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HIV drug resistance during antiretroviral therapy scale-up in Uganda, 2012–19: a population-based, longitudinal study

Background With scale-up of antiretroviral therapy (ART) in sub-Saharan Africa, increasing pretreatment HIV drug resistance has been reported; however, the broader effect of ART expansion on population-level resistance patterns remains insufficiently quantified. We aimed to estimate the longitudinal prevalence of drug resistance and resistance-conferring mutations. Methods This study used data collected as part of the Rakai Community Cohort Study (RCCS), an open population-based census and cohort study conducted in southern Uganda. At each survey round, residents aged 15–49 years are invited to participate and receive a structured questionnaire that obtains sociodemographic, behavioural, and health information, including self-reported past and current ART use. Voluntary HIV testing is conducted using a rapid test algorithm and a venous blood sample. People with HIV provide samples for viral load quantification and deep sequencing. We analysed RCCS survey, HIV viral load, and deep sequencing (which was used to predict resistance) data from five survey rounds. The key outcomes were the population prevalence of viraemic people with HIV with non-nucleoside reverse transcriptase inhibitor (NNRTI), nucleoside reverse transcriptase inhibitor (NRTI), protease inhibitor, or multiclass resistance among all participants (regardless of HIV serostatus) in the 2015 and 2017 surveys. Prevalence of class-specific resistance and resistance-conferring substitutions were estimated using robust log-Poisson regression. Findings Between Aug 10, 2011, and Nov 4, 2020, there were 43 361 participants in the RCCS and 7923 (18·27%) people with HIV. Over five survey rounds, 93 622 participant visits occurred, among which 17 460 (18·65%) were from people with HIV. Over the analysis period, the median age of study participants remained similar (28 years [22–35] in 2012 and 29 years [21–38] in 2019). Sufficient data were available to reliably genotype 4072 (90·03%) of 4523 participant visits from 3407 people with HIV for at least one drug. Overall population prevalence of resistance contributed by viraemic pretreatment people with HIV decreased between 2012 and 2017 from 0·56% (95% CI 0·42–0·75) to 0·25% (0·18–0·33) for NNRTI and from 0·24% (0·15–0·37) to 0·05% (0·02–0·10) for NRTI (prevalence ratio 0·44 [0·29–0·68] for NNRTI and 0·21 [0·09–0·47] for NRTI). Between 2012 and 2017, NNRTI resistance among viraemic pretreatment people with HIV increased from 4·86% (3·69–6·42) to 9·61% (7·27–12·7; prevalence ratio 1·98 [1·34–2·91]). The prevalence of NNRTI and NRTI resistance was substantially higher among viraemic treatment-experienced people with HIV (51·49% [46·24–57·34] for NNRTI and 36·46% [30·06–44·22] for NRTI in 2017) than among pretreatment people with HIV. NNRTI and NRTI resistance was predominantly attributable to rtK103N and rtM184V. inT97A was observed at a similar prevalence among viraemic treatment-experienced (9·96% [6·41–15·48]) and viraemic pretreatment (10·56% [8·01–13·93]) people with HIV; no major dolutegravir resistance mutations were observed. Interpretation Despite rising NNRTI resistance among pretreatment people with HIV, overall population prevalence of pretreatment HIV drug-resistant viraemia decreased due to increasing ART uptake and viral suppression. This finding underscores the crucial role of achieving and maintaining high ART coverage in reducing transmission of drug-resistant HIV. The high prevalence of mutations conferring resistance to components of first-line ART regimens among viraemic people with HIV is potentially concerning. Funding National Institutes of Health, Johns Hopkins University Center for AIDS Research, Bill & Melinda Gates Foundation, and the US Centers for Disease Control and Prevention.

59 BASIC BIOLOGICAL SCIENCES

Recent evolution of risk analyses in atomic bomb survivor studies: new methods and applications

Abstract Several decades ago a dramatic leap forward occurred in the development and application of statistical methods for modeling radiation risk at the Radiation Effects Research Foundation (RERF). Poisson regression analysis for grouped person-year cohort data and the linear excess relative risk model were introduced, and subsequently a devoted software system, Epicure® (https://www.hirosoft.com), was developed by researchers at RERF and at the U.S. National Cancer Institute. Numerous advancements in understanding radiation effects on humans were made possible with these methods, which are still the state-of-the-art for risk assessment at RERF and have remained part of the standard toolbox for radiation—and other environmental—epidemiological studies worldwide. Nevertheless, as our understanding of radiation risk has increased, so have the breadth and depth of questions that require answers based on emerging data that are not amenable to these conventional methods. This overview briefly recounts the conventional methods and then describes our recent diversification into the use or development of new statistical approaches to meet the challenges of burgeoning biological data and emerging mechanistic information. We briefly discuss the development and application of new methods, current and planned, that are part of the RERF Statistics Department’s role in supporting institution-wide research, especially in our collaborations involving the Life Span Study, Adult Health Study, and First-generation Offspring Clinical Study. Some approaches to modeling and assessing radiation risk with newer methods mentioned herein have already been published, while some are still in development or are only beginning at the proposal stage.

Oncology

Poisson-response Tensor-on-Tensor Regression and Applications

We introduce Poisson-response tensor-on-tensor regression (PToTR), a novel regression framework designed to handle tensor responses composed element-wise of random Poisson-distributed counts. Tensors, or multi-dimensional arrays, composed of counts are common data in fields such as inter national relations, social networks, epidemiology, and medical imaging, where events occur across multiple dimensions like time, location, and dyads. PToTR accommodates such tensor responses alongside tensor covariates, providing a versatile tool for multi dimensional data analysis. We propose algorithms for maximum likelihood estimation under a canonical polyadic (CP) structure on the regression coefficient tensor that satisfy the positivity of Poisson parameters and then provide an initial theoretical error analysis for PToTR estimators. We also demonstrate the utility of PToTR through three concrete applications: longitudinal data analysis of the Integrated Crisis Early Warning System database, positron emission tomography (PET) image reconstruction, and change-point detection of communication patterns in longitudinal dyadic data. These applications highlight the versatility of PToTR in addressing complex, structured count data across various domains.

97 MATHEMATICS AND COMPUTING

Poisson Log-Normal Process for Count Data Prediction

Modeling count data is important in physics and other scientific disciplines, where measurements often involve discrete, non-negative quantities such as photon or neutrino detection events. Traditional parametric approaches can be trained to generate integer-count predictions but may struggle with capturing complex, non-linear dependencies often observed in the data. Gaussian process (GP) regression provides a robust non-parametric alternative to modeling continuous data; however, it cannot generate integer outputs. We propose the Poisson Log-Normal (PoLoN) process, a framework that employs GP to model Poisson log-rates. As in GP regression, our approach relies on the correlations between data points captured via GP kernel structure rather than explicit functional parameterizations. We demonstrate that the PoLoN predictive distribution is Poisson-LogNormal and provide an algorithm for optimizing kernel hyperparameters. Furthermore, we adapt the PoLoN approach to the problem of detecting weak localized signals superimposed on a smoothly varying background - a task of considerable interest in many areas of science and engineering. Our framework allows us to predict the strength, location and width of the detected signals. We evaluate PoLoN's performance using both synthetic and real-world datasets, including the open dataset from CERN which was used to detect the Higgs boson at the Large Hadron Collider. Our results indicate that the PoLoN process can be used as a non-parametric alternative for analyzing, predicting, and extracting signals from integer-valued data.

Saha, Anushka [Rutgers U., Piscataway]

Utility of correlation techniques in gravity and magnetic interpretation

Internal correspondence uses Poisson's Theorem in a moving-window linear regression analysis between the anomalous first vertical derivative of gravity and total magnetic field reduced to the pole. The regression parameters provide critical information on source characteristics. The correlation coefficient indicates the strength of the relation between magnetics and gravity. Slope value gives delta j/delta sigma estimates of the anomalous source. The intercept furnishes information on anomaly interference. Cluster analysis consists of the classification of subsets of data into groups of similarity based on correlation of selected characteristics of the anomalies. Model studies are used to illustrate implementation and interpretation procedures of these methods, particularly internal correspondence. Analysis of the results of applying these methods to data from the midcontinent and a transcontinental profile shows they can be useful in identifying crustal provinces, providing information on horizontal and vertical variations of physical properties over province size zones, validating long wavelength anomalies, and isolating geomagnetic field removal problems.

Chandler, V. W.

Prediction of electric and magnetic fields from spectral data using machine learning algorithms for Doppler-free saturation spectroscopy diagnostics

The prediction of electric and magnetic field amplitudes from atomic spectral data is critical for plasma control in fusion devices such as tokamaks. Conventional approaches that rely on physics-based models are computationally expensive and unsuitable for real-time applications. In this work, we develop and benchmark three machine learning algorithms—simulation-based inference (SBI), fully connected neural networks (FCNN), and histogram-based gradient boosting regression (GBR-Hist)—to infer field intensities directly from Doppler-free saturation spectroscopy (DFSS) spectra. Synthetic datasets of spectra were generated using the EZSSS code and evaluated both with and without added Poisson noise to mimic experimental conditions. We find that SBI achieves the highest accuracy and robustness, FCNN provides a strong balance of accuracy and computational efficiency for real-time applications, and GBR-Hist offers the fastest inference but is more sensitive to noise. Furthermore, these results demonstrate the potential of machine learning to accelerate DFSS analysis and enhance its utility for plasma diagnostics and control.

Doppler-free saturation spectroscopy