Thesis (Ph. D.)--Oregon State University, 2010. / Printout. Includes bibliographical references (leaves 113-132). Also available on the World Wide Web.

Thesis (M.A.)--Kent State University, 2009. / Title from PDF t.p. (viewed April 16, 2010). Advisor: John Gunstad. Keywords: HIV; executive function; adherence. Includes bibliographical references (p. 41-54).

Thesis (M.A.)--University of Stellenbosch, 2008. / Includes bibliographical references. Also available via the Internet.

Thesis (M. A ) - - University of the Western Cape, 2008. / Summary in English. Includes bibliographical references.

Thesis (Master of Health Policy and Administration)--Washington State University, May 2006. / Includes bibliographical references (p. 39-45).

Thesis (Ph. D.)--Drexel University, 2007. / Includes abstract and vita. Includes bibliographical references (leaves 111-145).

“Cartas al editor” / Revisión por pares

Adherence to antiretroviral therapy (ART) is one of the most important issues in pediatric patients living with Human Immunodeficiency Virus (HIV). Combined with the fact that young patients face a large array of adherence barriers, interventions that can increase adherence are of great interest. Financial incentives (FIs) are a novel approach in pediatric HIV settings, and have not been studied previously in this disease for this age group. Thus, we sought to evaluate the effects FIs had in helping pediatric HIV patients achieve and maintain virologic suppression (VS). Furthermore, a post-incentive survey was administered to evaluate the self-perceived effects of FIs. In our study, FIs were not associated with achieving VS among pediatric and adolescent patients. The post-incentive survey has demonstrated many aspects of patients' and guardians' perceptions of FIs that should be considered in future FI studies. First, it was likely that patients who effectively grasped the concept of financial reward were most positively influenced by FIs. Second, the study data suggested that FIs may be contra-effective to those patients who report strong emotional responses to negative outcomes. Further and more comprehensive studies are required to fully characterize these effects.

Southern Africa has the highest prevalence of HIV worldwide, and South Africa has the highest number of HIV infected people. South Africa and other resource-limited countries provide antiretroviral therapy (ART) for people with HIV, with limited, standardized regimens for first line and second line. Patients who fail first line treatment are put on second line regimens, yet options for third line are very limited. The first study looks at predictors of first line treatment failure in South Africa and develops a predictive model that can estimate absolute risk of treatment failure over 5 years on ART, given a baseline profile of clinical and demographic factors. The model was developed with accelerated failure time models, using predictors that maximized discrimination between patients. The model can be used to identify patients who need adherence interventions, and to estimate how changes in baseline parameters in the population influence long-term need for second line ART. The second study explores whether delays from detection of first line treatment failure until second line treatment initiation, which are widespread in South Africa, decrease the effectiveness of second line ART. Marginal structural models were used to include patients who never switched to second line after failure in analysis. This study shows that, despite potency of second line drugs, short delays in second line among very sick patients can lead to worse outcomes. These findings may be due to drug resistance, immune system damage, and/or lack of adherence to medication. The third study examines whether switch in type of NRTI (nucleoside reverse transcriptase inhibitor, which is a drug class used in both first and second line regimens) from first line to second line improves outcomes on second line ART. While a switch in NRTI is recommended by treatment guidelines, it cannot always occur due to contraindications to some NRTIs. Using clinical data from South Africa and Zambia and adjusting for propensity scores, we see that switching from zidovudine in first line to a different NRTI in second line leads to less treatment failure on second line, suggesting that NRTI resistance may play a role in second line outcomes.

Human Endogenous Retroviruses (HERV) are segments of the human genome that are viral in origin and occupy approximately 8% of the human genome, which is nearly 3 times as much as functional protein coding genes (3%). Although most are defective due to accumulation of post insertional mutations, Human Endogenous Retrovirus Type K (HERV-K) retains the ability to produce functional particles and is activated during progression of malignant disease. The resulting proviral products have been associated tumorigenesis through their presumed role in malignant cell production. While therapeutics that focus on HERV-K inhibition have not been manufactured, current Federal Drug Administration (FDA) approved antiretroviral therapies are capable of decreasing expression of HERV-K in cancer cells. In summary, antiretroviral drugs may serve as a promising new anticancer drug by targeting and decreasing expression of HERV-K proteins.