ABSTRACT Introduction South Africa is estimated to have the largest number of HIV infected adults in Southern Africa with a higher HIV prevalence in females compared to males. While significant reductions in morbidity and mortality due to HIV and AIDS have been realized for over a decade internationally, HIV treatment involving highly active antiretroviral therapy (HAART) is still a relatively new phenomenon in this country and gender differences in HIV outcomes between males and females in South Africa have not been previously well described. This study aimed to determine and describe gender differences in clinical and immunological outcomes in a population of HIV infected South African adults initiated on HAART. Materials and Methods This retrospective data analysis reviewed 6,617 HIV-infected adultsABSTRACT Introduction South Africa is estimated to have the largest number of HIV infected adults in Southern Africa with a higher HIV prevalence in females compared to males. While significant reductions in morbidity and mortality due to HIV and AIDS have been realized for over a decade internationally, HIV treatment involving highly active antiretroviral therapy (HAART) is still a relatively new phenomenon in this country and gender differences in HIV outcomes between males and females in South Africa have not been previously well described. This study aimed to determine and describe gender differences in clinical and immunological outcomes in a population of HIV infected South African adults initiated on HAART. Materials and Methods This retrospective data analysis reviewed 6,617 HIV-infected adults initiated on HAART at the Themba Lethu Clinic, an urban public-sector antiretroviral rollout facility in Johannesburg, South Africa between 1st April 2004 and 31st March 2007. Clinical data from these antiretroviral naïve patients was analysed for gender differences in mortality, rates of loss to follow up, CD4 cell count response, virologic suppression and weight gain. Cox regression models and logistic regression models were used to estimate hazard ratios (HR) and odds ratios (OR), respectively, for associations between gender and outcomes. Models were adjusted for age and baseline CD4 count. Results At baseline, 4,388 (66.3%) women were significantly younger (p<0.0001) and less likely to be employed than the 2,229 (33.7%) men (p<0.001). Furthermore, women had significantly higher baseline CD4 counts (p<0.0001) and higher body mass index (BMI) (p<0.0001). Males experienced significantly reduced survival compared to females (p=0.0053) by Kaplan-Meier analysis. In adjusted multivariate analysis, men were 22% more likely to die or become lost to follow up than women [HR = 1.22 (95% CI 1.06 - 1.39]. The period with the highest risk of mortality or loss to follow up was within six months of starting HAART. Female gender was associated with better CD4 count response. In multivariate analysis adjusted for age and baseline CD4 count, women were 35% more likely to achieve a 100 cell increase in CD4 count at four months after initiation of HAART [OR =1.35 (95% CI = 1.19 -1.54)] and 45% more likely to increase their CD4 counts by 100 cells/mm3 after ten months on HAART [OR =1.42 (95% CI = 1.20 -1.68)] when compared to men. Women were also more likely to achieve virologic suppression at ten months post HAART initiation [OR =1.54 (95% CI =1.21-1.97)] and were more likely to have gained weight after four months on treatment than males [OR = 1.26 (95% CI = 1.07–1.49)] after adjusting for age, baseline CD4 count and baseline BMI. Conclusions Women had significant advantages over men in terms of short-term clinical and immunological outcomes. Earlier access treatment for men should be facilitated and adherence should be promoted once on treatment. Further research is required to determine if these gender differences persist during long-term HAART.

Introduction: Cystic lymphoid hyperplasia (CLH) is a common yet under recognised entity affecting the parotid gland in HIV infected patients. This is the largest global clinicopathological study of CLH to date consisting of 167 cases (85M, 82F). Aim: To define the clinical parameters, histology and immunopathological features of CLH with a view to elucidating the aetio-pathogenesis. Material and Methods: This retrospective study on archival cases of CLH included patient’s age, race, gender, nature of CLH, HIV status, CD4 counts and viral loads where available. Of the 167 confirmed cases of CLH, 109 cases were histologically reviewed and 25 cases were immunohistochemically analysed with CD3, CD20, CD4, CD8 and p24 using standard procedures. Ethics clearance (M080927 and M080850) was obtained. Results: CLH mainly affects the parotid gland with a male predominance. Submandibular gland (p = 0.27) and bilateral parotid involvement favours females (2:1). CLH affects females at a younger mean age in both the parotid and submandibular glands (36.5, 31 years) respectively compared to males (40.9, 42.4 years) (p = 0.0032). Intra-lymph nodal origin is favoured with 76.1% of cases occurring within entrapped salivary gland remnants. P24 staining reveals ~90% specificity in HIV associated CLH. Immunostaining showed a CD8:CD4 of ~1:1 except in selected cases where CD4 was decreased in the interfollicular areas. Conclusion: CLH is the preferred term to describe bilateral parotid enlargement in HIV infected patients. This study strongly supports origin of CLH following ductal ectasia of entrapped salivary gland inclusions within atypical lymphoid hyperplasia arising within lymph nodes in the context of an HIV setting. CLH should be classified as an orofacial lesion strongly associated with HIV and AIDS.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg in partial fulfilment of the requirements for the degree of Master of Science Physiotherapy. Johannesburg, 2014 / HIV is a global epidemic with the majority of people infected living in Sub-Saharan Africa. The era of Highly-Active Antiretroviral Therapy has resulted in HIV infected children living longer lives and more commonly reaching school going age. These children are expected to participate at the same level as their peers despite the numerous effects that HIV and HAART have on the body. The aim of this cross sectional comparative study was to compare the exercise endurance of a group of HIV infected children to that of their uninfected peers. Sixty children aged between seven and ten years were enrolled in the study; 30 HIV infected children and 30 children not infected with HIV. Children were assessed using the six minute walk test (6MWT) according to American Thoracic Society guidelines. The two groups were well matched in terms of socio-economic status, gender and age. Statistically significant differences were found when comparing anthropometric measurements of height and weight with HIV infected participants being shorter and weighing less than their non-infected peers. The distance walked in the 6MWT was significantly reduced in the HIV infected participants with these children walking 57.86 metres less than the non-infected participants. It was also found that HIV infected children had significantly lower heart rates at all stages of testing. Correlations were found between the distance walked in the 6MWT and average and maximum heart rates. This study confirms that the exercise endurance of a group of HIV infected children is significantly reduced when compared to their age matched non-infected peers. It indicates the need for further investigation into the exercise endurance in HIV-infected children in a larger more representative sample of the population. Further investigation into the possible benefits of the prescription of exercise programmes in children needs to be done.

In the context of decreasing mortality and increasing prevalence, prevention of HIV-transmission represents a public health priority. In the United States, the majority of infections are sexually-acquired, with men who have sex with men and minorities disproportionately affected. Although a number of promising biomedical prevention approaches have emerged over the past decade, a further 20 years could be needed before a suitable product becomes widely available. Evidence from vaccine and microbicide trials has shown that success in one population may not be replicated in another. To understand surprising or unexpected results, investigators need chronologically concordant evidence of both study product adherence and viral exposure. Since exposure to HIV cannot yet be independently verified, in seeking to measure this variable, investigators target the sexual behaviors through which it takes place deriving data for these surrogate measures from study participants' voluntary self-reports. Likely sources of reporting bias and efforts to minimize this phenomenon in the context of HIV-prevention research are critically reviewed in Chapter 1. Research describing the role of cognitive and affective functioning in the preparation of responses to potentially threatening questions is examined. Studies investigating techniques such as the use of colloquial language to facilitate comprehension, or variation in the length of the reference period to enhance recall are explored. Research comparing the effect of mode of administration on the amount of proscribed behavior reported - widely believed to correlate with validity - is reviewed. Contextual factors facilitating versus inhibiting disclosure of sensitive information are examined. Finally, risk-behavior measurement approaches used in selected HIV-prevention trials are inspected. Thereafter, the dissertation focuses on the properties of risk-assessment items, formulated specifically to elicit Global recall over six months, or Event-Specific (episodic) memory for selected recent episodes of limited duration, to capture sexual behaviors or temporally related activities. The capacity of the different questionnaire item formats to elicit responses with sufficient construct validity to serve as proxies for HIV-exposure is examined. Data for these studies are drawn from a large randomized controlled trial of a behavioral intervention to prevent HIV-transmission among men who have sex with men. Using a subset of 1295 cases and controls, models with good discriminant validity for HIV are derived separately for the Global and Event-Specific items. Thereafter, selected items from the two formats are combined to produce a single model with excellent discriminant validity, suggesting that these items can adequately represent true HIV-exposure. Next, a preliminary investigation of the contribution of psychosocial items to the predictive model based on exposure measures is undertaken. Specifically, interaction with exposure measures and the increase in discriminant validity obtained using data derived from constructs of partner type/relationship status, substance use, depressive symptoms and perceived self-efficacy is examined first in stratified analysis and then in logistic regression analysis using the case-control data. Effect-modification is observed for perceived relationship status and non-injection drug use. Evaluation of psychosocial items continues in a cohort study with prospective analysis of follow-up data from all trial participants who returned for at least one follow-up visit. Informed by the case-control study, a series of items representing psychosocial constructs known for their association with HIV-infection are tested for main effects and effect-modification. Evidence of the interaction observed in stratified analyses and confirmed in ordinary logistic regression persists in separate, topic-specific GEE analyses with assorted exposure measures, but abates in repeated measures analyses drawing on all available psychosocial items. Lastly, a single lagged variable indicating primary relationship status of the most recent partner (with respect to the preceding study visit) provides a significant addition to the model. Significant main effects for all except depressive symptoms and perceived self-efficacy and the increase in discriminant validity obtained for the multivariable model versus the `exposure-only' model are sufficient to warrant continued use of these risk-assessment items. Despite good predictive validity demonstrated for the sexual risk-behavior and psychosocial items, some inconsistent reporting between the Global and Event-specific formats is evident. Likely sources of this reporting bias are considered in light of the literature, and strengths and limitations of the overall study are discussed in the closing chapter.

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Thesis (B.A.)--Haverford College, Dept. of Economics, 2007. / Includes bibliographical references.

Thesis (Ph. D.)--University of Kentucky, 2000. / Title from document title page. Document formatted into pages; contains vi, 137 p. : ill. Includes abstract. Includes bibliographical references (p. 108-135).

Thesis (Ph. D.)--Oregon State University, 2010. / Printout. Includes bibliographical references (leaves 116-124). Also available on the World Wide Web.

Thesis (Ph. D.)--Lehigh University, 2000. / Includes vita. Includes bibliographical references (leaves 83-100).