“
“The aim of the study was to examine temporal and geographical patterns of mode of delivery in the European Collaborative Study (ECS), identify factors associated with elective caesarean section (CS) delivery in the highly active antiretroviral

therapy (HAART) era and explore associations between mode of delivery and mother-to-child transmission (MTCT). The ECS is a cohort study in which HIV-infected pregnant women are enrolled and their infants prospectively followed. Data on 5238 mother–child pairs (MCPs) enrolled in Western European ECS sites between 1985 and 2007 were analysed. The elective CS rate increased from 16% in 1985–1993 to 67% in 1999–2001, declining to 51% by 2005–2007. In 2002–2004, 10% of infants were delivered vaginally, increasing to 34% by 2005–2007. During the HAART era, women in Belgium, the United Kingdom and the Netherlands were less Wee1 inhibitor likely to deliver by elective CS than those

in Italy and Spain [adjusted odds ratio (AOR) 0.07; 95% confidence interval (CI) 0.04–0.12]. The MTCT rate in 2005–2007 was 1%. Among MCPs with maternal HIV RNA<400 HIV-1 RNA copies/mL (n=960), elective CS was associated with 80% decreased MTCT risk (AOR 0.20; 95% CI 0.05–0.65) adjusting for HAART and prematurity. Two infants born to 559 women with viral loads <50 copies/mL were infected, one of whom was delivered by elective CS (MTCT rate 0.4%; 95% CI 0.04–1.29). Our findings suggest that elective CS prevents MTCT even at low maternal viral loads, but the study was insufficiently powered to enable a conclusion to be drawn as to whether this applies for viral loads <50 copies/mL. selleck screening library Diverging mode of delivery patterns in Europe reflect uncertainties regarding the risk–benefit balance of elective CS for women on successful HAART. Prevention ROS1 of mother-to-child transmission (PMTCT) of HIV-1 (HIV) has become increasingly effective in the past decade, with mother-to-child transmission (MTCT) rates declining

from around 20–25% to <1–2% in developed country settings [1–4]. The effectiveness of elective caesarean section (CS) in reducing MTCT was first suggested by observational studies in the early 1990s, with an approximate halving of risk [5,6]. In 1998, an analysis from the French Perinatal Cohort indicated that, among HIV-infected women on zidovudine prophylaxis, elective CS was associated with an 80% reduced risk of MTCT [7]. In 1999 the results of the only randomized controlled trial of vaginal delivery vs. elective CS demonstrated an 80% efficacy for planned elective CS [8], while a large international individual patient data meta-analysis reported a 50% decreased MTCT risk associated with elective CS [9]. Use of antiretroviral drugs in pregnancy, initially zidovudine monotherapy [10,11] and subsequently highly active antiretroviral therapy (HAART), has been a key factor behind declining MTCT rates [3,4,12].

, 2008; Varillas et al., 2010), bacteria (Li et al., 2010; Robertson et al., 2010; Šimenc & Potočnik, 2011), nematodes (Holterman et al., 2012), and fungi (Ricchi et al., 2011). The recent development of better performing saturating DNA dyes and the technical progress that enabled the increased resolution and precision of the instruments have permitted the use of HRM for genotyping (Ganopoulos et al., 2011a, b). Although HRM is a very sensitive technique, the risk of contamination is significantly Fluorouracil mw reduced

compared to multi-step procedures, such as RFLP or nested PCR, because the entire process is completed in a single closed tube. The objective of this study was to develop and validate the HRM method for F. oxysporum formae speciales complex identification based on differences in melting curve characteristics via the ITS of the ribosomal DNA. The results presented in this study show that HRM curve analysis of Fusarium ITS sequences is a simple, quick, and reproducible method that

allows the identification of seven F. oxysporum formae speciales. Seven isolates of F. oxysporum formae speciales (F. oxysporum f. sp. phaseoli, F. oxysporum f. sp. lycopersici, F. oxysporum f. sp. radicis-lycopersici, F. oxysporum f. sp. melonis, F. oxysporum, F. oxysporum f. sp. dianthi, and F. oxysporum f. sp. vasinfectum) were analyzed with HRM analysis (Table 1). In addition, two click here fungal isolates of Verticillium dahliae and Thielaviopsis basicola that cause cotton vascular wilt disease and black root rot respectively were included in this study as out group (data not shown). Genomic fungal DNA was extracted according to Zambounis et al. (2007). DNA concentrations were determined spectrophotometrically and/or by quantitation on agarose gels stained with ethidium bromide in comparison with molecular marker λ-DNA-HindIII (Gibco-BRL, Gaithersburg, MD). PCR amplification, DNA melting, and end point fluorescence PLEKHM2 level acquiring PCR amplifications were performed in a total volume

of 15 μL on a Rotor-Gene 6000 real-time 5P HRM PCR Thermocycler (Corbett Research, Sydney, Australia) according to Ganopoulos et al. (2011a, b). Universal primers, ITS1 (5′-tccgtaggtgaacctgcgg-3′) and ITS4 (5′-tcctccgcttattgatatgc-3′), specific for the internal transcribed spacer of the rDNA were used to generate amplicons (c. 570 bp; White et al., 1990). More specifically, the reaction mixture contained 20 ng genomic DNA, 1× PCR buffer, 2.5 mM MgCl2, 0.2 mM dNTP, 300 nM forward and reverse primers, 1.5 mM Syto® 9 green fluorescent nucleic acid stain, and 1 U Kapa Taq DNA polymerase (Kapa Biosystems). A rapid PCR protocol was conducted in a 36-well carousel using an initial denaturing step of 95 °C for 3 min followed by 35 cycles of 95 °C for 20 s, 55 °C for 45 s and 72 °C for 50 s, then a final extension step of 72 °C for 2 min. The fluorescent data were acquired at the end of each extension step during PCR cycles.

, 1996). Together,

these characteristics make microsatellite loci, one of the best markers for genetic mapping and diversity studies. These markers have been widely used for investigating genetic diversity among cultivars and genetic resources, for developing genetic maps suitable for quantitative trait locus (QTL) detection studies and marker-assisted selection programs, whereas use of these markers to study diversity and polymorphism in fungi is limited. Genetic diversity could reveal the adaptive potential of pathogenic populations, and sometimes, SSR patterns could reflect the variability up to formae speciales, which make possible to increase the resolution of existing markers to discriminate individual strain or formae speciales. The transcripts and express sequence tags (EST) of PCI-32765 mw F. oxysporum are available in different databases, but any formal analysis of microsatellites within these sequences is yet to be reported. The aims of this study were (1) to access microsatellite variability in available EST and transcripts of three formae speciales of F. oxysporum and (2) to develop EST-based microsatellite markers for genetic characterization of Fusarium isolates.

To accomplish this, an in silico approach has been used to assess the frequency and distribution of SSRs in EST and transcript sequences within three formae speciales, and primers were designed and validated for polymorphism. The available ESTs of Fom and Foc were downloaded from National Center for Biotechnology Information (www.ncbi.nlm.nih.gov),

whereas annotated transcript sequences of Fol were NVP-BKM120 solubility dmso downloaded from ‘Fusarium Comparative Sequencing Project’ (www.broadinstitute.org). The identification of microsatellites was carried out using online software WebSat (Martins et al., 2009). All SSRs were analyzed for their frequency of occurrence, density, and relative abundance. Thirty SSR primers representing 10 from each forma specialis were randomly selected for PCR amplification to study their utility in revealing polymorphism. Primers complementary to the flanking regions of selected microsatellites were designed using the program primer 3 online software (frodo.wi.mit.edu/). A total of 24 different F. oxysporum isolates, which include six of F. oxysporum Succinyl-CoA f. sp. melonis (Fom), six of F. oxysporum f. sp. cucmerium (Foc), six of F. oxysporum f. sp. lycopersici (Fol), three of F. oxysporum f. sp. cubense (Fou), and three of F. oxysporum f. sp. ciceri (Foi), were obtained from National Agriculturally Important Microbial Culture Collection (NAIMCC), National Bureau of Agriculturally Important Microorganisms (NBAIM), Mau Nath Bhanjan, Uttar Pradesh, India, representing different agroclimatic zones of India. Total genomic DNA was extracted from 24 isolates of F. oxysporum using CTAB method (Abdelnoor et al., 1995). The PCR was performed in 10.0-μL reaction volume containing 1× PCR buffer (10 mM Tris–HCl pH 9.0, 1.5 μM MgCl2, 50 mM KCl, 0.

Greater buy-in to these services by GPs could persuade more patients to participate, and further

work is required to explore patient perceptions of these schemes as well as reasons why more patients are not recruited to NMS or MURs. 1. Sexton J, Ho, YJ, Green, CF and Caldwell, NA. Ensuring seamless care at hospital discharge: A national survey. Journal of Clinical Pharmacy and Therapeutics, 2000; 25: 385–393 R. Millera,b, C. Darcya, A. Friela, M. Scottc, S. Tonerc aWestern Health and Social Care Trust, Derry, Northern Ireland, UK, bUniversity of Ulster, Coleraine, Northern Ireland, UK, cNorthern Health and Social Care Trust, Antrim, Northern Ireland, UK The project objective was to implement and evaluate consultant pharmacist (CP) case management of older people within intermediate care (IC) and back out into primary care. Over a 12-month period 453 patients were Trametinib cell line case managed. Data on clinical interventions, medication appropriateness, drug costs and patient outcomes were collected and evaluated. CP case management for older people in IC demonstrated a cost- effective selleck products patient-centred model of pharmaceutical care which could be replicated in similar settings. In December 2011, the Compton Review ‘Transforming

Your Care’ outlined the remodelling of Health and Social Care in Northern Ireland (HSCNI), specifically recommending better integration of hospital and community services for older people. The consultant pharmacist is an integral part of the health care model addressing the complex medicines management needs of the frail elderly. The objective of this project was to develop, implement and robustly evaluate a CP led Dichloromethane dehalogenase case management pharmaceutical

care service for older patients admitted to intermediate care and continued back into the community setting. Prior to project initiation (May 2012), a multidisciplinary process mapping event was held informing development of the new patient care pathway where the CP case managed patients (≥ 65 years) throughout their stay in IC and for at least 30 days post-discharge. The trust research governance committee decided this project was service improvement and evaluation not requiring governance or ethical approvals. On admission to the IC hospital, the CP reviewed appropriateness of drugs prescribed using the Medication Appropriateness Index (MAI). Patient-specific pharmaceutical care plans were implemented with clinical interventions being recorded and graded according to Eadon criteria.1 Costs savings as a result of these interventions which prevent medication errors/Adverse Drug Events (ADEs) have been estimated by the University of Sheffield School of Health and Related Research (ScHARR)2; these figures were applied. Drugs stopped/started by the CP were costed using the NHS dictionary of medicines and devices (DM&D).

However, Che1-dependent signaling is shown to contribute indirectly to surface attachment, indicating that distinct mechanisms are likely underlying flocculation and attachment to surfaces in A. brasilense. Chemotaxis is a widespread function in motile soil bacteria as it affords cells with the ability to sense and to selleck navigate toward the most favorable niches

for growth (Wadhams & Armitage, 2004). At the molecular level, the chemotaxis pathway is the dedicated chemosensory signal transduction system that allows cells to couple detection of physicochemical changes in their surroundings to changes in the swimming pattern (i.e. chemotaxis). Chemotaxis signal transduction has been best studied in Escherichia coli and experimental evidence indicates that this prototypical enteric model is conserved and functions similarly (with some variations on the theme) in phylogenetically diverse motile bacteria. In addition to regulating chemotaxis responses in motile bacteria, chemotaxis-like signal transduction pathways were shown to regulate cellular behaviors other than flagellar rotation in several other bacterial species (Kirby, 2009), including the alphaproteobacterium Azospirillum brasilense, a soil diazotroph (Bible et al., 2008).

In only a few cases, however, have the molecular targets of these chemotaxis-like pathways been identified. Ivacaftor The A. brasilense Che1 chemotaxis-like pathway has been shown to have a minor,

and likely indirect, function in regulating chemotaxis behavior in this species (Hauwaerts et al., 2002; Bible et al., 2008; Edwards et al., 2011). Experimental evidence indicates that Che1 functions to modulate changes in adhesive cell surface properties which impact the propensity for cell-to-cell aggregation and flocculation (Bible et al., 2008). Deletions of cheA1 or cheY1, which each code for central proteins controlling the response output of the signal transduction pathway, yield cells that aggregate and flocculate more than the wild-type strain (Bible et al., 2008). A mutant strain deleted for all of the genes encoded within the che1 gene cluster has a phenotype similar to the strains lacking only CheA1 or CheY1, consistent with a role for Che1 Molecular motor in regulating the ability of cells to flocculate. A strain carrying a mutation that disrupts the function of both CheB1 and CheR1 is severely impaired in flocculation, consistent with CheB1 and CheR1 functioning in a signaling feedback loop that controls chemosensory adaptation (Stephens et al., 2006; Bible et al., 2008). Other possible roles that Che1 may have on functions such as adhesion to surfaces or root colonization, have been previously proposed to be related to flocculation (Burdman et al., 2000a, b) but have not yet been investigated. The purpose of the present study was to determine the conditions under which A.

fumigatus, has been reported to support an aspergilloma (Lee, 2010; Muller et al., 2011). One such recent case study described an Aspergillus flavus aspergilloma in a neonate who had urinary catheters placed for genitourinary complications (Martinez-Pajares et al., 2010). Aspergillus species of industrial importance can also be problematic. For example, adhesion of Aspergillus niger spores may cause surface deterioration on different substrates, and has

also been associated with colonization of contact lenses (Marques-Calvo, selleck chemicals llc 2002). However, many of the characteristics associated Aspergillus biofilms are beneficial with respect to industrial processes. Various organic acids have been produced by Aspergillus biofilms using different supports and bioreactors. In one of the oldest publications, A. niger was grown attached to the vertical discs of a rotating disc reactor (Blain et al., 1979), producing fourfold higher citric acid titres than in stirred tank reactor (Anderson et al., 1980). It was also found that MEK inhibition A. niger immobilized on polyurethane foam (biofilms) in a bubble reactor for citric acid production performed better than free-living pellets (Lee et al., 1989). Other organic acids have been produced by Aspergillus biofilms. For example, Aspergillus

terreus grown attached on polyurethane foam used for itaconic acid production (Kautola et al., 1989), gluconic acid has also been produced by passively immobilized A. niger (Vassilev et al., 1993; Fiedurek, 2001). Moreover, several enzymes have been produced by Aspergillus biofilm systems, such as the production of glucose oxidase, inulinase, amylase and cellulases by A. niger (Fiedurek & Ilczuk, 1991; Murado et al., 1994; Skowronek & Fiedurek, 2006; Gamarra et al., 2010), production

of β-frutofuranosidase by Aspergillus japonicas (Mussatto et al., 2009) and production of xylanases by A. terreus and A. niger (Gawande & Kamat, 2000). Aspergillus foetidus biofilms have been shown to degrade some plastics under growth (Upreti & Srivastava, 2003). Also, Aspergillus versicolor has been found to form biofilms on perlite particles in a packed column reactor, and in this condition, it could degrade n-alkanes, aromatic hydrocarbons and carbazoles of petroleum samples (Sanchez et al., 2006). Removal of heavy metals (copper, Loperamide chromium, iron and nickel) by biosorption of either A. niger or A. terreus biofilms formed on polyurethane, has also been reported to be a highly efficient method of metal removal (Tsekova & Ilieva, 2001; Dias et al., 2002). Clearly, Aspergillus biofilms are important in many industrial processes, particularly because they are much more productive than in the classical submerged fermentation with free-living mycelia. Filamentous growth is a fundamental feature of fungal biofilms and is an important morphological characteristic of A. fumigatus required during the development of an aspergilloma (Beauvais et al., 2007; Ramage et al., 2009; Loussert et al.

fumigatus, has been reported to support an aspergilloma (Lee, 2010; Muller et al., 2011). One such recent case study described an Aspergillus flavus aspergilloma in a neonate who had urinary catheters placed for genitourinary complications (Martinez-Pajares et al., 2010). Aspergillus species of industrial importance can also be problematic. For example, adhesion of Aspergillus niger spores may cause surface deterioration on different substrates, and has

also been associated with colonization of contact lenses (Marques-Calvo, learn more 2002). However, many of the characteristics associated Aspergillus biofilms are beneficial with respect to industrial processes. Various organic acids have been produced by Aspergillus biofilms using different supports and bioreactors. In one of the oldest publications, A. niger was grown attached to the vertical discs of a rotating disc reactor (Blain et al., 1979), producing fourfold higher citric acid titres than in stirred tank reactor (Anderson et al., 1980). It was also found that RG7204 A. niger immobilized on polyurethane foam (biofilms) in a bubble reactor for citric acid production performed better than free-living pellets (Lee et al., 1989). Other organic acids have been produced by Aspergillus biofilms. For example, Aspergillus

terreus grown attached on polyurethane foam used for itaconic acid production (Kautola et al., 1989), gluconic acid has also been produced by passively immobilized A. niger (Vassilev et al., 1993; Fiedurek, 2001). Moreover, several enzymes have been produced by Aspergillus biofilm systems, such as the production of glucose oxidase, inulinase, amylase and cellulases by A. niger (Fiedurek & Ilczuk, 1991; Murado et al., 1994; Skowronek & Fiedurek, 2006; Gamarra et al., 2010), production

of β-frutofuranosidase by Aspergillus japonicas (Mussatto et al., 2009) and production of xylanases by A. terreus and A. niger (Gawande & Kamat, 2000). Aspergillus foetidus biofilms have been shown to degrade some plastics under growth (Upreti & Srivastava, 2003). Also, Aspergillus versicolor has been found to form biofilms on perlite particles in a packed column reactor, and in this condition, it could degrade n-alkanes, aromatic hydrocarbons and carbazoles of petroleum samples (Sanchez et al., 2006). Removal of heavy metals (copper, ifenprodil chromium, iron and nickel) by biosorption of either A. niger or A. terreus biofilms formed on polyurethane, has also been reported to be a highly efficient method of metal removal (Tsekova & Ilieva, 2001; Dias et al., 2002). Clearly, Aspergillus biofilms are important in many industrial processes, particularly because they are much more productive than in the classical submerged fermentation with free-living mycelia. Filamentous growth is a fundamental feature of fungal biofilms and is an important morphological characteristic of A. fumigatus required during the development of an aspergilloma (Beauvais et al., 2007; Ramage et al., 2009; Loussert et al.

, 2010a, b; Leng et al., 2011). In this study, we found a new natural compound, apigenin, which inhibits the expression of α-hemolysin both in vitro and in vivo at a low concentration. Apigenin has only slight antimicrobial activity against S. aureus, which is thought to reduce selective pressure against the growth of this species. Moreover, it can significantly protect the alveolar epithelial cells against α-hemolysin-mediated cell injury at 4 μg mL−1, and it can release the pulmonary infection in a murine model. Because of the decrease in levels of α-hemolysin,

the quantity of cytokines found in the alveolar lavage fluid is also greatly reduced. From our study of the quantitative BYL719 purchase RT-PCR, we can conclude in general that all the effects we observed may be related to the apigenin-induced inhibition of the agr two-component system, which occurs in a dose-dependent

manner. Consequently, we can infer from the data shown in this study that apigenin, combined with β-lactam antibiotics, is a promising candidate for use in the treatment of S. aureus pneumonia. We thank Timothy J. Foster for kindly providing S. aureus strains 8325-4 and DU 1090. This work was supported by the National Nature Science Foundation of China (No. 31130053), the National 863 programme (No. 2012AA020303), and the State Key Laboratory SGI-1776 research buy for molecular virology and genetic engineering (No. 2011KF02). J.D. and J.Q. contributed equally to this PIK3C2G work. “
“The nematophagous

fungus Arthrobotrys oligospora is a potential biological agent against parasitic gastrointestinal nematodes. Its subtilisin-like serine proteases play an important role in nematode cuticle breach. In this study, the cDNA of the mature serine protease XAoz1 from A. oligospora XJ-XAo1 was expressed in Pichia pastoris to assess the in vitro nematicidal activity of recombinant XAoz1 (reXAoz1) on Caenorhabditis elegans and Haemonchus contortus. The cDNA sequence of the protease XAoz1 was amplified by reverse transcription polymerase chain reaction (RT-PCR) and inserted into the vector pPIC9K for expression in P.pastoris GS115. Our results show that the reXAoz1 had a molecular mass of 50 kDa after 3 days of 1.5%-methanol induction at 28 °C. The highest specific protease activity was achieved at 12 168 U mg−1 protein. The reXAoz1 had the highest hydrolytic activity at pH 6.5–9.5 with an optimal pH at 8.5. Moreover, the purified reXAoz1 displayed a highly toxic and biological activity to immobilize C. elegans and H. contortus by degrading their cuticles and inducing death. “
“Despite the obvious importance of viral transmission and ecology to medicine, epidemiology, ecology, agriculture, and microbiology, the study of viral bioaerosols and community structure has remained a vastly underexplored area, due to both unresolved technical challenges and unrecognized importance.

vaginosis and Prevotella bivia (Aroutcheva et al., 2001a). Consistent with this, Lactobacillus strains have been isolated from the human vaginal microbiota for probiotic use against vaginosis-associated pathogens (Reid & Burton, 2002; Reid et al., 2003) on the basis of their ability to produce high levels of hydrogen peroxide (Klebanoff et al., 1991; Hillier et al., 1992, 1993). Moreover, Pridmore et al. (2008) first reported for an

intestinal Lactobacillus that hydrogen peroxide contributes to the killing activity 3-MA manufacturer of L. johnsonii NCC533 against serovar Typhimurium. Consistent with these reports, here, we observed that hydrogen peroxide concentration-dependently kills serovar Typhimurium, G. vaginosis and UPEC strains. Moreover, we report that lactic acid acts synergistically with hydrogen peroxide to kill G. vaginalis, S. typhimurium and UPEC more efficiently. The mechanism underlying the stimulatory effect of lactic acid observed could be related to the observation by Greenacre et al. (2006), who have reported that the lactic acid-induced acid tolerance response causes hydrogen peroxide sensitivity in serovar Typhimurium via the downregulation

of the OxyR regulon. A second mechanism could also be proposed, www.selleckchem.com/products/ldk378.html resulting from the permeabilizing effect of lactic acid on the gram-negative bacterial outer membrane (Alakomi et al., 2000), thus facilitating the passage of molecules across the membrane, and in turn increasing the killing effects of antimicrobial compounds (Niku-Paavola et al., 1999; Alakomi et al., 2000). “
“Candidatus Methylomirabilis oxyfera’; is a polygon-shaped bacterium Methane monooxygenase that was shown to have the unique ability to couple anaerobic methane oxidation to denitrification, through a newly discovered intra-aerobic pathway. Recently, the complete genome of Methylomirabilis oxyfera was assembled into a 2.7-Mb circular single chromosome by metagenomic sequencing. The genome of M. oxyfera

revealed the full potential to perform both methane oxidation and the conversion of nitrite via nitric oxide into oxygen and dinitrogen gas. In this study, we show by immunogold localization that key enzymes from both methane- and nitrite-converting pathways are indeed present in single M. oxyfera cells. Antisera targeting the particulate methane monooxygenase (pMMO) and the cd1 nitrite reductase (NirS) were raised and used for immunogold localization in both single- and double-labelling experiments. Our previous studies have shown that M. oxyfera does not develop pMMO-containing intracytoplasmic membranes as is observed in classical proteobacterial methanotrophs. Our results suggest that in M. oxyfera, the pMMO and NirS enzymes localized to the cytoplasmic membrane and periplasm, respectively. Further, double-labelling showed co-occurrence of pMMO and NirS in single M. oxyfera cells.

Our study could not address this issue as the study population was too small and there was a large range of viral loads among patients with viruses harbouring the L90M mutation. Another concern is the significance of the L90M mutation in choosing a therapeutic regimen in naïve patients. A recent study showed that a single transmitted DRM is not an indicator for transmission of a more extensive resistance profile [25], but further investigations evaluating the efficacy of various regiments in treating L90M-harbouring patients are needed. In conclusion, Omipalisib mw this study provides data on transmitted viruses harbouring DRMs in Tel Aviv, Israel.

All patients with transmitted DRMs were from the MSM ERC. In contrast to the findings of other studies from industrialized countries, there was a high rate of PI-associated DRMs. Clustering was shown to possibly facilitate the spread of viruses harbouring these mutations. Questions regarding viral fitness and therapeutic strategy remain open and call for a larger prospective

investigation of this unique patient group. O.P. is a fellow of the Edmond J. Safra Bioinformatics program at Tel Aviv University and of the Converging Technologies scholarship program. T.P. is supported by grants from the Israel Science Foundation (878/09) and the National Evolutionary Synthesis Center (NESCent; NSF #EF-0905606). We thank Esther Eshkol for editorial assistance. “
“The aim of the study was to assess whether a simple, Selleck Ibrutinib routinely available measure of antiretroviral therapy (ART) adherence predicts viral rebound at the next HIV viral load (VL) measurement in virally suppressed patients. The analysis was performed on the Royal Free HIV Cohort, London, UK. Each ‘drug coverage–viral load episode’ (DCVL episode) Etoposide cost was defined as a 6-month period immediately prior to a VL ≤50 HIV-1 RNA copies/mL (time-zero), during which the patient had been continuously on HAART, with all measured VLs ≤50 copies/mL. The next VL after time-zero was used to assess whether VL rebound (defined as >200 copies/mL) had occurred.

Drug coverage, our measure of adherence, was calculated as the proportion of days in the 6-month period covered by a valid prescription for at least three antiretroviral drugs. A total of 376 (2.4%) VL rebounds occurred in 15 660 DCVL episodes among 1632 patients. Drug coverage was 100% for 32% of episodes, 95–99% for 16% of episodes and ≤60% for 10% of episodes. The risk ratio of rebound associated with a 10% increase in drug coverage, adjusted for potential confounding variables, was 0.93 (95% confidence interval 0.88–0.98). Antiretroviral drug coverage assessed at the time of VL measurement in patients with undetectable VL is potentially clinically useful for predicting VL rebound at the next VL measurement.