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Tool identifies infection clusters; rate of T cell drop not helpful in decision to start treating HIV

PLOS

In research published this week in PLoS Medicine, Susan Huang and colleagues describe the use of a novel automated cluster detection tool, WHONET-SaTScan, made by integrating two freely available software packages, to identify hospital infection clusters. After applying the software to microbiology data from patients admitted to a 750-bed academic medical center in the US across four years (2002-2006), the authors found that the tool identified a number of hospital clusters that had not been detected by routine methods. It also classified many previously identified clusters as events likely to occur because of normal random fluctuations and hence not requiring further control measures. The authors state "this automated method has the potential to provide valuable real-time guidance both by identifying otherwise unrecognized outbreaks and by preventing the unnecessary implementation of resource-intensive infection control measures that interfere with regular patient care."

Citation: Huang SS, Yokoe DS, Stelling J, Placzek H, Kulldorff M, et al. (2010) Automated Detection of Infectious Disease Outbreaks in Hospitals: A Retrospective Cohort Study. PLoS Med 7(2): e1000238. doi:10.1371/journal.pmed.1000238

Funding: This work was funded by US National Institutes of Health (MIDAS, 1U01 GM076672, Platt; (http://www.nigms.nih.gov/Initiatives/MIDAS/) and NIH RR025040-02 (Stelling). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests: RP has received research grants from Sanofi-Aventis, GlaxoSmithKline, Pfizer, and TAP Pharmaceuticals in the past two years. DSY has received research support from Sage Products. MK developed the space-time permutation scan statistic method and the free SaTScan software that were used and evaluated in the study. All other authors report no disclosures.

IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER: http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000238

PRESS-ONLY PREVIEW OF THE ARTICLE: www.plos.org/press/plme-07-02-huang.pdf

CONTACT:
Susan Huang
University of California Irvine
Division of Infectious Diseases
101 The City Drive South
City Tower, Suite 400,
Orange, CA 92868-3217
United States of America
714-456-5047
sshuang@partners.org


Rate of T cell count drop not found helpful in deciding when to start HIV treatment

Published this week in open access journal PLoS Medicine, Marcel Wolbers (Wellcome Trust Major Overseas Program, Oxford University Clinical Research Unit) and colleagues find that the rate of CD4 T cell decline is not useful in deciding when to start HIV treatment.

Wolbers and colleagues analyzed data from several thousand cohort study participants with HIV (the CASCADE collaboration) and found that the CD4 cell slope does not improve the prediction of clinical outcome in patients with a CD4 cell count above 350 cells/μl. The authors state "the findings of this study strongly suggest that knowledge of the current CD4 cell count and an assessment of other established risk factors for progression to AIDS are sufficient when deciding whether to initiate cART in symptom-free HIV-positive patients."

Citation: Wolbers M, Babiker A, Sabin C, Young J, Dorrucci M, et al. (2010) Pretreatment CD4 Cell Slope and Progression to AIDS or Death in HIV-Infected Patients Initiating Antiretroviral Therapy--The CASCADE Collaboration: A Collaboration of 23 Cohort Studies. PLoS Med 7(2): e1000239. doi:10.1371/journal.pmed.1000239

Funding: CASCADE has been funded through grants BMH4-CT97-2550, QLK2-2000-01431, QLRT-2001-01708, and LSHP-CT-2006-018949 from the European Union. MW and HCB are supported by research grants from sante suisse and the Gottfried and Julia-Bangerter-Rhyner Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests: HCB received travel grants, honoraria, and unrestricted research grants from various pharmaceutical companies including, GlaxoSmithKline, Bristol-Myers-Squibb, Gilead, Roche, Abbott, Tibotec, and Boehringer-Ingelheim. The research of MW, JY, and HCB is supported by unrestricted grants from sante suisse and the Gottfried and Julia Bangerter-Rhyner-Foundation. The Medical Research Council, Clinical Trials HIV Group, led by AB, received donated drugs and/or financial support for substudies from the following pharmaceutical companies: Abbott, Boehringer Ingelheim, Bristol-Myers Squibb, Cipla, Gilead, Tibotec, Roche, GlaxoSmithKline, Indevus, Merck, Novartis, Sanofi Pasteur, and Virco. KP also received honorarium from Tibotec. CS has received funding for research, teaching, and consultancy from several pharmaceutical companies (GlaxoSmithKline, Gilead Sciences, Bristol-Myers Squibb, and Tibotec) over the last few years. CM received travel grants and honoraria from: GlaxoSmithKline, Bristol-Myers-Squibb, Gilead, Roche, Abbott, Tibotec, and Boehringer-Ingelheim. The research of CM is supported by Istituto Superiore di Sanita.

IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER: http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000239

PRESS-ONLY PREVIEW OF THE ARTICLE: www.plos.org/press/plme-07-02-wolbers.pdf

CONTACT:
Marcel Wolbers
Wellcome Trust Major Overseas Program, Oxford University Clinical Research Unit
Hospital for Tropical Diseases
190 Ben Ham Tu
District 5
Ho Chi Minh City, Ho Chi Minh 00
Viet Nam
0084976072814
mwolbers@oucru.org

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