Hepatitis C virus (HCV) infection is the most common blood-borne infection in the United States (U.S.). The largest increases of incidence for HCV infection are reported in the Appalachian region. This study aimed to 1) examine the prevalence and trends of HCV infection in the U.S. from 1999 to 2012; 2) investigate barriers to HCV infection treatment in Northeast Tennessee and the U.S.; and 3) study characteristics and risk factors for HIV-infection and HCV-infection in Northeast Tennessee. In the U.S., data were obtained from the National Health and Nutrition Examination Survey (NHANES) 1999-2012 to study the prevalence of HCV infection and barriers to treatment. In Northeast Tennessee, hepatitis C and HIV/AIDS data were obtained from National Electronic Disease Surveillance System (NEDSS) and enhanced HIV/AIDS Reporting System (eHARS). Descriptive statistics and multiple logistic regression models were used for analysis. Odds ratios (OR) and 95% confidence intervals (CI) were reported. There was an estimated 3.8 million people having HCV antibody in the U.S. in 2012. No significant change was found in the prevalence of HCV infection during 1999 – 2012. The leading barrier to the treatment was cost issues in the U.S. (50.0%) and Northeast Tennessee (25.0%), respectively. HCV patients without symptoms in Northeast Tennessee were more likely to be untreated (OR: 3.08, 95% CI: 1.10-8.60) and patients without health insurance in the U.S. were more likely to be untreated than their counterparts (OR: 3.38, 95% CI: 1.14-10.05). The incidence of acute hepatitis C peaked in 2012-2013 in Northeast Tennessee, while the incidence of HIV/AIDS increased by 100% from 2013 to 2015. More injection drug users (IDUs) and less men who have sex with men (MSM) were observed in patients with HCV infection than in those with HIV infection (IDUs: 50.63% vs.16.38% p

Thesis ( MPH ) -- University of Limpopo (Medunsa Campus), 2013. / Background and introduction Disclosure of HIV sero-status is critical in the control of the spread of HIV and research. To better understand the factors influencing disclosure will enhance the development of prevention interventions and ultimately lead to better control of the spread of the disease. However literature shows that the rates of disclosure are generally low and vary substantially in different populations. Study purpose To determine the prevalence, reasons for disclosure, partner reaction to disclosure, and intentions of disclosure to sexual partners among HIV positive adults receiving antiretroviral treatment. Study design Cross sectional survey was conducted with 400 adult patients aged 18 years and above, who receive ART, and have known their HIV status for six more than six months. Structured close ended self-administered questionnaire was used to collect data. The study participants were recruited from a wellness clinic of an academic hospital in the City of Johannesburg, Gauteng province between October and November 2012. Descriptive and inferential statistics were performed using STATA 10 for analysis. Pearson X2 tests were used to determine variables associated with disclosure. Results A total of 400 HIV positive adults participated in the survey. There were slightly more female (n=229, 57%) than male (n=171, 43%), the mean age of participants was 39.9 years, (range 18-80 years). Almost half (n=176, 46%) had known of their HIV diagnosis for more than 5 years. High proportion (n=293, 73%) were sexually active three months prior to the survey, (n=250, 63%) knew their partner’s HIV status, more than a third (n=145, 36.3%) had more than one sexual partner, (n=263, 73.5%) reported condom use, (n=261, 75%) disclosed to their partners. Gender, discussing HIV testing with sexual partner, knowing partner’s HIV status, and living with partner were significantly associated with disclosure. iv The most common cited reasons for disclosure were that they needed to protect their partner from being infected with HIV, and needed support from their partner. Partner reactions to disclosure included support, shock, and denial of the test results, blame, abandonment, violence, anger, and divorce. The most cited reasons for nondisclosure were concerns that the partner might leave, partner might be afraid of catching HIV, partner might think they were unfaithful, partner might get angry, partner might hurt them physically and that partner might stop financial support. Conclusion The study concludes that the prevalence of disclosure to sexual partners among sexually active adults was high and that most respondents disclosed immediately after they were diagnosed with HIV. However, disclosure to multiple sexual partners was lower as compared to disclosure to the steady partner. Respondents disclosed to protect the partner from HIV infection and to receive support. Nondisclosure was mainly used to protect self from negative reactions from the partner. Recommendations Researchers and health care providers needs to take cognisant of the risk sexual behaviour an low condom use among HIV positive adults receiving ART. Secondary prevention efforts targeting risky sexual behaviour among HIV-positive persons need to receive greater attention.

Thesis (Ph.D. (Nutrition))--North-West University, Potchefstroom Campus, 2007.

This study is one of the only investigations to examine the complex inter-relationships between immune status, cognitive functioning, and disease progression in school-aged, perinatally infected, HIV+ children on HAART over time and is the first to conduct long-term follow-up assessments beyond one year after initiating HAART. Previous research has shown that HIV+ children on HAART show stability in cognitive functioning for up to one year. The current study investigated cognitive functioning, as measured by the Wechsler Intelligence Scale for Children -III, as a function of immune functioning and disease progression over time in this sample. Overall, results showed that PIQ scores remained stable over the three time points. However, further analyses demonstrated that poorer immune status, as measured by CD4% <25, at the first time point significantly predicted lower Performance IQ (PIQ)scores and PIQ subtest scores at the third time point, even after controlling for covariates. Similarly, additional analyses revealed that PIQ scores significantly declined over time as a function of CD4% category at the first time point. Finally, scores on the PIQ, Verbal IQ (VIQ), Coding, Picture Arrangement, Symbol Search, and Arithmetic at the first time point were all significant predictors of more advanced disease progression, as measured by CDC C classification at follow-up. The clinical relevance of this study and recommendations for future research in this area are discussed

Research from the U.S. suggests that maternal HIV-infection negatively impacts children's psychosocial functioning and that resources (e.g., the parent-child relationship) positively influence their adjustment to maternal HIV-infection. Although HIV-infection in South Africa is most prevalent among Black South African women, there is limited research examining its impact on their children. In addition, as these children are exposed to numerous socio-cultural stressors beyond those associated with HIV-infection, they are at particular risk for psychosocial difficulties. This study had two aims: 1) to evaluate whether maternal HIV-infection confers risk for psychosocial difficulties (i.e., internalizing and externalizing behaviors) among Black South African children; and, 2) to examine potential protective resources for children of HIV-infected mothers that could ideally be addressed through appropriate community-level interventions. Three categories of resources were considered: material (familial economic stability); maternal (maternal psychological functioning; maternal social support); and, caregiving (the parent-child relationship; quality of the caregiver - co-caregiver relationship). Participants included women who self-identified as HIV-infected or non-infected and who were the biological mother of a child aged 11-16. Results indicated that there were no psychosocial adjustment differences between the two groups of children. The lack of differences suggests that in the context of the constellation of stressors Black South African children face, maternal HIV-infection may not serve as a unique stressor for psychosocial adjustment difficulties. However, the lack of differences should not be construed to mean that a child whose mother is HIV-infected is not affected his/her mother's diagnosis. Maternal HIV-infection is a complex phenomenon that warrants further study among Black South African children. The results did not illuminate any resources that were particularly salient to the children of HIV-infected mothers; rather, variables salient to all children were identified, notably economic stability, maternal depression, family social support, the parent-child relationship, and conflict in the mother- co-caregiver relationship. Given the overall risk present in the lives of Black South African children beyond maternal HIV-infection, it appears important to address the needs of all children. This study provides important information about individual and family-level variables that could be emphasized in family interventions with the population as a whole.

OBJECTIVE: The main aim of this thesis was to investigate the role of nutrition during "early" HIV-infection in African women. METHODS: Data reported in this investigation formed part of two cross-sectional studies, the THUSA and Mangaung studies. The Mangaung study investigated women and, therefore, the sub-sample of the THUSA study was chosen accordingly. The data of the two studies were kept and analysed separately. The investigation consisted of 1040 women from the THUSA study, aged between 15 and 90 years of which 120 (11.5%) were HIV infected. The Mangaung study comprised of 488 women aged between 25 and 44 years of which 248 (51%) women were infected. Demographic data, anthropometric measurements, health outcome variables and habitual nutrient intakes by a quantified food frequency questionnaire were used. The SPSS statistical package (version 14.0; SPSS Inc., Chicago, Illinois, 2005) was used to analyse data. Descriptive statistics were done expressing variables as means, medians, standard deviations (SD), standard errors (SE) and confidence intervals (CI). An analysis of variance (ANOVA) was done to test for significance between the HIV-infected and non-infected groups in both studies. Partial correlations were done in the infected and non-infected groups to determine associations between dietary / nutrient intake, anthropometry and the biological health variables. In the THUSA study we controlled for age, education level, degree of urbanization and alcohol intake and in the Mangaung study for age, education level and alcohol intake. Nutrient intakes of both infected and non-infected women above and below median values as well as in the first and fourth quartile of total cholesterol (TC) and albumin distribution were compared to assess the role of nutrients in the observed decreases in TC and albumin of HIV-infected women. RESULTS AND DISCUSSION: The dietary intakes of the HIV-infected women in both the studies did not differ significantly from the non-infected women. Total serum cholesterol, albumin, fibrinogen and blood pressure were significantly lower in the HIV-infected women in both the THUSA and Mangaung studies. The non-infected THUSA women with lower serum cholesterol levels (than the median) had significantly lower intakes of percentage energy from fat (25.2 versus 26.4%, p ≤0.027), percentage energy from total protein (11.6 versus 12.1%, p≤0.000), animal protein (25.6 versus 27.7g, p≤0.005), and significantly higher intakes of plant protein (32.2 versus 29.4g, p≤0.002) and fibre (16.9 versus 15.89 p≤0.029). There were no significant differences observed in the nutrient intakes in the infected women with serum cholesterol levels above and below the median. In the Mangaung study no significant nutrient intake differences were observed in both of the HIV-infected and non-infected women with lower and higher than the median TC levels. In the THUSA study, higher intakes of fat (percentage energy) were close to significant (27.3 versus 24.5%, p≤0.053) in the infected women with higher (than the median) albumin levels. In the non-infected group with higher albumin levels, significant differences were observed in percentage energy from fat (26.6 versus 24.9%; p≤0.001) protein (12.2 versus 11.6%; p≤0.001) and carbohydrate (62.8 versus 65.2%; p≤0.000). Higher intakes of saturated fat (SATFAT) (17.7 versus 16.1g, p≤0.008), monounsaturated fats (MUFAT) (19.3 versus 17.4g, p≤0.004) as well as higher intakes of animal protein (28.5 versus 24.4g, p≤0.000) were observed in the group with higher than the median levels of serum albumin. In the Mangaung study the HIV-infected women (with higher than the median serum albumin levels), had significantly higher intakes of energy (13 275 versus 11 622 kJ, p≤0.022), polyunsaturated fatty acids (32.3 versus 17.3g, p≤0.036), dietary cholesterol (412.9 versus 344.5mg, p≤0.043) and plant protein (42.3 versus 35.3g, p≤0.008). No differences were observed in the non-infected women. The further analyses, comparing the dietary intakes in both studies of infected and non-infected women with TC and albumin levels in the first and fourth quartiles, showed that in the THUSA study, non-infected women with lower TC levels had significantly lower intakes of protein (% of total energy), total fat (% of total energy) and vitamin B12 and significantly higher intakes of total energy (TE), plant protein, total carbohydrate, % TE from carbohydrate, dietary fibre, added sugar and thiamine. In the infected women saturated fatty acids (SATFAT), calcium and the fat ratio (polyunsaturated/saturated ratio) differed significantly between women with TC levels in the first and the fourth quartile. A significant higher intake of riboflavin was seen in the non-infected women from Mangaung with TC levels in the fourth quartile, while significant higher intakes of energy, total protein, animal protein, total fat, SATFAT, MUFAT, total carbohydrate, phosphorus, chromium and iodine was seen in the infected women with TC levels in the fourth quartile. These results suggest that a more "westernized" diet with higher intakes of energy, and animal derived foods (SATFAT and calcium) could have protected against the detrimental decreases in TC observed in HIV infection. Significant differences were observed in the intakes in the non-infected THUSA women who had serum albumin in the first and fourth quartiles. lntakes in percentage energy from protein and fat, animal protein, total fat, SATFAT, MUFAT, calcium, zinc, vitamin C and fat ratio, were significantly lower in the women with albumin levels in the first quartile. Significantly higher carbohydrate intakes were observed in the women who had serum albumin levels in the first quartile. In the Mangaung study, significant differences were seen in the intakes between infected women who had serum albumin levels in the first and fourth quartiles. lntakes of total energy, protein, fat, MUFAT, SATFAT, carbohydrate, magnesium, zinc, chromium, biotin, pantothenic acid and iodine were significantly lower in the infected women with serum albumin levels in the first quartile. In the non-infected women significantly lower intakes of calcium were observed in the group who had serum albumin levels in the first quartile compared to those who had serum albumin levels in the fourth quartile. These results also suggest that a more "westernized” diet was associated with higher albumin levels in HIV-infected women. CONCLUSION: It is well known that nutrition has an integral part to play in the care of people living with HIV/AIDS (PLWHA). Maintaining proper nutrition, weight and immune function is thought to delay disease progression, prolong the asymptomatic phase and improve survival. These analyses suggest that the "prudent" diet generally regarded as an optimal diet for prevention of non-communicable diseases, may not be the optimal diet for PLWHA. The overall analyses therefore suggest that a more "westernized" diet, higher in fat and protein could be more beneficial to asymptomatic HIV-infected women compared to that of a more "prudent" diet. As these studies were not primarily designed to investigate HIV and nutrition, the role of a higher energy, fat and animal protein intake ("western" diet) in asymptomatic HIV warrants urgent investigation. / Thesis (Ph.D. (Nutrition))--North-West University, Potchefstroom Campus, 2007.

Thesis (Ph. D.)--University of Texas at Austin, 1998. / Vita. Includes bibliographical references (leaves 185-193). Available also in a digital version from Dissertation Abstracts.

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. Tech / HIV/AIDS is currently one of the most devastating conditions affecting the health of millions throughout the world. In South Africa it is estimated that 4,74 million individuals between 15-49 years are infected with HIV despite the intensive HIV prevention programs that are in place. KwaZulu Natal (KZN) province of South Africa has the highest HIV prevalence in the country (Statistics South Africa, 1996; South African DOH, 2001). Only in August 2003, the South African government announced that it would provide anti-aids drugs free of charge in the public sector. Previously this was unavailable to most HIV-infected South Africans. However despite the governments plan to roll out the provision of ARVs, there are mammoth logistical and human capacity challenges confronting the implementation of a treatment program of this magnitude. Furthermore due to the rapid spread of HIV/AIDS, the high cost of treatment and the association of symptomatic treatment with emergence of drug resistance, many patients with HIV/AIDS are seeking help from alternative systems of medicine. With the worldwide sales of homoeopathic products in 1997 estimated to be $1.5 billion, homoeopathy is growing and becoming an important aspect of healthcare. However in South Africa homoeopathy is relatively new and there seems to be a limited awareness of homoeopathy amongst the public and healthcare authorities. For this reason the Technikon Witwatersrand’s’ (TWR), Department of Homoeopathy has instituted a 3 Phase HIV/AIDS Research strategy in order to identify alternative remedies and support structures that could be useful in controlling the HIV/AIDS pandemic. This study aims to achieve phase one of the TWR’s 3 phase strategy. This study initiated the collection of basic data on the extent homoeopaths are treating HIV/AIDS, the current approaches utilised by the homoeopaths in KwaZulu Natal in the treatment of HIV/AIDS and the need for additional training for homoeopaths with regards to HIV/AIDS. The study was carried out by using the survey method and the measuring tool was a self-administered questionnaire as well as an interview. The study population (n = 59) comprised only registered homoeopathic practitioners of KwaZulu-Natal (KZN). The study was completed in four stages. Stage 1 comprised mailing a covering letter together with the questionnaire and self addressed stamped return envelope. Stage 2 and 3 involved the mailing of reminder letters to the study population. Stage 4 which was only carried out when the data from the questionnaire was analyses consisted of either a face to face or telephonic interview of practitioners. The data was analysed by means of descriptive statistics using the SPSS version 11.0 statistical program. The Mann-Whitney test, Kruskal-Wallis Test (non-parametric ANOVA) and Dunn’s Multiple Comparison Test which was used as a post-test to the Kruskal-Wallis and the Spearman Rank Correlation were used to test the association between various factors in the questionnaire. On analysing the results it can be seen that the demographics of practitioners who treat HIV-positive patients have been influenced by the political-legal and training history of Homoeopathy in South Africa. The majority of respondents in this survey are graduates of Durban Institute of Technology are White and have had less than ten years experience. It has been found that locality of the practice, race of the practitioner and the number of years in practice has an influence on the number of HIV-positive patients that the practitioner treats. Homoeopaths who practice in rural areas rather than urban, treat larger numbers of HIV-positive patients. Black homoeopaths see more HIV-positive patients than white homoeopaths. The longer a practitioner was in practice the more HIV-positive patients are seen. Homoeopathic simplex was the most frequently used treatment for HIV/AIDS patients. This was followed by vitamin supplementation and the use of homoeopathic complex. In addition, it was found that more than 90% of the respondents felt the need for further training with regards to HIV/AIDS. Specific topics that should be addressed were evaluated. This study raised many areas of concern with regards to the treatment of HIV/AIDS using homoeopathy and strongly highlights the need for more information and further research. / Professor A. N. Smith Dr. N. Wolf

Background: Clinical management of dyslipidemia is challenging, particularly hypertriglyceridemia in patients with HIV-infection. Changing combined anti-retroviral therapy (CART) and the use of lipid-lowering drugs have proven useful in treating dyslipidemia in HIV infected patients Objective: To assess the efficacy of lipid lowering drugs (LLDs) and/or CART switching, in the management of HIV-associated dyslipidemia Design: A retrospective, longitudinal cohort study Setting: Phidisa HIV research project, 6 sites in South Africa, period April 2008 and April 2011 Patients: HIV positive South African National Defence Force (SANDF) members and their dependents; who are on CART and are 18 years or older. Four hundred and forty eight participants with dyslipidemia had non-fasted, total serum cholesterol ≥ 8.0mmol/l, serum triglyceride levels ≥4.52 mmol/l and naïve to lipid lowering drugs at baseline. Measurements: Mean change over time of total serum cholesterol and serum triglyceride in the following treatment strategies were used: exercise and dietary advice, lipid-lowering drugs (statins or fibrates or both), CART switches separately and combined lipid lowering drug with ART switch was measured using panel data with first–order autoregressive-response and xtabond. Results: The mean age for a total of 448 participants was 39.9 years; males were 87%, females were only 13%. The participants contributed to 1861 follow-up visits. CD4 count was normally distributed with the baseline mean value of 402 cells/mm3 (18.5%). Mean change over time for total serum cholesterol and triglycerides increased by 0.099 mmol/l (p=0.007) and 0.248 mmol/l (p=0.018) respectively, with an increase in body mass index while an increase in CD4 cell percent decreased mean over time for total serum cholesterol by 0.045 mmol/l (p=0.002). Our hypothesis was confirmed when lipid lowering drugs and ART switch combined treatment strategy even more decrease in the mean total serum cholesterol and triglycerides levels over time by 0.754 mmol/l (p<0.001) and 2.073 mmol/l (p<0.001) respectively compared to the exercise and dietary advice treatment strategy. Our findings showed that combined treatment strategy maintained a decrease in both the mean total serum cholesterol and triglycerides levels over time of 0.283 mmol/l (p=0.038) and 0.941 mmol/l (p=0.016) respectively, when compared to lipid lowering drugs; the mean serum triglycerides over time were also reduced by 0.486 mmol/l (p=0.048) when the combined treatment strategy was compared to CART switch only. Furthermore combined treatment strategy of lipid lowering drugs with ART switch showed significant virological suppression by decreasing log of viral load, 0.486 (p<0.001) when compared to the exercise and dietary advice group. Conclusions: Combining lipid lowering drugs and ART switching as a treatment strategy in the management of HIV-associated dyslipidemia is effective in lowering the mean over time of both total serum cholesterol and triglycerides when compared to exercise and dietary advice strategy, while maintaining virological suppression. / Dissertation (MSc)--University of Pretoria, 2015. / tm2015 / School of Health Systems and Public Health (SHSPH) / MSc / Unrestricted