Made available in DSpace on 2014-06-12T18:31:01Z (GMT). No. of bitstreams: 2 arquivo8103_1.pdf: 576734 bytes, checksum: add06e925071142bf95395156c86620d (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2005 / Estimar a prevalência de resistência primária aos anti-retrovirais em pacientes cronicamente infectados pelo HIV-1, sem uso prévio de anti-retrovirais, em um Centro de Referência para o tratamento do HIV/AIDS do Nordeste do Brasil. Foram colhidas amostras de sangue para extração do RNA viral de pacientes com HIV/AIDS, cronicamente infectados, atendidos no Hospital das Clínicas da Universidade Federal de Pernambuco, antes do início do tratamento antiviral, no período de fevereiro de 2002 a janeiro de 2003. As regiões da transcriptase reversa (TR) e da protease (PR) foram seqüenciadas para a determinação das mutações relacionadas à resistência aos antivirais.Foram ampliadas e genotipadas um total de 84 amostras. Os pacientes apresentavam CD4 médio de 178,7 células/mm3 e Carga viral média de 269.305 cópias RNA/mL. A genotipagem revelou 2 (2,4%) pacientes com mutação principal relacionada aos ITRN e nenhuma mutação principal aos ITRNN ou IP. Foram encontrados 17 (20,2%) pacientes com mutações secundárias aos ITRN e 67 (79,8%) com mutações secundárias relacionadas aos IP. Mutações acessórias no gene da protease ocorreram nas seguintes posições: L63P [40/84 (47,6%)], M36I [29/84 (34,5%)], V77I [13/84 (15,5%)], L10V [9/84 (10,7%)], K20R [9/84 (10,7%)], A71T [6/84 (7,1%), L10I [5/84 (6%)], A71V [2/84 (2,4%)] e I54P [1/84 (1,2%)]. As mutações associadas a susceptibilidade reduzida aos ITRN foram: M41L [2/84 (2,4%)], G333E [6/84 (7,1%)], V118I [5/84 (5,9%)], S68G[4/84 (4,8%)], E44D [1/84 (1,2%)] e K219E [1/84 (1,2%)]. Observou-se baixa prevalência de mutações primárias relacionadas à resistência aos ITRN em pacientes cronicamente infectados pelo HIV e ausência de resistência aos ITRNN e IP

Background Nutrition and food security are important for maintaining a strong immune system and good general heath of People Living with HIV/AIDS (PLHA). The main aim of this study was to survey the nutritional status, habitual diet, dietary knowledge and demographic characteristics of PLHA in Nepal. A second aim of this study was to explore the voices of PLHA and policy level people on the current and possible future nutrition intervention programmes for PLHA in Nepal. Methods Using mixed methods (quantitative and qualitative) research techniques, 601 (M: 314 and F: 287) HIV positive people from the Kathmandu valley and Terai highway regions of Nepal were recruited and completed the study. All participants completed an interviewer administered questionnaire. This questionnaire includes an assessment of habitual food intake using a newly developed and validated 45-item semi-quantitative food frequency questionnaire. The validity of the FFQ was previously assessed against the 24-h multiple pass dietary recall in a sub-sample of the study population. Socio-economic and demographic information, dietary/nutritional knowledge, height, weight, waist circumferences and skinfold thickness were also collected. Finally, reported food intake was converted into energy and selected nutrient intakes (fat, protein, carbohydrate, iron, vitamin A and vitamin C) by linking with a newly compiled nutrient database of 116 food items for Nepal. Nutritional knowledge and perceptions of the current Nepalese nutritional supplementation and possible alternative interventions were explored using qualitative techniques. Four focus group discussions (FDG) and 11 in-depth interviews were carried out with PLHA and key local stakeholders respectively. Results The newly designed semi-quantitative FFQ can retrospectively assess the group mean intake for energy, protein, fat, carbohydrate, iron, carotene and vitamin C as there was no significant difference for reported intakes (all p > 0.2), but mean fat intake was significantly lower when determined by the FFQ than the 24-h recall (p < 0.001). The average age of participants was 33.8±6.4 years (mean ±SD) and 29% were classified as underweight (BMI < 18.5kg/m2). The study population typically ate a plant-based diet and intake of animal products was low, the energy intake of men and women was 1960±195 and 1880±261 kcal/d mean (±SD) respectively. Fat, protein and carbohydrate contributed 12%, 10% and 79% to total energy intake respectively. Iron and vitamin A intakes also tended to be lower than recommended, whereas vitamin C intake was satisfactory. Most participants (82%) believed that PLHA need a special diet but less than half of those reported changing their diet after diagnosis. A major reason for this was restricted income: 46% of participants reported being unable to afford sufficient food for the whole year, and 57% of those reported borrowing food for more than four months a year. Participants from FGD and in-depth interviews were not satisfied with the daily food and nutrient intake by HIV positive people. The Nepalese government currently provides a nutritional supplement for PLHA mainly for those who are on anti-retroviral treatment (ART). However, this was not satisfactory with the majority of volunteers reporting suffering negative health effects, including diarrhoea and vomiting, after consuming the supplement. Similarly, poor quality packaging, storage, delivery and lack of nutritional expertise and education were frequently reported problems for the proper implementation of the existing supplement. The participants suggested a nutrition intervention, based on a locally produced supplement, combined with dietary education and were highly motivated to support the development, implementation and evaluation of a new intervention. Conclusion Food and nutrient intakes by PLHA in Nepal were not adequate and did not meet dietary recommendations. Overall, the quality of the current nutritional supplement is poor and not suitable for ensuring maintenance of PLHA health. A nutrition intervention trial based on locally produced fortified mixed grain flour was favoured by PLHA and key stake holders. However, further research is needed to improve the nutritional status of PLHA in Nepal. Therefore, the evidence identified by this study could be used to inform the design of a new intervention. However, further research is recommended to clarify the issues.

Many severe clinical conditions encountered in Africa involve the effects of iron overload on diseases (AIDS, TB etc) and vital organs (e.g., liver). To intervene successfully in the HIV pandemic, knowledge of AIDS pathogenesis and factors that stimulate or inhibit viral replication are crucial. Iron overload is believed to cause serious damage during HIV infection. Indeed, it is believed that the metal is required by infected cells to synthesize viral particles. The consequences of excess iron in vivo include the stimulation of microorganism growth, an increase in oxidative stress and an impairment of immune system function. Iron chelation have been reported to modulate some of these effects. In a project designed to assess the effect of in vitro iron overload (also synonymously referred to as iron loading) on HIV infection, cells (HIV-infected and controls) were directly loaded with iron and desferrioxamine (DFO, an iron chelator) respectively or combined. We then performed experiments to investigate the effects of these chemicals on host cell defenses and viral replication. Effective iron loading of all cell lines used was confirmed by emission spectroscopy. Through viability assays using tetrazolium salts, flow cytometric analysis of apoptosis and necrosis using Annexin-V, and specialised ELISAS; the effect of iron loading on host cell viability, survival or death and cytokine production was studied. The effect of iron loading on virus infectivity was also investigated by looking at core protein (p24) levels and reverse transcriptase (RT) activity. Prior to the start of the bioassays, several dyes were compared during identical procedures to find an effective and consistently functional dye assay for the assessment of cell growth/viability or proliferation. Viability assays provided a qualitative picture of events while flow cytometric analysis allowed us to compare viability with specific types of cell death (apoptosis/necrosis). Excess iron in the form of 500ƒÝM FeSO4-7H2O in addition to serum iron was found to be non-toxic to cells alone but detrimental to HIV-infected cells. Equimolar amounts of DFO inhibited cell growth, cytokine production and viral replication. Our results indicate that Fe loading stimulates viral replication. Iron chelation on the other hand decreased HIV replication suggesting a possible area for further therapy research using iron chelators in situations of iron loading in the presence of HIV/AIDS. / Dr. Debra Meyer

M.A. / It is now well known that HIV/AIDS-sufferers face profound psychological, psychiatric and neurological sequelae as the disease progresses. However, studies indicate that women diagnosed with HIV-infection are twice more likely to be depressed, to suffer from PTSD and other psychiatric morbidity than men. Yet very few studies have attempted to investigate the role that gender plays in reacting to the illness. Finding out that one is HIV-infected is one of the most significant discoveries. This is due to the fact that in receiving an HIV-positive diagnosis individuals are exposed to news of prodigious personal consequence. And yet very few studies have focused on how the impact of finding out that one is HIV-positive may affect their adjustment to the illness. Moreover, how men and women are likely to react to such news. It is against this background that the current study was conducted. The aim of the current study was to compare post traumatic symptoms in men and women upon hearing news of their HIV-positive status and to investigate to what extent such reactions may be similar or different and to further assess how their reactions are likely to affect disease progression and adjustment. A total of one hundred participants (38 Male, 63 female) diagnosed with HIV/AIDS participated in the study. These men and women were obtained from support groups in the Gauteng region. The Impact of Event Scale-Revised and Mental Adjustment to HIV-Scale questionnaires were used to collect data over a period of a month. A large majority of 60.2% of the total sample (n = 87) reported experiencing feelings of shock upon hearing about their HIV-positive status, 66.0% of the total sample (n = 94) of those who responded to this item reported trying to remove the issue from their mind. A further 59.6% of the total sample of (n = 94) indicated feeling as though news about their HIV-positive status were not real suggesting that the incident was traumatic. There were no significant gender differences in how both men and women reacted to news of their HIV-positive diagnosis. However, significant differences were found in relation to adjustment. Men were found to be more likely to have more Fighting Spirit which is indicative of adaptive adjustment as compared to women. Women on the other hand were found to be more likely to be Hopeless which is indicative of maladaptive coping.

Magister Commercii - MCom / This study proposed a modification of the traditional cost-of-illness approach. It considered additional indirect cost parameters that yield a comprehensive cost structure for human capital at a micro level. Although HIV/AIDS is an epidemiological problem, it has enormous direct and indirect economic costs. Arguably, the most important cost associated with HIV/AIDS results from the high rates of morbidity and mortality among working age adults, the vast majority of those infected. These are essentially losses in an economy's existing stock and potential accumulation of human capital, implying lower levels of labor productivity and eventually loss of labor. These impacts are accounted for in existing macroeconomic and microeconomic impact studies. Indirect costs, such as forgone earnings due to illness, are included whereas forgone earnings of caregivers in the household are unaccounted for. / South Africa

Master of Public Health - MPH / Increased uptake of VCT services by pregnant women may be attributed to the development of counseling services and increased availability of rapid tests at the study clinics by the Namibian Health and Social Services. A high knowledge and understanding of HIV and VCT services by pregnant women also probably contributed. / South Africa

Magister Public Health - MPH / The aim of this study was to assess the factors associated with HIV risk behaviours in women in Livingstone, Zambia. A cross-sectional analytical survey using a structured questionnaire was carried out in two sites in Livingstone, which were selected on the basis of differences in socio-economic status. Married women and women in the urban community are at high risk of contracting HIV and every effort should be made to ensure that HIV/AIDS programmes help to reduce their vulnerability to HIV infection. / South Africa

Magister Public Health - MPH / The increased number of new infections in Uganda necessitates HIV prevention programmes that address risky behaviours especially among heterosexual populations. The AIDS Support Organisation (TASO) is the largest indigenous HIV/AIDS agency serving Uganda and the Great Lakes Region. TASO endeavours to empower sexually active clients to disclose their sero-status to their sexual partners and promotes partner testing for HIV. In spite of these efforts, only 12% of 2,071 sexually active clients in Mulago centre had disclosed by the end of 2006. This study aimed to explore the factors that influence clients’ decisions to disclose their HIV status to their partners in TASO Mulago, Kampala, Uganda. The study used a qualitative approach. Fourteen (14) in-depth interviews were conducted with English and Luganda speaking adult male and female clients on antiretroviral treatment (ART), in TASO Mulago. A focus group discussion (FGD) was conducted with 8 purposively selected ART clients who were considered to be ‘expert’ clients in TASO Mulago. These participants were expert clients/ peer educators, who were open about their HIV status and have been involved in HIV/AIDS education and advocacy. The individual interviews and the focus group discussion were transcribed verbatim, and subjected to thematic and content analysis. Male and female participants who were married (primary relationship) disclosed their sero-status to their sexual partners, while few of those cohabiting or in steady relationship (only one) disclosed to their partners. Enabling factors to disclose to current sexual partners included: desire for partner to get treatment, need for the partner’s support, having prior knowledge of partner’s HIV status, out of anger, and having anxiety about the future. Some of the barriers to disclosure included: fear of blame and disappointing the partner, fear of abandonment, fear of stigma and discrimination Participants suggested that couple counselling and testing, economic independence, peer support and involvement of the TASO staff in disclosure should be considered to facilitate or promote disclosure to sexual partners.While strategies like HBHCT and couple counselling have enhanced disclosure among sexual partners on ART living together in stable married relationships (primary), the partners in secondary relationships (cohabiting and steady) especially women, continue to face challenges in disclosure yet their sexual partners are at risk of HIV infection. The study has re-affirmed the fact that while some people living with HIV/AIDS wish to disclose their HIV status to their partners, there are compound factors that make it difficult to disclose. This calls for effective strategies by government, TASO and other agencies to ensure that sexual partners especially in cohabiting and steady relationships are disclosed to in order to reduce their vulnerability to HIV infection.

Magister Public Health - MPH / Background: The recognition of HIV/AIDS as a chronic life-long condition globally in recent years has demanded a different perception and an alignment to its association with other chronic diseases. Both HIV and other chronic non-communicable diseases are significant causes of morbidity and mortality. Their combined DALY contributions for Botswana would be significant if research and strategies in controlling these conditions are not put in place. Natural aging and specific HIV-related accelerated aging of patients who are on antiretroviral treatment means that age-related diseases will adversely affect this population. Princess Marina Hospital Infectious Diseases Care Clinic has been in operation since 2002. The clinic has initiated over 16 000 patients on anti-retroviral treatment (ART) since 2002. The current study estimated the prevalence of non-AIDS defining conditions (NADCs) in the attendees of the clinic in 2013. The majority of patients that attended the clinic had been on treatment for over three years with some patients more than ten years. These ART experienced patients were more likely to be susceptible to chronic non-communicable diseases, including non-AIDS defining conditions. The nomenclature used in classification of NADCs in the current study was appropriate for resource-limited settings; because the study setting offered HIV treatment under resources constraints. Aim: The current study characterised non-AIDS defining conditions, and determined their associations with virologic treatment failure in a cohort of patients that were enrolled at Princess Marina Hospital antiretroviral clinic in Gaborone, Botswana. Methods: A retrospective cross sectional study of records of patients who attended the Princess Marina Infectious Diseases Care Clinic in 2013. Stratified random sampling of a total of 228 patients’ records was achieved from a total population of 5,781 records. Data was transcribed into a Microsoft Excel Spreadsheet and then exported to Epi-Info statistical software for analysis. Results: Eighty (35%) cases of NADCs were reported/diagnosed in the study sample; with 27% (n=62) of the patients having at least one condition, 6.7% (n=17) two conditions, and 0.4% (n=1) three conditions. The top prevalent conditions were hypertension (n= 40), hyperlipidaemia (n=7) and lipodystrophy (n=7). The prevalence of NADCs on the various categories of patients compared with the total sample population was as follows: active patients (prevalence ratio= 0.70), transferred out patients (prevalence ratio = 1.24), patients who died (prevalence ratio=2.04) and patients who were lost to follow-up (prevalence ratio =2.86). The prevalence of NADCs was significantly associated with increasing age (p<0.001); having social problems (p=0.028); having been on treatment for over three years (p=0.007); an outcome of death (p = 0.03) and being lost to follow-up (p=0.007). The study showed that being controlled on second line or salvage regimen (p=0.014) and the presence of adherence problems in the past was associated with virologic failure (p=0.008). There was no association of presence of NADCs to virologic failure. Conclusions: There was significant morbidity of non-AIDS defining conditions in the Princess Marina Infectious Diseases Care Clinic shown by a prevalence of NADCs in the clinic of 35% in 2013.The significant associations of the presence of NADCs and virologic failure with outcomes of death and loss to follow-up illustrate the adverse effects that NADCs are having, and calls for strategies to address multi-morbidities in HIV patients on antiretroviral treatment.

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