Time to Treatment Initiation and Retrospective Analysis of Antiretroviral Therapy Outcomes among HIV-positive Methadone Maintenance Therapy Clients in Primary Health-care Centers, Kuantan, Pahang.

INTRODUCTION: Methadone maintenance therapy (MMT) program helped to improve access to antiretroviral therapy (ART) among people who inject drugs (PWID) with human immunodeficiency virus (HIV). However, the time to treatment initiation (TTI) and outcomes of ART intervention in this population have scarcely been analyzed. OBJECTIVES: The aim of this study was to analyze the TTI and outcomes of ART among MMT clients in primary health-care centers in Kuantan, Pahang. MATERIALS AND METHODS: This was a retrospective evaluation of MMT clients from 2006 to 2019. The TTI was calculated from the day of MMT enrolment to ART initiation. The trends of CD4 counts and viral loads were descriptively evaluated. Cox proportional hazard model was used to analyze the survival and treatment retention rate. RESULTS: A total of 67 MMT clients from six primary health-care centers were HIV-positive, of which 37 clients were started on ART. The mean TTI of ART was 27 months. The clients who were given ART had a mean CD4 count of 119 cells/mm3 at baseline and increased to 219 cells/mm3 after 6 months of ART. Only two patients (5.4%) in the ART subgroup had an unsuppressed viral load. The initiation of ART had reduced the risk of death by 72.8% (hazard ratio = 0.27, P = 0.024), and they are 13.1 times more likely to remain in treatment (P < 0.01). CONCLUSION: The TTI of ART was delayed in this population. MMT clients who were given ART have better CD4 and viral load outcomes, helped reduced death risk and showed higher retention rates in MMT program.

Availability of orchid mycorrhizal fungi on roadside trees in a tropical urban landscape.

Urban expansion threatens biodiversity worldwide, therefore urban spaces need to be amenable to biodiversity conservation. On trees in urban environments, natural colonisation and successful translocation of epiphytic orchids are necessary to enhance urban biodiversity, and depend on the availability of compatible orchid mycorrhizal fungi (OMF). However, the extent of OMF presence and distribution, as well as niche requirements for the OMF, remain poorly studied. To identify and quantify OMF on urban trees as well as assess their suitability for native epiphytic orchids, we conducted high-throughput sequencing on tree bark and orchid root samples. OMF were detected at 60% of the study sites on 16% of 270 bark samples (from stem, fork, and branch microsites within each tree). OMF presence and richness on bark samples were related to multiple biophysical factors; in general, humus presence and precipitation levels were positively predictive of OMF presence and richness. We found Ceratobasidiaceae- and Serendipitaceae-associated OMF both on bark and within roots. Orchid species also showed differing mycorrhizal specificity. Sites associated with fungal genera Ceratobasidium, Rhizoctonia, and Serendipita were considered suitable habitats for seven orchid species. The results suggest that urban trees support OMF and are therefore suitable for native orchid species; however, OMF availability are largely constrained by biophysical factors. To maximise the likelihood of translocation success and consequent natural establishment, we propose that (micro)sites are screened for compatible OMF prior to any intervention.

Germination niches and seed persistence of tropical epiphytic orchids in an urban landscape.

Urbanisation has contributed to significant biodiversity loss, yet, urban areas can facilitate biodiversity conservation. For instance, there is evidence of urban trees supporting natural establishments of orchids, the most species-rich plant family on Earth. However, the germination niches-which include both suitable biophysical conditions and orchid mycorrhizal fungus/fungi (OMF)-are not sufficiently known for most species, especially tropical epiphytic orchids. The fate of their dispersed seeds is poorly understood as well. We conducted fungal baiting and seed sowing experiments, next-generation sequencing, generalised linear models, and seed viability tests to detect and identify potential OMF, investigate biophysical factors that influenced OMF availability and orchid germination, and assess seed longevity. Ceratobasidiaceae- and Serendipitaceae-associated OMF were successfully detected in three of four orchid species. In general, orchid species and humus presence had significant effects on OMF availability. Orchid species and temperature were predictive of germination. Post-experiment viability tests revealed that one orchid species, Grammatophyllum speciosum Blume, may produce long-lived seeds. The results suggest that urban trees can support OMF and orchid germination, but both processes are limited by biophysical factors. This study also indicates the possibility of seed persistence among epiphytic species. As orchid germination niches are complex and tend to be unique to individual species, we do not encourage generalisations. In contrast, species-specific information can help formulate useful recommendations towards conservation.