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Mitigating the incidence of Clostridioides difficile infections (CDIs), particularly those acquired in healthcare settings, has received increased attention because of the notable prevalence of this contagion (2,2). Although the incidence [...]

Less costly but still accurate methods for monitoring HIV treatment response are needed. We prospectively evaluated if a qualitative polymerase chain reaction (PCR) amplification assay for virologic monitoring could maintain accuracy while reducing costs in Seoul, South Korea. We conducted the first prospective study comparing a qualitative PCR amplification of HIV-1 reverse transcriptase (RT) versus a commercial real time PCR assay (i.e., viral load) for virologic monitoring of 150 patients receiving antiretroviral therapy (ART) between November 2011 and August 2012 at an urban hospital in Seoul, South Korea. A total of 215 blood plasma samples from 150 patients receiving ART for more than 6 months were evaluated. Using the individual viral load assay, 12 of 215 (5.6%) plasma samples had more than 500 HIV RNA copies/ml. The qualitative PCR amplification assay detected individual samples with ≥500 HIV RNA copies/ml with 100% sensitivity. The specificities of the qualitative PCR amplification of the HIV-1 RT assay were 94.1%, 93.6%, and 93.2% compared to the real time PCR at 500, 1,000, and 5,000 threshold of HIV RNA copies/ml, respectively, and $24,940 USD would have been saved for 150 patients during 10 months. The qualitative PCR amplification of the HIV-1 RT assay might be a useful approach to effectively monitor patients receiving ART and save resources.

BackgroundThere have been various efforts to identify less costly but still accurate methods for monitoring the response to HIV treatment. We evaluated a pooling method to determine if this could improve screening efficiency and reduce costs while maintaining accuracy in Seoul, South Korea.MethodsWe conducted the first prospective study of pooled nucleic acid testing (NAT) using a 5 minipool + algorithm strategy versus individual viral load testing for patients receiving antiretroviral therapy (ART) between November 2011 and August 2012 at an urban hospital in Seoul, South Korea. The viral load assay used has a lower level of detection of 20 HIV RNA copies/ml, and the cost per assay is US$ 136. The 5 minipool +algorithm strategy was applied and 43 pooled samples were evaluated. The relative efficiency and accuracy of the pooled NAT were compared with those of individual testing.ResultsUsing the individual viral load assay, 15 of 215 (7%) plasma samples had more than 200 HIV RNA copies/ml. The pooled NAT using the 5 minipool + algorithm strategy was applied to 43 pooled samples; 111 tests were needed to test all samples when virologic failure was defined at HIV RNA ≥ 200 copies/ml. Therefore, 104 tests were saved over individual testing, with a relative efficiency of 0.48. When evaluating costs, a total of US$ 14,144 was saved for 215 individual samples during 10 months. The negative predictive value was 99.5% for all samples with HIV RNA ≥ 200 copies/ml.ConclusionsThe pooled NAT with 5 minipool + algorithm strategy seems to be a very promising approach to effectively monitor patients receiving ART and to save resources.

BackgroundMultiple prevention measures have the possibility of impacting HIV incidence in South Korea, including early diagnosis, early treatment, and pre-exposure prophylaxis (PrEP). We investigated how each of these interventions could impact the local HIV epidemic, especially among men who have sex with men (MSM), who have become the major risk group in South Korea. A mathematical model was used to estimate the effects of each these interventions on the HIV epidemic in South Korea over the next 40 years, as compared to the current situation.MethodsWe constructed a mathematical model of HIV infection among MSM in South Korea, dividing the MSM population into seven groups, and simulated the effects of early antiretroviral therapy (ART), early diagnosis, PrEP, and combination interventions on the incidence and prevalence of HIV infection, as compared to the current situation that would be expected without any new prevention measures.ResultsOverall, the model suggested that the most effective prevention measure would be PrEP. Even though PrEP effectiveness could be lessened by increased unsafe sex behavior, PrEP use was still more beneficial than the current situation. In the model, early diagnosis of HIV infection was also effectively decreased HIV incidence. However, early ART did not show considerable effectiveness. As expected, it would be most effective if all interventions (PrEP, early diagnosis and early treatment) were implemented together.ConclusionsThis model suggests that PrEP and early diagnosis could be a very effective way to reduce HIV incidence in South Korea among MSM.

The main goal of this article is to analyze the conditions under which South Korea would decide to go nuclear. It seeks to examine the key factors that would trigger Seoul's decision for nuclear‐arming. The article contends that South Korea is likely to go nuclear under the following conditions: where South Koreans' demands for nuclear weapons continue to rise despite US security assurances; where Pyongyang's threats of its nuclear weapons attacks are increasingly directed towards Seoul as opposed to Washington; where US security assurances for South Korea become highly questionable; and where potential nearby proliferators (Japan and Taiwan, in particular) go nuclear. Any single one of these conditions might not be enough for Seoul's decision to nuclearize, but when at least any two of them are fulfilled at the same time, South Korea is highly likely to go nuclear. [ABSTRACT FROM AUTHOR]

Furthermore, there is a worry that "a nuclear-armed South Korea could be emboldened to respond more aggressively to North Korean provocations with proactive deterrence or "quid pro quo plus" military operations, the inherent escalation risks of which are intended to dissuade North Korea in the first place."[14] South Korea's decision to nuclearize might jeopardize the US-ROK alliance Third, South Korea's decision to nuclearize might jeopardize the US-ROK alliance. Although Pyongyang blamed the US-ROK Combined Forces' large-scale navy drills as their impetus. according to the Korean Central News Agency (KCNA), Kim Jong-un guided all the exercises involving ballistic missiles equipped with artificial nuclear warheads as they simulated striking South Korea's military command facilities, main ports, and airports.[25] This demonstrated that the main target of North Korea's tactical nukes was not the US but South Korea. For example, Washington fears that it could be entrapped by Seoul if South Korea acquired nuclear weapons, since a nuclear-armed South Korea can make more independent security policy decisions including conflict-provoking ones that lead to regional instability. Given that North Korea's nuclear threats are a main driver of South Korea's nuclear proliferation, the US must find a way to disarm North Korea's nuclear capabilities. [Extracted from the article]