Thesis (MNutr)--University of Stellenbosch, 2008. / Bibliography. Also available via the Internet.

Thesis (M.Public Health) -- University of the Western Cape, 2008. / Includes bibliographic references (leaves 47-67).

Thesis (M.PH (Faculty of Medicine))--University of Pretoria, 2005. / Abstract in English. Includes bibliographical references (leaves 39-40). Also available online.

Too many children are still being newly infected with HIV. The Global Plan is to eliminate new HIV infections among children by 2015 and keep their mothers alive. The rate of MTCT of HIV-1 has fallen to less than 2% in countries with the implementation of recommendations. The best documented factor that correlates to higher rates of transmission is the maternal level of plasma viremia. Therefore it is important to maximally inhibit HIV replication in order to prevent HIV-associated morbidity and mortality and to prevent MTCT. Durable viral suppression prolongs life by improving immune function and overall quality of life, lowering the risk of both AIDs-defining and non-AIDS-defining complications. Clinical data are more limited on antiretroviral drugs in pregnant women than in non-pregnant individuals due to concerns for maternal and fetal safety, ethical considerations, the difficulty in designing appropriate trials to assess the study objectives, and funding limitations. However there are sufficient data to base recommendations for drug choice for many of the available antiretroviral drugs. Preferred drugs must show durable viral suppression, increased CD4 cell count, and a favorable safety profile. In addition to the aforementioned characteristics of a preferred drug, preferred antiretroviral drugs for pregnant individuals must pay special attention to maternal toxicity, potential teratogenicity, and fetal safety, efficacy of reducing perinatal transmission, and pharmacokinetics data during the perinatal transmission of HIV. Currently the optimal initial antiretroviral regimens to treat antiretroviral-naïve patients in high resource regions consist of two nucleoside/tide reverse transcription inhibitors in combination with either a nonnucleoside reverse transcriptase inhibitor or a protease inhibitor boosted with RTV. Continually re-evaluation is recommended to challenge current paradigms. Treatment advances may lead to safer and even superior alternatives to current first-line therapy. The WHO current first-line therapy in less developed or developing regions includes the nonnucleoside reverse transcriptase inhibitor, EFV and considerations of poorer overall efficacy compared to newer drugs, toxicity, resistance, and adverse effects suggest that EFV should be reconsidered for use in first-line therapy. Although preferred protease inhibitors are as effective as EFV with fewer adverse effects, serious issues arise when patients are on concomitant medications with drug interactions. Currently raltegravir is the only integrase strand transfer inhibitor drug (INSTI) with data during pregnancy. Raltegravir is an attractive alternative or additional drug for pregnant women requiring medications with resistance, incomplete virologic response, or significant interactions with current first-line regimen drugs. Furthermore, based on recent data, raltegravir could provide pre-exposure prophylaxis in the fetus. DTG is a newer generation INSTI with clinical trials data showing safety and efficacy in nonpregnant adults. These studies suggest great promise for DTG and justify its role as first-line therapy for the nonpregnant population with relatively few drug interactions; in addition, it offers the only single tablet regimen for patient with or at risk for renal dysfunction. Although more data must be collected to ensure the safety and efficacy of INSTI as a first-line therapy in pregnant women, current studies show promise and with increasing experience INSTI agents may become part of the recommended first-line regimen for pregnant women.

Made available in DSpace on 2014-06-11T19:31:28Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-05-25Bitstream added on 2014-06-13T20:02:00Z : No. of bitstreams: 1 gil_nlm_dr_botfm.pdf: 336399 bytes, checksum: eb6b6028092afa89e83fd18fa36b0e6a (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Universidade Estadual Paulista (UNESP) / O “HIV/aids - Quality of life” (HAT-Qol) é um instrumento específico multidimensional utilizado para mensurar a Qualidade de Vida de indivíduos infectados pelo HIV. É dividido em nove domínios, a saber, atividade geral, atividade sexual, preocupação com sigilo sobre a infecção, preocupação com a saúde, preocupação financeira, conscientização sobre o HIV, satisfação com a vida, questões relativas à medicação e confiança no médico. O presente estudo analisou a qualidade de vida de indivíduos com infecção pelo HIV ou aids atendidos no Programa de DST/Aids no município de Maringá (PR), relacionando com o uso ou não de terapia anti-retroviral (TARV) e as características sócio-demográficas, epidemiológicas e clínicas. A coleta de dados foi realizada, pela análise retrospectiva dos prontuários dos 1.200 pacientes cadastrados no Serviço e, a seguir, foi aplicado o instrumento HAT-Qol, no momento anterior à consulta médica ambulatorial de rotina. Preencheram os critérios de inclusão 169 pacientes com diagnóstico confirmado de infecção pelo HIV, que foram divididos em dois grupos de estudo, G1 com 118 indivíduos em uso de TARV e G2 com 51 sem uso de TARV. Na análise dos resultados, quanto às características sócio-demográficas, observou-se que, não houve influência nas respostas, em nenhum Domínio, em relação a gênero, grau de escolaridade e opção sexual. Houve influência da faixa etária em relação ao Domínio que avalia a satisfação com a atividade sexual e do estado civil em relação ao Domínio que avalia a conscientização sobre o HIV, nos quais obtiveram menor índice nas respostas ou pior qualidade de vida, respectivamente, os homens de 50 a 69 anos e os pacientes sem parceiros fixos em relação aos casados ou amasiados. Observou-se, ainda, que o tempo de diagnóstico da doença exerceu... / The “HIV/aids – Quality of life” (HAT-Qol) is a specific multifunctional instrument used to measure the Quality of life of HIV infected people. It’s divided in nine domains that are, general activity, sexual activity, concern about the infection secrecy, concern about health, financial concern, awareness about HIV, satisfaction with life, issues about medications and belief in the doctor. The current study has analyzed the quality of life of HIV or aids infected individuals attended in the DST/Aids Program in Maringá city, Paraná state, in relation with the use or not of antiretroviral therapy (TARV) and the social-demographic, epidemiological and clinical characteristics. The data collect was performed, by the retrospective analysis of the 1200 prontuaries of patients registered in the Service and, then, the HAT-Qol instrument was applied right before the routine ambulatory medical consultation. 169 patients had fit the inclusion criteria of HIV infection diagnosis confirmed, which were divided in two groups of study, G1 with 118 individuals in use of TARV and G2 with 51 individuals not using TARV. In the analysis of the results, in respect of the social-demographic characteristics, it was observed that it didn’t influence the answers in any Domain, in respect of the gender, educational degree and sexual option. The age rate influenced the Domain which evaluates the satisfaction with the sexual activity and of the marital status in relation with the Domain that evaluates the awareness about HIV, in which they had the lowest response index or the worst quality of life, respectively, the men between 50 and 69 years-old and the patients who didn’t have regular partners compared with the ones who were married or concubine. It was observed yet that the time of the disease’s diagnosis influenced the Domains... (Complete abstract click electronic access below)

Orientador: Lenice do Rosário de Souza / Banca: Lucilene Ruiz Resende Silva / Banca: Alcyone Artioli Machado / Resumo: A aids é uma doença causada pelo HIV, que compromete o sistema imune do organismo. O advento da terapia antirretroviral (TARV) altamente eficaz promoveu melhora substancial do prognóstico dessa doença e da qualidade de vida dos pacientes com HIV/AIDS. Durante seu tratamento prolongado notam-se algumas alterações hematológicas, como anemia e macrocitose, bem como carências de micronutrientes como a vitamina B12 e ácido fólico. O objetivo do presente trabalho é determinar a relação entre macrocitose e anemia e o uso de ARV ou a deficiência de vitamina B12 ou de ácido fólico. Foram avaliados 110 pacientes HIV-positivos, comparando-se aqueles em uso de TARV com AZT (G1), em TARV sem AZT (G2) e sem o uso de TARV (G3). Os pacientes dos três grupos não apresentaram variações significativas quanto aos níveis de hemoglobina (p=0,584). Os pacientes do G1 apresentaram VCM aumentado quando comparados aos do G3 (p<0,05), bem como os do G2 em relação aos do G3 (p<0,001). As dosagens de vitamina B12 do G1 e G3 foram menores do que as encontradas pelo G2 (p=0,008). As dosagens do ácido fólico não apresentaram diferença estatística entre os grupos (p=0,956). Conclui-se que os indivíduos em uso de TARV apresentaram macrocitose, embora esta não pudesse ser relacionada ao tipo de TARV ou à deficiência de vitamina B12, como também a deficiência de ácido fólico não esteve relacionada ao uso de TARV nem à macrocitose / Abstract: AIDS is a chronic disease characterized by HIV infection and results in immunodeficiency. HAART is an effective approach to this disease, substantially improving quality of life and prognostic factors. It has become frequent the occurrence of hematologic disorders such anemia and macrocytosis, as well as micronutrients deficiency with the outcome of the treatment. The objective of this study is to correlate macrocytosis, anemia and HAART collateral effects with B12 vitamin and folic acid deficiencies. 110 HIV positive patients were included and divided in 3 groups: HAART with AZT (Group 1), HAART without AZT (Group 2) and without any antiretroviral treatment (Group 3). All groups did not have difference related to hemoglobin level (p=0,584). G1 had higher VCM levels than G3 (p<0,05), as well as G2 than G3 (p<0,001). G1 and G3 Vitamin B12 levels were smaller than those from G2 (p=0,008). Folic acid measurements did not differ among groups (p=0,956). We conclude that patients in HAART treatment had macrocytosis, even though this could not be related to an specific drug among HAART treatment or vitamin B12 deficiency. However, folic acid deficiency was not related neither to HAART nor macrocytosis / Mestre

Submitted by Pedro Barros (pedro.silvabarros@ufpe.br) on 2018-08-06T20:40:31Z No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) DISSERTACAO Kaliene Maria Estevão Leite.pdf: 2337155 bytes, checksum: 08de5a1b54551f4eb37b4ef0aceeadfa (MD5) / Approved for entry into archive by Alice Araujo (alice.caraujo@ufpe.br) on 2018-08-08T18:28:42Z (GMT) No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) DISSERTACAO Kaliene Maria Estevão Leite.pdf: 2337155 bytes, checksum: 08de5a1b54551f4eb37b4ef0aceeadfa (MD5) / Made available in DSpace on 2018-08-08T18:28:42Z (GMT). No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) DISSERTACAO Kaliene Maria Estevão Leite.pdf: 2337155 bytes, checksum: 08de5a1b54551f4eb37b4ef0aceeadfa (MD5) Previous issue date: 2017-02-22 / CNPq / Os indivíduos com infecção pelo HIV estão em risco aumentado de desenvolver doença cardiovascular quando comparado com a população geral. Isso se deve a inflamação provocada pelo HIV, uso da terapia antirretroviral e fatores de risco tradicionais. Contudo poucos estudos observaram a ocorrência desses distúrbios na população de HIV positivos, considerada baixo risco cardiovascular e com carga viral indetectável. Deste modo o objetivo foi avaliar a associação entre os níveis dos mediadores inflamatórios com o espessamento carotídeo em pessoas vivendo com HIV, em tratamento com antirretrovirais (ITRN e ITRNN) e com baixo risco cardiovascular, além de comparar espessura mediointimal da carótida e níveis de mediadores inflamatórios entre pessoas com e sem o HIV. Para determinação do baixo risco cardiovascular, em ambos os grupos, HIV e não HIV foi utilizado cálculo através do escore de risco de Framingham. Foi realizada dosagem de marcadores inflamatórios (IFN-γ, IL-1β, IL-6, TNF-α, PCR-us, sVCAM-1 e sICAM-1) através da técnica de citometria de fluxo, assim como medidas de espessura mediointimal de carótida através de ultrassom Doppler. Entre os grupos houve diferença quando comparados os marcadores inflamatórios IFN-γ, IL-1 e TNF-α. Observa-se um maior nível desses marcadores no grupo sem HIV. No grupo HIV, os fatores associados à alteração da medida da espessura do complexo médio intimal de carótida foi idade e tabagismo. No grupo sem o HIV a idade, maior nível de colesterol total e LDL se mostraram associados ao aumento da espessura da carótida.A partir do cálculo de P75, na análise multivariada nos pacientes HIV, houve associação significativa entre níveis de TNF-α e IL1-βà uma maior chance de aterosclerose. Dessa forma, conclui-se que ambos os grupos apresentam risco semelhante de desenvolver doença cardiovascular. Alerta-se a importância do controle da carga viral nos pacientes HIV positivos somado à manutenção de parâmetros de risco cardiovascular sob controle, tais como tabagismo, diabetes, hipertensão e dislipidemia, assim como realização de exame de imagem na população HIV positiva com idade≥ 40. / Individuals with HIV infection are at increased risk of developing cardiovascular disease when compared to the general population. This is due to the inflammation caused by HIV, the use of antiretroviral therapy and traditional risk factors. However, few studies have observed the occurrence of these disorders in the HIV-positive population, considered low cardiovascular risk and with undetectable viral load. The objective was to evaluate the association between the levels of inflammatory mediators with carotid thickening in people living with HIV, in treatment with antiretrovirals (NRTIs and NNRTIs) and with low cardiovascular risk, in addition to comparing, in addition to comparing íntima-média thicknessof carotidand mediator levels Inflammation among people with and without HIV. To determine the low cardiovascular risk, in both groups, HIV and non-HIV was calculated using the Framingham risk score. Inflammatory markers (IFN-γ, IL-1β, IL-6, TNF-α, ss-CRP, sVCAM-1 and sICAM-1) were measured by flow cytometry as well as Carotid artery by Doppler ultrasound. Among the groups, there were differences when comparing the inflammatory markers IFN-γ, IL-1 and TNF-α. A higher level of these markers is observed in the non-HIV group. In the HIV group, the factors associated with the change in the thickness of the mean intimal carotid complex were age and smoking. In the group without HIV age, higher total cholesterol and LDL levels were associated with increased carotid thickness. From the calculation of P75, in the multivariate analysis in HIV patients, there was a significant association between levels of TNF-α and IL1-β at a higher chance of atherosclerosis. Thus, it is concluded that both groups present a similar risk of developing cardiovascular disease. The importance of viral load control in HIV-positive patients is added together with the maintenance of cardiovascular risk parameters under control, such as smoking, diabetes, hypertension and dyslipidemia, as well as image examination in the HIV positive population aged ≥ 40.

Made available in DSpace on 2014-06-12T18:28:44Z (GMT). No. of bitstreams: 2 arquivo1133_1.pdf: 1028526 bytes, checksum: 20ca171667f5d964e5113da84bf8b8d3 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2003 / Um estudo caso-controle foi realizado para identificar fatores associados à não adesão à terapia antiretroviral em indivíduos infectados pelo HIV nos três hospitais de referência para tratamento dessa doença em maiores de 13 anos de idade na cidade do Recife - PE. As variáveis estudadas foram agrupadas em biológicas, sócio-comportamentais e demográficas, econômicas, relacionadas à doença e ao tratamento, relacionadas aos hábitos de vida e aos distúrbios do humor. Estudou-se 412 pacientes, cujas informações foram obtidas a partir de prontuários médicos e de dois questionários: um elaborado especificamente para este estudo e outro (Escala de Hamilton para Avaliação de Depressão), já padronizado, para verificar a presença de depressão. Estimou-se &#8213;odds ratios&#8214; brutos e ajustados, intervalos de confiança e valor de &#8213;p&#8214; da associação de adesão à terapia antiretroviral com as variáveis independentes de cada grupo. As variáveis que demonstraram associação estatisticamente significante com adesão na análise univariada foram selecionadas para uma análise multivariada. Não houve associação entre sexo, idade, comportamento sexual, estado civil, município de residência, situação de trabalho, renda pessoal mensal, local de atendimento, tempo de tratamento antiretroviral, presença de sintomas, esquema antiretroviral em uso, expectativa quanto ao tratamento, participação em organizações não-governamentais, depressão e adesão ao tratamento antiretroviral. As variáveis que demonstraram associação estatisticamente significante com não adesão na análise univariada foram: tempo de diagnóstico da infecção pelo HIV, maior número diário de comprimidos, uso de álcool e uso de drogas, embora algum nível de associação também tenha sido observado com grau de instrução e renda mensal familiar. Após análise multivariada, no entanto, renda familiar, tempo de diagnóstico da infecção pelo HIV e uso de álcool foram as variáveis independentes que mais contribuíram para explicar a não adesão

Magister Public Health - MPH / Introduction: Zambia is among the countries in the sub-Saharan African region most severely affected with HIV/AIDS. Approximately 1.2 million (14%) Zambians were living with HIV in 2010. Zambia introduced antiretroviral therapy (ART) in the public sector in 2002, starting with two pilot sites, and rolling it out throughout the country in 2004 and 2005. To date,approximately 350,000 people have accessed HIV treatment. The long-term success of ART programs depends on optimal adherence to ART by patients.In 2010 Livingstone General Hospital (LGH), the setting for the current research had over 7,000 enrolled for HIV care of whom 3,880 patients were on ART. By the end of June 2011, it was reported that 343 patients in this hospital were between 2 to 30 days late for their medication refill appointments. This meant that these patients had missed more than one dose, and thus not meeting the required 95% of medication for viral suppression. This study explored the barriers to medication adherence experienced by ART patients at Livingstone General Hospital (LGH). Methodology: An exploratory qualitative study was conducted. Six focus group discussions(FGD) were conducted with 42 patients on ART, and follow up semi-structured interviews with 7 patients identified during the FGDs. FGDs and semi-structured interviews were audio-tape recorded and transcribed verbatim. Thematic and content analysis of transcribed data was done. Results: The study found that the barriers to ART adherence included socio-economic factors such as poverty, use of traditional complementary and alternative medicines (TCAM) and religious beliefs. Patient related factors reported to negatively affect adherence were HIV related-stigma and discrimination, alcohol use, low literacy and education levels, busy daily schedules and forgetfulness. Regimen related factors included experiencing side effects to medication and complexity of treatment regimen. Negative staff attitudes, traveling long distances to health facility, long waiting times, lack of confidentiality, poor health information and poor patient-health provider relationships were the health system factors that negatively impacted on ART adherence. Conclusion: The combination and complexity of factors affecting adherence identified in this study have posed a challenge to adherence to ART. People have been forced to make adjustments to their routine lives in order to accommodate ART. The most problematic factor identified was the use of TCAM in combination with ART or as replacement of ART.

Magister Public Health - MPH / Background: South Africa has one of the most severe HIV epidemics globally, with an estimated 737,000 AIDS related deaths annually and over a million children rendered orphans due to AIDS in 2006. However in 2007, the South African government made a giant commitment to dealing effectively with the AIDS epidemic by implementing a National Strategic Plan (NSP), which had as one of its principal objectives the provision of antiretroviral medications to 80% of all people in need of the treatment by 2011. By the end of June 2011, the rollout of antiretroviral therapy continued to be successful with 1.4 million persons started on antiretroviral therapy and treatment initiation rates reaching 30, 000 per month. Patients have to subject to an uncompromising adherence of taking at least 95% of antiretroviral medication as prescribed, because poor adherence to ART leads to treatment failure, viral mutations and the development of drug resistance. Of major concern to ART programmes are the current obstacles that patients’ face in lieu of treatment. Aim: The aim of this study was to explore the barriers to adherence to antiretroviral treatment among patients in a public ART programme in Vredenburg, Western Cape. Methodology: An explorative qualitative study was conducted where data was collected through interviews with 18 patients receiving treatment from the Vredenburg hospital. Data was audio-tape recorded, transcribed in full and thematic content analysis done. Results: The study identified awareness of HIV status, disclosure, unemployment, lack of transport,insufficient feeding, disability grants, alcohol and alternative forms of therapy as well as stigma as major barriers to adherence. Whereas inadequate follow ups, recklessness in the way patients’ HIV results were handled, long waiting times and the fear of picking up other types of infections from other patients in the OPD also came under major criticisms from patients. Finally, the sharing of experiences at clinic visits, good healthcare provider’s patient relationships, believing in the treatment, good treatment literacy, being a parent and having children to take care of, the use of pill boxes, social and spiritual support from family members and friends were identified as factors that positively influenced adherence. Conclusion: HIV/AIDS has been a stigmatized illness since its onset in the early 1980s and, these results highlight that such stigma has yet to dissipate in Vredenburg. Therefore, stigma and disclosure must remain at the forefront of the ART programme implementation in Vredenburg; while long term projects that can support ART users economically should be created through partnerships with non-governmental organizations and the government of South Africa to optimize adherence in the community.