Viral Load In Individuals Research Articles

Correlation between cytomegalovirus (CMV) viral load and mortality rate in individuals with acquired immunodeficiency syndrome (AIDS)

AIDS (acquired immunodeficiency syndrome) stems from immune deficiency caused by HIV (human immunodeficiency virus). CMV (cytomegalovirus), opportunistic in HIV/AIDS patients, is associate with mortality at elevated viral loads in individuals with AIDS. Objective: accomplish an integrative review to analyze the relation between CMV viral load and mortality rate in patients with AIDS. Methods: Usage of full review was made by following the said steps: theme identification and research questions structuring; definition of inclusion criteria; selection of articles based on scientific data; evaluation and analysis of selected studies; result interpretation and display of the final full review; insert method description. Result: High CMV viral loads are associated with elevated mortality in individuals with AIDS. Conclusion: It confirms the presence of a correlation between an increase in CMV viral load and an increase in the mortality rate of immunosuppressed patients, associates with viral loads ≥ 1000 copies/ml, marking this as a risk cutoff.

Optimal control of a multi-scale immuno-influenza A transmission model with viral load-dependent infection

Influenza A is a highly contagious respiratory illness that spreads globally and results in millions of cases worldwide. The transmission rate and mortality rate of influenza in the population are determined by the load of the influenza A virus. In this study, we have developed a multi-scale immuno-influenza model considering incomplete vaccine immunity. We have calculated the basic reproduction numbers for both immunological and epidemiological models. Additionally, we have examined the stability of the disease-free equilibrium and the existence of the endemic equilibrium at the population level. To assess the cost-effectiveness of antiviral therapy at an individual level and vaccination at a population level, we have formulated an optimal control problem. The objective of this problem is to minimize both the number of influenza cases and the cost of vaccination. To solve this optimal control problem, we have employed the Ekeland variational principle. Furthermore, we have designed a global forward and backward sweep algorithm to estimate the impact of antiviral treatment on reducing influenza transmission among humans. Our findings indicate that the use of antiviral treatment significantly reduces viral loads in individuals. However, it may also increase the potential risk at the population level. Therefore, vaccination against influenza is the most effective option from a public health perspective.

Characteristics of blood immune cell profile and their correlation with disease progression in patients infected with HIV-1

BackgroundAntiretroviral therapy (ART) can reduce viral load in individuals infected with human immunodeficiency virus (HIV); however, some HIV-infected individuals still cannot achieve optimal immune recovery even after ART. Hence, we described the profile of peripheral immune cells and explored the association with disease progression in patients infected with HIV-1.MethodsMass cytometry analysis was used to characterize the circulating immune cells of 20 treatment-naïve (TNs), 20 immunological non-responders (INRs), 20 immunological responders (IRs), and 10 healthy controls (HCs). Correlation analysis was conducted between cell subpopulation percentages and indicators including HIV-1 cell-associated (CA)-RNA, DNA, CD4+ T cell count, and CD4/CD8 ratio.ResultsGlobal activation, immunosenescence, and exhaustion phenotypes were observed in myeloid cells and T cells from individuals with HIV-1 infection. We also found that specific subsets or clusters of myeloid, CD4+ T, and CD8+ T cells were significantly lost or increased in TN individuals, which could be partially restored after receiving ART. The percentages of several subpopulations correlated with HIV-1 CA-RNA, DNA, CD4+ T cell count, and CD4/CD8 ratio, suggesting that changes in immune cell composition were associated with therapeutic efficacy.ConclusionThese data provide a complete profile of immune cell subpopulations or clusters that are associated with disease progression during chronic HIV-1 infection, which will improve understanding regarding the mechanism of incomplete immune recovery in INRs.

Host genetic variation at a locus near CHD1L impacts HIV sequence diversity in a South African population.

It has been previously shown that genetic variants near CHD1L on chromosome 1 are associated with reduced HIV VL in African populations. However, the impact of these variants on viral diversity and how they restrict viral replication are unknown. We report on a regional association analysis in a South African population and show evidence of selective pressure by variants near CHD1L on HIV RT and gag. Our findings provide further insight into how genetic variability at this locus contributes to host control of HIV in a South African population.

Assessment of clinical characteristics and viral load in individuals infected by Delta and Omicron variants of SARS-CoV-2

In late 2021, a new variant of SARS-CoV-2 called Omicron emerged, replacing Delta worldwide. Although it has been associated with a lower risk of hospitalization and severe forms of COVID-19, there is little evidence of its relationship with specific symptoms and viral load. The aim of this study was to verify the relationship between Delta and Omicron variants of concern, viral load, and the occurrence of symptoms in individuals with COVID-19. Nasopharyngeal swab samples were collected and sequenced from patients with COVID-19 from the Northeast Region of Brazil between August 2021 and March 2022. The results showed a gradual replacement of the Delta variant by the Omicron variant during the study period. A total of 316 samples (157 Delta and 159 Omicron) were included. There was a higher prevalence of symptoms in Delta-infected individuals, such as coryza, olfactory and taste disturbances, headache, and myalgia. There was no association between viral load and the variants analyzed. The results reported here contribute to the understanding of the symptoms associated with the Delta and Omicron variants in individuals affected by COVID-19.

Comparison of diagnostic performance of RT-qPCR, RT-LAMP and IgM/IgG rapid tests for detection of SARS-CoV-2 among healthcare workers in Brazil

BackgroundCOVID-19 has become a major public health problem after the outbreak caused by SARS-CoV-2 virus. Great efforts to contain COVID-19 transmission have been applied worldwide. In this context, accurate and fast diagnosis is essential. MethodsIn this prospective study, we evaluated the clinical performance of three different RNA-based molecular tests – RT-qPCR (Charité protocol), RT-qPCR (CDC (USA) protocol) and RT-LAMP – and one rapid test for detecting anti-SARS-CoV-2 IgM and IgG antibodies. ResultsOur results demonstrate that RT-qPCR using the CDC (USA) protocol is the most accurate diagnostic test among those evaluated, while oro-nasopharyngeal swabs are the most appropriate biological sample. RT-LAMP was the RNA-based molecular test with lowest sensitivity while the serological test presented the lowest sensitivity among all evaluated tests, indicating that the latter test is not a good predictor of disease in the first days after symptoms onset. Additionally, we observed higher viral load in individuals who reported more than 3 symptoms at the baseline. Nevertheless, viral load had not impacted the probability of testing positive for SARS-CoV-2. ConclusionOur data indicates that RT-qPCR using the CDC (USA) protocol in oro-nasopharyngeal swabs samples should be the method of choice to diagnosis COVID-19.

Influence of HIV infection on clinical course of the new coronavirus infection (COVID-19)

BACKGROUND: Human immunodeficiency virus (HIV)-associated severe immunosuppression, high viral load, non-HIV-related comorbidities and conditions, and lack of antiretroviral therapy may exacerbate the clinical course of coronavirus disease 2019 (COVID-19).
 AIM: To assess the effect of HIV infection on the clinical course of COVID-19, disease severity, and its outcomes.
 MATERIALS AND METHODS: Medical records of 35,328 patients who had COVID-19 in 2020 were analyzed, including 46 cases of COVID-19 in individuals with HIV infection. Clinical variants and COVID-19 severity, frequency of COVID-19 detection by polymerase chain reaction, CD4 lymphocyte count, viral load in individuals with HIV infection, and mortality rates were assessed.
 RESULTS: In 76% of patients with coinfection, signs of HIV infection progression, opportunistic infections, and concomitant diseases were noted. Moreover, 52.2% of the patients analyzed were users of psychoactive substances. Among patients with HIV and COVID-19, men predominated in groups aged 30 years, whereas among the HIV-negative population, women were predominant in groups aged 18 years. The proportion of severe COVID-19 in individuals with HIV infection (47.8%) exceeds that in the group without HIV (12.3%). The mortality rate from COVID-19 in the HIV-infected group was more than seven times higher than that in the HIV-negative group (t=1.81; p=0.01).
 CONCLUSIONS: In the HIV-infected group, extremely severe COVID-19 was more common. Weakness, cough, shortness of breath, and myalgia were significantly more common in the HIV-infected group. Moreover, the HIV-infected group with an undetectable viral load and adequate CD4 lymphocyte count in the blood was exposed to the same risks of the disease and its progression as the HIV-negative group.

HPR40 Cost-Effectiveness and Budget Impact of Baloxavir Marboxil in the Netherlands Based on Post-COVID Influenza Season Scenarios

Baloxavir marboxil is a novel antiviral treatment for influenza reducing the viral load in individuals infected with influenza. Baloxavir marboxil is effective in reducing illness duration and complications from influenza. Historically, antivirals against influenza have not been reimbursed in the Netherlands. However, after the COVID pandemic there is an increased uncertainty regarding the spread and severity of influenza in the population. We assessed the cost-effectiveness and budget impact of using baloxavir marboxil in the Netherlands for patients aged 60 and above and high-risk population who may not be adequately protected by the annual influenza vaccination.

SARS-CoV-2 nasopharyngeal viral load in individuals infected with BA.2, compared to Alpha, Gamma, Delta and BA.1 variants: A single-center comparative analysis.

Background. SARS-CoV-2 has evolved, leading to the emergence of new Variants Of Concern (VOCs) with significant impact on transmissibility. Although the transmission process is complex, higher nasopharyngeal viral load (NP-VL) can be considered as a proxy for greater transmissibility.Objectives. The aim of this analysis was to compare NP-VL across a set of representative VOCs observed in mildly symptomatic patients.Study design. Observational single-center comparative analysis of patients with early mild-to-moderate COVID-19, enrolled within the early treatment access program of Lazzaro Spallanzani Institute (March 2021-March 2022). NP-VL before drug administration was estimated through RT-PCR, based on cycle threshold values (CTs); VOCs were identified by Sanger sequencing. VOCs’ average treatment effect (ATE) was estimated on the CTs fitted in the log2 scale, controlling for potential confounders.Results. A total of 707 patients were included. VOCs were: 10% Alpha, 3% Gamma, 34% Delta, 34% BA.1, 19% BA.2. Mean CTs for BA.1 and BA.2 were lower than Delta and BA.1, respectively. After adjusting for calendar time, age, immunodeficiency and vaccination, CTs for Gamma were lower than those seen for Alpha and higher than Delta, for Delta were similar to BA.1, for BA.2 were lower than Delta and BA.1.Conclusions. Our analysis shows higher NP-VL of BA.2 compared to previously circulating VOCs, even after controlling for factors potentially contributing to the amount of nasopharyngeal viral RNA, included vaccination, supporting the increased transmissibility of BA.2. Further studies are necessary to clarify this mechanism and to provide guidance for public health measures.

Infectious viral load in unvaccinated and vaccinated individuals infected with ancestral, Delta or Omicron SARS-CoV-2.

Infectious viral load (VL) expelled as droplets and aerosols by infected individuals partly determines transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). RNA VL measured by qRT-PCR is only a weak proxy for infectiousness. Studies on the kinetics of infectious VL are important to understand the mechanisms behind the different transmissibility of SARS-CoV-2 variants and the effect of vaccination on transmission, which allows guidance of public health measures. In this study, we quantified infectious VL in individuals infected with SARS-CoV-2 during the first five symptomatic days by in vitro culturability assay in unvaccinated or vaccinated individuals infected with pre-variant of concern (pre-VOC) SARS-CoV-2, Delta or Omicron BA.1. Unvaccinated individuals infected with pre-VOC SARS-CoV-2 had lower infectious VL than Delta-infected unvaccinated individuals. Full vaccination (defined as >2 weeks after receipt of the second dose during the primary vaccination series) significantly reduced infectious VL for Delta breakthrough cases compared to unvaccinated individuals. For Omicron BA.1 breakthrough cases, reduced infectious VL was observed only in boosted but not in fully vaccinated individuals compared to unvaccinated individuals. In addition, infectious VL was lower in fully vaccinated Omicron BA.1-infected individuals compared to fully vaccinated Delta-infected individuals, suggesting that mechanisms other than increased infectious VL contribute to the high infectiousness of SARS-CoV-2 Omicron BA.1. Our findings indicate that vaccines may lower transmission risk and, therefore, have a public health benefit beyond the individual protection from severe disease.

High-dose ivermectin for early treatment of COVID-19 (COVER study): a randomised, double-blind, multicentre, phase II, dose-finding, proof-of-concept clinical trial

High concentrations of ivermectin demonstrated antiviral activity against SARS-CoV-2 in vitro. The aim of this study was to assess the safety and efficacy of high-dose ivermectin in reducing viral load in individuals with early SARS-CoV-2 infection. This was a randomised, double-blind, multicentre, phase II, dose-finding, proof-of-concept clinical trial. Participants were adults recently diagnosed with asymptomatic/oligosymptomatic SARS-CoV-2 infection. Exclusion criteria were: pregnant or lactating women; CNS disease; dialysis; severe medical condition with prognosis <6 months; warfarin treatment; and antiviral/chloroquine phosphate/hydroxychloroquine treatment. Participants were assigned (ratio 1:1:1) according to a randomised permuted block procedure to one of the following arms: placebo (arm A); single-dose ivermectin 600 μg/kg plus placebo for 5 days (arm B); and single-dose ivermectin 1200 μg/kg for 5 days (arm C). Primary outcomes were serious adverse drug reactions (SADRs) and change in viral load at Day 7. From 31 July 2020 to 26 May 2021, 32 participants were randomised to arm A, 29 to arm B and 32 to arm C. Recruitment was stopped on 10 June because of a dramatic drop in cases. The safety analysis included 89 participants and the change in viral load was calculated in 87 participants. No SADRs were registered. Mean (S.D.) log10 viral load reduction was 2.9 (1.6) in arm C, 2.5 (2.2) in arm B and 2.0 (2.1) in arm A, with no significant differences (P = 0.099 and 0.122 for C vs. A and B vs. A, respectively). High-dose ivermectin was safe but did not show efficacy to reduce viral load.

High Dose Ivermectin for the Early Treatment of COVID-19 (COVIER Study): A Randomised, Double-Blind, Multicentre, Phase II, Dose-Finding, Proof of Concept Clinical Trial

Background: High concentrations of ivermectin demonstrated antiviral activity against SARS-CoV-2 in vitro. Aim of this study was to assess safety and efficacy of high-dose ivermectin in reducing viral load in individuals with initial SARS-CoV-2 infection. Methods: Randomised, double-blind, multicentre, phase II, dose-finding, proof-of-concept clinical trial performed in outpatients in Italy. Participants: adults recently diagnosed with asymptomatic/oligosymptomatic SARS-CoV-2 infection, providing informed consent. Exclusion criteria: pregnant or lactating women; CNS diseases; participants under dialysis; severe medical condition with prognosis Findings. From 31th July, 2020 to 26th May, 2021, 32 participants were randomized to arm A, 29 to arm B and 32 to arm C. The recruitment was stopped on 10th June, because of a dramatic drop of cases. Eighty-nine participants were included in the safety analysis set, the change in viral load was calculated on 87 participants. No SADR were registered. The mean log10 viral load reduction was 2.9 in arm C (SD 1.6), 2.5 (2.2) in arm B and 2.0 (2.1) in arm A, with no significant differences (p=0.099 and 0.122 for C versus A and B versus A, respectively). Interpretation: High- dose ivermectin demonstrated safe, but did not prove efficacy to reduce viral load.Trial Registration: The protocol was registered with ClinicalTrials.gov , NCT04438850. Funding: The trial was partly funded by the Italian Ministry of Health.Declaration of Interest: None to declare. Ethical Approval: This study was approved by the national Ethics Committee of INMI – Spallanzani in Rome that is competent for all COVID-19 trials in Italy (resolution 139/2020 of 28th May, 2020), and by the Italian drug agency AIFA (resolution 136BIS/2020 of 18th May, 2020).

LB-11. Comparison of Viral Loads in Individuals With or Without Symptoms At Time of COVID-19 Testing Among 32,480 Residents and Staff of Nursing Homes and Assisted Living Facilities in Massachusetts

BackgroundTransmission of COVID-19 from people without symptoms confounds public health containment strategies. Comprehensive cross-sectional screening enables assessment of viral load independent of symptoms, informing transmission risks. We quantified SARS-CoV-2 burden by RT-qPCR from comprehensive screening of nursing homes and assisted living facilities in Massachusetts to inform our ability to detect SARS-CoV-2 in individuals with or without symptoms.MethodsFrom 4/9/20 to 6/9/20, we tested nasopharyngeal (NP) swabs from 32,480 unique individuals comprising staff and residents of the majority of nursing homes and assisted living facilities in Massachusetts. Symptomatology at the time of sampling and demographic information were provided by each facility. NP swabs were collected, RNA extracted, and SARS-CoV-2 testing performed by RT-qPCR. We compared cycle thresholds (Ct) with a standard curve to quantify viral loads.ResultsThe nursing home and assisted living facilities resident cohort (N = 16,966) was 65% female with mean age 82. The staff cohort (N = 15,514) was 76% female with mean age 45. In all, 2654 residents (15.5%) and 624 staff (4.1%) tested positive for SARS-CoV-2, including 12.7% of residents and 3.7% of staff without symptoms, compared to 53.1% of residents and 18.2% of staff with symptoms. The Ct distributions for viral probes were very similar between populations with and without symptoms (Fig 1), with a statistically but not meaningfully different mean (ΔCt 0.71 cycles, p = 0.006) and a similar range (12–38 cycles). This similarity persisted across all sub-categories examined (age, race, ethnicity, sex, resident/staff).Figure 1 ConclusionIn a large cohort of individuals screened for SARS-CoV-2 by RT-qPCR, we found strikingly similar viral load distributions in patients with or without symptoms at the time of testing. The size of the study population, including both staff and residents spanning a wide range of ages, provides a comprehensive cross-sectional point prevalence measurement of viral burden. Because the distributions of viral loads are very similar regardless of symptoms, existing testing modalities validated for detection of SARS-CoV-2 RNA in symptomatic patients should perform similarly well in individuals without symptoms at the time of testing.Disclosures All Authors: No reported disclosures

Factors associated to the control of viral load in HIV positive patients.

Introduction: The acquired immunodeficiency syndrome remains a health challenge in Brazil. Therapeutic failures, characterized by detectable viral load, must have their causes evaluated. Among the most relevant reasons is the lack of adherence to treatment. Objective: To evaluate factors associated with inadequate control of viral load in individuals with HIV in the CAP of Itajubá (MG). Methods: This is an observational, cross-sectional and documentary study with 261 medical records. The variables analyzed were gender, age, education, residence, sexual orientation, first and last test results of tests for viral load and CD4+ T lymphocytes, history of poor adherence, use of current antiretroviral therapy (ART), duration of ART use, depression and/or anxiety, use of illicit drugs, follow-up time at the CAP. Results: Of the patients, 90.42% had an undetectable viral load and 64.37% had a CD4+ T count ≥500 in the last available test. Some characteristics were related to detectable viral load in the last exam: history of poor adherence during treatment (p&lt;0,0001), inconsistent use of ART (p&lt;0,0001) and use of illicit drugs (p=0,0155). Anxiety and/or depression was not statistically significant (p=0,3321). Conclusion: History of poor adherence, inconsistent use of ART and use of illicit drugs were associated with an increased risk ok virological failure. The identification of groups at risk of poor adherence to treatment can support the development of intervention strategies in an early and transdisciplinary way to improve adherence and generate better results in the control of HIV infection.

Impact of HLA Allele-KIR Pairs on Disease Outcome in HIV-Infected Thai Population.

Class I human leukocyte antigen (HLA) molecules contribute to HIV control through antigen presentation to both cytotoxic T lymphocytes and natural killer cells. Contribution of cytotoxic T lymphocytes to HIV clinical outcome by HLA alleles has been well studied. However, reports about the role of natural killer cells in HIV clinical outcome, particularly, about the effect of HLA-killer immunoglobulin-like receptor (KIR) pairs, remain incomplete. The effects of HLA allele-KIR pairs on HIV clinical outcome were statistically analyzed in a Thai cohort of treatment-naive chronically infected population (n = 209). Five HLA allele-KIR pairs scored significantly in viral load (VL) differences. Among them, opposing effects on VL were identified among subjects expressing KIR2DL2 ligands within the HLA-C1 group: higher VL in individuals expressing HLA-B*46:01+KIR2DL2+ compared with individuals without KIR (HLA-B*46:01+KIR2DL2-) (5.0 vs 4.6 log10 copies/mL, P = 0.02), in HLA-C*01:02+KIR2DL2+ (5.0 vs 4.6 log10 copies/mL; P = 0.02), and lower VL in HLA-C*12:03+KIR2DL2+ (4.3 vs 5.6 log10 copies/mL; P = 0.01). In the longitudinal analysis of a ten-year follow-up, HLA-B*46:01+KIR2DL2+ve subjects also had a higher mortality rate compared with the subjects without that pair, independent of variables including antiretroviral treatment, as well as CD4 T-cell count, sex, and age (adjusted hazard ratio 5.9, P = 0.02). We identified several HLA allele-KIR pairs associated with clinical outcome differences including opposing effects on VL within 1 HLA group with the same KIR. Among them, HLA-B*46:01 emerged in Southeast Asia about 50,000 years ago and is now the most prevalent HLA-B allele in that area. These findings highlight that each endemic area has unique features of anti-HIV innate immunity that impact clinical outcome.

The effect of sexually transmitted co-infections on HIV viral load amongst individuals on antiretroviral therapy: a systematic review and meta-analysis.

BackgroundAntiretroviral therapy (ART) markedly reduces HIV transmission, and testing and treatment programs have been advocated as a method for decreasing transmission at the population level. Little is known, however, about the extent to which sexually transmitted infections (STIs), which increase the HIV infectiousness of untreated individuals, may decrease the effectiveness of treatment as prevention.MethodsWe searched major bibliographic databases to August 12th, 2014 and identified studies reporting differences in HIV transmission rate or in viral load between individuals on ART who either were or were not co-infected with another STI. We used hierarchical Bayesian models to estimate viral load differences between individuals with and without STI co-infections.ResultsThe search strategy retrieved 1630 unique citations of which 14 studies (reporting on 4607 HIV viral load measurements from 2835 unique individuals) met the inclusion criteria. We did not find any suitable studies that estimated transmission rates directly in both groups. Our meta-analysis of HIV viral load measurements among treated individuals did not find a statistically significant effect of STI co-infection; viral loads were, on average, 0.11 log10 (95 % CI −0.62 to 0.83) higher among co-infected versus non-co-infected individuals.ConclusionsDirect evidence about the effects of STI co-infection on transmission from individuals on ART is very limited. Available data suggests that the average effect of STI co-infection on HIV viral load in individuals on ART is less than 1 log10 difference, and thus unlikely to decrease the effectiveness of treatment as prevention. However, there is not enough data to rule out the possibility that particular STIs pose a larger threat.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-0961-5) contains supplementary material, which is available to authorized users.

P3: HIV(+) viral load in individuals with dengue virus infection in the Dominican Republic

P3: HIV(+) viral load in individuals with dengue virus infection in the Dominican Republic

Comparison of Viral Load in Individuals with and without Asthma during Infections with Rhinovirus

Most virus-induced attacks of asthma are caused by rhinoviruses (RVs). To determine whether people with asthma are susceptible to an increased viral load during RV infection. Seventy-four children (4-18 yr old) were enrolled; 28 with wheezing, 32 with acute rhinitis, and 14 without respiratory tract symptoms. Nasal washes were evaluated using quantitative polymerase chain reaction for RV to judge viral load along with gene sequencing to identify strains of RV. Soluble intercellular adhesion molecule-1, IFN-λ1, and eosinophil cationic protein in nasal washes, along with blood eosinophil counts and total and allergen-specific IgE in sera, were also evaluated. Similar assessments were done in 24 young adults (16 with asthma, 8 without) who participated in an experimental challenge with RV (serotype 16). Fifty-seven percent of wheezing children and 56% with acute rhinitis had nasal washes testing positive for RV. The geometric mean of viral loads by quantitative polymerase chain reaction in washes from wheezing children was 2.8-fold lower, but did not differ significantly from children with rhinitis (7,718 and 21,612 copies of viral RNA per microliter nasal wash, respectively; P = 0.48). The odds for wheezing were increased if children who tested positive for RV were sensitized to one or more allergens (odds ratio, 3.9; P = 0.02). Similarly, neither peak nor cumulative viral loads differed significantly in washes from adults with asthma compared with those without asthma during the experimental RV challenge. During acute symptoms, children infected with RV enrolled for wheezing or acute rhinitis had similar viral loads in their nasal washes, as did adults with and without asthma infected with RV-16 experimentally.

E-DNA IM or ID delivery prime enhances antibody and T cell responses following recombinant gp120 env boost

Background The results of the RV144 trial support the ability of vaccine induced Antibodies to protect from HIV acquisition. The STEP trial also appears to have impacted viral load in individuals who produced strong T cell immunity. The HVTN has recently reported that our enhanced DNA (Pennvax) can drive T cell immunity as robust as Adenoviral and Pox platforms in an accelerated format in humans. We have now focused on further driving T and B cell immunity by utilizing prime boost Methods Groups of rabbits or Indian Rhesus macaques were vaccinated with enhanced DNA vaccine plasmids encoding pGAG, pPOL + combinations of 3-5 consensus or COT designed envelopes that were either gp140 or gp160 constructs. Both IM as well as a novel minimally invasive skin delivery EP arrays (MID) were studied. DNA vaccinated animals were boosted two months following the final DNA immunization with SF162 gp120 in MF59. Results

Current Resources for Evidence‐Based Practice January/February 2012

The Institute of Medicine Report on Clinical Preventive Services for Women: From Evidence to Policy As a central component of the Affordable Care Act (ACA), new health insurance plans will be required to cover preventive health services without cost sharing to plan members beginning on or after August 1, 2012. In response to this directive within the ACA, the United States Department of Health and Human Services (HHS) charged the Institute of Medicine (IOM) with conducting a comprehensive review of women’s preventive health services and recommending those services deemed necessary for the health of women in the United States (Gee et al, 2011).