A novel neurotropic microsporidium from the swamp guppy Micropoecilia picta from Grenada, West Indies.

A novel microsporidium was observed in wild swamp guppies Micropoecilia picta from Levera Pond within Levera National Park Grenada, West Indies. Initial observations indicated similarity with Pseudoloma neurophilia, an important pathogen in zebrafish Danio rerio. P. neurophilia exhibit broad host specifity, including members of the family Poecillidae, and both parasites infect the central nervous system. However, spore morphology and molecular phylogeny based on rDNA showed that the swamp guppy microsporidium (SGM) is distinct from P. neurophilia and related microsporidia (Microsporidium cerebralis and M. luceopercae). Spores of the SGM were smaller than others in the clade (3.6 µm long). Differences were also noted in histology; the SGM formed large aggregates of spores within neural tissues along with a high incidence of numerous smaller aggregates and single spores within the surface tissue along the ventricular spaces that extended submeninx, whereas P. neurophilia and M. cerebralis infect deep into the neuropile and cause associated lesions. Analysis of small subunit ribosomal DNA sequences showed that the SGM was <93% similar to these related microsporidia. Nevertheless, one of 2 commonly used PCR tests for P. neurophilia cross reacted with tissues infected with SGM. These data suggest that there could be other related microsporidia capable of infecting zebrafish and other laboratory fishes that are not being detected by these highly specific assays. Consequently, exclusive use of these PCR tests may not accurately diagnose other related microsporidia infecting animals in laboratory and ornamental fish facilities.

Levodopa attenuates the feed intake reduction caused by ergot alkaloids in cattle.

Consumption of ergot alkaloids from endophyte-infected tall fescue results in losses to the livestock industry in many countries and a means to mitigate these losses is needed. The objective of this study was to evaluate intra-abomasal infusion of the dopamine precursor, levodopa (L-DOPA), on dopamine metabolism, feed intake, and serum metabolites of steers exposed to ergot alkaloids. Twelve Holstein steers (344.9 ±â€…9.48 kg) fitted with ruminal cannula were housed with a cycle of heat challenge during the daytime (32 °C) and thermoneutral at night (25 °C). The steers received a basal diet of alfalfa cubes containing equal amounts of tall fescue seed composed of a mixture of endophyte-free (E-) or endophyte-infected tall fescue seeds (E+) equivalent to 15 µg ergovaline/kg body weight (BW) for 9 d followed by intra-abomasal infusion of water (L-DOPA-) or levodopa (L-DOPA+; 2 mg/kg BW) for an additional 9 d. Afterward, the steers were pair-fed for 5 d to conduct a glucose tolerance test. The E+ treatment decreased (P = 0.005) prolactin by approximately 50%. However, prolactin increased (P = 0.050) with L-DOPA+. Steers receiving E+ decreased (P < 0.001) dry matter intake (DMI); however, when supplemented with L-DOPA+ the decrease in DMI was less severe (L-DOPA × E, P = 0.003). Also, L-DOPA+ infusion increased eating duration (L-DOPA × E, P = 0.012) when steers were receiving E+. The number of meals, meal duration, and intake rate were not affected (P > 0.05) by E+ or L-DOPA+. The L-DOPA+ infusion increased (P < 0.05) free L-DOPA, free dopamine, total L-DOPA, and total dopamine. Conversely, free epinephrine and free norepinephrine decreased (P < 0.05) with L-DOPA+. Total epinephrine and total norepinephrine were not affected (P > 0.05) by L-DOPA+. Ergot alkaloids did not affect (P > 0.05) circulating free or total L-DOPA, dopamine, or epinephrine. However, free and total norepinephrine decreased (P = 0.046) with E+. Glucose clearance rates at 15 to 30 min after glucose infusion increased with L-DOPA+ (P < 0.001), but not with E+ (P = 0.280). Administration of L-DOPA as an agonist therapy to treat fescue toxicosis provided a moderate increase in DMI and eating time and increased plasma glucose clearance for cattle dosed with E+ seed.

Fescue has become the dominant cool-season perennial grass in the southeastern region of the United States and is also found in other countries. Endophytes from a plant­fungus symbiotic relationship produce toxic alkaloids that have caused significant annual economic losses to the livestock industry. Treatments to alleviate this toxicosis are still demanded. This study evaluates the infusion of the dopamine precursor, levodopa (L-DOPA), to mitigate the toxicosis caused by ergot alkaloids. When L-DOPA was infused, eating duration increased and the decrease in feed intake caused by ergot alkaloids was less severe. Additionally, circulating dopamine and glucose clearance increased with L-DOPA. These results suggest that L-DOPA has the potential to aid in the mitigation of the toxicosis caused by ergot alkaloids.

5-hydroxytryphophan mitigates ergot alkaloid-induced suppression of serotonin and feed intake in cattle.

The impact of ergot toxicosis on livestock industries is detrimental and treatments are needed in many countries. The objective of this study was to evaluate the effects of acute exposure to ergot alkaloids and 5-hydroxytryptophan (5-HTP) supplementation on feed intake, serotonin metabolism, and blood metabolites in cattle. Eight Holstein steers (538 ±â€…18 kg) fitted with ruminal cannulas were used in a replicated 4 × 4 Latin Square design experiment with a 2 × 2 factorial treatment structure. The treatments were the combination of 0 (E-) or 15 µg ergovaline/kg BW (E+) and 0 (5HTP-) or 0.5 mg of 5-hydroxy-l-tryptophan/kg BW (5HTP+) administered daily for 6 d. Toxic endophyte-infected tall fescue seed was used to supply the daily dose of ergovaline. Endophyte-free seed was used to equalize seed intake between treatments. Ground seed was placed into the rumen immediately before feeding. The 5-HTP was dissolved in water and infused into the abomasum via the reticulo-omasal orifice. Blood was collected from a jugular vein catheter at 0, 1, 2, 4, 8, and 24 h after treatment administration. Ergovaline without 5-HTP (E+/5HTP-) decreased dry matter intake (DMI) in comparison to steers without ergovaline and 5-HTP (E-/5HTP-). However, 5-HTP infusion in association with ergovaline (E+/5HTP+) normalized the DMI. Although E + did not affect (P > 0.05) the area under the curve (AUC) of serum 5-HTP, 5-hydroxyindoleacetic acid, tryptophan, and kynurenine, serum and plasma serotonin concentrations were decreased (P < 0.05). The infusion of 5-HTP increased (P < 0.05) the AUC of serum 5-HTP, serum and plasma serotonin, and serum 5-hydroxyindoleacetic acid. In conclusion, acute exposure to ergot alkaloids reduced DMI and circulating serotonin in cattle but 5-HTP administration showed potential to normalize both circulating serotonin and feed intake.

Some grass species have a symbiotic relationship with an endophytic fungus that produces toxic ergot alkaloids which have detrimental impacts on herbivores. Ergot alkaloids have a significant impact on livestock production causing annual loss to the livestock industry that likely exceeds $1 billion. Effective treatment for this toxicosis is still needed. The objective of this study was to evaluate the effects of acute exposure to ergot alkaloids and 5-hydroxytryptophan supplementation on feed intake, serotonin metabolism, and blood metabolites in cattle. We found that 5-hydroxytryptophan administration has the potential to normalize both circulating serotonin and feed intake reduced by ergot alkaloid consumption.

Impact of an acute heat shock during in vitro maturation on interleukin 6 and its associated receptor component transcripts in bovine cumulus-oocyte complexes.

An acute heat stress event after the LH surge increased interleukin 6 (IL6) levels in the follicular fluid of the ovulatory follicle in hyperthermic cows. To examine direct consequences of a physiologically-relevant elevated temperature (41.0°C) on the cumulus-oocyte complex (COC), IL6 transcript abundance and related receptor components were evaluated throughout in vitro maturation. Heat-induced increases in IL6 were first noted at 4 hours of in vitro maturation (hIVM); peak levels occurred at 4.67 versus 6.44 hIVM for 41.0 and 38.5°C COCs, respectively (SEM = 0.23; P < 0.001). Peak IL6ST levels occurred at 6.95 versus 8.29 hIVM for 41.0 and 38.5°C, respectively (SEM = 0.23; P < 0.01). Transcript for LIF differed over time (P < 0.0001) but was not affected by 41.0°C exposure. Blastocyst development after performing IVF was not affected by 41.0°C exposure for 4 or 6 h. When limiting analysis to when IL6 was temporally produced, progesterone levels were only impacted by time and temperature (no interaction). Heat-induced shift in the temporal production of IL6 and IL6ST along with its impact on progesterone likely cooperate in heat-induced hastening of meiotic progression described by others.

The HIV Treatment Cascade among Men who have sex with Men attending a large HIV Clinic in Trinidad

The Medical Research Foundation of Trinidad and Tobago (MRFTT) is the largest HIV Treatment Centre in the English speaking Caribbean and as of May 31, 2019, there were 6,434 patients currently enrolled in care and of these, 688 (10.7%) were self-identified MSM. The MRFTT accounts for approximately 74% of all PLHIV engaged in care in Trinidad and Tobago. In 2013 the UNAIDS launched the 90-90-90 strategy, an ambitious treatment target to end the HIV/AIDS epidemic. By the year 2020, 90% of persons living with HIV should know their status, 90% of those diagnosed with HIV should be linked to care anf on antiretoviral therapy (ART) and 90% of those on ART should have their HIV viral load suppressed. Studies have shown that MSM living i high-income countries with lower levels of same-sex stigma and discrimination had better HIV care cascade outcomes as compared to MSM living in environments with very high stigma and discrimination that had some of the worst HIV cascade outcomes.

Implementation of SARS-CoV-2 testing at Medical Research Foundation of Trinidad and Tobago

The HIV Clinic at the Medical Reserch Foundation of Trinidad and Tobago (MRFTT) in collaboration with the Ministry of Health (MoH) supports national level diagnostic efforts by conducting HIV viral load testing using the Abbott m2000 real time poymerase chain reation (PCR) platform installed at the MRFTT Laboratory. The MRFTT is strategically poised to scale up diagnostic PCR testing for SARS-CoV-2. In August 2020, the SARS-CoV-2 pandemic in Trinidad and Tobago was categorized as having community spread. To support the government's efforts to rapidly scale up testing and reduce the turn around time whie delivering quality results, an agreement was reached with MoH to expand diagnostic testing for SARS-CoV-2 at the MRFTT laboratory. Goals: 1. Support the efforts of government to rapidly scale up testing for SARS-CoV-2 2. Integrate SARS-CoV-2 testing at a Regional HIV Care and Treatment Site.

Size and position of the reproductive tract impacts fertility outcomes and pregnancy losses in lactating dairy cows.

There are multiple factors that contribute to reduced fertility in lactating dairy cows. Recently, a reproductive tract size and position score (SPS) system was developed as a management tool to identify dairy cows with decreased fertility. The aim of this study was to evaluate the association between the SPS on fertility outcomes such as ovulation failure, pregnancy per artificial insemination (P/AI), concentration of pregnancy-associated glycoproteins (PAGs), and pregnancy loss in lactating dairy cows. Primiparous and multiparous lactating Holstein cows (n = 869) were enrolled at two locations. Location 1 (Loc. 1) in Minas Gerais, Brazil (n = 613) and location 2 (Loc. 2) in Agassiz, British Columbia, Canada (n = 256). At the time of AI (d 0), cows were classified as SPS (small [SPS1], medium [SPS2], or large [SPS3] sized reproductive tract) and ovulation failure was determined at 48 h and 7 d post-AI via ultrasonography (Loc. 2 only). Blood samples were collected on d 24 and 31 of gestation for quantification of PAGs and pregnancy diagnosis was performed via ultrasonography at d 31 and 60 post-AI (Loc. 1) and at d 31 ± 3 and 60 ± 3 post-AI (Loc. 2). Cows diagnosed pregnant at d 31 post-AI but not pregnant at d 60 were defined to have undergone late embryonic pregnancy loss. Parity was found to impact SPS (P < 0.01), as primiparous cows had a higher frequency of SPS1 and lower frequency of SPS3 when compared with multiparous cows (SPS1: 42.6 vs. 15.0%; SPS3: 7.0 vs. 22.0%, respectively). Cows classified as SPS3 had greater ovulation failure at 48 h (P = 0.04) and 7 d post-AI (P = 0.05). Cows classified as SPS1 had greater P/AI when compared to SPS2 and SPS3 (45.9 ± 3.3 vs. 37.4 ± 2.6 and 29.1 ± 3.5%, respectively; P = 0.004). There was no interaction between parity and SPS on P/AI. Pregnancy loss between 31 and 60 d post-AI was increased in cows classified as SPS3 compared to SPS2 and SPS1 (24.3 ± 0.05 vs. 11.6 ± 0.02 and 9.4 ± 0.02%, respectively; P = 0.04). Cows classified as SPS1 and SPS2 had greater concentrations of PAGs at 31 d post-AI when compared to SPS3 at both Loc.1 (P < 0.01) and Loc. 2 (P < 0.01). There was no interaction between SPS and pregnancy loss on PAGs at 24 and 31 d post- AI for either Loc. 1 (P = 0.75 and P = 0.76, respectively) or Loc. 2 (P = 0.61 and P = 0.81, respectively). In conclusion, cows that were classified as SPS3 had greater ovulation failure, reduced P/AI, similar concentrations of PAG on d 24, but decreased on d 31, and a greater incidence of pregnancy loss. Thus, size and position of the reproductive tract is associated with fertility and this scoring system could be used to make reproductive management decisions on dairy operations.

Impact of an acute heat shock during in vitro maturation on interleukin 6 and its associated receptor component transcripts in bovine cumulus-oocyte complexes

An acute heat stress event after the LH surge increased interleukin 6 (IL6) levels in the follicular fluid of the ovulatory follicle in hyperthermic cows. To examine direct consequences of a physiologically-relevant elevated temperature (41.0°C) on the cumulus-oocyte complex (COC), IL6 transcript abundance and related receptor components were evaluated throughout in vitro maturation. Heat-induced increases in IL6 were first noted at 4 hours of in vitro maturation (hIVM); peak levels occurred at 4.67 versus 6.44 hIVM for 41.0 and 38.5°C COCs, respectively (SEM = 0.23; P < 0.001). Peak IL6ST levels occurred at 6.95 versus 8.29 hIVM for 41.0 and 38.5°C, respectively (SEM = 0.23; P < 0.01). Transcript for LIF differed over time (P < 0.0001) but was not affected by 41.0°C exposure. Blastocyst development after performing IVF was not affected by 41.0°C exposure for 4 or 6 h. When limiting analysis to when IL6 was temporally produced, progesterone levels were only impacted by time and temperature (no interaction). Heat-induced shift in the temporal production of IL6 and IL6ST along with its impact on progesterone likely cooperate in heat-induced hastening of meiotic progression described by others.

Impact of an acute heat shock during in vitro maturation on interleukin 6 and its associated receptor component transcripts in bovine cumulus-oocyte complexes

An acute heat stress event after the LH surge increased interleukin 6 (IL6) levels in the follicular fluid of the ovulatory follicle in hyperthermic cows. To examine direct consequences of a physiologically-relevant elevated temperature (41.0°C) on the cumulus-oocyte complex (COC), IL6 transcript abundance and related receptor components were evaluated throughout in vitro maturation. Heat-induced increases in IL6 were first noted at 4 hours of in vitro maturation (hIVM); peak levels occurred at 4.67 versus 6.44 hIVM for 41.0 and 38.5°C COCs, respectively (SEM = 0.23; P < 0.001). Peak IL6ST levels occurred at 6.95 versus 8.29 hIVM for 41.0 and 38.5°C, respectively (SEM = 0.23; P < 0.01). Transcript for LIF differed over time (P < 0.0001) but was not affected by 41.0°C exposure. Blastocyst development after performing IVF was not affected by 41.0°C exposure for 4 or 6 h. When limiting analysis to when IL6 was temporally produced, progesterone levels were only impacted by time and temperature (no interaction). Heat-induced shift in the temporal production of IL6 and IL6ST along with its impact on progesterone likely cooperate in heat-induced hastening of meiotic progression described by others.(AU)

Prevalence and risk factors of Sexually Transmitted Infections (STI) among persons living with HIV attending the STI Clinic in Trinidad

Objective: To determine the prevalence and risk factors for sexually transmitted infections (STIs) among persons living with HIV (PLHIV) attending the STI Clinic in Trinidad. Design and Methodology: A cross-sectional study of STI prevalence among PLHIV attending the STI Clinic in Trinidad was conducted during the period April-September 2014. A questionnaire was administered to obtain socio-demographic data and risk factors for STI infections, a physical examination was carried out and patients were screened for STIs. Data were analysed using SPSS Version 22. Results: A total of 210 HIV infected patients (138 males [65.7%] and 72 females [34.3%]) were enrolled; age range 17-68 years, mean age 36.4 years. Of these, 68 (32.4%) were newly HIV diagnosed and 142 (67.6%) had a known history of HIV infection. Seventy-eight (37.1%) of the 210 patients were concurrently diagnosed with a STI. Homosexual/ bisexual study patients were more likely to be diagnosed with a STI (OR, 3.56; 95% CI, 1.94- 6.51) and more likely to be diagnosed with syphilis (OR, 4.84; 95% CI, 2.40-9.77). Multivariate analysis using binary multiple regression showed that risk factors for STIs included male sex (OR, 2.46; 95% CI, 1.06-5.73), homosexual/bisexual sexual orientation (OR, 2.26; 95% CI, 1.06-4.80) and multiple sex partners within the past 12 months (OR, 1.99; 95% CI, 1.03-3.86). Conclusion: There is a high prevalence of STIs among PLHIV in this study, especially among homosexual/ bisexual sexual males in whom the most commonly diagnosed STI was syphilis. Hence targeted HIV/STI prevention efforts are urgently needed in these patients.

Cost of using a patient tracer to reduce loss to follow up and resolve the status of nonactive patients at the HIV Clinic, Medical Research Foundation of Trinidad and Tobago

Objective: To evaluate a pilot intervention to engage two patient tracers to track patients lost to follow up at the HIV Clinic, Medical Research Foundation of Trinidad and Tobago. Design and Methodology: Two social workers trained as patient tracers spent six months contacting via phone calls a sample of patients who were initiated on anti-retroviral therapy (ART) 6 months or more and who missed their scheduled clinic visit for over one month. The patient tracers also counseled patients helping them to overcome the barriers to accelerate their return to care. Both the start-up and implementation costs of the intervention were assessed. Results: The patient tracers were able to determine the status of 871 (82%) of a sample of 1058 patients who missed their scheduled visits for one month or more. Of the 871, 192 patients were no longer active in care (including deaths, transfer to other clinics, migration). The patient tracers successfully contacted 679 patients (78%) and of those 550 patients (81%) returned to care at an average cost of $56 USD per patient returned. Conclusions; Patient Tracer is cost effective way to resolve the status of lost patients and to improve the efficiency of "loss to follow-up" interventions. Greater capacity to trace patients from one treatment site to another and to resolve deaths is urgently needed through a Health Information system (HMIS) linked to HIV case surveillance, hospital data and a national death registry.

Timpanismo ruminal crônico secundário à hipoplasia de pregas de omaso em dois bovinos / Chronic ruminal bloat secondary to omasal laminae hypoplasia in two cattle

Um novilho normando e outro charolês apresentando distensão abdominal, diarreia intermitente e timpanismo ruminal crônico, que iniciaram após desmame, foram enviados para necropsia. Observou-se ausência de pregas omasais associada à hipoplasia do órgão, assim como redução de tamanho das papilas ruminais e reticulares. Com base nas lesões e histórico, conclui-se que o timpanismo ruminal foi ocasionado pela falha no desenvolvimento do omaso...

Two emaciated juvenile steers, one Normande and one Charolaise breed with abdominal distension, intermittent diarrhea and chronic ruminal bloat that had begun at weaning were necropsied. Absence of the omasal laminae with omasal hypoplasia were found together with loss of ruminal papillae and reticular folds. Based on the lesions and history we concluded that the ruminal bloat was due to a development failure of the omasum...

Timpanismo ruminal crônico secundário à hipoplasia de pregas de omaso em dois bovinos / Chronic ruminal bloat secondary to omasal laminae hypoplasia in two cattle

Um novilho normando e outro charolês apresentando distensão abdominal, diarreia intermitente e timpanismo ruminal crônico, que iniciaram após desmame, foram enviados para necropsia. Observou-se ausência de pregas omasais associada à hipoplasia do órgão, assim como redução de tamanho das papilas ruminais e reticulares. Com base nas lesões e histórico, conclui-se que o timpanismo ruminal foi ocasionado pela falha no desenvolvimento do omaso.(AU)

Two emaciated juvenile steers, one Normande and one Charolaise breed with abdominal distension, intermittent diarrhea and chronic ruminal bloat that had begun at weaning were necropsied. Absence of the omasal laminae with omasal hypoplasia were found together with loss of ruminal papillae and reticular folds. Based on the lesions and history we concluded that the ruminal bloat was due to a development failure of the omasum.(AU)

Access to care for patients with time-sensitive conditions in Pennsylvania.

STUDY OBJECTIVE: Collective knowledge and coordination of vital interventions for time-sensitive conditions (ST-segment elevation myocardial infarction [STEMI], stroke, cardiac arrest, and septic shock) could contribute to a comprehensive statewide emergency care system, but little is known about population access to the resources required. We seek to describe existing clinical management strategies for time-sensitive conditions in Pennsylvania hospitals. METHODS: All Pennsylvania emergency departments (EDs) open in 2009 were surveyed about resource availability and practice patterns for time-sensitive conditions. The frequency with which EDs provided essential clinical bundles for each condition was assessed. Penalized maximum likelihood regressions were used to evaluate associations between ED characteristics and the presence of the 4 clinical bundles of care. We used geographic information science to calculate 60-minute ambulance access to the nearest facility with these clinical bundles. RESULTS: The percentage of EDs providing each of the 4 clinical bundles in 2009 ranged from 20% to 57% (stroke 20%, STEMI 32%, cardiac arrest 34%, sepsis 57%). For STEMI and stroke, presence of a board-certified/board-eligible emergency physician was significantly associated with presence of a clinical bundle. Only 8% of hospitals provided all 4 care bundles. However, 53% of the population was able to reach this minority of hospitals within 60 minutes. CONCLUSION: Reliably matching patient needs to ED resources in time-dependent illness is a critical component of a coordinated emergency care system. Population access to critical interventions for the time-dependent diseases discussed here is limited. A population-based planning approach and improved coordination of care could improve access to interventions for patients with time-sensitive conditions.

Analgesia for older adults with abdominal or back pain in emergency department.

OBJECTIVE: To determine the association between age and analgesia for emergency department (ED) patients with abdominal or back pain. METHODS: Using a fully electronic medical record, we performed a retrospective cohort study of adults presenting with abdominal or back pain to two urban EDs. To assess differences in analgesia administration and time to analgesia between age groups, we used chi-square and Kruskal-Wallis test respectively. To adjust for potential confounders, we used a generalized linear model with log link and Gaussian error. RESULTS: Of 24,752 subjects (mean age 42 years, 65% female, 69% black, mean triage pain score 7.5), the majority (76%) had abdominal pain and 61% received analgesia. The ≥80 years group (n=722; 3%), compared to the 65-79 years group (n=2,080; 8%) and to the <65 years group (n=21,950; 89%), was more often female (71 vs. 61 vs. 65%), black (72 vs. 65 vs. 69%), and had a lower mean pain score (6.6 vs. 7.1 vs. 7.6). Both older groups were less likely to receive any analgesia (48 vs. 59 vs. 62%, p<0.0001) and the oldest group less likely to receive opiates (35 vs. 47 vs. 44%, p<0.0001). Of those who received analgesia, both older groups waited longer for their medication (123 vs. 113 vs. 94 minutes; p<0.0001). After controlling for potential confounders, patients ≥80 years were 17% less likely than the <65 years group to receive analgesia (95% CI 14-20%). CONCLUSION: Older adults who present to the ED for abdominal or back pain are less likely to receive analgesia and wait significantly longer for pain medication compared to younger adults.

Adherence to antiretroviral therapy by people accessing services from non-governmental HIV support organisations in three Caribbean countries.

OBJECTIVE: To identify factors associated with antiretroviral therapy (ART) adherence in order to guide the development of strategies to improve the situation. DESIGN AND METHODS: A cross-sectional survey was conducted with people living with HIV (PLHIV) who receive services from non-governmental organisations affiliated to the Caribbean Regional Network of People Living with HIV/AIDS (CRN+) in Antigua and Barbuda, Grenada and Trinidad and Tobago. PLHIV from CRN+, traced potential participants, administered informed consent procedures and carried out structured interviews. The main outcome measure was 95% to 100% adherence over the previous seven days. Multiple logistic regression was conducted to identify associations with demographic characteristics, psychological status, health and support service use, sexual behaviour and substance abuse. RESULTS: Of 394 respondents, 69.5% were currently taking ART. Of these, 70.1% took 95% to 100% of their prescribed pills. One in 20 took more pills than prescribed, all of whom were prescribed fewer or equal to the median pill number. Factors independently associated with adherence were use of a counselling service (OR 3.20; 95% CI 1.55, 6.61), revelation of HIV status without consent (OR 2.31; 95% CI 1.13, 4.74), alcohol consumption (OR 0.47; 95% CI 0.23, 0.96) and side effects (OR 0.32; 95% CI 0.15, 0.68). Drug resistance to ART was reported by 6% of users. CONCLUSION: Improvements in ART adherence may be achieved by counselling, focussed attention to alcohol users and developing drugs with reduced side effects. Such measures are critical to maintain PLHIV quality of life gains and prevent the proliferation of drug resistant HIV strains.

Factors associated with condom use: economic security and positive prevention among people living with HIV/AIDS in the Caribbean.

In the Caribbean region, an estimated 1.1% of the population aged 15-49 is living with HIV. We aimed to measure factors associated with condom use, the primary form of positive prevention in the Caribbean, among people living with HIV (PLHIV) in its major agency advocating on behalf of PLHIV (the Caribbean Regional Network of People Living with HIV/AIDS, or CRN +). Condom use at last sex was selected for analysis from a broad-ranging cross-sectional survey (n=394) among PLHIV who were members of or received services from CRN+ in Antigua and Barbuda, Grenada, Trinidad and Tobago. PLHIV from CRN+ traced potential participants, administered informed consent procedures and carried out structured interviews. Fifty-four percent of respondents reported using a condom the last time they had sex. Condom use was positively associated with partner being HIV negative, disclosure of HIV status, alcohol use, economic security, education level and being employed. Multivariate logistic regression found independent associations between condom use and economic security (p=0.031; odds ratio (OR) for "enough" income 5.06; 95% CI 1.47-17.39), partner being HIV negative (p=0.036; OR 2.85; 95% CI 1.28-6.33) and being married (p=0.043; OR 2.86; 95% CI 1.03-7.91). Seventy-three percent of respondents reported inadequate family income, 26% reported an HIV-negative partner and 9% were married. Condom use appears to be motivated by protection of HIV-negative partners and spouses. Low socioeconomic status is associated with the overall percentage using condoms. Restriction to members of CRN+ limits generalisability of the findings. Nevertheless, the findings support the view that programmes for the socioeconomic empowerment of PLHIV are needed to slow the Caribbean HIV epidemic. Expectations for protection of different types of partners should be further explored in order to develop culturally appropriate interventions with couples.

Prospective assessment of exclusive breastfeeding in relation to weight change in women.

OBJECTIVE: To study prospectively the relation of parity, prepregnancy body mass index (BMI), and exclusive breastfeeding to weight gain. DESIGN: The cohort of the Nurse's Health Study II, with analysis restricted to women who were aged 24 to 40 y at baseline (1989), who had a history of no more than one past full-term pregnancy at baseline, gave birth to one child between 1990 and 1991, but had no other pregnancies during the follow-up. SUBJECTS: 1538 of the 33 082 nulliparous women and 2810 of the 20 261 primiparous, in 1989. MEASUREMENTS: Introduction of daily formula/milk was assumed to represent the end of exclusive breastfeeding period. Duration of exclusive breastfeeding was categorized into 0, 1-3, 4-7, 8-11, and 12 months or more. RESULTS: After adjusting for age, physical activity, and BMI in 1989, lactation was associated with a weight gain from 1989 to 1993 of approximately 1 kg (statistically significant only for women nulliparous in 1989 with a BMI <25 kg/m(2) (P=0.02) and for those women primiparous in 1989, with a BMI >/=25 kg/m(2) (P=0.04)) comparing women who breastfed with women who did not, and duration of lactation was unrelated to the magnitude of weight change (P>0.40 for all comparisons). CONCLUSIONS: Although promotion of breastfeeding has high priority because of its enormous advantages for a newborn child, the associated maternal weight reduction is minimal. Dietary guidelines for pregnant and breastfeeding women should include ways to prevent weight retention after parity.

A distinctive clade B HIV type 1 is heterosexually transmitted in Trinidad and Tobago.

HIV-1 transmission worldwide is predominantly associated with heterosexual activity, and non-clade B viruses account for the most spread. The HIV-1 epidemic in Trinidad/Tobago and the Caribbean shares many features with such heterosexual epidemics, including a prominent role for coincident sexually transmitted diseases. This study evaluates the molecular epidemiology of HIV-1 in Trinidad/Tobago during a period when abrupt transition from homosexual to heterosexual transmission occurred in the absence of injecting drug use, concomitant with a rapid rise in HIV-1 prevalence in the heterosexual population. Of 31 viral isolates studied during 1987-1995, all cluster with subtype B reference strains. In the analysis of full env genes from 22 early seroconverters, the Trinidad isolates constitute a significant subcluster within the B subtype. The Trinidad V3 consensus sequence differs by a single amino acid from the prototype B V3 consensus and demonstrates stability over the decade of this study. In the majority of isolates, the V3 loop of env contains a signature threonine deletion that marks the lineage of the Trinidad HIV-1 clade B epidemic from pre-1984. No phenotypic features, including syncitium induction, neutralization profiles, and chemokine receptor usage, distinguish this virus population from other subtype B viruses. Thus, although the subtype B HIV-1 viruses being transmitted in Trinidad are genetically distinguishable from other subtype B viruses, this is probably the result of a strong founder effect in a geographically circumscribed population rather than genetic selection for heterosexual transmission. These results demonstrate that canonical clade B HIV-1 can generate a typical heterosexual epidemic.

Antenatal screening for HIV in North Trinidad. Demographic characteristics of patients, acceptability of testing and the rising prevalence of infection - Poster abstract

OBJECTIVE: To ascertain the acceptability of HIV screening in pregnancy and the prevalence of HIV in pregnant women in north Trinidad. DESIGN AND METHOD: All women attending an antenatal clinic at the Port of Spain General Hospital were offered HIV testing at booking. Written consent was obtained after testing counselling and blood samples were tested using an ELISA assay with positive results confirmed by western blot. Demographic data were also collected. HIV positive women/infant pairs were tested using a modified CDC - Thailand regime. RESULTS: A total of 338 new patients were seen between March and November 1999 of whom only 8 refused testing. Ten patients tested positive giving a prevalence of 3 percent. All of the HIV positive patients were of African or mixed race descent which reflected the population attending this clinic. CONCLUSION: Our data indicated a slowly rising prevalence of HIV in pregnant women in north Trinidad. The majority of patients (98 percent) easily accept screening.(AU)