole population, causes of death by body system were multisystemic (47.6%), musculoskeletal (15.5%), respiratory (8.3%), and digestive (8.3%). Neonatal complications accounted for 50.0% of all deaths in animals prior to 1 mon of age. In juveniles, a nutritional cause of death was most common (27.3%) and significantly higher compared to measures of this cause within other age categories. In adults, metabolic etiologies and trauma each accounted for 28.0% of deaths. Degenerative etiologies were most common in geriatric individuals, representing 31.3% of the deaths. Death from infectious disease was found across all ages, representing 11.9% of all mortalities. Results from this study provide a baseline reference for this species and may aid clinicians in decision-making as it relates to the medical care and management of this species during different life stages.

USE OF A HUMAN INDIRECT IMMUNOFLUORESCENCE ANTIBODY ASSAY FOR BALAMUTHIA MANDRILLARIS IN A GROUP OF CAPTIVE NORTHWEST BORNEAN ORANGUTANS (PONGO PYGMAEUS PYGMAEUS).

Granulomatous amoebic encephalitis caused by the free-living amoeba Balamuthia mandrillaris is a highly fatal disease that was first isolated from a mandrill (Mandrillus sphinx), and has since been diagnosed in several nonhuman primates including orangutans. Indirect immunofluorescence antibody (IFA) techniques for Balamuthia have been used in the fields of human medicine and epidemiology both for exposure assessment and screening of clinical patients for antemortem diagnosis. Stored serum samples from five captive Northwest Bornean orangutans (Pongo pygmaeus pygmaeus), including one who had died from B. mandrillaris infection, housed at a single facility were screened with a human IFA assay for B. mandrillaris. Only the single, clinically affected individual was seropositive, and the results suggest that the use of the available human B. mandrillaris IFA assay is a novel diagnostic option for detection of Balamuthia antibodies in this species. A validated screening serological test could be used in individuals exhibiting signs consistent with granulomatous amoebic encephalitis to facilitate earlier antemortem diagnosis of Balamuthia infection, which is critical if treatment is to be pursued. This pilot study presents the use of serological detection methods for B. mandrillaris screening in a nonhuman primate. Subsequent use of the B. mandrillaris IFA assay in the larger captive population should be pursued for validation of the test and to provide further information on seroprevalence and evaluation of risk factors for exposure to Balamuthia and subsequent development of disease.

STREPTOCOCCUS EQUI SSP. ZOOEPIDEMICUS MENINGOENCEPHALOMYELITIS IN A SOUTHERN TAMANDUA (TAMANDUA TETRADACTYLA) ASSOCIATED WITH A RAW HORSEMEAT DIET.

A 1-y-old female southern tamandua (Tamandua tetradactyla) presented with vomiting, hyporexia, and neurologic signs. Magnetic resonance imaging revealed contrast-enhancing material within the lateral and fourth ventricles and a T2 hyperintense cerebellar lesion, consistent with meningoencephalitis. The tamandua rapidly declined and was euthanatized. On gross postmortem exam, the tamandua had diffusely injected leptomeninges, opaque fluid in the fourth ventricle, and subdural brainstem and spinal cord hemorrhage. Histologically, there was regionally hemorrhagic and multifocal fibrinosuppurative meningoencephalomyelitis, ventriculitis, choroid plexitis, cerebellar folia necrosis, ependymitis, radiculoneuritis, and abundant intralesional gram-positive cocci. Streptococcus equi ssp. zooepidemicus was cultured from brain, cardiac blood clot, and multiple samples of horsemeat collected from the animal's diet. This is the first report of streptococcal meningoencephalomyelitis in a southern tamandua. The route of infection was likely gastrointestinal inoculation, which may have implications for the routine practice of feeding diets containing raw meat to insectivores.

PILOT STUDY: PHARMACOKINETICS OF ORAL AND TOPICAL MOXIDECTIN IN THE RETICULATED GIRAFFE (GIRAFFA CAMELOPARDALIS).

The objective of this study was to obtain an estimate of the pharmacokinetic parameters of moxidectin administered at a dosage of 1 mg/kg orally and topically to healthy adult giraffe ( Giraffa camelopardalis ). The maximum plasma concentration (CMAX) of moxidectin after oral and topical administration was 69.2 ± 4.6 and 18.6 ± 16.1 ng/ml (P = 0.045), respectively. The areas under the plasma curve (AUC), a measure of total drug exposure, was 532.0 ± 232.3 and 209.1 ± 180.0 day*ng/ml (P = 0.308) for the oral and topical administrations, respectively. These data suggest moxidectin achieves higher peak plasma concentrations following oral administration compared with topical (transdermal) administration using the cattle pour-on formulation. Additionally, the percent coefficient of variation, a measure of variability, was smaller for the oral formulation (CMAX %CV = 7%; AUC %CV = 44%) compared with the topical formulation (CMAX %CV = 86%; AUC %CV = 86%). The smaller variability suggests that oral administration of moxidectin produces more predictable and less variable drug absorption than topical administration in giraffe and is the preferred route of administration.

USE OF COMPUTED TOMOGRAPHY FOR INVESTIGATION OF RHINITIS AND SINUSITIS IN A GREATER RHEA (RHEA AMERICANA).

Sinusitis is a common finding in avian species; however, it presents unique treatment challenges in ratites. A 6-yr-old male greater rhea ( Rhea americana ) presented acutely with right infraorbital sinus swelling and chemosis. Oral antibiotics were prescribed based on bacterial culture results with incomplete resolution of clinical signs. A computed tomography scan of the skull demonstrated a mixed-density soft tissue mass with extensive destruction of the right nasal bone, hard palate, maxilla, and frontal bone. The affected tissue was surgically resected and histopathology was consistent with inspissated necrotic tissue. Aerobic culture of the mass grew a multidrug-resistant Escherichia coli and was treated with amikacin. Ten months postsurgery, no further clinical signs were observed. Advanced diagnostic imaging with computed tomography and surgical therapy facilitated complete resolution of this resistant bacterial sinusitis in a species that is not typically amenable to frequent handling and restraint.

Use of urinary biomarkers of ovarian function and altrenogest supplementation to enhance captive breeding success in the Indian rhinoceros (Rhinoceros unicornis).

Urinary hormone analysis was conducted on two adult female Indian rhinoceroses (Rhinoceros unicornis) that exhibited minimal or no estrual behaviors traditionally used to time breeding. Urine was collected throughout two consecutive estrous cycles to establish preliminary data on each individual's pattern and concentration of estrogen conjugates (EC) and progesterone metabolites (PdG) during follicular and luteal phases. Following preliminary endocrine analysis, urine samples were shipped on a frequent basis to verify when each female was off baseline in EC. Estrus and breeding dates were then predicted. Females were introduced to fresh male rhinoceros fecal samples daily throughout the follicular phase to potentially stimulate estrous behaviors. Despite successful assessment of follicular phase dynamics, females sometimes failed to exhibit estrus. Both females conceived following mating introductions that were timed using hormone analysis. Pregnancy was diagnosed either by endocrine analysis or rectal ultrasonography. Progestational support (altrenogest) occurred after pregnancy confirmation and varied for each female (21 and 66 days post-breeding). One female experienced early pregnancy loss and the other successfully completed a term pregnancy. These results demonstrate that a science based management strategy that relies on urinary biomarkers of ovarian function can facilitate naturally breeding captive Indian rhinoceroses.

Meningoencephalitis with secondary obstructive hydrocephalus caused by probable coccidioides species in a buff-cheeked gibbon (Nomascus gabriellae).

An 8-yr-old male buff-cheeked gibbon (Nomascus gabriellae) acutely developed abnormal behavior, decreased appetite, and dull mentation. Mild generalized muscle wasting and weight loss were the only other abnormalities noted on examination. Routine immunodiffusion serology for Coccidioides spp. were IgG and IgM positive. Magnetic resonance imaging of the brain was suggestive of an infectious meningoencephalitis with secondary obstructive hydrocephalus. A ventriculoperitoneal shunt was placed in standard fashion to reduce the imminent risk of mortality from increased intracranial pressure. Postoperative treatment included oral fluconazole, a tapered course of prednisolone, and physical therapy. Clinical signs improved steadily and the gibbon was fit to return to exhibit 8 wk post-shunt placement. This case of coccidioidomycosis demonstrates the complications that can occur with dissemination to the central nervous system and its management. It is the first published report describing the use of ventriculoperitoneal shunt placement in this species.

Batrachochytrium dendrobatidis in aquatic caecilians (Typhlonectes natans): a series of cases from two institutions.

Infection with the fungal organism Batrachochytrium dendrobatidis was documented in two captive populations of aquatic caecilians (Typhlonectes natans), including 24 confiscated animals at the Bronx Zoo's Wildlife Health Center and two captive-born animals at the Phoenix Zoo. The animals at the Bronx Zoo were asymptomatic, and infection was discovered during quarantine polymerase chain reaction screening. Both animals at the Phoenix Zoo were clinically ill, and Batrachochytrium dendrobatidis infection was confirmed in both animals, but it is unclear what role, if any, the infection played in the animals' clinical signs. All of the Bronx Zoo's caecilians were successfully cleared of infection by elevating to and then holding water temperatures at 32.2 degrees C (90 degrees F) for 72 hr. One animal at the Phoenix Zoo died before treatment could be instituted, and the second died despite treatment with a 0.01% itraconazole bath. Chytridiomycosis has only been very recently first reported in caecilians, and much remains unknown about its behavior in this amphibian order. This is the first published report of Batrachochytrium dendrobatidis infection in captive-born caecilians and also the first describing details of treatment of chytridiomycosis in caecilians. It appears that raising tank temperature to 32.2 degrees C for 72 hr is a safe and effective treatment for aquatic caecilians with chytridiomycosis.

Intestinal coccidioidomycosis in a red coachwhip snake (Masticophis flagellum piceus).

An adult female, wild-caught red coachwhip snake (Masticophis flagellum piceus) was euthanized at the Phoenix Zoo due to severe neurologic signs. Necropsy and histopathology revealed an invasive liposarcoma of the vertebral column, which likely caused the neurologic signs. Histology of the small intestine revealed a granuloma with intralesional yeasts morphologically compatible with the genus Coccidioides. The diagnosis of coccidioidomycosis was confirmed with immunohistochemistry staining. Coccidioides posadasii is endemic to Arizona and is an important cause of disseminated fungal infections in mammals in this region. This is the first known report of intestinal coccidioidomycosis in a veterinary species and the second report of coccidioidomycosis in a reptile.

EVALUATION OF A COMBINATION OF TILETAMINE-ZOLAZEPAM, MEDETOMIDINE, AND AZAPERONE WITH NASAL OXYGEN SUPPLEMENTATION FOR THE IMMOBILIZATION OF CAPTIVE CHACOAN PECCARIES (CATAGONUS WAGNERI) IN THE CHACO REGION OF PARAGUAY.

A combination of tiletamine-zolazepam, medetomidine, and azaperone was used to immobilize captive Chacoan peccaries (Catagonus wagneri) for health assessments and biological sample collection at the Centro Chaqueño para la Conservación e Investigación (CCCI) in the Paraguayan Chaco during July in 2017 and 2018. In total, 83 peccaries kept in 0.25-1.50 hectare enclosures were immobilized via dart-administered anesthetic. Mean animal weight was 33.89±3.74 kg (standard deviation; n=77). The mean intramuscular (IM) anesthetic drug and dosages were 0.03±0.00 mg/kg of medetomidine, 0.91±0.10 mg/kg of Zoletil 50 (tiletamine-zolazepam), and 0.30±0.03 mg/kg azaperone. The mean time to recumbency after darting was 6.07±2.65 min. The mean time to reach the anesthetic plane postdarting was 10.00±2.00 min. Muscle relaxation was adequate to allow minor veterinary procedures. A mean dosage of 0.15±0.02 mg/kg of atipamezole was given IM to reverse the medetomidine. Recoveries were smooth and animals were standing by 59.17±30.18 min postreversal. Full recovery and release back to enclosures occurred 90±30 min postreversal. A single dose of this drug combination provided adequate anesthesia for 88% of adult Chacoan peccaries; 12% needed a supplemental dose of tiletamine-zolazepam because of failure to receive the full dose from the anesthetic dart. Sex and age did not impact the dosage required to achieve immobilization. Confinement during recovery from anesthesia is required with this protocol. Aside from mild hypoxemia, no adverse effects from anesthesia were observed. However, oxygen supplementation as a part of this protocol is recommended to support circulatory and respiratory capacity.

Diagnostic evaluation of fatal Balamuthia mandrillaris meningoencephalitis in a captive Bornean orangutan (Pongo pygmaeus) with identification of potential environmental source and evidence of chronic exposure.

A female Bornean orangutan (Pongo pygmaeus) aged 11 years and 6 months was examined by veterinarians after caretakers observed lethargy and facial grimacing. Within 72 h the primate had left-sided hemiparesis that worsened over the next week. An MRI revealed a focal right-sided cerebral mass suspected to be a neoplasm. Ten days after onset of clinical signs, the orangutan died. On postmortem exam, the medial right parietal lobe was replaced by a 7 × 4 × 3.5 cm focus of neuromalacia and hemorrhage that displaced the lateral ventricle and abutted the corpus callosum. Histopathology of the cerebral lesion revealed pyogranulomatous meningoencephalitis with intralesional amoeba trophozoites and rare cysts. Fresh parietal lobe was submitted to the Centers for Disease Control and Prevention lab for multiplex free-living amoebae real-time PCR and detected Balamuthia mandrillaris DNA at a high burden. Mitochondrial DNA was sequenced, and a 760-bp locus 19443F/20251R was compared to several human infections of B. mandrillaris and shown to be identical to the isolates from four human cases of encephalitis: 1998 in Australia, 1999 in California, 2000 in New York, and 2010 in Arizona. Indirect immunofluorescent antibody testing of stored serum samples indicated exposure to B. mandrillaris for at least 2 years prior to death. Within 1 week of the orangutan's death, water from the exhibit was analyzed and identified the presence of B. mandrillaris DNA, elucidating a possible source of exposure. B. mandrillaris, first reported in a mandrill in 1986, has since occurred in humans and animals and is now considered an important emerging pathogen.

The use of intermittent positive pressure ventilation to differentiate pneumonia from atelectasis during anesthesia in a red panda (Ailurus fulgens).

Radiography is a valuable tool for assessment of pulmonary disease. Specifically, radiographs utilizing positive pressure ventilation can distinguish between anesthesia-induced atelectasis and pulmonary disease when survey radiographs are ambiguous. Positive pressure ventilation can be used to radiographically prove or disprove pulmonary disease. This is of particular clinical importance when working with exotic, zoo, or wildlife species because the majority of these patients require general anesthesia to perform physical examinations and diagnostics such as radiography safely and efficiently. This report is a case example of pulmonary disease in a red panda (Ailurus fulgens) and demonstrates how positive pressure ventilation verified both the presence of pulmonary disease and the eventual resolution of the disease. Anesthetized patients on gas anesthesia will rapidly become atelectic. Through the use of positive pressure ventilation, anesthesia-induced atelectasis and true pulmonary disease can readily be distinguished. This is a technique that should not be overlooked when performing thoracic radiography in zoo species.

Semen analysis parameters from a captive population of the endangered Chacoan peccary (Catagonus wagneri) in Paraguay.

Baseline information about the reproductive physiology of an endangered species is vital to captive breeding programs. This study analyzed reproductive parameters from eleven captive Chacoan peccaries (Catagonus wagneri) (mean age: 10.5 ±â€¯1.2 years old) in Paraguay. After immobilization, testis length, width and firmness (hard to flaccid, 1-3) were assessed, followed by electroejaculation and analysis of semen. Samples were examined for percentage and progressive motility, total cell count, percentage live spermatozoa and morphology. Mean (±SEM) testis volume and firmness were 24.7 ±â€¯1.8 cm3 and 2.1 ±â€¯0.1, respectively. Mean ejaculate volume was 2.9 ±â€¯0.7 ml with a pH of 7.7 ±â€¯0.3. Few male peccaries had motile spermatozoa (n = 5/9) with a mean percentage and progressive motility of 18.3 ±â€¯8.5% and 0.6 ±â€¯0.3, respectively. The mean percentage of live spermatozoa was 25.1 ±â€¯5.6%. Male peccaries had a low percentage of normal spermatozoa (12.4 ±â€¯2.5%). The mean total count of spermatozoa per ejaculate was also quite low at 1.58 ±â€¯1.01 million total spermatozoa per ejaculate. Spermatozoa defects were predominantly primary (77.7%) with the most common spermatozoa defects being tapered head (19.0 ±â€¯7.4%), diadem/crater (17.7 ±â€¯2.8%), and excess residual cytoplasm (9.6 ±â€¯2.5%). Male age was not correlated with semen parameters (percent live: r=-0.19; motility percentage: r = 0.01; percent normal spermatozoa: r = 0.38; total count: r = 0.29; p>0.05). Evaluation of additional males from this population as well as other captive populations at various time points during the year is warranted.

Focusing HIV prevention on those most likely to transmit the virus.

Despite some success in reducing HIV incidence, the global epidemic continues to grow. For every person with AIDS in developing countries placed on treatment in 2005, many others were newly infected. We need more effective prevention programs that focus interventions on those most at risk for HIV transmission (MART), particularly those with 1) high behavioral risk and 2) high viral loads due to acute or recent infection, co-infections with other diseases, high viral set points, or untreated AIDS. This article provides examples of how prevention programs can incorporate emerging testing technologies and social/behavioral approaches to reach these individuals, their partners, and the social networks where active transmission is occurring.

Plasma pharmacokinetics of selamectin after a single topical administration in the American bullfrog (Rana catesbeiana).

Parasitism is common in wild and captive amphibians; however, pharmacologic data are lacking for anthelmintic drugs. This study was developed to determine the plasma pharmacokinetics of selamectin after topical administration in bullfrogs. Thirty-two adult American bullfrogs (Rana catesbeiana) were randomly assigned into eight groups of four with each group representing a different collection time point. Seven groups received selamectin (6 mg/ kg) topically and the remaining group served as the untreated control group. One group of frogs was euthanized and blood samples immediately collected on days 0 (control), 1, 5, 10, 15, 20, 25, and 30. Plasma was analyzed for selamectin using high performance liquid chromatography with fluorescence detection. Individual samples were analyzed, then data were reported as the mean of the four frogs at each time point. A histologic evaluation of the lung, liver, kidney, and skin tissues was performed and none of the frogs showed histologic evidence of toxicity due to selamectin administration. The mean peak plasma concentration was 162.5 +/- 42.3 ng/ml, area under the curve was 2,856 ng day/ml, mean residence time was 12.2 days, and disappearance half-life was 1.87 days. Based on the plasma pharmacokinetics, bullfrogs appear to absorb selamectin very efficiently, concentrations reach high levels in the plasma, and there were no apparent histologic effects from single dose administration.

Epitheliotropic lymphoma in a captive bontebok (Damaliscus pygargus).

A 16-yr-old, female, captive-bred bontebok (Damaliscus pygargus) estimated to be 75 kg, was presented with a 1-mo history of chronic diarrhea and weight loss. A cause for the deteriorating condition was not found antemortem, and the bontebok was humanely euthanatized when it failed to respond to empirical therapy. On necropsy, numerous nodules were present on the pleural surfaces and within the lung parenchyma, the pancreas appeared inflamed and fibrotic. Histologic examination revealed lymphoma in the mesenteric lymph nodes, alimentary tract, reproductive tract, and liver. In the small and large intestine, rumen, esophagus, bile duct, and vagina, the neoplastic cells had a tropism for epithelium. The neoplastic cells within the epithelium and subepithelium of the alimentary tract stained positively for CD3, consistent with T cell differentiation.

Factors associated with HIV RNA viral loads in ART-naïve patients: implications for treatment as prevention in concentrated epidemics.

BACKGROUND: Limited data are available on factors associated with HIV-RNA viral load (VL) among antiretroviral treatment (ART)-naïve key populations in concentrated epidemics. METHODS: We conducted a cross-sectional survey of 1211 adult ART-naïve patients at 19 HIV clinics in Ho Chi Minh City (HCMC), Vietnam. Data collection included a standardised questionnaire, routine laboratory testing, hepatitis serology and HIV VL. Correlation between CD4 cell count and VL was assessed across all participants. In 904 participants not meeting Vietnam criteria for ART (CD4 cell count >350 cells/mm(3), WHO clinical stage 1 or 2 and not pregnant), multivariate analyses were conducted to assess factors associated with HIV VL. RESULTS: Pre-ART patients had a median age of 31 years and 54% were male. Median CD4 cell count was 533 cells/mm(3). Median HIV VL was 17,378 copies/mL; 60% had VL greater than 10,000 copies/mL and 16% had VL above 100,000 copies/mL. Although declining CD4 cell count was correlated with rising VL across all CD4 cell counts, correlation of VL with CD4 cell counts between 351 and 500 cell/mm(3) was not significant. On multivariate linear regression, higher HIV VL was independently associated with male sex, men who have sex with men (MSM), CD4 cell count 351-500, HIV diagnosis within the previous 6 months, and hepatitis B (HBV). Lower HIV VL was independently associated with hepatitis C (HCV). CONCLUSIONS: The majority of HIV patients who were not eligible for ART in HCMC in 2014 had HIV VL greater than 10,000 copies/mL. These data support expanded eligibility of ART to all HIV patients with the goal of treatment as prevention. This study is also among the first to demonstrate that MSM had a higher VL than women and heterosexual men and highlights the need for improved outreach and linkages to HIV care for this high-risk group.