The average incubation period for dengue infection is 5 days, followed by an infectious period of viremia lasting for an average of 4.5 days.4,5 There is no licensed dengue vaccine and the only means of prevention is through avoidance of bites from the mosquito vector. The principal dengue vectors, Aedes aegypti and Aedes albopictus mosquitoes, are common throughout the tropics and subtropics. Roughly, one third of the world’s population lives

in dengue-endemic areas in over 100 countries, with an estimated 50 to 100 million dengue cases occurring worldwide annually.6 Over the past two decades, dengue epidemics with cases of DHF have been occurring with increasing frequency around the globe.7,8 Although the vast majority of dengue AZD5363 infections occur among residents of dengue-endemic areas, dengue is being increasingly diagnosed among travelers to these destinations.9 Recent findings from the GeoSentinel Surveillance Network9,10 indicate that dengue is the

most commonly reported cause of acute febrile illness in travelers returning from the Caribbean, South America, south central Asia, and southeast Asia. Moreover, dengue was found to be the second most common cause of febrile learn more illness (after malaria) in travelers returning from sub-Saharan Africa and Central America.9 In the United States, this upward trend will likely continue with the increasing rates of international travel in recent years,11 and the increasing number of new US immigrants from endemic countries12 who are likely to visit friends and relatives in their countries of origin.13,14 Concern over the risk of reintroduction of dengue virus into the United States has been recently expressed.15Ae. aegypti mosquitoes

exist in a few states in the southeastern United States.16 However, Ae. albopictus mosquitoes exist in 26 states throughout the southeastern United States and Hawaii.17 The presence of competent vectors in the continental United States and Hawaii, along with the Aspartate increasing global incidence of dengue and travel to dengue-endemic areas, underscores the need for vigilance regarding possible importation of dengue virus via travel-associated cases. The Division of Vector-Borne Infectious Diseases at the US Centers for Disease Control and Prevention (CDC) conducts dengue surveillance in collaboration with the Puerto Rico Department of Health. This laboratory-based Passive Dengue Surveillance System (PDSS) collects serum samples and epidemiologic information from suspected dengue cases reported by healthcare providers from Puerto Rico, the US Virgin Islands, and the 50 US states and the District of Columbia. This analysis uses PDSS surveillance data to describe the epidemiology of travel-associated dengue among travelers from the United States during the period of 1996 to 2005.

HAART may provide more reassurance about prevention of MTCT but will also expose both mother and infant to more potential drug toxicities. The choice of HAART is as per Recommendation 5.3.3. Data

on the mode of delivery in elite controllers are sparse and limited to case reports Z-VAD-FMK in vivo [142]. The benefits of PLCS at various levels of viraemia are discussed in Section 7.2 (Mode of delivery). There are no data to support the use of PLCS for PMTCT when the VL is <50 HIV RNA copies/mL in women on ART. The Writing Group therefore recommends vaginal delivery for all elite controllers on ART. 5.6.1 The discontinuation of NNRTI-based HAART postpartum should be according to BHIVA guidelines for the treatment of HIV-1-positive adults with antiretroviral therapy 2012 (www.bhiva.org/PublishedandApproved). Grading: 1C The literature comparing strategies for stopping ART in pregnant women is limited and therefore no alternative recommendation, compared with non-pregnant women, is made. 5.6.2 ARV therapy should be continued in all pregnant women who commenced HAART with a history of an AIDS-defining illness or with a CD4 cell count <350 cells/μL as per adult treatment guidelines. Grading: 1B Available RCT data to address the question as to whether one should continue or stop HAART in women receiving it to prevent MTCT and not for their own health are sparse and have limited applicability

to current ART treatment practices. What information there is comes from early RCTs with zidovudine monotherapy [143] with or without HIV immunoglobulin [144] and from ATM/ATR inhibitor review observational studies with their inherent weaknesses [145-148]. Nevertheless, concerns have been raised regarding the discontinuation of ARVs postpartum in light of results from CD4-guided interruption studies (SMART [149] and TRIVICAN [150] in particular) although interruption of ART given for PMTCT after delivery is not completely

analogous. In both these studies, which were halted prematurely because of the significantly worse outcome in the CD4-guided interruption arm, lower CD4 cell count thresholds for resumption Rapamycin of therapy were used than would be currently based on clinical treatment guidelines. Moreover, these CD4-based treatment RCTs (SMART and TRIVICAN) and the major cohort studies (NA-ACCORD [151], ART-CC [152]) either excluded or did not collect data on pregnant women. Hence, these recommendations extrapolate data used to inform internationally accepted treatment guidelines for all adults as well as incorporating evidence available from the limited data for postpartum drug management. In addition, observations on the collated evidence of the deleterious effect of direct virus infection, and indirect inflammatory response and its correlation to CD4 cell count, allow tentative conclusions to be made on the potential for this to be prevented by cART.

peucetius occurs by the action of drrA, drrB (Guilfoile & Hutchinson, 1991) and drrC (Lomovskaya et al., 1996) genes. Adjacently placed drrA and drrB genes encode DrrAB proteins that belong to the ABC family of membrane transporters. DrrA is a peripheral membrane protein and DrrB is an integral membrane protein of 36 and 30 kDa, respectively (Kaur, 1997). They function together as a complex that may consist of two subunits of DrrA and two subunits

of DrrB to efflux DNR (Kaur & Russell, 1998). The drrA and drrB genes have overlapping stop and start codons that are translationally coupled. Furthermore, it was observed that a functional complex could be achieved only when the genes were maintained in cis BMS-354825 purchase and in a translationally coupled manner (Pradhan et al., 2009). The drrC gene encodes a 764 amino acid protein that possibly inhibits or destabilizes the binding of DNR to genomic DNA (Lomovskaya et al., 1996). DNR biosynthesis in S. peucetius is regulated by three sequentially activated transcriptional regulators dnrN, dnrO and

dnrI. The dnrO gene is located adjacent to dnrN and is divergently transcribed. The DnrN protein binds specifically to the dnrI promoter region (Furuya & Hutchinson, Sirolimus manufacturer 1996) and activates the transcription of the dnrI gene (Otten et al., 1995). DnrI activator protein binds to promoter elements of biosynthetic and resistance genes to turn them on. (Madduri & Hutchinson, 1995). DNR inhibits binding of DnrN to the dnrI promoter region. The dnrO gene encodes a DNA-binding protein that binds specifically to the dnrN/dnrO promoter region and activates dnrN (Otten et al., 2000). DnrO is an activator/repressor that activates dnrN and represses its own transcription. Repression is relieved in the presence of drug intermediate rhodomycin (Jiang & Hutchinson, 2006). Disruption of any regulatory gene leads to complete cessation of DNR production. In this study,

simultaneous targeted disruption of drrA and drrB was performed to obtain a null mutant strain with a low self-resistance and drug production. Quantitative real-time (qRT)-PCR was carried out to understand the Glutamate dehydrogenase negative feedback regulation activated by the disruption of a specific antibiotic efflux pump. Feedback inhibition of antibiotic biosynthesis by DNR discussed in earlier studies is revisited and supported by our new findings. Taq DNA polymerase, DNR, fine chemicals and oligonucleotide primers were purchased from Sigma Aldrich Chemicals Pvt Ltd, India. Antarctic alkaline phosphatase was purchased from New England Biolabs Inc. Culture media components were obtained from HiMedia Laboratories Pvt Ltd, India. Restriction enzymes, T4 DNA ligase and polynucleotide kinase were purchased from Promega. Other analytical-grade laboratory reagents were procured from standard commercial sources. Strain plasmids and genes with accession numbers used in the study are provided as Supporting Information, Table S1.

Since the degree

of 131I contamination in the tap water and in vegetables was much higher before March 22 than after March 22 in many cities, as expected from the data shown in Figures 2 to 5, the total amount of 131I ingested by the mothers before March 22 may have far exceeded that ingested after March 22. If we had conducted this study earlier, around March 20, a much higher 131I content in the breast milk would likely have been detected. Thus, nursing infants may also have been exposed to large doses before March 22. The radiation doses received after the Chernobyl accident remain somewhat uncertain.6 Our findings regarding the extent of breast milk contamination with 131I in relation to the extent of the pollution of the atmosphere, water and vegetables may be helpful in the future http://www.selleckchem.com/JAK.html and may enable click here a relatively accurate estimation of

the relationship between breast milk contamination with 131I and the development of infant thyroid cancer. However, large differences in the level of exposure after the Chernobyl reactor accident were reported to exist between neighboring villages, within families inside the same village, or even within the same family depending on diet, living habits and occupation, and the level of exposure was considered to depend mainly on individual behavior.17 Therefore, the possibility that the participants in this study may have been more interested in the danger of breast milk contamination with 131I than lactating women in general should be kept in mind, as the study population may not be representative of lactating women in general. All authors declare that they have no financial relationship with a biotechnology manufacturer, a pharmaceutical company or other commercial entity that has an interest in the subject matter or materials discussed in the manuscript. Nobuya Unno: study design, data analysis, coordination with the JMHLW and draft preparation; Hisanori

Minakami: study design, data analysis and draft preparation; Takahiko Kubo: responsible for privacy protection and illustrations; Lck Keiya Fujimori: data sampling and critical discussion; Isamu Ishiwata: data sampling and critical discussion; Hiroshi Terada: measurement of 131I in the breast milk; Shigeru Saito: data sampling and critical discussion; Ichiro Yamaguchi: measurement of 131I in the breast milk; Naoki Kunugita: measurement of 131I in the breast milk, critical discussion and obtaining approval from the institutional review board of the Ethics Committee; Akihito Nakai: data sampling and critical discussion; Yasunori Yoshimura: supervision. This study was supported by the Japanese Ministry of Health, Labour and Welfare (JMHLW). “
“To determine accuracy and costs of placental α-microglobulin-1 (PAMG-1) test compared to standard clinical assessment (SCA) for diagnosing rupture of membranes (ROM).

Mating experiments were performed at concentrations of each metal that were below the minimum inhibitory concentration (MIC). The definition of ‘transconjugants’ is recipient strains acquired OTC resistance by the mating. The tet(M) gene was detected in transconjugants using PCR (Rahman et al., 2008). Chemical determination of V in Pacific marine sediment was performed. Details of sampling sites and condition are reported in elsewhere (Rahman et al., 2008). Analysis was performed by using inductively coupled plasma-mass spectrometry (ICP-MS) according to the method of Ha et al. (2009). Briefly, the sediment samples were treated with a mixture of HF–HNO3 (1 : 5) and digested by a closed vessel microwave system (Ethos

D, Milestone S.r.l., Sorisole, BG, Italy). The digested solution was heated Selleckchem Compound Library until acid was removed. The residue was dissolved by HNO3 and diluted with Milli-Q water. Concentrations of 28 trace elements were measured with an ICP-MS (Hewlett-Packard, HP-4500, Avondale, PA). Units of concentrations of trace elements were represented as μg g−1 dry weight. The OTC resistance rate in the sediment has been reported previously (Rahman et al., 2008). The correlation between the V concentration and OTC resistance rate was analyzed in this study.

Susceptibility of all strains used in this ERK inhibitor study to OTC and various metals was determined as the MIC according to the method described by the National Committee for Clinical Laboratory Standards (NCCLS) (2003). The MICs of OTC and various metals for each strain are shown in Table 1. Exposure to 500 and 1000 μM

V (as VCl3) resulted in a significant increase in the conjugation rate (P < 0.05) (Fig. 1a), and exposure to Ca (CaCl2) also increased the conjugation rate in a dose-dependent manner (Fig. 1b). Exposure of E. coli JM109 to Inositol oxygenase zinc (Zn as ZnSO4), copper (Cu as CuSO4), and cadmium (Cd as CdCl2) resulted in a decrease in the conjugation rate (Fig. 1c–e). The conjugation rate also increased in an apparent dose-dependent manner upon exposure to mercury (Hg as HgCl2) (Fig. 1f); however, the increase was not significant. It is known that Ca2+ can increase the competency of bacterial cells and induce DNA compaction due to compensation of the DNA electrostatic charge and hydrophobic interactions of the complex sites (Kabanov & Kabanov, 1995), and it is believed that this mechanism contributes to DNA incorporation. Although the mechanism(s) leading to increased rates of OTC resistance following V exposure are not clear, the present study is the first to demonstrate that V can promote conjugation leading to OTC resistance. The MIC of OTC for the recipient E. coli strain was 2 μg mL−1, whereas that of all the transconjugants was significantly higher (256 μg mL−1) (Table 1). The results of PCR analyses indicated that the tet(M) gene was transferred to the recipient E. coli cells, suggesting that the acquisition of OTC resistance occurred through HGT.

Mating experiments were performed at concentrations of each metal that were below the minimum inhibitory concentration (MIC). The definition of ‘transconjugants’ is recipient strains acquired OTC resistance by the mating. The tet(M) gene was detected in transconjugants using PCR (Rahman et al., 2008). Chemical determination of V in Pacific marine sediment was performed. Details of sampling sites and condition are reported in elsewhere (Rahman et al., 2008). Analysis was performed by using inductively coupled plasma-mass spectrometry (ICP-MS) according to the method of Ha et al. (2009). Briefly, the sediment samples were treated with a mixture of HF–HNO3 (1 : 5) and digested by a closed vessel microwave system (Ethos

D, Milestone S.r.l., Sorisole, BG, Italy). The digested solution was heated Rapamycin solubility dmso until acid was removed. The residue was dissolved by HNO3 and diluted with Milli-Q water. Concentrations of 28 trace elements were measured with an ICP-MS (Hewlett-Packard, HP-4500, Avondale, PA). Units of concentrations of trace elements were represented as μg g−1 dry weight. The OTC resistance rate in the sediment has been reported previously (Rahman et al., 2008). The correlation between the V concentration and OTC resistance rate was analyzed in this study.

Susceptibility of all strains used in this ZD1839 research buy study to OTC and various metals was determined as the MIC according to the method described by the National Committee for Clinical Laboratory Standards (NCCLS) (2003). The MICs of OTC and various metals for each strain are shown in Table 1. Exposure to 500 and 1000 μM

V (as VCl3) resulted in a significant increase in the conjugation rate (P < 0.05) (Fig. 1a), and exposure to Ca (CaCl2) also increased the conjugation rate in a dose-dependent manner (Fig. 1b). Exposure of E. coli JM109 to before zinc (Zn as ZnSO4), copper (Cu as CuSO4), and cadmium (Cd as CdCl2) resulted in a decrease in the conjugation rate (Fig. 1c–e). The conjugation rate also increased in an apparent dose-dependent manner upon exposure to mercury (Hg as HgCl2) (Fig. 1f); however, the increase was not significant. It is known that Ca2+ can increase the competency of bacterial cells and induce DNA compaction due to compensation of the DNA electrostatic charge and hydrophobic interactions of the complex sites (Kabanov & Kabanov, 1995), and it is believed that this mechanism contributes to DNA incorporation. Although the mechanism(s) leading to increased rates of OTC resistance following V exposure are not clear, the present study is the first to demonstrate that V can promote conjugation leading to OTC resistance. The MIC of OTC for the recipient E. coli strain was 2 μg mL−1, whereas that of all the transconjugants was significantly higher (256 μg mL−1) (Table 1). The results of PCR analyses indicated that the tet(M) gene was transferred to the recipient E. coli cells, suggesting that the acquisition of OTC resistance occurred through HGT.

“
“To evaluate the clinical courses and outcomes of patients with monoarthritis and to investigate the predictive factors of clinical outcomes. A retrospective analysis was performed of 171 patients with chronic monoarthritis at a single tertiary hospital between January 2001 and January 2011. Baseline characteristics, radiographic findings and the clinical course were HDAC inhibitor reviewed. The most commonly involved joints were the knees (24.0%), followed by the wrists (22.8%) and ankles (18.7%). A final diagnosis

was established in 74 (43.3%) patients. Thirty-one (18.1%) patients were diagnosed with rheumatoid arthritis (RA), 23 (13.5%) with peripheral spondyloarthritis (SpA), and 19 (11.1%) with Behçet’s disease (BD). Among 108 patients who were initially undiagnosed, 85 (78.7%) patients remained with undiagnosed monoarthritis, with relatively

shorter symptom durations and requiring less treatment. The initially involved joint was a predictive factor for the final diagnosis: the wrist joint for RA (odds ratio [OR] 11.58, P < 0.001), the ankle joint for SpA (OR 6.19, P < 0.001), and the knee joint for BD (OR 3.43, P = 0.014). Bony erosion at baseline was associated with progression to oligo- or polyarthritis (OR 2.88, P = 0.030) and with radiographic progression. Ipilimumab price In patients presenting with monoarthritis, a final diagnosis was established in less than Carbohydrate half of the patients, and a majority of undiagnosed patients showed benign clinical courses. The initially involved joint and the presence of erosion at baseline were predictors of the final diagnosis and of clinical outcomes.

“
“Nonspecific chronic synovitis of the knee joint was reported by Pollard in 1962 and its pathogenesis is considered to be a physiological reaction to intra-articular disease. In this study, we evaluated the pathological findings of the synovium of early osteoarthritis (OA)-affected knee joints with hydrarthrosis in comparison to typical OA. Synovial tissues were harvested from early OA knee joints with hydrarthrosis graded 0–2 according to the Kellgren and Lawrence classification and examined by histopathology. The synovial tissues showed proliferation of fibroblast-like synoviocytes (FLS) as if in rheumatoid arthritis (RA), and were immunohistochemically positive for matrix metalloproteinase 3, tumor necrosis factor α and interleukin 6. The histology of RA is characterized by marked proliferation of FLS. In this study, the synovial tissues of early OA with hydrarthrosis showed moderate FLS proliferation. They also expressed the cytokines that are detected in the synovial tissues of RA. We suggest long-term follow-up is needed because early OA with hydrarthrosis might progress to overt RA.

“
“To evaluate the clinical courses and outcomes of patients with monoarthritis and to investigate the predictive factors of clinical outcomes. A retrospective analysis was performed of 171 patients with chronic monoarthritis at a single tertiary hospital between January 2001 and January 2011. Baseline characteristics, radiographic findings and the clinical course were Rapamycin clinical trial reviewed. The most commonly involved joints were the knees (24.0%), followed by the wrists (22.8%) and ankles (18.7%). A final diagnosis

was established in 74 (43.3%) patients. Thirty-one (18.1%) patients were diagnosed with rheumatoid arthritis (RA), 23 (13.5%) with peripheral spondyloarthritis (SpA), and 19 (11.1%) with Behçet’s disease (BD). Among 108 patients who were initially undiagnosed, 85 (78.7%) patients remained with undiagnosed monoarthritis, with relatively

shorter symptom durations and requiring less treatment. The initially involved joint was a predictive factor for the final diagnosis: the wrist joint for RA (odds ratio [OR] 11.58, P < 0.001), the ankle joint for SpA (OR 6.19, P < 0.001), and the knee joint for BD (OR 3.43, P = 0.014). Bony erosion at baseline was associated with progression to oligo- or polyarthritis (OR 2.88, P = 0.030) and with radiographic progression. http://www.selleckchem.com/products/ITF2357(Givinostat).html In patients presenting with monoarthritis, a final diagnosis was established in less than CHIR-99021 mouse half of the patients, and a majority of undiagnosed patients showed benign clinical courses. The initially involved joint and the presence of erosion at baseline were predictors of the final diagnosis and of clinical outcomes.

“
“Nonspecific chronic synovitis of the knee joint was reported by Pollard in 1962 and its pathogenesis is considered to be a physiological reaction to intra-articular disease. In this study, we evaluated the pathological findings of the synovium of early osteoarthritis (OA)-affected knee joints with hydrarthrosis in comparison to typical OA. Synovial tissues were harvested from early OA knee joints with hydrarthrosis graded 0–2 according to the Kellgren and Lawrence classification and examined by histopathology. The synovial tissues showed proliferation of fibroblast-like synoviocytes (FLS) as if in rheumatoid arthritis (RA), and were immunohistochemically positive for matrix metalloproteinase 3, tumor necrosis factor α and interleukin 6. The histology of RA is characterized by marked proliferation of FLS. In this study, the synovial tissues of early OA with hydrarthrosis showed moderate FLS proliferation. They also expressed the cytokines that are detected in the synovial tissues of RA. We suggest long-term follow-up is needed because early OA with hydrarthrosis might progress to overt RA.

, 2011) (Fig. 4). Compared with other angucyclinone antibiotics mentioned previously, kiamycin has two distinctive characteristics, 6a-OH and epoxy moiety. A plausible pathway was that oxidoreductases (ang 5 and ang 18) were in charge of synthesis of 6a-OH and epoxy structure, respectively (Fig. 4). In our study, we have used a genome scanning method to discover metabolic loci. The basis of this approach is that the genes required for secondary metabolites

biosynthesis are typically clustered together in a streptomycete chromosome (Martín & Liras, 1989; Zazopoulos et al., 2003). Genomic sequence analysis reveals the most diverse assemblage of biosynthetic modules involved in producing polyketides and nonribosomal peptides in the Streptomyces. This work provides Selleckchem Seliciclib powerful evidence for discovering cryptic metabolic Vincristine supplier potential and directing traditional natural product research based on genome sequence. This work was supported by the National Natural Science Foundation of China (31000037), the Knowledge Innovation Program of the Chinese Academy of Sciences (KZCX2-YW-JC201), CAS International Innovation Partnership Program: Typical Environmental Process and Effects on Resources in Coastal Zone Area, Outstanding Young Scholar Fellowship of Shandong Province (JQ200914), the Natural

Science Foundation of Shandong Province (ZR2009EQ004), the Foundation of the Key Laboratory of Marine Bioactive Substance and Modern Analytical Techniques, SOA (MBSMAT-2010-07), and Public Science and Technology Research Funds Projects of Ocean below (200905021-3). H. Zhang and H. Wang contributed equally to this work. “
“Clostridium difficile is the major cause of nosocomial diarrhoea. Several detection methods are available for

the laboratory diagnosis of C. difficile, but these vary in terms of sensitivity and specificity. In this study, we compared the performance of three following laboratory tests to detect C. difficile: in-house real-time PCR aiming for toxin B gene (tcdB), EIA for detection of toxins A and B (Premier Toxins A & B) and C. difficile culture in selective medium (bioMerieux). Our results were grouped into three categories as follows: (1) C. difficile-associated diarrhoea (CDAD); (2) asymptomatic carriers; and (3) negative results. Among the 113 patients included in the study, 9 (8.0%) were classified as CDAD, 19 (16.8%) were asymptomatic carriers, 76 (67.2%) had negative results and 9 (8.0%) could not be categorized (positive test for C. difficile toxins only). PCR was found to be the most sensitive diagnostic test in our study, with the potential to be used as a screening method for C. difficile colonization/CDAD. Diagnosis of CDAD would be better performed by a combination of PCR and EIA tests. “
“To better understand the effect of temperature on mycotoxin biosynthesis, RNA-Seq technology was used to profile the Aspergillus flavus transcriptome under different temperature conditions.

349) (Table 1). A two-factor solution emerged with 69.02% of the variance explained. The data were suitable for PCA as the Kaiser–Meyer–Oklin value was 0.90, exceeding the recommended value of 0.6, and Bartlett’s test of sphericity was statistically significant (P<0.001). The first eight items loaded more

strongly on the first component, corresponding to the process of shared decision-making and patient involvement, and the last two items loaded more strongly on the second component, corresponding to the process of making the final medical decision. Cronbach’s α reliability estimate was high for the 10 items at 0.91. Cronbach’s α was 0.92 for the first eight items and 0.72 for the last two items. Given that the concordance items loaded on two correlated factors, analyses were performed for summed scores Selleckchem Obeticholic Acid of the 10 items (referred to as ‘concordance’) as well as summed scores of the first eight items (referred to as ‘shared decision-making process’) and summed scores of the last two items (referred to as

‘medical decision’). Spearman correlations were used to investigate relationships between concordance (as well as shared decision-making and medical decision) and continuous variables. Mann–Whitney and Kruskal–Wallis tests were used to investigate relationships buy Ipilimumab between concordance (as well as shared decision-making and medical decision) and categorical variables. Nonparametric tests were selected as concordance, shared decision-making and medical decision scores were skewed. Six linear regressions investigated the relationship between each independent variable (concordance, shared decision-making and medical

decision) and the dependent variables (CD4 cell count at baseline and CD4 cell count at 6–12 months post-study) controlling for treatment status oxyclozanide (on treatment/stopped treatment), baseline CD4 cell count (for CD4 cell count at 6–12 months post-study as dependent variable) and any demographic variable related to concordance, shared decision-making or medical decision and CD4 cell count at P<0.25. Treatment status was included in regression analyses looking at concordance or shared decision-making because it was associated with these variables and CD4 cell count (at baseline and at follow-up) in univariate analyses at P<0.25. Ethnicity was included in regression analyses looking at medical decision because it was associated with this variable in univariate analyses and CD4 cell count (at baseline and at follow-up) at P<0.25. White patients scored lower on medical decision and reported higher CD4 cell counts than non-White patients. None of the other demographic variables was associated with medical decision and CD4 cell count at P<0.25.