Philip J Peters

University of North Carolina at Chapel Hill, North Carolina, United States

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Publications (42)119.55 Total impact


  • No preview · Article · Sep 2015 · MMWR. Morbidity and mortality weekly report

  • No preview · Article · Jul 2015 · Journal of the International AIDS Society
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    ABSTRACT: On January 23, 2015, the Indiana State Department of Health (ISDH) began an ongoing investigation of an outbreak of human immunodeficiency virus (HIV) infection, after Indiana disease intervention specialists reported 11 confirmed HIV cases traced to a rural county in southeastern Indiana. Historically, fewer than five cases of HIV infection have been reported annually in this county. The majority of cases were in residents of the same community and were linked to syringe-sharing partners injecting the prescription opioid oxymorphone (a powerful oral semi-synthetic opioid analgesic). As of April 21, ISDH had diagnosed HIV infection in 135 persons (129 with confirmed HIV infection and six with preliminarily positive results from rapid HIV testing that were pending confirmatory testing) in a community of 4,200 persons.
    No preview · Article · May 2015 · MMWR. Morbidity and mortality weekly report
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    ABSTRACT: Background: HIV transmission risk is affected by HIV status awareness and care and treatment status. We aimed to describe the diagnosis, care, and viral suppression status of HIV-infected partners identified by persons newly diagnosed with HIV in North Carolina (NC). Methodology: The STOP study is a multi-site, prospective study assessing methods to detect acute HIV infection (AHI). In NC, participants (age >12 years) at 3 sexually transmitted infection clinics were screened for HIV infection from 9/2011 to 10/2013. For newly diagnosed persons (indexes), partner services interviews elicited information about past sex partners within a specified period (AHI indexes=3 months; chronic HIV infection [CHI] indexes=12 months). The HIV status (HIV-infected, HIV-uninfected, status-unknown) and diagnosis (new or previously diagnosed), care (CD4 or viral load [VL] reported in NC surveillance databases), and viral suppression (VL<50 copies/ml) status were determined for reported partners. Results: Overall, 146 persons were newly diagnosed with HIV infection during the STOP study (20 AHI indexes; 126 CHI indexes). Index persons were predominately MSM (66%), young (median age 26 years), and black (86%). Index persons reported 791 sexual partners (80 by AHI indexes, 711 by CHI indexes). Over half of all partners were of unknown status (460 anonymous, 21 counselling-and-testing refusals, 45 testing-only refusals, 32 unlocatable). Of the remaining 331 partners, 129 (39%) were HIV-infected (24 newly diagnosed; 105 previously diagnosed). A total of 66 (63%) previously diagnosed partners had a reported VL/CD4 before the index diagnosis date; the last VL/CD4 for 30 (45%) of these partners was >6 months before the index diagnosis date, suggesting loss to care. Of those with a VL 6 months before the index diagnosis date (N=28), 19 were not virally suppressed (68%). AHI and CHI indexes reported a similar proportion of previously diagnosed partners; AHI indexes reported a higher proportion of virally suppressed, previously diagnosed partners (33% versus 4%; p=0.004). Half (N=80) of all indexes named ≥1 HIV-infected partner; 70 (48%) named ≥1 previously diagnosed partner. Conclusions: Previously diagnosed partners, many of whom were not in care and virally suppressed, were prominent in networks of newly diagnosed persons. Prioritizing interventions to find previously diagnosed persons not in care and facilitate re-engagement and treatment could greatly impact HIV transmission.
    Full-text · Conference Paper · Feb 2015
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    ABSTRACT: Background: Sexually transmitted disease (STD) program and clinic staff play an important role in providing linkage and referrals to programs and services that address the complex medical and psychosocial needs of their clients. We synthesized recent published literature related to effective practices for linkage to care for HIV and referral to other medical and social services. Methods: Three PubMed searches were conducted to identify relevant studies published since 2004 on (1) linkage to HIV care, (2) referral within STD clinical contexts, and (3) (review articles only) referral practices among all medical specialties. Systematic review procedures were not used. Results: Thirty-three studies were included in this review. Studies highlight the limited value of passive referral practices and the increased effectiveness of active referral and linkage practices. Numerous studies on linkage to HIV care suggest that case management approaches, cultural-linguistic concordance between linkage staff and clients, and structural features such as colocation facilitate timely linkage to care. Integration of other medical and social services such as family planning and alcohol screening services into STD settings may be optimal but resource-intensive. Active referral practices such as having a written referral protocols and agreements, using information technology to help transfer information between providers, and making appointments for clients may offer some benefit. Few studies included information on program costs associated with linkage and referral. Conclusions: Recent literature provides some guideposts for STD program and clinical staff to use in determining their approach to helping link and refer clients to needed care. Much experience with these issues within STD services remains unpublished, and key gaps in the literature remain.
    No preview · Article · Jan 2015 · Sex Transm Dis

  • No preview · Article · Oct 2014 · Journal of Clinical Virology
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    ABSTRACT: Background: In the new HIV testing algorithm, specimens reactive on an HIV antigen/antibody combination immunoassay (IA) but negative on a supplemental confirmatory test are tested for HIV-1 RNA to distinguish acute HIV infection (AHI) from false positive IA results. We evaluated the diagnostic performance of quantitative HIV-1 RNA viral load (VL) and IA signal-to-cutoff ratios (S/COs) to diagnose AHI in this setting. Methods: The STOP study is a prospective study evaluating methods to detect AHI. Participants (age > 12 years) from 12 HIV testing sites in sexually transmitted infection clinics and community-based programs were screened for HIV with an IA (Architect, Abbott). Repeatedly reactive IA results (S/CO ≥1.00) were confirmed with an HIV-1/HIV-2 antibody differentiation assay (Multispot, Bio-Rad). Discordant IA (reactive) and Multispot (negative) results were tested with a FDA-approved qualitative HIV-1 RNA assay (Aptima; qual-RNA) and/or VL (Abbott m2000 or Roche Amplicor v1.5). Results: Among 86,929 participants who received HIV testing from September 2011 to October 2013, 191 (0.22%) had discordant IA (reactive) and Multispot (negative) results of whom 101 (52.9%) were diagnosed with AHI and 90 (47.1%) were determined to be HIV negative. Among 70 participants who had both qual-RNA and VL performed, 69 (98.6%, 95% Confidence Interval [CI] 90.6 99.8%) had concordant results (49 both reactive, 20 both negative). The one discordant result (non-reactive qual-RNA but detectable VL) was determined to be consistent with AHI on repeat testing. Among participants with AHI who had a VL test (n=100), the estimated geometric mean VL was 1,408,316 (95% CI 915,166 2,167,704) copies/ml and only two of the VLs were less than 10,000 copies/ml (Figure). Among participants determined to be HIV negative who had a VL test (n=50), all VL results were undetectable. IA S/COs among participants with AHI (median 23.68, Interquartile Range [IQR] 7.44 60.43) were also significantly higher than S/COs among those determined to be HIV negative (median 1.91, IQR 1.37 2.93) (p <0.0001). Conclusion: VL, which is more widely available and clinically useful than qual-RNA, consistently distinguished AHI from false positive IA results in the context of the new HIV testing algorithm.
    No preview · Conference Paper · Oct 2014
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    ABSTRACT: In 2012, the World Health Organization (WHO) amended their 2010 guidelines for women receiving limited duration, triple-antiretroviral drug regimens during pregnancy and breastfeeding for prevention of mother-to-child transmission of HIV (tARV-PMTCT) (Option B) to include the option to continue lifelong combination antiretroviral therapy (cART) (Option B+). We evaluated clinical and CD4 outcomes in women who had received antiretrovirals for prevention of mother-to-child transmission and then discontinued antiretrovirals 6-months postpartum.
    Full-text · Article · Apr 2014 · PLoS ONE
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    ABSTRACT: The incidence of human immunodeficiency virus (HIV) infection has significantly increased among black men who have sex with men (MSM) in the United States, and young black MSM have been disproportionately affected. HIVinfected black MSM are also less likely to engage in HIV care and achieve viral suppression than MSM of other races/ethnicities. Engaging in care and achieving viral suppression is a multistep process that starts with diagnosis. Diagnosing persons unaware of their HIV status traditionally has been a critical component of HIV partner services, but partner services also provide an important opportunity to reengage HIVinfected partners in medical care. One approach for partner services involves contacting partners of persons with newly diagnosed HIV infection and using sexual and social network and molecular phylogenetic data to improve the continuum of HIV care among black MSM. To evaluate the effectiveness of that approach, results from a prospective partner services study conducted in North Carolina were examined, and one of the partner networks identified through this study was evaluated in depth. Overall, partner services were provided to 30 black, HIV-infected MSM who named 95 sex partners and social contacts, of whom 39 (41%) previously had been diagnosed with HIV infection. The partner network evaluation demonstrated that HIV-infected and HIV-negative partners were frequently in the same network, and that the majority of HIV-infected partners were already aware of their diagnosis but had not achieved viral suppression. Using partner services to ensure that HIV-infected partners are linked to care and treatment might reduce HIV transmission and might improve outcomes along the continuum of care.
    No preview · Article · Feb 2014 · MMWR. Morbidity and mortality weekly report
  • Philip J Peters · Barbara J Marston · Paul J Weidle · John T Brooks

    No preview · Chapter · Dec 2013
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    ABSTRACT: A new HIV diagnostic algorithm has been proposed which replaces the use of the HIV-1 Western blot and HIV-1 immunofluorescence assays (IFA) as the supplemental test with an HIV-1/HIV-2 antibody differentiation assay. To compare an FDA-approved HIV-1/HIV-2 antibody differentiation test (Multispot) as a confirmatory test with the HIV-1 Western blot and IFA. Participants were screened with an HIV-1/HIV-2 combination Antigen/Antibody (Ag/Ab) screening assay. Specimens with repeatedly reactive results were tested with Multispot and either Western blot or IFA. Specimens with discordant screening and confirmatory results were resolved with HIV-1 RNA testing. Individuals (37,876) were screened for HIV infection and 654 (1.7%) had a repeatedly reactive Ag/Ab assay result. On Multispot, 554 (84.7%) were HIV-1 reactive, 0 (0%) were HIV-2 reactive, 1 (0.2%) was reactive for both HIV-1 and HIV-2 (undifferentiated), 9 (1.4%) were HIV-1 indeterminate, and 90 (13.8%) were non-reactive. HIV-1 RNA was detected in 47/90 Multispot non-reactive (52.2%) specimens. Among specimens confirmed to have HIV infection (true positives), Multispot and Western blot detected HIV-1 antibody in a similar proportion of cases (93.7% vs. 94.4% respectively) while Multispot and IFA also detected HIV-1 antibody in a similar proportion of cases (84.5% vs. 83.4% respectively). In this study, Multispot confirmed HIV infections at a similar proportion to Western blot and IFA. Multispot, Western blot, and IFA, however, did not confirm all of the reactive Ag/Ab assay results and underscores the importance of HIV NAT testing to resolve discordant screening and confirmatory results.
    Full-text · Article · Dec 2013 · Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology
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    ABSTRACT: Background: FDA-approved 4th-generation HIV antigen/antibody immunoassays can detect HIV infection earlier than traditional confirmatory tests (i.e., Western blot). Screening and confirmatory test results (4th-generation reactive / Western blot negative) that are discordant may be misclassified as HIV-negative by clinicians. Use of an algorithm with HIV-1 Nucleic Acid Amplification Testing (NAAT) for confirmation enables proper classification of reactive 4th-generation test results. We report a prospective evaluation of a testing algorithm using HIV-1 NAAT to confirm reactive 4th-generation results. Methods: The STOP study is an ongoing, multi-site study comparing methods to detect acute HIV infection. In New York City, participants at three STD clinics and two community-based testing programs were screened for HIV with a 4th-generation antigen/antibody immunoassay (Architect, Abbott). Specimens with a reactive 4th-generation result were tested with a qualitative HIV-1 NAAT (APTIMA, Gen-Probe), Western blot (WB, Bio-Rad), and a HIV-1/HIV-2 antibody differentiation assay (Multispot, Bio-Rad). Results: From October 3, 2011 to March 11, 2013, we tested 13,931 specimens with the 4th-generation assay, of which 501 (3.6%) were reactive. HIV-1 RNA was detected in 459 (92%) of these specimens by HIV-1 NAAT (Figure 1). Among the 42 specimens with HIV-1 RNA not detected by NAAT, 7 (1.4%) were reactive by both WB and Multispot, consistent with HIV-1 infection. Three of these 7 individuals were determined to have newly diagnosed HIV infection and denied any HIV antiretroviral use, 4 were already aware of their HIV status. Overall, among 466 HIV infections that were diagnosed in this study, HIV-1 infection was confirmed by NAAT in 98.5% of cases (n=459) compared with 93.6% confirmed by Multispot (n=437; p<0.0001) and 95.1% by WB (n=443; p<0.0001), respectively. Conclusion: In an HIV testing algorithm that uses a 4th-generation assay as the screening test, NAAT confirmed a higher proportion of HIV infections than Multispot or WB. Discordant 4th-generation/NAAT results (4th-generation reactive/NAAT not detected), however, must be resolved by Multispot or WB to properly diagnose infections in persons with undetectable levels of HIV RNA.
    No preview · Conference Paper · Oct 2013
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    ABSTRACT: Background: FDA-approved 4th-generation combination HIV antigen/antibody immunoassays are highly sensitive for recent infection, but they may not diagnose very early HIV infection when only viral RNA is detectable. The Architect (Abbott) 4th-generation assay generates signal-to-cutoff ratios (S/CO) for each specimen tested; S/CO values < 1 are considered non-reactive. We examined pooled HIV RNA nucleic acid amplification testing (pNAAT) results for specimens with 4th-generation S/CO values < 1. Methods: STOP is an on-going, prospective, within-individual study comparing the 4th-generation assay with pNAAT for detection of early HIV infection in participants with negative rapid HIV antibody tests. Sites include sexually transmitted disease clinics and community-based programs in New York City, San Francisco, and North Carolina. All participants have blood drawn for laboratory-based testing by both methods. We examined the proportion of HIV infections detected by pNAAT in 4th-generation non-reactive specimens (S/CO < 1) and calculated the number needed to test with supplemental RNA screening to detect one additional HIV infection for S/CO thresholds ranging from 0 to 0.999. Results: Between September 2011 and January 2013, 52,118 participants had non-reactive (S/CO <1) Architect results. Of these, 19 (0.04%) had HIV infection detected by pNAAT. Overall, 134 (0.26%) specimens from participants had a S/CO values between 0.7 – 0.999 and HIV infection was diagnosed in 6 (4.48%)[Figure]. At S/CO stratifications below 0.7, the percentage of individuals with HIV infection identified by RNA testing ranged from 0% to 0.14%. To detect one additional HIV infection, supplemental RNA testing would be required for 22.3 (95% CI: 10.4, 49.4) 4th-generation non-reactive specimens with a S/CO range of 0.7 - 0.999 and 83.5 (95% CI: 37.9, 185.5) specimens with a S/CO range of 0.5 - 0.999. Conclusion: Detecting very early HIV infections is an essential step to prevent further HIV transmission and 4th-generation S/CO data can guide the use of RNA screening to detect these infections. This strategy would increase the sensitivity of 4th-generation-based HIV testing algorithms for very early HIV infection. Nicholas J. Moss, MD, MPH, Alameda County Public Health Department, Oakland, CA, Charles Rose, PhD, Centers for Disease Control, Atlanta, GA, Cynthia L. Gay, MD, MPH, Medicine, University of North Carolina, Chapel Hill, NC, Laura Hall, MPH, ICF International, Atlanta, GA, Lisa B. Hightow-Weidman, MD, MPH, University of North Carolina, Chapel Hill, Chapel Hill, NC, Benjamin Tsoi, MD, MPH, Bureau of HIV/AIDS Prevention, New York City Department of Health and Mental Hygiene, Queens, NY, Emily Westheimer, MSc, Bureau of STD Prevention and Control, New York City Department of Health and Mental Hygiene, Queens, NY, Philip J. Peters, MD, Centers for Disease Control and Prevention, Atlanta, GA and Mark Pandori, PhD, San Francisco Department of Public Health, San Francisco, CA Disclosures: N. J. Moss, None C. Rose, None C. L. Gay, None L. Hall, None L. B. Hightow-Weidman, None B. Tsoi, None E. Westheimer, None P. J. Peters, None M. Pandori, None
    No preview · Conference Paper · Oct 2013
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    Full-text · Dataset · Sep 2013
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    ABSTRACT: Cryptococcal meningitis (CM) remains a significant HIV-associated opportunistic infection in Southeast Asia and Africa, with a high burden of disease and a high mortality rate despite the availability of antiretroviral therapy (ART). We retrospectively examined the utility of cryptococcal antigen screening to identify risk for CM among 211 Thai women initiating ART. Antigenemia prevalence was 11% (n = 9) among 84 women with a CD4 count <100 cells/mm(3). Screening identified all women who later developed CM. Cryptococcal antigen titers decreased over time with ART. Our study confirmed findings from previous studies in Thailand and South Africa and provided novel observational data regarding the course of cryptococcal antigenemia in patients initiating ART and the poor efficacy of low-dose fluconazole prophylaxis in preventing CM among patients with antigenemia.
    No preview · Article · Sep 2013 · Journal of the International Association of Providers of AIDS Care
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    ABSTRACT: Coinfection with HIV and hepatitis B virus (HBV) is common in resource-limited settings but is frequently not diagnosed. The authors retrospectively tested specimens for HBV in HIV-infected Thai women who had participated in an antiretroviral therapy (ART) clinical study. A substantial proportion (27 of 211; 13%) of HIV-infected women were HBV coinfected. Among HIV/HBV-coinfected women, the authors observed similar rates of antiretroviral-associated liver toxicity (despite nevirapine [NVP] use) and CD4 count reconstitution as observed in HIV-monoinfected women. Hepatitis B surface antigen (HBsAg) screening detected the majority (81%) of HBV coinfections, including all 5 HBV-coinfected women who did not suppress HBV despite 48 weeks of lamivudine (3TC)-containing ART and could be used to tailor ART for patients diagnosed with HBV coinfection in accordance with World Health Organization guidelines. Although HBsAg screening did not diagnose 5 occult HBV coinfections, these women achieved HBV suppression on 3TC-containing ART, suggesting that not detecting occult HBV coinfection would have limited clinical impact.
    Full-text · Article · Jun 2013 · Journal of the International Association of Providers of AIDS Care
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    ABSTRACT: Data on the interaction between methicillin-resistant Staphylococcus aureus (MRSA) colonization and clinical infection are limited. During 2007-2008, we enrolled HIV-infected adults in Atlanta, Georgia, USA, in a prospective cohort study. Nares and groin swab specimens were cultured for S. aureus at enrollment and after 6 and 12 months. MRSA colonization was detected in 13%-15% of HIV-infected participants (n = 600, 98% male) at baseline, 6 months, and 12 months. MRSA colonization was detected in the nares only (41%), groin only (21%), and at both sites (38%). Over a median of 2.1 years of follow-up, 29 MRSA clinical infections occurred in 25 participants. In multivariate analysis, MRSA clinical infection was significantly associated with MRSA colonization of the groin (adjusted risk ratio 4.8) and a history of MRSA infection (adjusted risk ratio 3.1). MRSA prevention strategies that can effectively prevent or eliminate groin colonization are likely necessary to reduce clinical infections in this population.
    Full-text · Article · Apr 2013 · Emerging Infectious Diseases
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    ABSTRACT: We performed a nested case-control study of Thai women prescribed nevirapine-based antiretroviral therapy (ART) to determine if development of rash or hepatotoxicity during the first 24 weeks of treatment is associated with plasma nevirapine concentrations. From May 2005-January 2007, we enrolled 217 women initiating nevirapine-based ART in Thailand. Cases (n = 54) were women who during the first 24 weeks of treatment with nevirapine developed rash (any grade, n = 42) or hepatotoxicity (≥grade 2, n = 22, [10 had both]). Controls were the next enrolled woman who was confirmed not to meet the case definition during the first 24 weeks. Nevirapine concentrations after the two week lead-in dose of 200 mg once daily were compared between cases and controls by Wilcoxon rank-sum tests. We found no difference in Week 2 pre-dose nevirapine concentrations: cases median = 3,528 ng/mL (n = 24), controls median = 3,150ng/mL (n = 30), p = 0.5. Cases had higher post-dose nevirapine concentrations (median = 6,150 ng/mL, n = 21) than controls (median = 4,746 ng/mL, n = 20, p = 0.02). When limited to cases who developed a rash at Week 2, we found no differences in the pre-dose (median = 3,270 ng/mL, n = 12, p = 0.9) or post-dose nevirapine concentration (median = 5,443 ng/mL, n = 9, p = 0.4) compared with controls. We cannot conclude definitively that nevirapine concentrations at two weeks of therapy are associated with rash or hepatotoxicity. It is unlikely that therapeutic drug monitoring at that time will improve identification of patients at risk for rash or hepatotoxicity.
    Full-text · Article · Dec 2012 · The Open AIDS Journal
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    ABSTRACT: A high prevalence of hepatitis B virus (HBV) and human immunodeficiency virus (HIV) infections have been reported among persons with severe mental illness. In October, 2009, the Cook County Department of Public Health (CCDPH) initiated an investigation following notification of a cluster of HBV infections among mentally ill residents at a long term care facility (LTCF). LTCF staff were interviewed and resident medical records were reviewed. Residents were offered testing for HBV, HCV, and HIV. Serum specimens from residents diagnosed with HBV or HIV infection were sent to the Centers for Disease Control and Prevention (CDC) for analysis. Eleven newly diagnosed HBV infections were identified among mentally ill residents at the LTCF. Of these 11 infections, 4 serum specimens were available for complete HBV genome sequencing; all 4 genomes were found to be closely related. Four newly diagnosed HIV infections were identified within this same population. Upon molecular analysis, 2 of 4 HIV sequences from these new infections were found to be nearly identical and formed a tight phylogenetic cluster. HBV and HIV transmission was identified among mentally ill residents of this LTCF. Continued efforts are needed to prevent bloodborne pathogen transmission among mentally ill residents in LTCFs.
    Full-text · Article · Aug 2012 · PLoS ONE
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    ABSTRACT: We compared adverse events among breast-feeding neonates born to Kenyan mothers receiving triple-antiretroviral therapy, including either nevirapine or nelfinavir. Nevirapine-exposed infants had an absolute increase in the risk of rash but no significant risk differences for hepatotoxicity or high-risk hyperbilirubinemia compared with nelfinavir-exposed infants. From an infant-safety perspective, nevirapine-based regimens given during pregnancy and breast-feeding are viable options where alternatives to breast milk are not safe, affordable or feasible.
    Full-text · Article · Jul 2012 · The Pediatric Infectious Disease Journal

Publication Stats

501 Citations
119.55 Total Impact Points

Institutions

  • 2015
    • University of North Carolina at Chapel Hill
      North Carolina, United States
  • 2014-2015
    • Center for HIV/AIDS Educational Studies and Training
      New York, New York, United States
  • 2008-2014
    • Centers for Disease Control and Prevention
      • Division of HIV/AIDS Prevention, Intervention and Support
      Атланта, Michigan, United States
    • Rajavithi Hospital
      Krung Thep, Bangkok, Thailand
  • 2006-2008
    • Emory University
      • Division of Infectious Diseases
      Atlanta, Georgia, United States