Background: Voluntary HIV counselling and testing (VCT) is considered one of the key strategies in the prevention and control of HIV/AIDS in South Africa. However its role in modifying risky sexual behaviour among patients tested as HIV-negative (primary prevention) is controversial. Objective: This study was intended to demonstrate the likelihood of VCT reducing risky sexual practices among patients testing sero-negative for HIV infection. Methods: This is a quantitative cross-sectional survey that took place over a period of 3½ months in a district hospital in rural South Africa. A self-administered questionnaire was completed by 54 patients who had VCT and tested sero-negative for HIV infection during the previous 12 months (Study Group). The same questionnaire was filled in by 61 patients who had never received VCT before (Control Group). Both groups consisted of women and men aged 18 years or older. Socio-demographic information, sexual behaviour, willingness to disclose the HIV sero-status with the sexual partner, and readiness to have VCT were asked in the survey. To compare differences between two independent proportions the Pearson Chi-square test was used. Significant results were regarded as a p-value of less than 0, 05, which was taken as an indication of association between VCT and the variable being measured. Results: The median age of our sample was 29 years (Interquartile Range 24-40), with most of the respondents (38 %) between the ages of 26 and 35 years. More than 90 % of patients in both groups reported being sexually active. Sexual intercourse with more than one partner was significantly lower in the Study group (p=0,003). Those who had never received VCT before had a higher (although not significant) incidence of episodes of unprotected sexual intercourse and symptoms of sexually transmitted infections (STIs) (81, 9 % and 42, 6 % respectively) when compared to the study group (77, 7 % and 35, 1 %). Most of the participants in both groups did not consider the disclosing of their sero-status an issue of concern for their sexual partner(s). Readiness to receive VCT was significantly higher in the study group (p=0, 02). Conclusions: In this study, people who tested sero-negative for HIV through VCT showed a significant decrease in the number of sexual partners as compared to the control group who did not undergo VCT. The VCT group had less unprotected sexual intercourse and less symptoms of STIs than the control group.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / OBJECTIVES: The objective of this study was to perform a systematic review and meta-analysis of the literature to evaluate the efficacy and safety of therapies for cerebral toxoplasmosis in HIV-infected adults. The pyrimethamine plus sulfadiazine (P-S) combination is considered the mainstay therapy for cerebral toxoplasmosis and pyrimethamine plus clindamycin (P-C) is the most common alternative treatment. Although trimethoprim-sulfamethoxazole (TMP-SMX) has potential advantages, its use is infrequent. METHODS: We searched PubMed and four other databases to identify randomized controlled trials (RCTs) and cohort studies. Two independent reviewers searched the databases, identified studies and extracted data. Risk ratios (RRs) were pooled across studies using random-effects models. RESULTS: Nine studies were included (five RCTs, three retrospective cohort studies and one prospective cohort study). In comparison to P-S, treatment with P-C or TMP-SMX was associated with similar rates of partial or complete clinical response [P-C: RR 0.87; 95% confidence interval (CI) 0.70-1.08; TMP-SMX: RR 0.97; 95% CI 0.78-1.21], radiological response (P-C: RR 0.92; 95% CI 0.82-1.03), skin rash (P-C: RR 0.81; 95% CI 0.56-1.17; TMP-SMX: RR 0.17; 95% CI 0.02-1.29), gastrointestinal impairment (P-C: RR 5.16; 95% CI 0.66-40.11), and drug discontinuation because of adverse events (P-C: RR 0.32; 95% CI 0.07-1.47). Liver impairment was more frequent with P-S than P-C (P-C vs. P-S: RR 0.48; 95% CI 0.24-0.97). CONCLUSIONS: The current evidence fails to identify a superior regimen in terms of relative efficacy or safety for the treatment of HIV-associated cerebral toxoplasmosis. Use of TMP-SMX as preferred treatment may be consistent with the available evidence and other real-world considerations. Larger comparative studies are needed. / Revisión por pares

<p> Background: Vitamin D activity is important for the functioning of a broad range of body systems. Some of these, including the skeletal, immune, and cardiovascular systems, are particularly relevant in the management of HIV-infection; thus, and in consideration of evidence that factors associated with the scenario of HIV-infection can disrupt vitamin D metabolism, the assessment of vitamin D status in people living with HIV-infection may be particularly important. In this thesis, I address cardiovascular implications of vitamin D status in HIV-infection. More specifically, and based on a growing body of evidence implicating low vitamin D status in the development of cardiovascular disease (CVD), I hypothesized that in HIV-positive adults low 25-hydroxyvitamin D (25(0H)D) concentration would be associated with increased subclinical vascular disease as measured by carotid intima-medial thickness (IMT).</p> <p> Methods: Using regression analyses I cross-sectionally studied the relationship between 25(0H)D and carotid IMT in 283 participants of the Canadian HIV Vascular Study, a prospective study of CVD risk among HIV-positive Canadians.</p> <p> Results: The prevalence of vitamin D deficiency in the Canadian HIV Vascular study was surprisingly low. Plasma 25(0H)D by quartile was not associated with carotid IMT. However, in restricted cubic spline regression analyses designed to accommodate non-linearity there was evidence of an inverted U-shaped 25(0H)D-carotid IMT relationship. In exploratory regression models restricted to participants comprising the suboptimal range of vitamin D status, lower 25(0H)D concentration was statistically significantly associated with lower carotid IMT after adjustment for known CVD risk factors and other variables hypothesized to potentially confound a 25(0H)D-carotid IMT association.</p> <p> Main implication: While inference from these exploratory findings requires cautious interpretation, future investigations into the relationship between vitamin D status and vascular disease should consider the problem of non-linearity as a feature of primary analyses; otherwise, such studies might fail to detect a true association.</p> / Thesis / Master of Science (MSc)

No description available.

Tenofovir disoproxil fumarate (TDF) is a nucleotide reverse transcriptase inhibitor and a prodrug of tenofovir (TFV). It is the currently recommended first line combination treatment of human immunodeficiency virus (HIV) infection in adults. Various clinical studies have associated treatment with a TDF-containing antiretroviral therapy (ART) regimen with reduced bone mineral density (BMD) and renal dysfunction. Hardly any studies to date have correlated plasma TFV concentration with markers of renal function and bone turnover (BTM). This knowledge is also unavailable in the South African public health care system. Hence, the correlations between plasma TFV concentration and renal function markers and BTM in HIV-infected women were investigated. Renal function markers and BTM in HIV-infected women were compared with those in HIV-uninfected control women. A pilot cross-sectional sub-study within the Prospective Urban and Rural Epidemiology (PURE) South Africa study was conducted. Sixty women participated, of which 30 HIV-infected women were matched for age and body mass index with 30 HIV-uninfected ones. Ethics approval was obtained from the North-West University, Human Research Ethics committee (NWU-00016-10-A1) on 12 April 2013 to conduct this sub-study and the North West Department of Health, Mmabatho on 08 August 2013 to access patient health information. A validated high-performance liquid chromatography tandem mass spectrometry method was developed to analyse TFV in plasma. Renal markers measured were the estimated glomerular filtration rate (eGFR), creatinine clearance (CrCl), albuminuria, serum creatinine (SCr), serum urea, serum uric acid, glucosuria, urine sodium (UNa) and maximum tubular reabsorption of phosphate (TmPO4/GFR). The BTM markers measured included C-terminal telopeptide (CTx), alkaline phosphatase (ALP), parathyroid hormone (PTH), total vitamin D (VitD), serum calcium (SrCa), serum phosphate (SrP) and BMD. BMD was assessed using the DTX-200 peripheral DXA system (Osteometer MediTech, Hawthorn, California, USA). Renal and bone markers were analysed on Elecsys® 2010 and COBAS INTERGRA® 400 plus (Roche Diagnostics, Switzerland). Baseline data for HIV-infected participants with regard to CD4+ cell count, SCr prior to TDF initiation, time since TDF initiation, weight prior to TDF initiation and time since HIV diagnosis were collected retrospectively from participants’ public health care files. Statistical analyses applied were linear regression, analysis of covariance, the Mann-Whitney U test, paired t-test and unpaired t-test. IBM® SPSS® Statistics software 22 was used to perform all the statistical analyses. The median and interquartile range of plasma TFV concentration was 113 (74-139.4) ng/mL (n=25) and no TFV was detected in five participants’ plasma. Adjusted analyses showed TFV concentration to be associated with albuminuria (adjusted r2 = 0.339; p = 0.001). Values of CrCl, eGFR and albuminuria (p = 0.032; p = 0.038; p = 0.048, respectively) were significantly higher in HIV-infected women compared to HIV-uninfected women. CrCl [112 (84-137) mL/min] and eGFR [134 (93-153) mL/min/1.73m2] values were abnormally high in HIV-infected women. There was also an increase in both CrCl and eGFR (p = 0.008; p < 0.001, respectively) from baseline to median follow-up of 16.6 (8.8-23.4) months in HIV-infected women. At a TFV plasma concentration of ≥ 120 ng/mL, CTx and ALP correlated positively (r = 0.704; p = 0.016). ALP (112 ± 28 U/L; p < 0.001), CTx (0.68 ± 0.4 ng/mL; p = 0.027) and PTH (56.3 ± 32 pg/mL; p = 0.050) were higher in HIV-infected women compared to HIV-uninfected women. CD4+ cell count increased from baseline to follow-up in HIV-infected women (+250 cells/mm3; p = 0.001). In HIV-infected women on a TDF-based regimen, TFV plasma concentration is associated with an increase in albuminuria, while perturbations in BTM equilibrium occur at ≥ 120 ng/mL of TFV plasma concentration. Abnormally higher CrCl and eGFR are present in HIV-infected women, seen as glomerular hyperfiltration compared with HIV-uninfected women. There was immunological improvement with TDF-based ART in HIV-infected women. Longitudinal studies with larger sample sizes are needed to confirm these findings. / MSc (Pharmacology), North-West University, Potchefstroom Campus, 2015

Tenofovir disoproxil fumarate (TDF) is a nucleotide reverse transcriptase inhibitor and a prodrug of tenofovir (TFV). It is the currently recommended first line combination treatment of human immunodeficiency virus (HIV) infection in adults. Various clinical studies have associated treatment with a TDF-containing antiretroviral therapy (ART) regimen with reduced bone mineral density (BMD) and renal dysfunction. Hardly any studies to date have correlated plasma TFV concentration with markers of renal function and bone turnover (BTM). This knowledge is also unavailable in the South African public health care system. Hence, the correlations between plasma TFV concentration and renal function markers and BTM in HIV-infected women were investigated. Renal function markers and BTM in HIV-infected women were compared with those in HIV-uninfected control women. A pilot cross-sectional sub-study within the Prospective Urban and Rural Epidemiology (PURE) South Africa study was conducted. Sixty women participated, of which 30 HIV-infected women were matched for age and body mass index with 30 HIV-uninfected ones. Ethics approval was obtained from the North-West University, Human Research Ethics committee (NWU-00016-10-A1) on 12 April 2013 to conduct this sub-study and the North West Department of Health, Mmabatho on 08 August 2013 to access patient health information. A validated high-performance liquid chromatography tandem mass spectrometry method was developed to analyse TFV in plasma. Renal markers measured were the estimated glomerular filtration rate (eGFR), creatinine clearance (CrCl), albuminuria, serum creatinine (SCr), serum urea, serum uric acid, glucosuria, urine sodium (UNa) and maximum tubular reabsorption of phosphate (TmPO4/GFR). The BTM markers measured included C-terminal telopeptide (CTx), alkaline phosphatase (ALP), parathyroid hormone (PTH), total vitamin D (VitD), serum calcium (SrCa), serum phosphate (SrP) and BMD. BMD was assessed using the DTX-200 peripheral DXA system (Osteometer MediTech, Hawthorn, California, USA). Renal and bone markers were analysed on Elecsys® 2010 and COBAS INTERGRA® 400 plus (Roche Diagnostics, Switzerland). Baseline data for HIV-infected participants with regard to CD4+ cell count, SCr prior to TDF initiation, time since TDF initiation, weight prior to TDF initiation and time since HIV diagnosis were collected retrospectively from participants’ public health care files. Statistical analyses applied were linear regression, analysis of covariance, the Mann-Whitney U test, paired t-test and unpaired t-test. IBM® SPSS® Statistics software 22 was used to perform all the statistical analyses. The median and interquartile range of plasma TFV concentration was 113 (74-139.4) ng/mL (n=25) and no TFV was detected in five participants’ plasma. Adjusted analyses showed TFV concentration to be associated with albuminuria (adjusted r2 = 0.339; p = 0.001). Values of CrCl, eGFR and albuminuria (p = 0.032; p = 0.038; p = 0.048, respectively) were significantly higher in HIV-infected women compared to HIV-uninfected women. CrCl [112 (84-137) mL/min] and eGFR [134 (93-153) mL/min/1.73m2] values were abnormally high in HIV-infected women. There was also an increase in both CrCl and eGFR (p = 0.008; p < 0.001, respectively) from baseline to median follow-up of 16.6 (8.8-23.4) months in HIV-infected women. At a TFV plasma concentration of ≥ 120 ng/mL, CTx and ALP correlated positively (r = 0.704; p = 0.016). ALP (112 ± 28 U/L; p < 0.001), CTx (0.68 ± 0.4 ng/mL; p = 0.027) and PTH (56.3 ± 32 pg/mL; p = 0.050) were higher in HIV-infected women compared to HIV-uninfected women. CD4+ cell count increased from baseline to follow-up in HIV-infected women (+250 cells/mm3; p = 0.001). In HIV-infected women on a TDF-based regimen, TFV plasma concentration is associated with an increase in albuminuria, while perturbations in BTM equilibrium occur at ≥ 120 ng/mL of TFV plasma concentration. Abnormally higher CrCl and eGFR are present in HIV-infected women, seen as glomerular hyperfiltration compared with HIV-uninfected women. There was immunological improvement with TDF-based ART in HIV-infected women. Longitudinal studies with larger sample sizes are needed to confirm these findings. / MSc (Pharmacology), North-West University, Potchefstroom Campus, 2015

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.

Magister Curationis - MCur / As South Africa continues to experience the highest prevalence of HIV/AIDS globally, co-occurring mental illness poses challenges for public health. Mental illness has increased among people living with HIV/AIDS (PLWHA), as infected individuals succumb to the psychological stress and trauma of the disease. Key research issues, not yet well established, relate to whether professional nurses, working in psychiatric hospitals in South Africa, are equipped with the necessary knowledge and skills to be able to provide effective mental healthcare services, given the increase in mental illness of PLWHA. An increase in mental illness translates into an increase in demand for psychiatric services by PLWHA. There is a paucity of research on HIV/AIDS knowledge of professional nurses working in psychiatric hospitals in South Africa, despite the established acknowledgement of the increase of mental illness amongst PLWHA. The aim of this study was to assess the HIV/AIDS knowledge, attitude and perceived risks of professional nurses working in a psychiatric hospital in the Western Cape, South Africa. A quantitative, descriptive survey design, using an all-inclusive sampling method, was used to select 121 professional nurses employed at a psychiatric hospital in Western Cape to participate in the study. The objectives of the study were to: describe professional nurses’ knowledge of HIV/AIDS; describe the attitudes of professional nurses towards PLWHA and mental illness; and determine professional nurses’ perceived HIV risks in a psychiatric hospital.

Abstract The utilization of oral lesions as a screening tool for HIV is not well documented. Attendees at two primary health care facilities (Khutsong and Heidelberg) were assessed to determine the predictive value of group I oral lesions for HIV infection. The objectives were to investigate the: 1) HIV prevalence amongst attendees at PHC facilities, 2) Prevalence of HIV-related oral lesions and 3) Correlation between the oral lesions and the HIV status using the Likelihood Ratio test. Methods: All patients over 12 months of age presenting at the two facilities for a curative care consultation over a one-week period (in April 2005) were included. Consent was obtained by trained counselors who also conducted a brief interview and offered pre-test counseling to patients wishing to know their HIV status. Two calibrated dentists conducted a head, neck and oral examination and administered a rapid saliva HIV test (OraQuick HIV-1/2-Rapid HIV-1/2 Antibody Test). Results: A total of 654 attendees were surveyed in the 2 facilities. There was a 100% response. The mean age of the participants was 34 years (range: 1-94), and the majority (73%) were female. HIV prevalence rates were 34% at Khutsong and 36% at Heidelberg. The HIV prevalence peaked at 46% in the 16-45 age groups. Of the 228 who tested positive for HIV, 121 (53%) patients were diagnosed with 1 or more Group I oral lesion. Oral candidiasis (46%) and oral hairy leukoplakia (19%) were the two most common oral lesions diagnosed in the HIV positive cohort. The positive predictive values and specificity values for multiple lesions ranged between 96% and 100%. Most of the likelihood ratios for multiple lesions were greater than 10 which implied that the patients who presented with these lesions were extremely likely to test positive for HIV. The sensitivity values (1% to 37%) and negative predictive values (66% to 70%) remained relatively low. Conclusion: The HIV prevalence of patients attending PHC facilities was high (34%). Oral lesions are useful markers of HIV-infection and should alert clinicians to the presence of HIV infection. Multiple group I lesions were more predictive of HIV infection compared to single lesions.

Apesar da infecção pelo HIV/aids permanecer até a atualidade como uma doença incurável, os avanços científicos referentes ao tratamento medicamentoso possibilitaram atenuar o processo de adoecimento, reduzir a morbimortalidade e melhorar a qualidade e expectativa de vida das pessoas infectadas pelo vírus. Essas mudanças tornaram possível a reconstrução e/ou a manutenção de projetos de vida incluindo o estabelecimento e a manutenção dos relacionamentos afetivo-sexuais com pessoas com sorologias distintas, quando um é infectado pelo HIV/aids e o outro não, chamados de sorodiferentes. Assim, esse estudo teve como objetivo analisar a vulnerabilidade à transmissão sexual do HIV de parcerias afetivo-sexuais estáveis, heterossexuais e homossexuais, sorodiferentes. Trata-se de um estudo transversal, descritivo, com abordagem qualitativa, realizado no município de Ribeirão Preto-SP em dois serviços especializados no atendimento em HIV/aids (SAE). Adotou-se como referencial teórico conceitual a Vulnerabilidade (AYRES, 2003), operacional os marcadores de vulnerabilidade proposto por Takahashi (2006). Os dados foram coletados, no período de setembro de 2017 a março de 2018, por meio de entrevista individual com os participantes, utilizando um questionário semiestruturado para as variáveis sociodemográficas e clínicas e um roteiro temático com questões norteadoras sobre aspectos relacionadas ao comportamento afetivo-sexual e preventivo. As entrevistas foram transcritas na íntegra e organizadas seguindo as etapas: pré-análise; exploração do material e tratamento dos resultados, inferência e interpretação segundo a Análise de Conteúdo (BARDIN, 2009). O projeto foi aprovado pelo Comitê de ética em pesquisa e todos os preceitos éticos foram resguardados. Participaram da pesquisa 21 pessoas vivendo com HIV/aids que mantinham relação afetivo-sexual com parceria sorodiferente. Os resultados da análise dos discursos, a partir do material transcrito das gravações, indicam questões importantes relacionadas as três dimensões da vulnerabilidade: individual, social e programática. Referente aos marcadores de vulnerabilidade na dimensão individual podemos destacar os conhecimentos incorretos ou insuficientes sobre novos métodos preventivos, entre os quais PEP, PrEP e uso do tratamento como prevenção, desconhecimento sobre a lógica da prevenção combinada, uso inconsistente do preservativo masculino, ter parceiros casuais além do fixo/principal, uso de álcool e outras drogas antes da relação sexual. Na dimensão social verificou-se desigualdades de gênero que coloca a mulher em desvantagem na negociação de estratégias de prevenção, estigma e preconceito relacionados ao viver com HIV, dificultando a revelação da soropositividade à parceria sexual e a construção social da masculinidade em detrimento ao cuidado com a saúde do homem. Referente aos marcadores na dimensão programática observou-se ausência de protocolo para acompanhamento da parceria soronegativa, pouca visibilidade das parcerias sorodiferentes, déficit nas ações de orientação sobre novas tecnologias de prevenção da transmissão sexual do HIV, centralização do uso do preservativo, baixa testagem para o HIV pela parceria sorodiferente, suporte insuficiente de planejamento familiar, baixa oferta de atividades de educação em saúde. Estes resultados reforçam a necessidade da inclusão do parceiro HIV-negativo na dinâmica dos serviços de saúde, a importância de mudança no cuidado em saúde das pessoas que vivem e convivem com o vírus para a lógica de redução de riscos personalizada, que flexibilize as alternativas de prevenção e respeite as individualidades e dificuldades, compreendendo não só os aspectos clínicos/biológicos mas as percepções subjetivas de cada indivíduo / Although HIV/aids infection remains an incurable disease, scientific advances regarding medical treatment have mitigated the process of illness, decreased morbidity and mortality, and improved quality and expectancy of life for people infected with the virus. These changes yielded reconstructing and/or maintaining life projects possible, including establishment and maintenance of affective-sexual relations among people with distinct serological profiles, one infected individual and one healthy individual, which are called serodifferent. Therefore, the aim of the study was to analyze vulnerability to HIV transmission among stable, heterosexual and homosexual affective-sexual serodifferent partners. For this purpose, we used a transversal study with qualitative approach, performed at two practices of Ribeirão Preto-SP specialized in HIV/aids (SAE). The theoretical reference comprised Vulnerability (AYRES, 2003) and markers of vulnerability according to Takahashi (2006). Data was collected from September 2017 to March 2018 through individual interviewing of participants, using a semistructured questionnaire for sociodemographic and clinical variables, and a themed script with guiding questions regarding affective-sexual and preventive behavior. Interviews were fully transcribed and organized following a series of steps: preanalysis, data exploration and treatment of results, inference and interpretation, according to Content Analysis (BARDIN, 2009). The study was approved by the Ethics Committee and every ethical precept was protected. Twenty-one people living with HIV/aids and having affectivesexual relations with serodifferent partners were enrolled in the study. The results of speech analysis obtained from transcribed data of recordings indicate important matters related to three dimensions of vulnerability: individual, social and programmatic. Markers of vulnerability from the individual dimension comprised incorrect or insufficient knowledge regarding novel preventive methods, among which PEP, PrEP, use of treatment as prevention, unfamiliarity with combined prevention, inconsistent use of male preservatives, maintaining casual partners besides the main/steady partner, alcohol and drug use before sexual relations were observed. Social dimension analyses showed inequalities of gender which render women in disadvantage when negotiating prevention strategies, stigmas and prejudgment related to life with HIV, which make seropositivity revelation difficult among partners, and the social construction of masculinity over healthcare among men. Programmatic markers showed absence of a protocol for seronegative follow-up, little visibility of serodifferent partnerships, shortage of actions and orientation regarding new technologies for preventing sexual HIV transmission, centralization of preservative use, low testing for HIV among serodifferent partners, insufficient support and planning from families, and lack of activities for education on healthcare. These results reinforce the need for including HIV-negative partners in the dynamics of healthcare and the importance of changing health services for people living with the virus with regard to individualized lowering of risks, in order to improve alternatives for prevention and respect individuality and difficulties, understanding not only clinical/biological aspects of each individual, but also their subjective perceptions