Early intervention in sleep disturbance may play a significant role in decreasing risk for metabolic disease, particularly among women, according to a new study from Japan.

The suggestion is based on findings from the study, published online in 

, that point to sex-specific associations between sleep duration and subclinical indicators of metabolic disease. 

Study authors, led by Lili Huang of the School of Public Health, Shanghai Jiao Tong University School of Medicine, point to accumulating evidence for the role of sleep in metabolic regulation, particularly metabolic rhythm and glucose metabolism. They cite, too, existing epidemiologic data linking sleep quality and duration with chronic conditions including type 2 diabetes, hypertension, and cardiovascular disease. “However,” they write, “the short or long sleep duration may also be the consequence of comorbidities, such as depression, which may confound the relationship between sleep duration and outcomes.”

Their study was designed to avoid such potential confounding by exploring the relationship between early clinical surrogate markers of metabolic disease and sleep duration in asymptomatic patients.

The research team used data from the national China Health and Nutrition Survey, excluding from an original group of 10 286 adults aged ≥18 years those with diabetes, heart disease, history of stroke or other CVD, and hypertension. The final group for analysis numbered 4922 (men, 44.6%; mean age: men 48 years, women 46 years).

Early-stage metabolic disease was assessed using 3 proxies—triglyceride to high-density lipoprotein cholesterol ration (TG/HDL-C), the product of triglyceride and fasting glucose (TyG), and lipid accumulation product (LAP).

To gauge sleep duration, participants responded to a single question regarding “usual” hours of sleep per day. Fasting blood samples were collected and measures of height, weight, waist circumference, body mass index, and blood pressure recorded.

 of the American Academy of Sleep Medicine and Sleep Research Society, sleep duration of 7-8 h per day is recommended for adults, and sleep duration <7 h or ≥9 h may increase the risk of adverse health conditions.

Sleep duration was classified into three groups: <7 h, 7-9 h, and ≥9 h.

Using multivariable linear and logistic regression models to evaluate associations between sleep duration and the 3 early-stage disease indicators, the investigators found that among women, sleep duration <7 hours/day vs 7-9 hours/day was associated with an increase in LAP of 25% (95% CI, 10.7-41.6%) and in TyG of 0.104 (95%CI: 0.024-0.185).

Although they were attenuated, the effects for LAP remiained signficant (11.4% [95% CI, 1.6-22.3%]) after adjusting for multiple covariates. 

Of significant interest, there were no associations between sleep duration and elevation in any of the proxy indicators among men.

"Notably, the effects of short sleep duration on subclinical indicators were more likely to be found in females,” the authors write. “There is notable sex divergence in the risk of metabolic disease, which may be related to sex-specific hormonal and behavioral differences. 

"In addition, the evidence indicated that sleep duration deficiency might be associated with an elevated inflammatory level in females but not in males. The sex differences need to be confirmed in further studies.”

Sex-specific association of sleep duration with subclinical indicators of metabolic diseases among asymptomatic adults.

Articles

Results of a new study that used early clinical surrogate markers of metabolic disease find women at greater risk related to suboptimal sleep. 

Sleep Duration May Have Greater Cardiometabolic Impact on Women vs Men 

How many fully vaccinated Americans have received a booster dose?

Centers for Disease Control and Prevention (CDC)

as of today, January 27, 2022, at 2:56 PM, EDT:

41% of fully vaccinated persons in the US 

 have received a booster dose of COVID-19 vaccine.

What percentage of people across age groups in the US have been fully vaccinated?

 as of today, January 27, 2022, at 2:56 PM, EDT:

The 5 states/territories with the highest percentage of population fully vaccinated are:

How many cases of COVID-19 have been confirmed in the US?

as of today, January 27, 2022 at 3:21 PM, EDT, there have been:

The 5 states with the highest total confirmed cases are:

 California has the highest number of deaths due to COVID-19 with 79 299 reported fatalities, followed by Texas with 78 651 and Florida with 64 368. 

How many cases of COVID-19 have been confirmed globally?

Data from the CDC on boosters and US vaccination rates and from the Johns Hopkins COVID-19 interactive map on cases and deaths in the US and worldwide.

COVID-19 Updates: US Vaccinations, Booster Doses, & Global Data as of January 27, 2022

 to subscribe on your favorite streaming service.

The Primary Viewpoints podcast features informative conversations with health care experts, opinion leaders, and practicing physicians, about what impacts primary care medicine today.

In episode 13, New York City-based psychiatrist Samoon Ahmad, MD, discusses the impetus for his most recent book, 

Coping with COVID-19: The Mental, Medical, and Social Consequences of the Pandemic

, and the complex sociocultural issues health care professionals will face going forward. 

is a clinical professor of psychiatry at New York University Grossman School of Medicine. He has been at Bellevue Hospital Center in Manhattan for 30 years, and has written in the past about human coping and resilience in the aftermath of disasters.

 to subscribe to the Primary Viewpoints podcast. Be sure to leave a rating and review for the show. Thanks for listening!

Podcasts

"Primary Viewpoints," a podcast from Patient Care Online, brings you an exclusive interview with author and psychiatrist Samoon Ahmad, MD. 

Primary Viewpoints Episode 13: Possible Consequences of a Prolonged COVID-19 Era

The Centers for Disease Control and Prevention (CDC) released its Preexposure Prophylaxis for the Prevention of HIV Infection in the United States—

—A Clinical Practice Guideline in December 2021. 

The updates reflect the most recent science and are intended to support clinicians in prescribing all FDA-approved PrEP medications and to increase PrEP use among all those who could benefit. 

The most noteworthy new recommendation which applies to all health care providers is to inform all sexually active adults/adolescents about PrEP, an effort to broaden awareness of PrEP. And, in addition to taking a brief history to identify those with inidications for PrEP, that PrEP be prescribed for anyone who requests it, even if they do not disclose specific risk behaviors.  

Slideshows

The CDC update recommends that clinicians advise all sexually active patients about PrEP and includes a new section on prescribing injectable bimonthly cabotegravir. 

PrEP for HIV Prevention: A Guideline Update Topline 

Rates of outpatient visits for mental health and substance use among physicians increased 27% during the first year of the COVID-19 pandemic, according to new research published online in 

The study, conducted among practicing physicians in Ontario, Canada, found notably that the relative increase in visits was significantly greater among physicians without prior histories of mental health or 

“Surveys of physicians during the COVID-19 pandemic have found increased reports of depression, anxiety and burnout. However, because these surveys generally only capture a single point in time and many had a very low response rate, it was unclear how reflective they were of physician mental health overall,” said lead author Daniel Myran, MD, MPH, a family physician, public health and preventive medicine specialist, and postdoctoral fellow at the University of Ottawa Department of Family Medicine and The Ottawa Hospital in a 

. “To help understand how COVID-19 has been impacting physician mental health we looked at changes over time in health care visits by physicians.”

Using health data from the universal Ontario Health Insurance Plan for the period from March 1, 2017 to March 10, 2021, Myran et al compared the rate of all virtual and in-person outpatient visits to a primary care physician or a psychiatrist coded for mental health or substance for the 12 months following and preceding the start of 

 (March 11, 2020) among 34 055 physicians, residents and fellows in Ontario, Canada. Mean age of the cohort was 41.7 years and half (52.6%) were men.

The authors report that the proportion of physicans making first-time mental health/substance abuse visits during the pandemic grew by 40.6%, compared with a 19.3% increase among those who had made such visits before the start of the pandemic. 

Overall, the annual number of visits increased 27%, from 816.8 to 1037.6 per 1000 physicians.

The authors report that the proportion of physicans making first-time mental health/substance abuse visits during the pandemic grew by 40.6%, compared with a 19.3% increase among those who had made such visits before the start of the pandemic. Overall, the annual number of visits increased 27%, from 816.8 to 1,037.6 per 1000 physicians.

The findings suggest, according to the researchers, that the increases in visits result from both an increase in the number of doctors accessing mental health services and in the number of those with multiple mental health visits.

“Together, these findings suggest that generally, physicians have displayed resiliency during the pandemic, but a small group may have developed very high new mental health care needs…which are possibly related to pandemic-specific stressors.”

Among practicing specialists, surgeons and anesthesiologists were the least likely to seek mental health/substance abuse help, with 460.6 and 740.3 visits per 1000 physicians, respectively. On the other hand, visits among anesthesiologists grew by 74% after the start of the pandemic, the largest among any of the specialties in the study. Specialties with the greatest number of visits were psychiatrists (4,252 per 1000) and family physicians (890.3 per 1000). 

The authors note that while earlier studies have shown prolonged contact with COVID-infected patients to be a risk factor for negative psychological outcomes, their results found little difference between those who did or did not provide acute care for these patients. They speculate this may be because physicians providing acute care for COVID-19 patients had lower rates of mental health/substance abuse visits before the pandemic.

This result may, in turn, suggest that this group of doctors has greater resilience to mental health conditions, be more reluctant to 

, or a combination of the two that continued during the pandemic. Another possibility is that their increased workloads during the pandemic may not have allowed them time to seek mental health care.

The authors say that their findings of increases in mental health/substance abuse visits, when combined with surveys of doctors showing high levels of self-reported anxiety, depression and stress, may indicate worsening mental health among doctors generally.

Physician health care visits for mental health and substance abuse during the COVID-19 pandemic in Ontario, Canada

Family physicians and psychiatrists were the specialties with the greatest number of visits, according to study authors. 

Physician Mental Health Care Visits Ticked Up Significantly During First Year of Pandemic 

Board-certified Physician Assistant and a Fellow of the Obesity Medicine Association. Ms. Burridge earned her Certificate of Advanced Education in Obesity Medicine in 2017. She is the President of PAs in Obesity Medicine and serves on the Board of the Illinois Obesity Society. 

As our patients transition into the new year, they may evaluate their health goals and set lofty nutrition and exercise targets. While New Year’s resolutions don’t always have the best track record for ongoing success, we can take advantage of the opportunity to educate our patients about long-term health habits that lead to happier and longer lives.

To enjoy a high-quality life with as much independence as possible, healthy aging requires maintaining strength, mobility, and cognitive function. It also involves minimizing chronic pain and disability and reducing the risk of diseases, such as obesity, type 2 diabetes, and cardiovascular disease (CVD).

 of older adults already live with obesity and that obesity is a primary risk factor for both diabetes and CVD, it’s critical to guide our older patients on how to mitigate this key risk factor as they age. Obesity is a chronic yet treatable disease, and because older adults with obesity face an increased risk of 

, it’s important to discuss diet and nutrition when planning long-term treatment.

There is no one-size-fits-all approach to nutrition, which is why it is important to work closely with older patients to design a personalized diet. Changes in 

 (eg, loss of muscle mass, increased body fat, decreased bone density), are a natural part of aging; but obesity and metabolic disease in older adults can have a significant impact on morbidity, mortality, and quality of life. Weight loss can promote several improvements to physical function—a key indicator of healthy aging.

Our understanding of weight management has evolved beyond the old “

” advice. We now know that physical activity promotes 

 outcomes, including positive changes in body composition, strength and balance, and improved insulin sensitivity.

When it comes to nutrition, today’s most 

 have many similarities, such as an avoidance of processed foods; an emphasis on consuming fresh vegetables, nuts and other minimally processed foods; and promotion of healthy fats and proteins.

This diet became prominent in the 1960s when it was discovered that 

 caused fewer deaths in countries,such as Italy and Greece where the dietary pattern was endemic. The Mediterranean diet plan includes daily consumption of vegetables, fruits, whole grains, and healthy fats; weekly intake of poultry, fish, beans, and eggs; moderate portions of dairy products; and limited intake of red meat. Medical benefits include improved lipid and lipoprotein profiles, improved insulin sensitivity, lower blood pressure, and reduced inflammation. Adhering to the diet is associated with a 50% lower mortality rate among individuals aged 70 to 90 years old, suggesting the eating plan might also benefit older adults with obesity.

Vegetarian and vegan styles of eating that emphasize whole, minimally processed foods and avoid animal products can, like the Mediterranean plan of eating, also support positive cardiovascular outcomes. 

 food plans are associated with reduced blood lipid concentrations and a lower risk of CVD, which can make them a good choice for older patients with obesity who are concerned about maintaining nutritional status. However, it is important that these patients also consume sufficient high-quality protein to maintain muscle mass, and supplement vitamins and minerals that may be deficient in a plant-based diet, such as vitamin B complex, calcium, vitamin D, and iron.

 A well-formulated ketogenic diet plan is low-carb, high-fat, and includes moderate proteins. It emphasizes whole foods, such as non-starchy vegetables, low-sugar fruits, healthy fats, and proteins or vegan sources (eg, tofu). The diet’s appetite suppressing effect makes it effective for promoting 

 and it can also improve blood glucose control, lower triglyceride levels, and reduce blood pressure, making it a good option for older patients with metabolic disease.

We play an important role in helping patients manage obesity and achieve healthy outcomes as they age and working to advance our knowledge of obesity medicine is essential to that role. The 

 (OMA) offers a spectrum of educational tools and resources to support that education. Designed for all health care providers who treat patients with obesity, the 

Fundamentals of Obesity Treatment Virtual Course

 provides introductory education about the evidence-based approaches for evaluating, diagnosing and treating obesity in a clinical setting.

Karli Burridge is an internationally recognized, award winning leader in obesity management. She is a physician assistant and Fellow of the Obesity Medicine Association and holds the Certificate of Advanced Education in Obesity Management. She is the President of PAs in Obesity Medicine and serves on the Board of Trustees for the Illinois Obesity Society.

Karli is the owner of Gaining Health, which she developed to provide resources and tools for providers who want to incorporate obesity management into their medical practice. She is also a clinical provider for Enara Health, a telemedicine-based obesity medical weight management organization.

Three diets that can help patients with obesity age healthier, how to make nutrition personal, and more highlighted, here. 

Helping Patients with Obesity Age Healthier and Happier

as of today, January 26, 2022, at 4:24 PM, EDT:

40.4% of fully vaccinated persons in the US 

 as of today, January 26, 2022, at 4:24 PM, EDT:

as of today, January 26, 2022 at 3:21 PM, EDT, there have been:

 California has the highest number of deaths due to COVID-19 with 79 037 reported fatalities, followed by Texas with 78 605 and Florida with 64 368. 

COVID-19 Updates: US Vaccinations, Booster Doses, & Global Data as of January 26, 2022

Middle-aged men in the US with anxiety may be at a greater risk for developing cardiometabolic disease later in life, according to a new long-term study published in the 

Journal of the American Heart Association.


“While the participants were primarily white men, our findings indicate higher levels of anxiousness or worry among men are linked to biological processes that may give rise to heart disease and metabolic conditions, and these associations may be present much earlier in life than is commonly appreciated – potentially during childhood or young adulthood,” said lead author Lewina Lee, PhD, assistant professor of psychiatry, Boston University School of Medicine, in an 

American Heart Association press release.

 to elevated risk of incident cardiometabolic disease, including coronary heart disease (CHD) and stroke, but the underlying mechanisms and trajectories of risk are unclear.

Lee and colleagues examined the prospective association of 2 anxiety facets—neuroticism and worry—with cardiometabolic risk (CMR) trajectories over a 40-year follow-up period. The team analyzed data from the Normative Aging Study— a longitudinal trial of aging processes in men.

The analysis included 1561 participants who in 1975 were free from cardiovascular disease or cancer and completed assessments of neuroticism and worry. At baseline, the analytic sample was 97% White and had an average age of 53 years.

After baseline, participants underwent physical exams and blood tests every 3 to 5 years until death, dropout, or the end of the study in 2015, according to the authors. During each follow-up visit, 7 cardiometabolic risk factors were measured: systolic blood pressure (BP), diastolic BP, total cholesterol, triglycerides, obesity as determined by body mass index, fasting blood glucose levels, and erythrocyte sedimentation rate.

High risk for each cardiometabolic factor was defined as exceeding the cut points from national guidelines or taking medication related to that factor. For erythrocyte sedimentation rate, for which there is no universal definition of high risk, those in the top quartile were considered high risk, according to researchers.

The investigators found that CMR increased at 0.8 markers per decade between ages 33 to 65 years, at which point participants had an average of 3.8 high‐risk markers, followed by a slower increase of 0.5 markers per decade.

Higher levels of neuroticism (B=0.08; 95% confidence interval [CI], 0.02-0.15) and worry (B=0.07; 95% CI, 0.001-0.13) were associated with elevated CMR across time, according to the results.

In addition, higher neuroticism and worry levels were associated with 13% (95% CI, 1.03-1.23) and 10% (95% CI, 1.01-1.20) greater risks, respectively, of having ≥6 high‐risk CMR markers, after researchers adjusted for demographics and family history of CHD.

“While we do not know whether treatment of anxiety and worry may lower one’s cardiometabolic risk, anxious and worry-prone individuals should pay greater attention to their cardiometabolic health,” said Lee in the press release. “For example, by having routine health check-ups and being proactive in managing their cardiometabolic disease risk levels (such as taking medications for high blood pressure and maintaining a healthy weight), they may be able to decrease their likelihood of developing cardiometabolic disease.”

“It would be important for future studies to evaluate if these associations exist among women, people from diverse racial and ethnic groups, and in more socioeconomically varying samples, and to consider how anxiety may relate to the development of cardiometabolic risk in much younger individuals than those in our study,” added Lee.

Anxiety may affect cardiometabolic health earlier in life than previously thought, according to a new long-term study of US middle-aged men.

Anxiety Elevates Cardiometabolic Risk Over Time in US Men, Suggests New 40-year Study

"I could stand in the middle of First Avenue at rush hour and not see another soul around," remembered Samoon Ahmad, MD.

The New York City-based psychiatrist says his own eerie sense of desolation during the early weeks of the COVID-19 pandemic lockdown in Manhattan caught him by surprise. It started his thinking about, and then concentrated research into, the potential destructive and far-reaching sociocultural consequences of a prolonged COVID-19 era.  

Ahmad was infected with SARS-CoV-2 in March 2020 and during his quarantine and extended recovery began to organize his research; the project evolved into his most recent book, 

Coping with COVID-19: The Mental, Medical, and Social Consequences of the Pandemic.

He spoke recently wtih Patient Care Online about how the book came together and the energy that kept the process moving. It will be available in April 2022.  

is a clinical professor of psychiatry at New York University Grossman School of Medicine. He has been at Bellevue Hospital Center in Manhattan for 30 years, and has written in the past about human coping and resilience in the aftermath of disasters. 

The following transcript has been lightly edited for clarity and style.

 Congratulations on the publication of the book—that’s right around the corner. I’m curious what your inspiration was for a project of this scope—really covering all potential sequelae of the pandemic? It's a huge undertaking.

I would say that's an understatement, yes. I think a large part of it was seeing the impact of the pandemic, in New York City during the spring of 2020. The rolling count at the bottom of the television screens on every news network, and this constant coverage in the press felt surreal. But seeing the emptiness of Manhattan in March 2020 shook me in a way that I wasn't expecting. It was like being Will Smith in 

I could stand in the middle of the First Avenue and not see a car. And perhaps this feeling of desolation would have been less impactful in a suburban setting. But being so used to the streets in New York, standing in the middle of First Avenue at rush hour, and not seeing another soul around you is a very eerie feeling. 

And it really hit me how far reaching the effects of the pandemic were going to be. I realized that we were going to be battling what are called two distinct problems: the SARS CoV-2 virus and the pandemic as a sociological phenomenon. Now, I would say in the case of the former, I felt confident that the medical community could come around and we will learn how to better treat COVID-19, develop preventive medicines and vaccines that would boost our immunity, or at the very least improve patient prognosis and these things have happened, even though the virus keeps throwing a curveball at us. In the case of the latter, somehow, I lacked that same level of confidence, I had no idea how the shutdown and these months of isolation would affect millions, if not billions of people. And you know, as I look back on the wake of September 11th, certainly the largest mass strategy I've experienced, personally, at least you could be with your family, or you could be with your friends, and most people, you know, went back to work within a few days, or they were going to school. And these kinds of support networks that have been a part of human stories since before recorded history were still intact. But the problem is with the pandemic, we were completely cut off from these groups that were integral to our social and personal identities, and many people had nothing to do and nowhere to go, and no one to talk to. So, one cannot underestimate the impact of such significant psychological trauma. 

And, and then, I got COVID, and I was asked to quarantine at home for two weeks. And though I was lucky that I didn't experience the full blown sequelae of symptoms and it was not as severe, but the disease did take a toll on my body and it took weeks to recover from a lingering cough and fatigue. And I'm a very active guy who likes to bike and run and exercise and and I was telling my wife that after about eight, nine months, I felt my endurance level had come back to where it was. That was the timespan and I wasn't even hit that severely. So, I could just imagine, what's it like. 

During that time of quarantine, I was struggling so with not having structure, not being able to go to work, that I started delving into the origin, the source,  the pathology of transmission of the virus. And I kept finding myself going down this rabbit hole that kept on branching into different directions. As I dug deeper and deeper, one of the most interesting things was that one could not even find good, objective scientific information in one place, and I had to search all over. And if I, as a physician had this problem, I couldn't even imagine how a lay person would find and digest this information.

I just started to realize and it was cemented in my mind how severe and long- lasting the lingering economic, psychological, and psychosocial impacts were going to be. This was a major impetus to write the book; to bring all the scientific information in one place and secondly to discuss the psychological and social consequences, which will probably  continue to linger for a long time. So that's what I would tell you was the impetus for the book.

Videos

Dr Ahmad's book explores in depth the complex long-term consequences of COVID-19 for medicine, mental health, and social conventions. 


Samoon Ahmad, MD, Discusses His New Book, "Coping with COVID-19: The Mental, Medical, and Social Consequences of the Pandemic"


In 2014, the Joint United Nations Programme on HIV/AIDS announced an ambitious worldwide strategy to end the HIV pandemic by 2030 (and change HIV to a “low-level endemic disease”). The strategy became known as “90-90-90 by 2020.” 

The idea was to get 90% of all HIV-infected persons diagnosed, get 90% of them on antiretroviral therapy (ART), and get 90% of those on ART “undetectable.” Doing the math (0.9 x 0.9 x 0.9) would result in getting 73% of all HIV-infected patients undetectable.

In 2017, Botswana was at 81% of all HIV-infected persons undetectable. The UK was at 87%. And the United States? Only an estimated 55% of all HIV-infected persons were undetectable. Thus, it should not come as a big surprise that the US failed to meet the 90-90-90 goal by the end of 2020. 

 It wasn’t diagnosis. In 2017, an estimated 86% of all HIV-infected persons were aware of their status. But knowledge of status is not the same as starting ART, and starting ART is not the same as staying on ART. 

 is defined as getting a newly identified HIV-infected person an appointment at an HIV-experienced facility within 30 days of the diagnosis.

 is defined as having 2 CD4+ cell counts, or 2 HIV RNA levels obtained in the same calendar year.

In 2019, it was estimated that in the United States, only 81% of newly diagnosed HIV-infected persons were linked to care within 30 days. And only 58% of HIV-infected persons were retained in care.

In the Ryan White-funded clinic where I see patients, 92% of those retained in care are undetectable. We retain in care 80% of our patients, but assuming that all of the 20% of the others have detectable viral loads, then our “effective” HIV RNA suppression rate is about 74%. Nationally, it is estimated that 23% of those not retained in care are responsible for 43% of new infections.

The White House Office of National AIDS Policy (ONAP) recently has developed and published an ambitious plan to address these issues.

“The United States will be a place where new HIV infections are prevented, every person knows their status, and every person with HIV has high-quality care and treatment, lives free from stigma and discrimination, and can achieve their full potential for health and well-being across the lifespan.”

Reduce new infections by 75% (from a baseline of 37,000 in 2017)

Increase PrEP (pre-exposure prophylaxis) use to 50% (from a 2017 baseline of 13%)

Increase viral suppression to 95% among those diagnosed with HIV

It seems to me that the key to getting 95% of those diagnosed with HIV to undetectable is improving retention in care. Obstacles to doing so include transportation difficulties, poverty, comorbid psychiatric conditions, substance use, multiple other sexually-transmitted infection epidemics, multiple other public health urgencies, financial and healthcare-related resources, and stigma, to mention just a few. The document goes into considerable detail about ways to do so, but none of them will be easy.

We have the tools to end the HIV epidemic, including the newly FDA-approved every-other-monthly injectable FDA-approved PrEP treatment, cabotegravir extended-release injectable suspension (Apretude). In 2 NIH-funded trials on the African continent, the injectable PrEP was over 99% efficacious at preventing HIV-infections during the trial. Additionally, we have many very effective and well-tolerated co-formulated once-daily antiretroviral regimens that are widely available even for those with no or limited financial resources. 

The concept of “treatment as prevention” (undetectable = untransmissible) has been well-established for years. But getting our public health infrastructure to where it needs to be by 2030 to substantially improve retention in care seems like a pretty heavy lift from my view from the trenches.

National HIV/AIDS Strategy for the United States 2022–2025

Professor of Medicine, Division of Infectious Diseases and Office of Academic Affairs, Medical College of Georgia at Augusta University, Augusta, Georgia.

Dr MacArthur is an NIH-funded researcher and before arriving at the Medical College of Georgia, he headed the Wayne State University AIDS clinical trial program. He is widely recognized as an authority the development of antiretroviral treatment.

Get 90% of all HIV-infected persons diagnosed, get 90% of them on ART, and get 90% of those on ART “undetectable.” Are we there yet? 