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Bridging The Gap Between Health And Justice, Lior Gideon

Publications and Research

No abstract provided.

The Role Of Dairy Products And Milk In Adolescent Obesity: Evidence From Hong Kong’S ‘‘Children Of 1997’’ Birth Cohort, Shi Lin Lin, Marie Tarrant, Lai Ling Hui, Man Ki Kwok, Tai Hing Lam, Gabriel M. Leung, Mary Schooling

Publications and Research

Background
Observational studies, mainly from Western populations, suggest dairy consumption is inversely associated with adiposity. However, in these populations the intake range is limited and both diet and obesity may share social patterning. Evidence from non-Western developed settings with different social patterning, is valuable in distinguishing whether observed associations are biologically mediated or socially confounded.

Objective
To examine the associations of milk or other dairy product consumption with adolescent obesity.

Methods
We used multivariable linear regression models to examine the associations of milk or other dairy product consumption, obtained from a food frequency questionnaire, at 11 years with body mass …

Module-Based Subnetwork Alignments Reveal Novel Transcriptional Regulators In Malaria Parasite Plasmodium Falciparum, Hong Cai, Changjin Hong, Jianying Gu, Timothy G. Lilburn, Rui Kuang, Yufeng Wang

Publications and Research

Background Malaria causes over one million deaths annually, posing an enormous health and economic burden in endemic regions. The completion of genome sequencing of the causative agents, a group of parasites in the genus Plasmodium, revealed potential drug and vaccine candidates. However, genomics-driven target discovery has been significantly hampered by our limited knowledge of the cellular networks associated with parasite development and pathogenesis. In this paper, we propose an approach based on aligning neighborhood PPI subnetworks across species to identify network components in the malaria parasite P. falciparum. Results Instead of only relying on sequence similarities to detect functional orthologs, …

Attack Rates Assessment Of The 2009 Pandemic H1n1 Influenza A In Children And Their Contacts: A Systematic Review And Meta-Analysis, Aharona Glatman-Freedman, Ian Portelli, Susan K. Jacobs, Justin I. Mathew, Jonathan E. Slutzman, Lewis R. Goldfrank, Silas W. Smith

Publications and Research

Background The recent H1N1 influenza A pandemic was marked by multiple reports of illness and hospitalization in children, suggesting that children may have played a major role in the propagation of the virus. A comprehensive detailed analysis of the attack rates among children as compared with their contacts in various settings is of great importance for understanding their unique role in influenza pandemics. Methodology/Principal Findings We searched MEDLINE (PubMed) and Embase for published studies reporting outbreak investigations with direct measurements of attack rates of the 2009 pandemic H1N1 influenza A among children, and quantified how these compare with those of …

What Can Phages Tell Us About Host-Pathogen Coevolution?, John J. Dennehy

Publications and Research

The outcomes of host-parasite interactions depend on the coevolutionary forces acting upon them, but because every host-parasite relation is enmeshed in a web of biotic and abiotic interactions across a heterogeneous landscape, host-parasite coevolution has proven difficult to study. Simple laboratory phage-bacteria microcosms can ameliorate this difficulty by allowing controlled, well-replicated experiments with a limited number of interactors. Genetic, population, and life history data obtained from these studies permit a closer examination of the fundamental correlates of host-parasite coevolution. In this paper, I describe the results of phage-bacteria coevolutionary studies and their implications for the study of host-parasite coevolution. Recent …

The Role Of Dental Hygienists In Conducting Rapid Hiv Testing, Anthony J. Santella, Susan H. Davide, Marilyn Cortell, Winnie Furnari, Janet Tuthill

Publications and Research

Expanding rapid HIV testing in the dental setting may increase the number of individuals who are aware of their HIV status and can begin medical care and social support services if seropositive and appropriate.

The Determinants Of Helminth Infection In Baboons, Rita Monfort

Publications and Research

THE DETERMINANTS OF HELMINTH INFECTION IN BABOONS

Summary Paragraph:

Intestinal parasitic helminths are common in wild primate populations [1, 2] and can impose a significant burden on their host’s fitness. Numerous factors can affect the prevalence and diversity of intestinal parasites in natural populations including environmental factors [3, 4], the host’s behavior and genetics [5, 6]. How these different factors interact in natural populations remains unclear. This is in all probability due to the fact that previous studies have seldom looked at the prevalence and diversity of parasitic helminths in the same species but in different habitats over periods longer …

What Is The Predictive Power Of The Colobine Protein-To-Fiber Model And Its Conservation Value?, Jan F. Gogarten, Melissa Guzman, Colin A. Chapman, Aerin L. Jacob, Patrick A. Omeja, Jessica Rothman

Publications and Research

Predicting variation in animal abundance across time and space has proven very difficult; however, a model exists to predict the biomass of small folivorous primates that has considerable correlative support. This model suggests that the protein-to-fiber ratio of leaves in a habitat can predict folivore biomass. Here we present an experimental test of this protein-to-fiber model to assess if the number of infant monkeys per female and group size can be predicted based on the leaf chemistry of a habitat. We expected regenerating forest in Kibale National Park, Uganda to have leaves with higher concentrations of crude protein and lower …

Detecting The Immune System Response Of A 500 Year-Old Inca Mummy, Angelique Corthals, Antonius Koller, Dwight W. Martin, Robert Rieger, Emily I. Chen, Mario Bernaski, Gabriella Recagno, Liliana M. Dávalos

Publications and Research

Disease detection in historical samples currently relies on DNA extraction and amplification, or immunoassays. These techniques only establish pathogen presence rather than active disease. We report the first use of shotgun proteomics to detect the protein expression profile of buccal swabs and cloth samples from two 500-year-old Andean mummies. The profile of one of the mummies is consistent with immune system response to severe pulmonary bacterial infection at the time of death. Presence of a probably pathogenic Mycobacterium sp. in one buccal swab was confirmed by DNA amplification, sequencing, and phylogenetic analyses. Our study provides positive evidence of active pathogenic …

Genome Plasticity And Systems Evolution In Streptomyces, Zhan Zhou, Jianying Gu, Yong-Quan Li, Yufeng Wang

Publications and Research

Background Streptomycetes are filamentous soil-dwelling bacteria. They are best known as the producers of a great variety of natural products such as antibiotics, antifungals, antiparasitics, and anticancer agents and the decomposers of organic substances for carbon recycling. They are also model organisms for the studies of gene regulatory networks, morphological differentiation, and stress response. The availability of sets of genomes from closely related Streptomyces strains makes it possible to assess the mechanisms underlying genome plasticity and systems adaptation. Results We present the results of a comprehensive analysis of the genomes of five Streptomyces species with distinct phenotypes. These streptomycetes have …

Awareness And Interest In Intrauterine Contraceptive Device Use Among Hiv-Positive Women In Cape Town, South Africa, Catherine S. Todd, Heidi E. Jones, Tracy C. Garber, Hoviyeh Afnan-Holmes, Helen Woolgar, Linda-Gail Bekker, Landon Myer

Publications and Research

Objective. To assess awareness of and interest in intrauterine contraceptive device (IUCD) use among HIV-positive women in Cape Town, South Africa. Design. Cross-sectional survey. Methods. HIV-positive women aged 18 through 45 years presenting for care at a primary health care clinic in Cape Town, South Africa participated in this study. Consented participants completed a staff-administered questionnaire in a private setting. Descriptive statistics were generated. Comparisons between demographic and reproductive health-related variables and IUCD awareness and interest were performed with multiple logistic regression. Analyses for IUCD interest excluded women with prior surgical sterilization. Results. Of 277 HIV-positive women, 37% were aware …

Trends In Mortality From Septicaemia And Pneumonia With Economic Development: An Age-Period-Cohort Analysis, Irene O.L. Wong, Benjamin J. Cowling, Gabriel M. Leung, Mary Schooling

Publications and Research

Background
Hong Kong population has experienced drastic changes in its economic development in the 1940s. Taking advantage of Hong Kong’s unique demographic and socioeconomic history, characterized by massive, punctuated migration waves from Southern China, and recent, rapid transition from a pre-industrialized society to the first ethnic Chinese community reaching ‘‘first world’’ status over the last 60 years (i.e., in two or three generations), we examined the longitudinal trends in infection related mortality including septicemia compared to trends in non-bacterial pneumonia to generate hypotheses for further testing in other recently transitioned economies and to provide generalized aetiological insights on how economic …

Mapping Populations At Risk: Improving Spatial Demographic Data For Infectious Disease Modeling And Metric Derivation, Andrew J. Tatem, Susana Adamo, Nita Bharti, Clara R. Burgert, Marcia Castro, Audrey Dorelien, Gunter Fink, Catherine Linard, Mendelsohn John, Livia Montana, Mark R. Montgomery, Andrew Nelson, Abdisalan M. Noor, Deepa Pindolia, Greg Yetman, Deborah Balk

Publications and Research

The use of Global Positioning Systems (GPS) and Geographical Information Systems (GIS) in disease surveys and reporting is becoming increasingly routine, enabling a better understanding of spatial epidemiology and the improvement of surveillance and control strategies. In turn, the greater availability of spatially referenced epidemiological data is driving the rapid expansion of disease mapping and spatial modeling methods, which are becoming increasingly detailed and sophisticated, with rigorous handling of uncertainties. This expansion has, however, not been matched by advancements in the development of spatial datasets of human population distribution that accompany disease maps or spatial models. Where risks are heterogeneous …

Polyglutamine Toxicity Is Controlled By Prion Composition And Gene Dosage In Yeast, He Gong, Nina V. Romanova, Kim D. Allen, Pavithra Chandramowlishwaran, Kavita Gokhale, Gary P. Newnam, Piotr Miceczkowski, Michael Y. Sherman, Yury O. Chernoff

Publications and Research

Polyglutamine expansion causes diseases in humans and other mammals. One example is Huntington’s disease. Fragments of human huntingtin protein having an expanded polyglutamine stretch form aggregates and cause cytotoxicity in yeast cells bearing endogenous QN-rich proteins in the aggregated (prion) form. Attachment of the proline(P)-rich region targets polyglutamines to the large perinuclear deposit (aggresome). Aggresome formation ameliorates polyglutamine cytotoxicity in cells containing only the prion form of Rnq1 protein. Here we show that expanded polyglutamines both with (poly-QP) or without (poly-Q) a P-rich stretch remain toxic in the presence of the prion form of translation termination (release) factor Sup35 (eRF3). …

Genome Stability Of Lyme Disease Spirochetes: Comparative Genomics Of Borrelia Burgdorferi Plasmids, Sherwood R. Casjens, Emmanuel F. Mongodin, Wei-Gang Qiu, Benjamin J. Luft, Steven E. Schutzer, Eddie B. Gilcrease, Wai Mun Huang, Marija Vujadinovic, John K. Aron, Levy C. Vargas, Sam Freeman, Diana Radune, Janice F. Weidman, George I. Dimitrov, Hoda M. Khouri, Julia E. Sosa, Rebecca A. Halpin, John J. Dunn, Claire M. Fraser

Publications and Research

Lyme disease is the most common tick-borne human illness in North America. In order to understand the molecular pathogenesis, natural diversity, population structure and epizootic spread of the North American Lyme agent, Borrelia burgdorferi sensu stricto, a much better understanding of the natural diversity of its genome will be required. Towards this end we present a comparative analysis of the nucleotide sequences of the numerous plasmids of B. burgdorferi isolates B31, N40, JD1 and 297. These strains were chosen because they include the three most commonly studied laboratory strains, and because they represent different major genetic lineages and so are …

A Cross-Sectional Description Of Social Capital In An International Sample Of Persons Living With Hiv/Aids (Plwh), Allison Webel, J Craig Phillips, Carol Dawson Rose, William L. Holzemer, Wei-Ti Chen, Lynda Tyer-Viola, Marta Rivero-Méndez, Patrice Nicholas, Kathleen Nokes, Jeanne Kemppainen, Elizabeth Sefcik, John Brion, Lucille Eller, Scholastika Iipinge, Kenn Kirksey, Dean Wantland, Puangtip Chaiphibalsarisdi, Mallory O. Johnson, Carmen Portillo, Inge B. Corless

Publications and Research

Background Social capital refers to the resources linked to having a strong social network. This concept plays into health outcomes among People Living with HIV/AIDS because, globally, this is a highly marginalized population. Case studies show that modifying social capital can lead to improvements in HIV transmission and management; however, there remains a lack of description or definition of social capital in international settings. The purpose of our paper was to describe the degree of social capital in an international sample of adults living with HIV/AIDS. Methods We recruited PLWH at 16 sites from five countries including Canada, China, Namibia, …

Genetic Reporter System For Positioning Of Proteins At The Bacterial Pole, Kathryn R. Fixen, Anuradha Janakiraman, Sean Garritty, Daniel J. Slade, Andrew N. Gray, Nilay Karahan, Ann Hochschild, Marcia C. Goldberg

Publications and Research

Spatial organization within bacteria is fundamental to many cellular processes, although the basic mechanisms underlying localization of proteins to specific sites within bacteria are poorly understood. The study of protein positioning has been limited by a paucity of methods that allow rapid large-scale screening for mutants in which protein positioning is altered. We developed a genetic reporter system for protein localization to the pole within the bacterial cytoplasm that allows saturation screening for mutants in Escherichia coli in which protein localization is altered. Utilizing this system, we identify proteins required for proper positioning of the Shigella autotransporter IcsA. Autotransporters, widely …

Maize Provitamin A Carotenoids, Current Resources, And Future Metabolic Engineering Challenges, Eleanore T. Wurtzel, Abby Cuttriss, Ratnakar Vallabhaneni

Publications and Research

Vitamin A deficiency is a serious global health problem that can be alleviated by improved nutrition. Development of cereal crops with increased provitamin A carotenoids can provide a sustainable solution to eliminating vitamin A deficiency worldwide. Maize is a model for cereals and a major staple carbohydrate source. Here, we discuss maize carotenogenesis with regard to pathway regulation, available resources, and current knowledge for improving carotenoid content and levels of provitamin A carotenoids in edible maize endosperm. This knowledge will be applied to improve the nutritional composition of related Poaceae crops. We discuss opportunities and challenges for optimizing provitamin A …

Parasites Of Civets (Mammalia, Viverridae) In Sabah, Borneo: A Coprological Survey, Christina P. Colon, Sharon Patton

Publications and Research

Parasite data were collected from unlogged and selectively logged lowland rain forests in Borneo. Scat from a female Viverra tangalunga (Malay civet) in the unlogged forest contained eggs of Capillaria spp., Trichuris sp., Mamomoganomus sp., and nematode larvae. Scat attributed to V. tangalunga contained reproductive products (eggs/oocysts/cysts/larvae) of Capillaria sp., Toxocara sp., Ancylostoma sp. (probably A. ceylanicum), Isospora spp., strongylate-type eggs (probably Ancylostoma spp.), Paragoni­ mus sp. and other Trematoda eggs, Monocystis sp. cysts, Gnathostoma sp. (probably G. spinigerum), the lungworm Viverrostrongylus brauni, pinworm-type eggs, Eimeria spp., Sarcocystis-type sporocyst, dermanysid mites and mesostigmatid mites. Parasites from gut samples from two …

Sexual And Injection-Related Risks In Puerto Rican-Born Injection Drug Users Living In New York City: A Mixed-Methods Analysis, Camila Gelpí-Acosta, Holly Hagan, Samuel M. Jenness, Travis Wendel, Alan Neaigus

Publications and Research

Background These data were collected as part of the National HIV Behavioral Surveillance (NHBS) study. NHBS is a cross-sectional study to investigate HIV behavioral risks among core risk groups in 21 U.S. cities with the highest HIV/AIDS prevalence. This analysis examines data from the NHBS data collection cycle with IDU conducted in New York City in 2009. We explored how the recency of migration from Puerto Rico (PR) to New York City (NYC) impacts both syringe sharing and unprotected sex among injection drug users (IDU) currently living in NYC. Methods We used a mixed-methods approach to examine differences in risk …

Phosphodiesterase-4 Inhibition Alters Gene Expression And Improves Isoniazid – Mediated Clearance Of Mycobacterium Tuberculosis In Rabbit Lungs, Selvakumar Subbian, Liana Tsenova, Paul O'Brien, Guibin Yang, Mi-Sun Koo, Blas Peixoto, Dorothy Fallows, Veronique Dartois, George Muller, Gilla Kaplan

Publications and Research

Tuberculosis (TB) treatment is hampered by the long duration of antibiotic therapy required to achieve cure. This indolent response has been partly attributed to the ability of subpopulations of less metabolically active Mycobacterium tuberculosis (Mtb) to withstand killing by current anti-TB drugs. We have used immune modulation with a phosphodiesterase-4 (PDE4) inhibitor, CC-3052, that reduces tumor necrosis factor alpha (TNF-α) production by increasing intracellular cAMP in macrophages, to examine the crosstalk between host and pathogen in rabbits with pulmonary TB during treatment with isoniazid (INH). Based on DNA microarray, changes in host gene expression during CC-3052 treatment of Mtb infected …

Differences Between Trypanosoma Brucei Gambiense Groups 1 And 2 In Their Resistance To Killing By Trypanolytic Factor 1, Paul Capewell, Nicola J. Veitch, C. Michael R. Turner, Jayne Raper, Matthew Berriman, Stephen L. Hajduk, Annette Macleod

Publications and Research

Background: The three sub-species of Trypanosoma brucei are important pathogens of sub-Saharan Africa. T. b. brucei is unable to infect humans due to sensitivity to trypanosome lytic factors (TLF) 1 and 2 found in human serum. T. b. rhodesiense and T. b. gambiense are able to resist lysis by TLF. There are two distinct sub-groups of T. b. gambiense that differ genetically and by human serum resistance phenotypes. Group 1 T. b. gambiense have an invariant phenotype whereas group 2 show variable resistance. Previous data indicated that group 1 T. b. gambiense are resistant to TLF-1 due in-part to reduced …

The -Omics Era- Toward A Systems-Level Understanding Of Streptomyces, Zhan Zhou, Jianying Gu, Yi-Ling Du, Yong-Quan Li, Yufeng Wang

Publications and Research

Streptomyces is a group of soil bacteria of medicinal, economic, ecological, and industrial importance. It is renowned for its complex biology in gene regulation, antibiotic production, morphological differentiation, and stress response. In this review, we provide an overview of the recent advances in Streptomyces biology inspired by -omics based high throughput technologies. In this post-genomic era, vast amounts of data have been integrated to provide significant new insights into the fundamental mechanisms of system control and regulation dynamics of Streptomyces.

Proteases In Malaria Parasites - A Phylogenomic Perspective, Hong Cai, Rui Kuang, Jianying Gu, Yufeng Wang

Publications and Research

Malaria continues to be one of the most devastating global health problems due to the high morbidity and mortality it causes in endemic regions. The search for new antimalarial targets is of high priority because of the increasing prevalence of drug resistance in malaria parasites. Malarial proteases constitute a class of promising therapeutic targets as they play important roles in the parasite life cycle and it is possible to design and screen for specific protease inhibitors. In this mini-review, we provide a phylogenomic overview of malarial proteases. An evolutionary perspective on the origin and divergence of these proteases will provide …

Experimental Tuberculosis In The Wistar Rat: A Model For Protective Immunity And Control Of Infection, Amit Singhal, El Moukhtar Aliouat, Maxime Herve, Vanessa Mathys, Mehdi Kiass, Colette Creusy, Baptiste Delaire, Liana Tsenova, Laurence Fleurisse, Julie Bertout, Luis Camacho, Damian Foo, Hui Chien Tay, Jie Yee Siew, Warda Boukhouchi, Marta Romano, Barun Mathema, Veronique Dartois, Gilla Kaplan, Pablo Bifani

Publications and Research

Background: Despite the availability of many animal models for tuberculosis (TB) research, there still exists a need for better understanding of the quiescent stage of disease observed in many humans. Here, we explored the use of the Wistar rat model for the study of protective immunity and control of Mycobacterium tuberculosis (Mtb) infection.

Methodology/Principal Findings: The kinetics of bacillary growth, evaluated by the colony stimulating assay (CFU) and the extent of lung pathology in Mtb infected Wistar rats were dependent on the virulence of the strains and the size of the infecting inoculums. Bacillary growth control was associated with induction …

The Impact Of Bisphenol A And Triclosan On Immune Parameters In The U.S. Population, Nhanes 2003–2006, Erin M. Rees Clayton, Megan Todd, Jennifer B. Dowd, Allison E. Aiello

Publications and Research

Background: Exposure to environmental toxicants is associated with numerous disease outcomes, many of which involve underlying immune and inflammatory dysfunction.

Objectives: To address the gap between environmental exposures and immune dysfunction, we investigated the association of two endocrine-disrupting compounds (EDCs) with markers of immune function.

Methods: Using data from the 2003–2006 National Health and Nutrition Examination Survey, we compared urinary bisphenol A (BPA) and triclosan levels with serum cytomegalovirus (CMV) antibody levels and diagnosis of allergies or hay fever in U.S. adults and children ≥ 6 years of age. We used multivariate ordinary least squares linear regression models to examine …

Correcting Mortality For Loss To Follow-Up: A Nomogram Applied To Antiretroviral Treatment Programmes In Sub-Saharan Africa, Matthias Egger, Ben D. Spycher, John Sidle, Ralf Weigel, Elvin H. Geng, Matthew P. Fox, Patrick Macphail, Gilles Van Custem, Eugene Messou, Robin Wood, Denis Nash, Margaret Pascoe, Diana Dickinson

Publications and Research

Background

The World Health Organization estimates that in sub-Saharan Africa about 4 million HIV-infected patients had started antiretroviral therapy (ART) by the end of 2008. Loss of patients to follow-up and care is an important problem for treatment programmes in this region. As mortality is high in these patients compared to patients remaining in care, ART programmes with high rates of loss to follow-up may substantially underestimate mortality of all patients starting ART.

Methods and Findings

We developed a nomogram to correct mortality estimates for loss to follow-up, based on the fact that mortality of all patients starting ART in …

Cytomegalovirus Antibodies In Dried Blood Spots: A Minimally Invasive Method For Assessing Stress, Immune Function, And Aging, Jennifer B. Dowd, Allison E. Aiello, Laura Chyu, Yuan-Yen Huang, Thomas W. Mcdade

Publications and Research

Background Cytomegalovirus (CMV) is a prevalent herpesvirus with links to both stress and aging. This paper describes and validates a minimally invasive method for assessing antibodies against CMV in finger stick whole blood spot samples for use as an indirect marker of an aspect of cell-mediated immunity. Results Analysis of CMV in dried blood spot samples (DBS) was based on modifications of a commercially available protocol for quantifying CMV antibodies in serum or plasma. The method was evaluated through analysis of precision, reliability, linearity, and correlation between matched serum and DBS samples collected from 75 volunteers. Correlation between DBS and …

Antibodies Elicited In Response To Ebna-1 May Cross- React With Dsdna, Pragya Yadav, Hoa Tran, Roland Ebegbe, Paul Gottlieb, Hui Wei, Rita H. Lewis, Alice Mumbey-Wafula, Atira Kaplan, Elina Kholdarova, Linda Spatz

Publications and Research

Background:Several genetic and environmental factors have been linked to Systemic Lupus Erythematosus (SLE). One environmental trigger that has a strong association with SLE is the Epstein Barr Virus (EBV). Our laboratory previously demonstrated that BALB/c mice expressing the complete EBNA-1 protein can develop antibodies to double stranded DNA (dsDNA). The present study was undertaken to understand why anti-dsDNA antibodies arise during the immune response to EBNA-1.

Methodology/Principal Findings: In this study, we demonstrated that mouse antibodies elicited in response to EBNA-1 cross-react with dsDNA. First, we showed that adsorption of sera reactive with EBNA-1 and dsDNA, on dsDNA cellulose …

Trends In The Clinical Characteristics Of Hiv Infected Patients Initiating Antiretroviral Therapy In Kenya, Uganda And Tanzania Between 2002 And 2009, Elvin H. Geng, Peter W. Hunt, Lameck O. Diero, Sylvester Kimaiyo, Geofrey R. Somi, Pius Okong, David R. Bangsberg, Mwebesa B. Bwana, Craig R. Cohen, Juliana A. Otieno, Deo Wabwire, Batya Elul, Denis Nash, Philippa J. Easterbrook, Paula Braitstein, Beverly S. Musick, Jeffrey N. Martin, Constantin T. Yiannoutsos, Kara Wools-Kaloustian

Publications and Research

Background: East Africa has experienced a rapid expansion in access to antiretroviral therapy (ART) for HIVinfected patients. Regionally representative socio-demographic, laboratory and clinical characteristics of patients accessing ART over time and across sites have not been well described.

Methods: We conducted a cross-sectional analysis of characteristics of HIV-infected adults initiating ART between 2002 and 2009 in Kenya, Uganda and Tanzania and in the International Epidemiologic Databases to Evaluate AIDS Consortium. Characteristics associated with advanced disease (defined as either a CD4 cell count level of less than 50 cells/mm3 or a WHO Stage 4 condition) at the time of ART initiation …