Enzyme reactions were confirmed by monitoring the formation of pr

Enzyme reactions were confirmed by monitoring the formation of products as well as the disappearance of reactants via HPLC by incubating the activity bands with the appropriate reaction mixtures. GDH expression was determined utilizing the method described in Mailloux et al. (2009a, b). Briefly, the protein samples were solubilized in 62.5 mM Tris-HCl (pH 6.8), 2% SDS, and 2%β-mercaptoethanol at 100 °C for 5 min. Following solubilization, the protein samples were then loaded into a 10% isocratic gel and electrophoresed using a discontinuous buffer system. CP-868596 price Following electrophoresis, the proteins were transferred electrophoretically to

a Hybond™- polyvinylidene difluoride membrane for immunoblotting. Nonspecific binding sites were blocked by treating the membrane with 5% nonfat skim milk dissolved in TTBS [20 mM Tris-HCl, 0.8% NaCl, and 1% Tween-20 (pH 7.6)] for 1 h. Polyclonal antibodies for GDH were obtained from Abcam. The secondary http://www.selleckchem.com/products/abt-199.html antibodies (Li-Cor, Lincoln, NE) consisted of infrared 700 nm tagged goat anti-rabbit. Visualization of the immunoblot was documented using an Odyssey infrared imaging system (Li-Cor). The H2O2-mediated

regulation of KGDH, GDH, and ICDH was studied as follows: 10 mg of protein equivalent of H2O2-treated cells were transferred into the control (without H2O2) medium and a 10 mg protein equivalent of control cells were incubated in a 100/500 μM H2O2-containing medium. Following a 4–8-h incubation period, the cells were isolated and fractionated as described previously to determine enzymatic activities and/or expression. For a proper comparison, control cells (24 h) and H2O2-treated cells (28 h) in a similar growth phase were utilized to inoculate the different media, respectively. Two milligrams of protein equivalent of CFE from control and stressed cells were placed in a reaction Thymidylate synthase mixture consisting

of 5 mM histidine and 5 mM citrate, in the presence or absence of 5 mM fluorocitrate, an inhibitor of aconitase, in a phosphate buffer (Nasser et al., 2006). After 30 min, the reaction was halted by placing the mixture at 100 °C for 10 min. The reaction mixture was then subjected to HPLC analysis to monitor the production of KG. Data were expressed as means±SDs. Statistical correlations of data were checked for significance using the Student’s t-test (P≤0.05). All experiments were performed at least twice and in triplicate. While both citrate and histidine were utilized readily by the microorganism, it appeared that in the stationary phase of growth, nearly the entire amino acid was consumed (Fig. 1). The biomass yield was relatively similar in these two situations, with the H2O2-stressed bacteria attaining the stationary phase of growth at a slightly later time. Metabolomic analyses of the CFEs revealed that the H2O2-stressed cells contained significantly more KG and succinate (Fig. 2).

Here, we review the approaches for modeling bacterial diversity a

Here, we review the approaches for modeling bacterial diversity at both the very large and the very small scales at which microbial systems interact with their environments. We show that modeling can help to connect biogeochemical

processes to specific microbial metabolic pathways. To understand microbial systems, it is necessary to consider the scales at which they interact with their environment. These scales range spatially from microns to kilometers and temporally from eons to hours. Accounting for 350–550 billion tons of extant biomass (Whitman et al., 1998), microorganisms are the principal form of life on Earth, and they have dominated Earth’s evolutionary history. Prokaryotes, the oldest lineage on the tree of life, first appeared about 3.8 billion years ago (Mojzsis et al., 1996) and AZD2281 molecular weight have been detected in selleck inhibitor virtually every environment that has been investigated, from boiling lakes (Barns et al., 1994; Hugenholtz et al., 1998), to the atmosphere (Fierer et al., 2008; Bowers et al., 2009), to deep in the planet’s crust (Takai et al., 2001; Fisk et al.,

2003; Edwards et al., 2006; Teske & Sorensen, 2008). Microbial metabolism contributes to biogeochemical cycles (O’dor et al., 2009; Hoegh-Guldberg, 2010) and has both direct and indirect impacts on Earth’s climate (Bardgett et al., 2008; Graham et al., 2012). Indeed, marine microbial activity has even been implicated as a correlate in earlier mass species extinction Dichloromethane dehalogenase events (Baune & Bottcher, 2010). The concept that living processes drive changes the physical environment at the global scale is not new. The ‘Gaia Hypothesis’, which postulates that living processes help maintain atmospheric

homeostasis, was published nearly 40 years ago (Lovelock et al., 1974), and there is mounting evidence that this is indeed the case (Charlson et al., 1987; Cicerone & Oremland, 1988; Gorham, 1991). Use of next-generation high-throughput data, however, has only recently made possible direct investigations of the specific molecular mechanisms and microbial consortia responsible for the planet’s dynamic equilibrium. While their effects may be global, microbial systems interact with their environments at microscopic scales. A single gram of soil might contain around 109 microbial units (Torsvik & Ovreas, 2002), and an average milliliter of seawater will contain approximately a million bacterial cells. The wide taxonomic diversity of these populations (Pedros-Alio, 2006) is fostered, at least in part, by myriad microenvironments accessible to the bacteria. In soil and marine systems, the majority of microbial diversity is represented in the minority of biomass (Pedros-Alio, 2006; Sogin et al., 2006; Ashby et al., 2007; Elshahed et al., 2008). Generally, in highly diverse microbial communities, a few abundant taxa predominate, with a long tail of low abundance taxa (Sogin et al., 2006).

[15] Combined PET/CT images confirmed the localization of the tra

[15] Combined PET/CT images confirmed the localization of the tracer in thickened synovia in knee joints.[15] Therefore, pre-treatment with rituximab is necessary for saturating the peripheral binding sites, and visualization of the CD20-antigen expression could provide a tool to localize sites of inflammation and could be of additive value in the treatment follow-up of RA patients. In one study, Minamimoto et al.[52] examined an RA patient who complained of cervical lymphadenopathy at 66 months after initiation of methotrexate (MTX) treatment for RA. PET/CT imaging showed an FDG-avid lesion at bilateral tonsils, bilateral supraclavicular fossa, bilateral axillary nodes and left inguinal

region. Diffuse large B cell lymphoma (DLBCL) was proven from the biopsy tissue of the FDG-avid lesion at the right supraclavicular fossa. In another patient with a 10-year history of RA, splenomegaly, liver tumor and left renal tumor were identified on Roxadustat order CT examination. After a week’s withdrawal of MTX, these lesions shrank, CH5424802 manufacturer but rapid regrowth occurred when MTX therapy was restarted. PET/CT imaging showed FDG-avid foci at the right inguinal region, para-aortic region, bilateral adrenal glands and liver.[52] These findings showed the usage of FDG PET/CT for diagnosis and follow-up of patients with MTX-related malignancies.

The mean of aortic maximum 18F-FDG target-to-background ratios (TBRmax) in the whole aorta was significantly higher in RA patients in comparison with cardiovascular disease (CVD) patients.[44] Similarly, there was a marked rightward shift in the distribution of TBRmax at baseline in RA patients compared with CVD patients, and RA patients had a higher proportion of hot slices within the aorta than were found in CVD patients.[44] However, Nintedanib (BIBF 1120) after anti-TNF therapy (adalimumab, etanercept), PET/CT images showed a strong reduction in mean aortic TBRmax and reduced proportion of hot slices.[44] Similarly, 18F-FDG PET/CT imaging on RA patients showed distinct areas

of extra-articular soft tissue FDG uptake, such as axillary lymph nodes, epitrochlear lymph node, cervical lymph nodes, inguinal nodes, thyroid gland and subcutaneous (possibly rheumatoid) nodules.[24, 42, 43, 53-57] In addition, PET/CT imaging can find RA-complicated diseases such as interstitial pneumonia,[58] multiple extra-articular synovial cysts,[59] rheumatoid lung disease[60, 61] and atlanto-axial osteoarthritis.[62] Collectively, these data suggest that FDG PET/CT is not only able to find RA-complicated tumors, but also has the potential to detect RA-complicated inflammatory diseases. Positron emission tomography/computed tomography has become a valuable ancillary tool for evaluating RA. This technique can visualize the degree of disease activity or ‘burden of inflammation’. It may be helpful for the assessment of the extent of RA throughout the whole body, including high-risk lesions such as those in the atlanto-axial joint.

The genes required for PGA synthesis in B anthracis

are

The genes required for PGA synthesis in B. anthracis

are part of the cap operon (capBCADE) located on the pX02 plasmid (Makino et al., 1989; Uchida et al., 1993; Candela et al., 2005). The capD gene encodes a γ-glutamyltranspeptidase, or PGA depolymerase, which was found to be required for the covalent anchoring of PGA to the peptidoglycan in B. anthracis (Candela & Fouet, 2005). PGA producers that lack capD produce a loose slime layer instead of a covalently linked capsule (Candela & Fouet, 2005). While all Group I and II isolates in this study tested negative for the four cap genes tested (including capD), they were still able to produce a covalently linked PGA capsule. Homologs to several of the cap genes selleck chemicals llc have been found in other bacteria, such as Bacillus subtilis, Bacillus licheniformis, and Staphylococcus epidermidis (Ashiuchi & Misono, 2002; Urushibata et al., 2002; Candela & Fouet, 2005, 2006; Candela et al., 2005; Kocianova Alectinib et al., 2005). It is possible that the Group I and II isolates contain PGA synthesis genes that more closely resemble these homologs than those in the cap operon of B. anthracis and are thus too divergent to amplify using the cap PCR primers used in this study. A clear difference in colony morphology on bicarbonate

agar was evident for about half of the isolates. These isolates, as well as the B. cereus G9241-positive control, produced dull or dry colonies, whereas virulent strains of B. anthracis produce the shiny or the mucoid morphology. Thus, although commonly used for capsule expression and observation in B. anthracis, the colony morphology of other species on bicarbonate agar alone is not an accurate indicator of capsule production. The d-PGA capsule of B. anthracis is required for virulence, in addition to Docetaxel cost the tripartite toxin encoded by the pX01 plasmid. The role in virulence, if any, of the B. anthracis-like PGA capsules produced by

Group I and II isolates, however, is unknown. We cannot be certain that these isolates were responsible for the infections, as Bacillus spp. are frequent contaminates of clinical samples, and no further epidemiological data were available (Farrar & Reboli, 2006). However, during the course of this study, 20 clinical isolates from CDC’s Special Bacteriology Reference Laboratory’s (SBRL) culture collection were identified as having a high degree of 16S rRNA gene sequence similarity (99.87–100%) to one or more of the Group I or II isolates, and were subsequently tested for capsule production. These isolates had been sent by various states or territories (AK, CA, CO, MO, OH, PA, PR, TN, VA, and VT) for identification from 2001 to 2008, and were ultimately identified by SBRL as either Bacillus spp. or Brevibacterium spp. Nineteen of the 20 isolates tested positive for capsule production, detected by both methods described above.

LBB performed the statistical analysis All authors participat

L.B.B. performed the statistical analysis. All authors participated in the interpretation of the data and critical review and revision of the manuscript. “
“International Journal of Paediatric Dentistry 2012; 22 (Suppl. 1): 1–35 Objective.  To Navitoclax mouse provide the users with information on the current best practices for managing the oral health care of people living with EB. Methods.  A systematic literature search, in which the main topic is dental care in patients with Epidermolysis Bullosa, was performed. Consulted sources, ranging from 1970 to 2010, included MEDLINE,

EMBASE, CINAHL, The Cochrane Library, DARE, and the Cochrane controlled trials register (CENTRAL). In order to formulate the recommendations of the selected studies the SIGN system was used. The first draft was analysed and discussed by clinical experts, methodologists and patients representatives on a two days consensus meeting. The resulting document went through an external review process by a panel of experts, other health care professionals, patient representatives and lay reviewers. The final document was piloted in three different centres in United Kingdom, Czech Republic and Argentina. Results.  The guideline is composed of 93 recommendations divided into 3 main areas: 1) learn more Oral Care – access issues, early referral, preventative strategies, management of microstomia, prescriptions

and review appointments-, 2) Dental treatment: general treatment modifications, radiographs, restorations, endodontics, oral rehabilitation, periodontal treatment, oral surgery and orthodontics-, and 3) Anaesthetic management of dental treatment. Conclusions.  A preventive protocol is today’s dental management approach of choice. DEBRA International is a worldwide network of national groups working on behalf of those affected by the genetic skin blistering condition, epidermolysis bullosa (EB). Epidermolysis bullosa is a rare disease with multiple oral manifestations, Adenosine triphosphate which requires a special approach from the dental point of view. Because of its low prevalence, many dentists have limited knowledge of the disease. The scientific

literature regarding oral health care of people living with EB is relatively scarce. This makes it difficult for dentists with no experience in treating people with EB to know how to approach them in a safe manner given all the special care these patients might need. As part of their vision for working to ensure access to the best quality support and medical care for people living with EB, DEBRA International entrusted the development of Clinical Guidelines to health care professionals with significant experience in EB around the world. It became necessary to gather experts from different centres around the world to discuss the different treatment alternatives and to work towards establishing the best clinical practice guidelines. These guidelines contain the appropriate precautions that people with EB might require to receive optimal oral health care.

1a); however, under these conditions, we were not able to detect

1a); however, under these conditions, we were not able to detect NspC in cells that did not overexpress this protein. To detect wild-type levels of NspC, we had to use a more sensitive detection system, which allowed us to visualize the NspC protein in cells that did not contain the pnspC plasmid. This result ensured that NspC was being expressed from its chromosomal location under our experimental conditions (Supporting Information, Fig. S1). We then assayed the effect of elevated NspC levels on various aspects of V. cholerae physiology. The presence of pnspC altered growth characteristics of the cells such that the lag time was much shorter, the growth rate 1.5-fold higher, and the cell density

at stationary phase also higher (Fig. S2). SCH772984 Thus, the presence of pnspC appears to impart a growth advantage to V. cholerae selleck compound under the conditions of our

experiment. Biofilm assays showed that increased production of NspC resulted in an approximately fivefold increase in biofilm cell density (Fig. 1b). This result is in contrast to a previous study which reported an inhibitory effect of ectopic expression of nspC on biofilms formed by V. cholerae O1 El Tor (Lee et al., 2009). The reasons for this disagreement are not known but can potentially be a result of different genetic backgrounds or plasmid systems used in these experiments. Planktonic cell density showed a very small but statistically significant reduction in the strain containing the pnspC plasmid. In most cases, strains that have a high propensity to form biofilms show reduced densities of planktonic cells. The fact that we did not see a large very reduction in planktonic cells overexpressing nspC may be accounted

for by the fact that this strain can grow slightly faster and to higher cell densities. Formation of biofilms usually requires the presence of an exopolysaccharide in the biofilm matrix whose synthesis and export is achieved by proteins encoded by the vps genes (Watnick & Kolter, 1999; Yildiz & Schoolnik, 1999). Under most conditions, increases in biofilm formation are accompanied by increases in vps gene transcription. These genes are found on the V. cholerae large chromosome in two operons: vpsA-K and vpsL-Q (Watnick & Kolter, 1999; Yildiz & Schoolnik, 1999). To test whether increased nspC gene expression also leads to an increase in vps gene transcription, we assayed the activity of the vpsL promoter, making use of a chromosomal vpsLp-lacZ fusion in our strains (Haugo & Watnick, 2002). This insertion does not change the physiological characteristics of the wild-type bacteria such as growth, motility, and biofilm formation under the conditions of our experiments. Increased levels of the NspC protein resulted in a threefold and an eightfold increase in β-galactosidase activity in exponential and stationary-phase cells, respectively (Fig. 1c).

In the current study, we confirmed previous

reports indic

In the current study, we confirmed previous

reports indicating that the PMv has an inhibitory influence on the M1 at rest in healthy subjects (Davare et al., 2008). This ipsilateral ventral premotor–motor Olaparib purchase inhibition might depend on GABA-a interneurons. Indeed, it has previously been shown in monkeys that injection of bicuculline (a GABA-a antagonist) in the premotor cortex (dorsal and ventral) provoked co-contractions of agonists and antagonists (Matsumura et al., 1991). The effects provoked by bicuculline injection in the premotor cortex were not as severe as those observed after M1 injection, but they shared the same time-course. Kurata & Hoffman (1994) confirmed the GABA-a dependency of PMv neurons by injecting muscimol (a HDAC inhibitor GABA-a agonist) in the PMv. They observed a decrease of movement (wrist flexion or extension) amplitude and velocity. Although the PMv has some direct projections to the spinal cord (Dum & Strick, 1991, 2005; He et al., 1993; Luppino et al., 1999), it has strong output onto the hand representation of the M1 (Cerri et al., 2003; Shimazu et al., 2004). Shimazu et al. (2004) showed that, in monkeys, stimulation of F5 (the equivalent of the human PMv) can facilitate the cortico-spinal volley from the M1 and that this effect can be abolished by a reversible inactivation of M1. The ISI of 6 ms between the conditioning stimulus and test stimulus in our

experiment suggests that the cortico-cortical pathway between the PMv and M1 might be a direct oligosynaptic connection (Shimazu et al., 2004). The lack of ipsilateral ventral premotor–motor inhibition at rest in patients with FHD (Fig. 3) is coherent with the

pathophysiology of the disease and more particularly with the hypothesis of a dysfunction in GABA-a transmission. Indeed, many studies conducted on dystonic animal models have demonstrated alterations in GABA levels (Messer & Gordon, 1979; Loscher & Horstermann, Adenosine triphosphate 1992) or in GABA receptor density and affinity in different brain regions (Beales et al., 1990; Nobrega et al., 1995; Pratt et al., 1995; Gilbert et al., 2006; Alterman & Snyder, 2007). In patients with FHD, a magnetic resonance spectroscopy study showed a decreased GABA level in the sensorimotor cortex and lentiform nuclei contralateral to the affected hand (Levy & Hallett, 2002). This result, however, could not be reproduced in a larger population (Herath et al., 2010). Recently, a positron emission tomography study conducted on patients presenting with primary dystonia showed a significant reduction in GABA-a receptor expression and affinity in the premotor and M1, primary and secondary somatosensory cortex and cingulate gyrus (Garibotto et al., 2011). The involvement of the PMv in FHD has also been suggested by several neuroimaging studies. Positron emission tomography studies have shown abnormal functioning of the PMv either toward an increase of activity (Ceballos-Baumann et al.

, 1998) Natural genotypic variation due to repeated subculture w

, 1998). Natural genotypic variation due to repeated subculture would exhibit only 1 or 2 AF differences. This would signify a close genetic relationship

between Bioactive Compound Library in vitro the two isolates, indicating a clonal origin. On the other hand, FAFLP profiles that are completely different from the reference strain profile or those that differ by >10 AFs could indicate a probable cross-contamination during subculturing with another bacterial species or strain. All isolates in this study were typeable using the standardized endonuclease and primer combination for each of the four bacterial genera. Ten unique profiles were detected among the 50 isolates with distinct profiles observed for each of the four bacterial genera. All the B. cereus isolates and S. Nottingham isolates exhibited profiles identical to or similar to the respective reference strain profiles. This indicates that no detectable genetic differences were observed by FAFLP on repeated subculturing of these isolates. However, some isolates of L. monocytogenes and S. aureus showed significant genetic differences by FAFLP when compared with the respective reference strains. The FAFLP profile of one L. monocytogenes working culture submitted by laboratory #5 exhibited 24 AF differences compared with the reference strain. This indicated

that FDA approved Drug Library screening a genetically different strain was used as a working culture in that laboratory. Similarly, for the eight S. aureus working cultures submitted, only two had identical FAFLP profiles to the reference strain. The four profiles exhibited by the remaining six working cultures were significantly different from that of the reference strain profile. This indicates that only two laboratories (#5 and #7) were using genetically

identical working cultures to the reference strain, NCTC 6571. In order to investigate the genetically PJ34 HCl divergent strains of S. aureus submitted by six of the eight laboratories, further information was obtained from these laboratories. In all cases, the laboratories confirmed that the reference stock had been prepared from freeze-dried cultures purchased directly from NCTC and had been preserved in their own laboratories on cryoprotective beads. The working cultures were subsequently prepared from these beads. Two laboratories indicated that the freeze-dried culture had been purchased between 8 and 10 years ago and one laboratory had recently purchased a new ampoule. Three laboratories had no records of when the ampoules were purchased and no information was available for the strains from the remaining two laboratories. The results obtained in this study highlight that some bacterial species may show evidence of genotypic variation from the original strain upon repeated subculture. Such variation may affect the phenotypic and physiological traits over a period of time. For S. aureus strains, there seems to be a larger possibility of contamination with a different strain due to the presence of S. aureus on the skin of humans.

, 1998) Natural genotypic variation due to repeated subculture w

, 1998). Natural genotypic variation due to repeated subculture would exhibit only 1 or 2 AF differences. This would signify a close genetic relationship

between AG14699 the two isolates, indicating a clonal origin. On the other hand, FAFLP profiles that are completely different from the reference strain profile or those that differ by >10 AFs could indicate a probable cross-contamination during subculturing with another bacterial species or strain. All isolates in this study were typeable using the standardized endonuclease and primer combination for each of the four bacterial genera. Ten unique profiles were detected among the 50 isolates with distinct profiles observed for each of the four bacterial genera. All the B. cereus isolates and S. Nottingham isolates exhibited profiles identical to or similar to the respective reference strain profiles. This indicates that no detectable genetic differences were observed by FAFLP on repeated subculturing of these isolates. However, some isolates of L. monocytogenes and S. aureus showed significant genetic differences by FAFLP when compared with the respective reference strains. The FAFLP profile of one L. monocytogenes working culture submitted by laboratory #5 exhibited 24 AF differences compared with the reference strain. This indicated

that find more a genetically different strain was used as a working culture in that laboratory. Similarly, for the eight S. aureus working cultures submitted, only two had identical FAFLP profiles to the reference strain. The four profiles exhibited by the remaining six working cultures were significantly different from that of the reference strain profile. This indicates that only two laboratories (#5 and #7) were using genetically

identical working cultures to the reference strain, NCTC 6571. In order to investigate the genetically Smoothened divergent strains of S. aureus submitted by six of the eight laboratories, further information was obtained from these laboratories. In all cases, the laboratories confirmed that the reference stock had been prepared from freeze-dried cultures purchased directly from NCTC and had been preserved in their own laboratories on cryoprotective beads. The working cultures were subsequently prepared from these beads. Two laboratories indicated that the freeze-dried culture had been purchased between 8 and 10 years ago and one laboratory had recently purchased a new ampoule. Three laboratories had no records of when the ampoules were purchased and no information was available for the strains from the remaining two laboratories. The results obtained in this study highlight that some bacterial species may show evidence of genotypic variation from the original strain upon repeated subculture. Such variation may affect the phenotypic and physiological traits over a period of time. For S. aureus strains, there seems to be a larger possibility of contamination with a different strain due to the presence of S. aureus on the skin of humans.

Thus, the present study does not provide evidence of a general on

Thus, the present study does not provide evidence of a general ongoing detrimental effect on BMD following the early period after HAART initiation of either of these two drug classes. The results may suggest that HAART or HAART-induced immunological changes cause a temporary imbalance between bone resorption and bone formation or that treatment abrogates HIV-induced accelerated

bone loss. Ganetespib ic50 Randomized studies to evaluate the influence of earlier treatment initiation on bone metabolism are warranted. Author contributions Conception and design: A. B. Hansen, N. Obel, H. Nielsen, C. Pedersen and J. Gerstoft. Collection of data: A. B. Hansen, N. Obel, H. Nielsen, C. Pedersen and J. Gerstoft. Analysis and interpretation of the data: A. B. Hansen and J. Gerstoft. Drafting of the article: A. B. Hansen. Critical revision of the article: A. B. Hansen, N. Obel, H. Nielsen, C. Pedersen and J. Gerstoft. Financial support This study was supported by an unconditional grant from Abbott, Denmark. Abbott was not involved in the design or conduct of the study, data collection, management, analysis or interpretation of data, preparation or approval of the manuscript, or the decision to submit for publication. “
“Highly active antiretroviral therapy (HAART) has transformed HIV

infection into a manageable chronic illness, yet AIDS mortality among ethnic minorities persists in the USA. HAART nonadherence is associated with increased Selleckchem Roxadustat HIV viral load, low CD4 cell count and racial disparities in HIV outcomes. While there is no universal consensus on how to improve medical adherence in HIV-positive populations, the community health worker (CHW) model is emerging as an effective strategy to overcome barriers to HAART adherence. Although utilized in international settings, there is little evidence regarding the effects of CHWs on HIV outcomes in the USA. We performed a comprehensive search from May 2010 to November

2010 to identify studies carried out in the USA that Lenvatinib solubility dmso utilized CHWs to improve HAART adherence and measured HIV viral loads and CD4 cell counts to assess intervention effects. Sixteen studies met the inclusion criteria and were reviewed for this article. All studies reported clinical HIV outcomes. Interventions that lasted at least 24 weeks, provided frequent contact with participants, and focused on medication management were associated with improved HAART adherence, as indicated by reduced HIV viral load and increased CD4 cell count. Compared with current standards of care, CHW programmes may offer a practical and cost-effective alternative to improve HAART adherence, which may lead to reduced HIV viral load and increased CD4 cell counts among HIV-positive populations in the USA. Highly active antiretroviral therapy (HAART) can transform HIV/AIDS from a fatal diagnosis to a manageable chronic illness [1,2].