Introduction A group of 317 HIV-1 infected pregnant women and 53 postpartum HIV-negative women were recruited for a two-year prospective descriptive study of psychosocial and other determinants of antenatally planned and actual postnatal feeding, associations between maternal status and infant feeding practices, and health outcomes. Methods The subjects were interviewed periodically for 2 years using structured research instruments. Anthropometric measurements, biomarkers of nutritional status and measurements of pysychosocial wellbeing were obtained from the mothers. Data was collected on infant feeding and outcomes for the babies. Results At recruitment, 74% of mothers planned to formula-feed. Significant differences between these women and those who planned to breastfeed emerged. After delivery, 25% of the women who antenatally planned to formula-feed changed their minds and actually breastfed. Conversely, half of the women who antenatally planned to breastfeed actually formula-fed. Some significant reasons emerged for these feeding changes. Most mothers were well-nourished or overweight. Breastfeeding mothers lost little weight between six weeks and six months after delivery. At the end of follow-up, 65% were obese. While there were differences between HIV-infected and uninfected women in respect of micronutrients, no deficiencies were observed. Vitamin A and selenium concentrations were higher in the HIV-infected women than uninfected women at six weeks. There were no significant micronutrient changes over time. Most mothers maintained an adequate immune status with only slow deterioration of CD4 counts. At two years postpartum, 60% had a CD4 cell count greater than 500cells/mm³, and only about 8% less than 200/mm3. HIV transmission was 15% by 24 months of follow-up. Among the 65 ever breastfed children, 16 (24.6%) were HIV-infected compared to 12.8% of never breastfed children. Most children were growing normally, suggesting that, overall, maternal HIV status did not interfere with feeding ability. Eight mothers (3%) and 33 children (11%) died. Only 12 of 33 children who had died had a positive HIV-PCR. By 2 years, 78% surviving HIV-infected children had been initiated onto ARV therapy. Maternal adherence to HAART was poor. Conclusion HIV and infant feeding counselling is inadequate in the routine PMTCT programme, with stigma and lack of disclosure continuing as major barriers to appropriate care. Whilst maternal obesity was common, most children were growing normally. Weaknesses in routine PMTCT services were identified, and compliance with HAART was poor. / Thesis (PhD)--University of Pretoria, 2010. / Paediatrics and Child Health / unrestricted

This dissertation profiles the needs of abandoned or orphaned, HIV affected or infected children living in a South African institution. The purpose of my research is to identify the needs of the children; then identify how the staff within the institution perceive that they provide for these needs; and lastly look at what Music Therapy as a discipline can offer the children in regards to the needs identified. Interviews with fulltime and part-time staff members suggest that the needs of the children relate mainly to a lack of individual attention. Inconsistent quality of care and limited opportunities for forming attachments to specific caregivers were identified foremost as resulting in difficulties with forming and maintaining relationships and social functioning with peer members and staff members, in the institutional social cultural context. The therapeutic relationship offered to the children in Music therapy sessions offers opportunities to address the individual and social needs identified. / Dissertation (MMus (Music Therapy))--University of Pretoria, 2006. / Music / unrestricted

A l'ère des multithérapies antirétrovirales, le poids des manifestations de l'infection VIH sur la morbi/mortalité s'est allégé alors que d'autres pathologies pèsent de plus en plus sur l'état de santé des personnes vivant avec le VIH (PvVIH). Le recours au dépistage des cancers et la prise en charge des facteurs de risque cardiovasculaire liés au mode de vie (tabac, alcool, inactivité physique, obésité) sont deux importantes composantes dans la prévention de ces comorbidités chez les PvVIH. A partir des données de l'enquête ANRS-Vespa2, nous avons montré que le recours au dépistage des cancers n'était pas moindre chez les PvVIH que dans la population générale. Cependant, le dépistage annuel du cancer du col de l'utérus n'était pas optimal, et le dépistage du cancer colorectal demeurait faible. Un faible niveau d'éducation et l'immunodépression étaient associés à un moindre recours au dépistage des cancers gynécologiques. D'autre part, plus de la moitié des PvVIH présentait au moins un facteur de risque cardiovasculaire. Les usagers de drogues et les hommes ayant des rapports sexuels avec des hommes étaient particulièrement sujets aux addictions, cumulant fréquemment ces facteurs, et les immigrées d'Afrique sub-Saharienne étaient surtout exposées à l'obésité et l'inactivité physique. Ces comportements étaient liés à la situation sociale et aux caractéristiques de la maladie VIH. Cette thèse permet de mieux appréhender la fréquence et les facteurs associés à ces comportements de santé au sein des groupes de la population séropositive, et de proposer des pistes pour améliorer la prévention des comorbidités afin de contribuer à en limiter le poids sur la santé des PvVIH. / In the era of combined antiretroviral therapy, the burden of HIV-related morbidity/mortality has decreased while other health conditions are of growing concern among HIV-infected people. Cancer screening uptake and management of behavioral risk factors for cardiovascular disease (tobacco smoking, alcohol intake, lack of physical activity, obesity) are two major components in the prevention of those comorbidities among HIV-infected people. Analysis of data from the ANRS-Vespa2 survey showed that levels of cancer screening uptake were not lower among HIV-infected people compared to the general population. However, the level of cervical cancer screening uptake within the past year was suboptimal and the level of colorectal cancer screening uptake was low. Low educational attainment and immunodepression were correlated with a lower level of screening uptake for gynecological cancers. Furthermore, more than half of the HIV-infected population was exposed to at least one behavioral cardiovascular risk factor. Intravenous drug users and men who have sex with men were particularly prone to addictive behaviors (and lack of physical activity) and risk factors were often combined. Sub-Saharan African migrant women were mainly exposed to obesity and insufficient physical activity. Those behaviors were associated with social status and certain characteristics of the HIV-infection. This thesis allows to better understand the frequency and correlates of those health behaviors among the various sub-groups of people living with HIV and provides evidence to improve the prevention of comorbidities in order to reduce their burden on the health of those living with HIV.

En Afrique sub-Saharienne, les femmes et les filles sont particulièrement vulnérables à l’infection parle VIH. L’infection par le VIH est une menace importante pour la santé reproductive de cettepopulation. Les études de recherche présentées dans le cadre de cette thèse ont été conduites enAfrique de l’Ouest et avaient pour objectifs principaux : i) Estimer la prévalence de la violenceperpétrée par le partenaire intime selon le statut sérologique ; ii) Estimer l’incidence de grossesseaprès la mise sous traitement antirétroviral ; iii) Déterminer l’effet de la grossesse après la mise sousARV sur le risque de décès, de progression de la maladie à VIH et d’être perdu de vue. Nos résultatsnous montrent que la prévalence de violence physique et sexuelle perpétrée par le partenaire intimeest plus élevée auprès des femmes VIH-positives qu’auprès de celles non-infectées (63,1 vs. 39,3%,p=0.01 and 69,7 vs. 35,3%, p=0.01, respectivement). De plus, l’incidence brute globale de premièregrossesse après la mise sous ARV en Afrique de l’Ouest est de 2,9 par 100 femmes-années(IC95% :2,7 – 3,0). Auprès des jeunes femmes âgées de 25-29 ans cette incidence peut être de 4,7per 100 femmes-années (IC95% :4,3 – 5,1). Finalement, la grossesse après la mise sous ARV réduitle risque de décès ou de progression de la maladie à VIH (aHR : 0,61, CI95% : 0,40-0,92) ainsi que lerisque de devenir perdue de vu (aHR : 0,74 ; CI95% : 0,60-0,92) des femmes ouest-africaines infectéespar le VIH. La prévalence de violence perpétrée par le partenaire intime est très élevée auprès desfemmes infectées par le VIH et cela pourrait entrainer des conséquences négatives de santé de cesfemmes. La grossesse est un évènement fréquent auprès des femmes VIH positives sous ARV qui ades répercussions importantes sur le statut de santé des femmes séropositives. L’intégration desprogrammes de prise en charge maternelle dans les services de prise en charge du VIH doit êtrepriorisé en Afrique sub-saharienne. / HIV infection in sub-Saharan Africa is a major public health threat particularly for girls and women ofreproductive age. The research presented in this thesis was conducted particularly in West Africa andthe specific objectives are i) to estimate the prevalence of intimate partner violence according to HIVserological status; ii) to estimate the incidence rate of pregnancy following ART initiation; iii) todetermine the effect of pregnancy after ART initiation on the risk of death, HIV-disease progressionand loss to follow-up. Firstly, in Togo, According to our findings, the prevalence rates of lifetimephysical and sexual violence (IPV) among HIV-infected women were significantly higher thanamong uninfected women (63.1 vs. 39.3%, p=0.01 and 69.7 vs. 35.3%, p=0.01, respectively).Secondly, Among HIV-infected West African women, the crude incidence of first pregnancy afterART initiation was 2.9 per 100 women-years [95% confidence interval (CI): 2.7 to 3.0] and it could beas high as 4.7 per 100 women-years (95% CI: 4.3 to 5.1) among women aged 25-29 years old. Finally,pregnancy after ART initiation appeared to reduce the risk of death or HIV-disease progression(Adjusted Hazard Ratio [aHR] =0.61; 95%CI: 0.40-0.92) and the risk of becoming LTFU at M48(aHR=0.74; 95%CI: 0.60-0.92) among West African HIV-infected women. Intimate partner violence ishighly prevalent among HIV-infected women and it may have negative repercussions on their healthstatus. Pregnancy is a common event after ART initiation and it might have repercussions on thehealth status of HIV-infected women. The design of safe motherhood programs addressed to HIVinfectedwomen and its integration within HIV care services must are a public health priority in sub-Saharan Africa.

Introduction: Virus-specific CD8+ T cells are crucial to suppress the viral replication in HIV infection. Their functional status is important as well. Also, the chronic nonspecific immune activation of T and B lymphocytes plays an important role in the immunopathogenesis of HIV infection. Aim of the study: To analyze the frequency and functional status of HIV-specific CD8+ T cells and the expression of nonspecific activation markers on B and T cells in HIV+ patients and to assess the effect of combined antiretroviral therapy (cART) on these parameters. Patients and methods: Our cohort included 80 HIV+ patients: 36 HIV+ patients on cART, 18 patients without therapy, in whom cART was introduced during our study, 9 patients without therapy, 10 patients with primary HIV infection, 3 long-term non-progressors and 4 patients initially on cART, in whom the therapy was discontinued. Control group consisted of 34 HIV- healthy individuals. We examined CD4+ a CD8+ T cell counts, viral load, expression of nonspecific activation markers on T cells and the frequency of HIV-specific CD8+ T cells by ELISpot method and flow cytometry using MHC tetramers and intracellular cytokine detection. Results: No significant differences in HIV-specific CD8+ T cells were found between treated and untreated HIV+ patients. The frequency...

Thesis (PhD. (Nursing Science)) --University of Limpopo, 2019 / The ability of professional nurses to support and motivate people living with HIV and AIDS to disclose to sexual partner continue to be a challenge based on the social, economic, psychological and ethical circumstances that surround the process to do so. A qualitative research study using semi-structured interviews with a schedule guide whereby probing questions were used to elicit more data. Two focus groups with 6 professional nurses were also conducted to explore and describe professional nurse’s knowledge and practices as they support People Living With HIV and AIDS (PLWHA) to disclose their positive status to sexual partners. The interviews were carried out in five (5) district hospitals of Limpopo Province, South Africa. Dickoff, James, and Wiedenbach (1968) practice theory guided the study. Study findings revealed that professional nurses do understand the concept but however it is difficult for them to translate and link learning and understanding in the clinical area. Social, economic, psychological and ethical dilemmas pose a challenge for professional nurses to support individuals to disclose to sexual partners. Professional nurses refer individuals with challenges to psychologists and social workers, but however, they do not receive referral back on the outcome. The absence of support groups and link with community-based groups to support PLHWA reduce efforts to improve knowledge on benefits of disclosure to communities led by PLHWA including reduction of stigma and discrimination associated with the diagnosis. The study therefore, recommends a training programme that links the South African Nursing Council statutes, including that of World Health Organization and Department of Health with teaching and learning methods that clarify and simulate real clinical situation to enhance the translation of this policy in the real-life situation. The training programme further suggests a link with community base structures led by PLWHA to enhance disclosure of HIV positive status to a sexual partner, reduction of stigma and discrimination associated with the diagnosis and reduce the incidence of HIV among people living with HIV. Key words: People living with HIV infection, Professional nurses, disclosure of HIV to sexual partners

HIV/AIDS studies mostly lack distinction between the US-born Blacks and non-US-born Blacks while African Americans (AAs) continues to represent the group with the heaviest burden of AIDS deaths and new diagnosis of HIV. A review of studies on HIV infection in the US, Europe, and other Western countries revealed a knowledge gap on HIV infection with non-refugee African immigrants (NRAIs), especially the Nigerian African Immigrants (NAIs) who are non-US-born Blacks. The purpose of this descriptive phenomenological study is to address this gap by exploring the expressed views of NAIs, a sub-group of the NRAIs living in Houston, Texas, on the issue of HIV infection. In a qualitative research design, 13 NAI individuals aged 18 to 49 were purposively selected for a face-to-face interview. The health belief model provided the conceptual framework for the development of study questions and analysis of the gathered data using the phenomenological approach. The study findings showed that 90% of the participants have knowledge of HIV infection. Even though 100% of the participants acknowledged the severity of unprotected sex and multiple sexual relationships in the acquisition of HIV, 27% engaged in multiple sexual relationships and there was inconsistent use of condoms in 64% of the participants. The participants expressed low levels of perception regarding the threat of contracting HIV in their relationships. Evidence of sexual mixing was found in about 61% of the study participants. This study provided an opportunity for future research with NAIs, an upcoming set of immigrants, in the US. The study also highlighted how knowledge of the NAIs' culture and language can be used in promoting preventative interventions like the use of condoms and HIV testing.

No description available.

In the United States, individuals of Hispanic ethnicity receive disproportionately lower-quality healthcare. These healthcare disparities exacerbate unequal access to quality healthcare services, including disparities in cardiovascular disease (CVD) and human immunodeficiency virus (HIV) care. Research on the role of ethnicity on the CVD outcomes of people living with HIV (PLWH) has been limited. We hypothesize that immunological (CD4+ cell count) and virological (HIV viral load) control may play a role in the development of acute myocardial infarction (AMI) among PLWH, and that Hispanic ethnicity may worsen these outcomes. To verify our hypotheses, we conducted a retrospective cross-sectional study to investigate the strength and direction of association between CD4+ cell count (immunological cohort, n=513) and HIV viral load (virological cohort, n=261) on AMI among respondents of the All of Us Research Program. Hispanic and non-Hispanic respondents for both cohorts were comparable in terms of demographic characteristics, except for a significantly different distribution by race. While we identified increased proportion of non-Hispanic individuals with AMI in the immunologic (6.0% vs. 1.0%; P=0.04) and virologic (5.8% vs. 0%; P=0.007) cohorts, we were not able to identify CD4+ cell count or viral load as significant predictors significantly increasing the likelihood of AMI. Potential explanations discussed include self-selection bias resulting in incomplete laboratory data and an underpowered sample size. While the sample in this study did not support an increased likelihood of AMI by ethnicity, the results should be interpreted carefully in light of the limitations and the established pathophysiological and epidemiological associations posited, underscoring the importance of future research efforts that better represent ethnic minorities and the associations between HIV infection and CVD.

Objectives: The study aim was to analyse the kinetics of stem and transit cells in the crypts of jejunal mucosa infected with HIV and Microsporidia. Design: The size of villi, depth of crypts and proliferative activity of transit and stem cells in jejunal mucosa were measured using morphometric techniques. Methods: The surface area/volume ratio (S/V) of jejunal biopsies was estimated under light microscopy using a Weibel graticule. Crypt length was measured by counting enterocytes along the crypt side from the base to the villus junction, and the mean crypt length was calculated. The S/V and crypt lengths of the jejunal mucosa of 21 HIV and Microsporidia-infected test cases were compared with 14 control cases. The labelling index in relation to the crypt cell position of 10 of the test cases was analysed compared with 13 control cases. Results: Differences were found in the S/V and crypt length, and there was a negative correlation between S/V and crypt length in test and control cases combined. Cell labelling indices fell into low and high proliferation groups. There were significant differences in labelling indices between low proliferation test cases and controls, between high proliferation test cases and controls, and between high and low proliferation test cases. Conclusion: Villous atrophy induced by HIV and Microsporidia is attributed to crypt cell hyperplasia and the encroachment of crypt cells onto villi. These infections induce crypt hypertrophy by stimulating cell mitosis predominantly in transit cells but also in stem cells. Increased stem cell proliferation occurs only in high proliferation cases.