Terry Lee - Academia.edu (original) (raw)

Papers by Terry Lee

Climate Dynamics, 2008

A range of existing statistical approaches for reconstructing historical temperature variations f... more A range of existing statistical approaches for reconstructing historical temperature variations from proxy data are compared using both climate model data and realworld paleoclimate proxy data. We also propose a new method for reconstruction that is based on a state-space time series model and Kalman filter algorithm. The statespace modelling approach and the recently developed RegEM method generally perform better than their competitors when reconstructing interannual variations in Northern Hemispheric mean surface air temperature. On the other hand, a variety of methods are seen to perform well when reconstructing surface air temperature variability on decadal time scales. An advantage of the new method is that it can incorporate additional, non-temperature, information into the reconstruction, such as the estimated response to external forcing, thereby permitting a simultaneous reconstruction and detection analysis as well as future projection. An application of these extensions is also demonstrated in the paper.

World Journal of Gastroenterology, 2014

To determine if early initiation of anti-tumor necrosis factor therapy affects the need for dose ... more To determine if early initiation of anti-tumor necrosis factor therapy affects the need for dose escalation. This was a retrospective review of patients receiving infliximab therapy for Crohn's disease (CD) at two outpatient gastroenterology clinics during July 2009 to October 2010. All patients included in the study were biologic agent naïve and had moderate to severe CD (Harvey Bradshaw index > 8). Patients were divided into groups based on length of time between diagnosis to therapy initiation and concurrent immunosuppressant therapy. Kaplan-Meier survival analysis was used to compare the time to dose escalation for the four groups. There were 68 patients, 51% female and 49% male, with an average age at diagnosis of 24.7 ± 11.9 years. The average age at infliximab initiation was 34.8 ± 14.8 years. Of the 68 patients, 19% initiated inflixiamb within 2 years of diagnosis, and 51% had concurrent immunosuppressant therapy at the time of therapy initiation. Fifty percent of patients required dose escalation and the median time from therapy initiation to dose escalation was 10 mo (interquartile range: 5.3-14.8). There was a statistically significant higher probability of requiring dose esclataion in patients who initiated biologic therapy within 2 years of diagnosis, without concurrent immunosuppressant therapy (P < 0.01). Those who receive infliximab within 2 years of CD diagnosis require more intense immunosuppressant therapy than those who received infliximab later.

Statistics in Medicine, 2011

This paper provides a systematic comparison of cancer mortality and incidence projection methods ... more This paper provides a systematic comparison of cancer mortality and incidence projection methods used at major national health agencies. These methods include Poisson regression using an age-period-cohort model as well as a simple log-linear trend, a joinpoint technique, which accounts for sharp changes, autoregressive time series and state-space models. We assess and compare the reliability of these projection methods by using Canadian cancer mortality data for 12 cancer sites at both the national and regional levels. Cancer sites were chosen to provide a wide range of mortality frequencies. We explore specific techniques for small case counts and for overall national-level projections based on regional-level data. No single method is omnibus in terms of superior performance across a wide range of cancer sites and for all sizes of populations. However, the procedures based on age-period-cohort models used by the Association of the Nordic Cancer Registries tend to provide better performance than the other methods considered. The exception is when case counts are small, where the average of the observed counts over the recent 5-year period yields better predictions.

Canadian Journal of Statistics, 2011

The authors link time-to-event models with longitudinal models through shared latent variables wh... more The authors link time-to-event models with longitudinal models through shared latent variables when the time of the event of interest is known only to lie within an interval. The context of tree growth and mortality studies presents a natural application of shared parameter joint modelling where a latent feature of each tree impacts both mortality and growth. The authors' developments are motivated by such an application, with the additional caveat that event-times are not known exactly, since the trees are subject to intermittent observation, with the time between measurements extending into decades or longer. Such interval censoring is a common occurrence in similar long-term experiments in resource management, ecology and health research. The additional numerical complexity resulting from interval censored time-to-event data often makes inference for joint models prohibitive. The authors examine properties of three event-time imputation methods that enable application of now standard joint modelling techniques to interval censored time-to-event data. The imputation techniques include the midpoint method, a kernel smoothing method, and a backsolve method which incorporates information from the longitudinal trajectory. Joint analysis of a designed, long-term, forestry experiment is presented, accompanied by a simulation study investigating the properties of the three event-time imputation techniques.

Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2015

Bilateral sacrospinous fixation with tailored mesh arms (bSSVF) uses polypropylene mesh to suspen... more Bilateral sacrospinous fixation with tailored mesh arms (bSSVF) uses polypropylene mesh to suspend the vault to the sacrospinous ligaments bilaterally with minimal tension, recreating nulliparous midline anatomy. It can be used with uterine conservation. Our primary objective was to determine objective cure rate at one year following bSSVF compared with a control group undergoing abdominal sacrocolpopexy (ASC). Secondary objectives were to compare symptoms, quality of life, sexual function, pain, and global satisfaction before and after surgery and between bSSVF and ASC groups at one year. This prospective cohort study enrolled patients with symptomatic prolapse who chose to undergo bSSVF or ASC. Baseline demographics were obtained. Prolapse quantification, validated symptom questionnaire scores, and McGill pain scores were obtained at baseline, six weeks, and one-year postoperatively. Global satisfaction was recorded. The primary outcome measure was the difference in cure rate (vau...

World journal of gastroenterology : WJG, Jan 7, 2015

To determine if longer battery life improves capsule endoscopy (CE) completion rates. A retrospec... more To determine if longer battery life improves capsule endoscopy (CE) completion rates. A retrospective study was performed at a tertiary, university-affiliated hospital in Vancouver, Canada. Patients who underwent CE with either PillCam™ SB2 or SB2U between 01/2010 and 12/2013 were considered for inclusion. SB2 and SB2U share identical physical dimensions but differ in their battery lives (8 h vs 12 h). Exclusion criteria included history of gastric or small bowel surgery, endoscopic placement of CE, interrupted view of major landmarks due to technical difficulty or significant amount of debris, and repeat CE using same system. Basic demographics, comorbidities, medications, baseline bowel habits, and previous surgeries were reviewed. Timing of major landmarks in CE were recorded, and used to calculate gastric transit time, small bowel transit time, and total recording time. A complete CE study was defined as visualization of cecum. Transit times and completion rates were compared. F...

Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2013

Self-confidence is a feeling of trust in one's abilities, qualities, and judgement. It is one... more Self-confidence is a feeling of trust in one's abilities, qualities, and judgement. It is one of the cognitive mechanisms underlying behavioural change. Variations in self-confidence influence motivation and predict performance success. We sought to validate a new tool for measuring self-confidence in surgical residents. A self-confidence rating scale was developed and consisted of six questions about the attitudes of gynaecology residents while performing a vaginal hysterectomy. The residents were participants in a randomized controlled trial (2008 to 2011) and performed a vaginal hysterectomy before and after an educational intervention. They rated their own surgical performance on a validated global rating scale (GRS) of surgical skill and their self-confidence on the new rating scale. Supervising surgeons concurrently rated the residents' performance on the GRS. Correlations were sought between self-confidence scale scores and measures of competence. There was no differe...

Gastrointestinal Endoscopy, 2010

were identified. Data were obtained by searching our prospectively collected electronic database ... more were identified. Data were obtained by searching our prospectively collected electronic database (Medos,Langensebold, Germany). Perforation was defined as a transmural opening of the colon wall of any size. Endoscopic closure was defined as any endoscopic attempt using clips, loops and/or fibrin glue to close the defect.Results: During the study period, a total of 10,601 colonoscopies were performed (3,272 therapeutic interventions, 30.8%). A total of 12 iatrogenic colonic perforations occurred, yielding an incidence of 0.11%. Five (41.7%) occurred during a diagnostic colonoscopy (perforation rate of 0.07%). The remaining 7 perforations (58.3%) occurred as the result of a therapeutic intervention, perforation rate, 0.21%. (p Ͻ 0.03, as compared to perforations occurring during a diagnostic colonoscopy). These included: polypectomy, nϭ4, dilation of stenosis, nϭ2, decompression tube placement, nϭ1. Endoscopic closure of the perforation site was attempted in 6 patients and successful in 5. In the patient with failed endoscopic closure and the remaining patients (nϭ7) surgery was performed (large defects, nϭ3, difficult scope position, nϭ2, stool contamination, nϭ2). One patient died as a consequence of colon perforation.Discussion: The overall perforation rate of colonoscopy was 0.11%, occurring more frequently after therapeutic than diagnostic colonoscopies. Immediate endoscopic closure was possible in 42% and successful in 83% of these patients. In patients with defects larger than 2 cm, stool contamination and with perforations located in angulated colon areas, endoscopic closure was not attempted. For these patients we followed a strategy of immediate laparotomy. With the advancement of NOTES techniques, we speculate that in the future a larger number of colon perforations can be approached endoscopically.

American Journal of Respiratory and Critical Care Medicine, 2013

Rationale: Changes in plasma cytokine levels may predict mortality, and therapies (vasopressin ve... more Rationale: Changes in plasma cytokine levels may predict mortality, and therapies (vasopressin versus norepinephrine) could change plasma cytokine levels in early septic shock. Objectives: Our hypotheses were that changes in plasma cytokine levels over 24 hours differ between survivors and nonsurvivors, and that there are different effects of vasopressin and norepinephrine on plasma cytokine levels in septic shock. Methods: We studied 394 patients in a randomized, controlled trial of vasopressin versus norepinephrine in septic shock. We used hierarchical clustering and principal components analysis of the baseline cytokine concentrations to subgroup cytokines; we then compared survivors to nonsurvivors (28 d) and compared vasopressin-versus norepinephrine-induced changes in cytokine levels over 24 hours. Measurements and Main Results: A total of 39 plasma cytokines were measured at baseline and at 24 hours. Hierarchical clustering and principal components analysis grouped cytokines similarly. Survivors (versus nonsurvivors) had greater decreases of overall cytokine levels (P , 0.001). Vasopressin decreased overall 24-hour cytokine concentration compared with norepinephrine (P ¼ 0.037). In less severe septic shock, the difference in plasma cytokine reduction over 24 hours between survivors and nonsurvivors was less pronounced than that seen in more severe septic shock. Furthermore, vasopressin decreased interferon-inducible protein 10 and granulocyte colonystimulating factor more than did norepinephrine in less severe septic shock, whereas vasopressin decreased granulocyte-macrophage colony-stimulating factor in patients who had more severe shock. Conclusions: Survivors of septic shock had greater decreases of cytokines, chemokines and growth factors in early septic shock. Vasopressin decreased 24-hour plasma cytokine levels more than did norepinephrine. The vasopressin-associated decrease of cytokines differed according to severity of shock. Clinical trial registered with www.controlled-trials.com (ISRCTN94845869).

Hiv Clinical Trials, 2014

Background: Depression related to interferon-alpha (IFN-α) is common, may reduce adherence, and c... more Background: Depression related to interferon-alpha (IFN-α) is common, may reduce adherence, and can be treatment limiting. HIV-HCV coinfected persons experience lower sustained virologic response rates and commonly have psychiatric comorbidities, thus they may benefi t from prevention of depression. Objective: The aim of the study was to determine whether prophylactic citalopram can increase HCV treatment adherence and reduce the incidence of moderate depression in HIV-HCV coinfected patients initiating PEG-IFN-α/ribavirin therapy. Methods: This was an investigator-initiated Canadian multicenter randomized, double-blind placebo-controlled trial. HIV-HCV coinfected patients were randomized in a 1:1 ratio to receive citalopram or placebo 3 weeks prior to starting PEG-IFN-α2b/ ribavirin, stratifi ed by study center and HCV genotype. The protocol design permitted the comparison of prophylaxis with the treatment of emergent depression. The primary outcomes were adherence (assessed through questionnaire and returned medication) and time to moderate depression measured by Beck Depression Inventory-II (BDI-II) score greater than 15, confi rmed 2 weeks apart. Results: Seventy-six patients (36 citalopram/40 placebo) were randomized. Overall adherence was high, ranging from 95% (week 12) to 91% (week 48). There was no difference between arms with respect to mean or median adherence at any study time point. Cumulative incidence of moderate depression did not differ signifi cantly by group (log rank P = .32). The hazard ratio for moderate depression was 0.81 (95% CI, 0.26 to 2.54) for citalopram compared with placebo when adjusted for baseline BDI-II score. Conclusions: A strategy of prophylactic citalopram compared to treatment of emergent depression was not associated with higher adherence or a reduction in treatment-limiting depression nor did it signifi cantly reduce depressive symptoms among HIV-HCV coinfected persons during treatment for HCV.

Climate Dynamics, 2008

A range of existing statistical approaches for reconstructing historical temperature variations f... more A range of existing statistical approaches for reconstructing historical temperature variations from proxy data are compared using both climate model data and realworld paleoclimate proxy data. We also propose a new method for reconstruction that is based on a state-space time series model and Kalman filter algorithm. The statespace modelling approach and the recently developed RegEM method generally perform better than their competitors when reconstructing interannual variations in Northern Hemispheric mean surface air temperature. On the other hand, a variety of methods are seen to perform well when reconstructing surface air temperature variability on decadal time scales. An advantage of the new method is that it can incorporate additional, non-temperature, information into the reconstruction, such as the estimated response to external forcing, thereby permitting a simultaneous reconstruction and detection analysis as well as future projection. An application of these extensions is also demonstrated in the paper.

World Journal of Gastroenterology, 2014

To determine if early initiation of anti-tumor necrosis factor therapy affects the need for dose ... more To determine if early initiation of anti-tumor necrosis factor therapy affects the need for dose escalation. This was a retrospective review of patients receiving infliximab therapy for Crohn's disease (CD) at two outpatient gastroenterology clinics during July 2009 to October 2010. All patients included in the study were biologic agent naïve and had moderate to severe CD (Harvey Bradshaw index > 8). Patients were divided into groups based on length of time between diagnosis to therapy initiation and concurrent immunosuppressant therapy. Kaplan-Meier survival analysis was used to compare the time to dose escalation for the four groups. There were 68 patients, 51% female and 49% male, with an average age at diagnosis of 24.7 ± 11.9 years. The average age at infliximab initiation was 34.8 ± 14.8 years. Of the 68 patients, 19% initiated inflixiamb within 2 years of diagnosis, and 51% had concurrent immunosuppressant therapy at the time of therapy initiation. Fifty percent of patients required dose escalation and the median time from therapy initiation to dose escalation was 10 mo (interquartile range: 5.3-14.8). There was a statistically significant higher probability of requiring dose esclataion in patients who initiated biologic therapy within 2 years of diagnosis, without concurrent immunosuppressant therapy (P < 0.01). Those who receive infliximab within 2 years of CD diagnosis require more intense immunosuppressant therapy than those who received infliximab later.

Statistics in Medicine, 2011

This paper provides a systematic comparison of cancer mortality and incidence projection methods ... more This paper provides a systematic comparison of cancer mortality and incidence projection methods used at major national health agencies. These methods include Poisson regression using an age-period-cohort model as well as a simple log-linear trend, a joinpoint technique, which accounts for sharp changes, autoregressive time series and state-space models. We assess and compare the reliability of these projection methods by using Canadian cancer mortality data for 12 cancer sites at both the national and regional levels. Cancer sites were chosen to provide a wide range of mortality frequencies. We explore specific techniques for small case counts and for overall national-level projections based on regional-level data. No single method is omnibus in terms of superior performance across a wide range of cancer sites and for all sizes of populations. However, the procedures based on age-period-cohort models used by the Association of the Nordic Cancer Registries tend to provide better performance than the other methods considered. The exception is when case counts are small, where the average of the observed counts over the recent 5-year period yields better predictions.

Canadian Journal of Statistics, 2011

The authors link time-to-event models with longitudinal models through shared latent variables wh... more The authors link time-to-event models with longitudinal models through shared latent variables when the time of the event of interest is known only to lie within an interval. The context of tree growth and mortality studies presents a natural application of shared parameter joint modelling where a latent feature of each tree impacts both mortality and growth. The authors' developments are motivated by such an application, with the additional caveat that event-times are not known exactly, since the trees are subject to intermittent observation, with the time between measurements extending into decades or longer. Such interval censoring is a common occurrence in similar long-term experiments in resource management, ecology and health research. The additional numerical complexity resulting from interval censored time-to-event data often makes inference for joint models prohibitive. The authors examine properties of three event-time imputation methods that enable application of now standard joint modelling techniques to interval censored time-to-event data. The imputation techniques include the midpoint method, a kernel smoothing method, and a backsolve method which incorporates information from the longitudinal trajectory. Joint analysis of a designed, long-term, forestry experiment is presented, accompanied by a simulation study investigating the properties of the three event-time imputation techniques.

Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2015

Bilateral sacrospinous fixation with tailored mesh arms (bSSVF) uses polypropylene mesh to suspen... more Bilateral sacrospinous fixation with tailored mesh arms (bSSVF) uses polypropylene mesh to suspend the vault to the sacrospinous ligaments bilaterally with minimal tension, recreating nulliparous midline anatomy. It can be used with uterine conservation. Our primary objective was to determine objective cure rate at one year following bSSVF compared with a control group undergoing abdominal sacrocolpopexy (ASC). Secondary objectives were to compare symptoms, quality of life, sexual function, pain, and global satisfaction before and after surgery and between bSSVF and ASC groups at one year. This prospective cohort study enrolled patients with symptomatic prolapse who chose to undergo bSSVF or ASC. Baseline demographics were obtained. Prolapse quantification, validated symptom questionnaire scores, and McGill pain scores were obtained at baseline, six weeks, and one-year postoperatively. Global satisfaction was recorded. The primary outcome measure was the difference in cure rate (vau...

World journal of gastroenterology : WJG, Jan 7, 2015

To determine if longer battery life improves capsule endoscopy (CE) completion rates. A retrospec... more To determine if longer battery life improves capsule endoscopy (CE) completion rates. A retrospective study was performed at a tertiary, university-affiliated hospital in Vancouver, Canada. Patients who underwent CE with either PillCam™ SB2 or SB2U between 01/2010 and 12/2013 were considered for inclusion. SB2 and SB2U share identical physical dimensions but differ in their battery lives (8 h vs 12 h). Exclusion criteria included history of gastric or small bowel surgery, endoscopic placement of CE, interrupted view of major landmarks due to technical difficulty or significant amount of debris, and repeat CE using same system. Basic demographics, comorbidities, medications, baseline bowel habits, and previous surgeries were reviewed. Timing of major landmarks in CE were recorded, and used to calculate gastric transit time, small bowel transit time, and total recording time. A complete CE study was defined as visualization of cecum. Transit times and completion rates were compared. F...

Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2013

Self-confidence is a feeling of trust in one's abilities, qualities, and judgement. It is one... more Self-confidence is a feeling of trust in one's abilities, qualities, and judgement. It is one of the cognitive mechanisms underlying behavioural change. Variations in self-confidence influence motivation and predict performance success. We sought to validate a new tool for measuring self-confidence in surgical residents. A self-confidence rating scale was developed and consisted of six questions about the attitudes of gynaecology residents while performing a vaginal hysterectomy. The residents were participants in a randomized controlled trial (2008 to 2011) and performed a vaginal hysterectomy before and after an educational intervention. They rated their own surgical performance on a validated global rating scale (GRS) of surgical skill and their self-confidence on the new rating scale. Supervising surgeons concurrently rated the residents' performance on the GRS. Correlations were sought between self-confidence scale scores and measures of competence. There was no differe...

Gastrointestinal Endoscopy, 2010

were identified. Data were obtained by searching our prospectively collected electronic database ... more were identified. Data were obtained by searching our prospectively collected electronic database (Medos,Langensebold, Germany). Perforation was defined as a transmural opening of the colon wall of any size. Endoscopic closure was defined as any endoscopic attempt using clips, loops and/or fibrin glue to close the defect.Results: During the study period, a total of 10,601 colonoscopies were performed (3,272 therapeutic interventions, 30.8%). A total of 12 iatrogenic colonic perforations occurred, yielding an incidence of 0.11%. Five (41.7%) occurred during a diagnostic colonoscopy (perforation rate of 0.07%). The remaining 7 perforations (58.3%) occurred as the result of a therapeutic intervention, perforation rate, 0.21%. (p Ͻ 0.03, as compared to perforations occurring during a diagnostic colonoscopy). These included: polypectomy, nϭ4, dilation of stenosis, nϭ2, decompression tube placement, nϭ1. Endoscopic closure of the perforation site was attempted in 6 patients and successful in 5. In the patient with failed endoscopic closure and the remaining patients (nϭ7) surgery was performed (large defects, nϭ3, difficult scope position, nϭ2, stool contamination, nϭ2). One patient died as a consequence of colon perforation.Discussion: The overall perforation rate of colonoscopy was 0.11%, occurring more frequently after therapeutic than diagnostic colonoscopies. Immediate endoscopic closure was possible in 42% and successful in 83% of these patients. In patients with defects larger than 2 cm, stool contamination and with perforations located in angulated colon areas, endoscopic closure was not attempted. For these patients we followed a strategy of immediate laparotomy. With the advancement of NOTES techniques, we speculate that in the future a larger number of colon perforations can be approached endoscopically.

American Journal of Respiratory and Critical Care Medicine, 2013

Rationale: Changes in plasma cytokine levels may predict mortality, and therapies (vasopressin ve... more Rationale: Changes in plasma cytokine levels may predict mortality, and therapies (vasopressin versus norepinephrine) could change plasma cytokine levels in early septic shock. Objectives: Our hypotheses were that changes in plasma cytokine levels over 24 hours differ between survivors and nonsurvivors, and that there are different effects of vasopressin and norepinephrine on plasma cytokine levels in septic shock. Methods: We studied 394 patients in a randomized, controlled trial of vasopressin versus norepinephrine in septic shock. We used hierarchical clustering and principal components analysis of the baseline cytokine concentrations to subgroup cytokines; we then compared survivors to nonsurvivors (28 d) and compared vasopressin-versus norepinephrine-induced changes in cytokine levels over 24 hours. Measurements and Main Results: A total of 39 plasma cytokines were measured at baseline and at 24 hours. Hierarchical clustering and principal components analysis grouped cytokines similarly. Survivors (versus nonsurvivors) had greater decreases of overall cytokine levels (P , 0.001). Vasopressin decreased overall 24-hour cytokine concentration compared with norepinephrine (P ¼ 0.037). In less severe septic shock, the difference in plasma cytokine reduction over 24 hours between survivors and nonsurvivors was less pronounced than that seen in more severe septic shock. Furthermore, vasopressin decreased interferon-inducible protein 10 and granulocyte colonystimulating factor more than did norepinephrine in less severe septic shock, whereas vasopressin decreased granulocyte-macrophage colony-stimulating factor in patients who had more severe shock. Conclusions: Survivors of septic shock had greater decreases of cytokines, chemokines and growth factors in early septic shock. Vasopressin decreased 24-hour plasma cytokine levels more than did norepinephrine. The vasopressin-associated decrease of cytokines differed according to severity of shock. Clinical trial registered with www.controlled-trials.com (ISRCTN94845869).

Hiv Clinical Trials, 2014

Background: Depression related to interferon-alpha (IFN-α) is common, may reduce adherence, and c... more Background: Depression related to interferon-alpha (IFN-α) is common, may reduce adherence, and can be treatment limiting. HIV-HCV coinfected persons experience lower sustained virologic response rates and commonly have psychiatric comorbidities, thus they may benefi t from prevention of depression. Objective: The aim of the study was to determine whether prophylactic citalopram can increase HCV treatment adherence and reduce the incidence of moderate depression in HIV-HCV coinfected patients initiating PEG-IFN-α/ribavirin therapy. Methods: This was an investigator-initiated Canadian multicenter randomized, double-blind placebo-controlled trial. HIV-HCV coinfected patients were randomized in a 1:1 ratio to receive citalopram or placebo 3 weeks prior to starting PEG-IFN-α2b/ ribavirin, stratifi ed by study center and HCV genotype. The protocol design permitted the comparison of prophylaxis with the treatment of emergent depression. The primary outcomes were adherence (assessed through questionnaire and returned medication) and time to moderate depression measured by Beck Depression Inventory-II (BDI-II) score greater than 15, confi rmed 2 weeks apart. Results: Seventy-six patients (36 citalopram/40 placebo) were randomized. Overall adherence was high, ranging from 95% (week 12) to 91% (week 48). There was no difference between arms with respect to mean or median adherence at any study time point. Cumulative incidence of moderate depression did not differ signifi cantly by group (log rank P = .32). The hazard ratio for moderate depression was 0.81 (95% CI, 0.26 to 2.54) for citalopram compared with placebo when adjusted for baseline BDI-II score. Conclusions: A strategy of prophylactic citalopram compared to treatment of emergent depression was not associated with higher adherence or a reduction in treatment-limiting depression nor did it signifi cantly reduce depressive symptoms among HIV-HCV coinfected persons during treatment for HCV.