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: Introduction: Many HIV‐positive individuals in Africa have advanced disease when initiating antiretroviral therapy (ART) so have high risks of opportunistic infections and death. The REALITY trial found that an enhanced‐prophylaxis package including fluconazole reduced mortality by 27% in individuals starting ART with CD4 Methods: The REALITY trial enrolled from June 2013 to April 2015. A decision‐analytic model was developed to estimate the cost‐effectiveness of six management strategies in individuals initiating ART in the REALITY trial countries. Strategies included standard‐prophylaxis, enhanced‐prophylaxis, standard‐prophylaxis with fluconazole; and three CrAg testing strategies, the first stratifying individuals to enhanced‐prophylaxis (CrAg‐positive) or standard‐prophylaxis (CrAg‐negative), the second to enhanced‐prophylaxis (CrAg‐positive) or enhanced‐prophylaxis without fluconazole (CrAg‐negative) and the third to standard‐prophylaxis with fluconazole (CrAg‐positive) or without fluconazole (CrAg‐negative). The model estimated costs, life‐years and quality‐adjusted life‐years (QALY) over 48 weeks using three competing mortality risks: cryptococcal meningitis; tuberculosis, serious bacterial infection or other known cause; and unknown cause. Results: Enhanced‐prophylaxis was cost‐effective at cost‐effectiveness thresholds of US$300 and US$500 per QALY with an incremental cost‐effectiveness ratio (ICER) of US$157 per QALY in the CD4 Conclusions: The REALITY enhanced‐prophylaxis package in individuals with advanced HIV starting ART reduces morbidity and mortality, is practical to administer and is cost‐effective. Efforts should continue to ensure that components are accessed at lowest available prices., Introduction In low‐ and middle‐income settings, more than a third of HIV‐positive individuals starting antiretroviral therapy (ART) present with advanced disease (CD4 ≤ 200 cells/mm[sup.3]); over half of these have [...]

Background: Bladder cancer is a genetically heterogeneous disease. The chromosomal aberrations observed are non-random and they are often correlated with disease progression. Several environmental risk factors have also been reported to be implicated in the pathogenesis of this disease. The aim of this study was to evaluate, by FISH technique, the numerical aberrations of chromosomes 9 and 11 in Greek bladder cancer patients and to correlate them with grade and histological stage of the tumors., Materials and Methods: FISH with a-satellite DNA probes specific for chromosomes 9 and 11 were applied to 35 primary bladder tumors directly processed for cytogenetic study., Results: Numerical aberrations of chromosome 9 were observed in 23 out of 27 tumors (85.18%). Monosomy 9 was detected in 12 cases (44.45%) and polysomy in 11 cases (40.74%). Statistical analysis showed that polysomy 9 was linked to histological stage (p = 0.024) and grade (p = 0.01) of the tumors, while monosomy 9 was correlated with tumor stage (p = 0.050). Numerical aberrations of chromosome 11 were observed in 25 out of 35 cases (71.43%). Polysomy was detected in 24 cases (68.57%), while only one case (2.86%) had monosomy 11. Polysomy 11 was found mainly in high-grade and advanced-stage tumors., Conclusion: Numerical aberrations of chromosome 9 could be a potential biomarker for bladder cancer screening. Further studies must be carried out to investigate gene alterations reflected by numerical aberrations of chromosomes 9 and 11 also contributing to the classification of this disease.