M.Med.(Paediatrics), Faculty of Health Sciences, University of the Witwatersrand, 2011 / Medium and large vessel vasculopathy in HIV-infected patients is an uncommon but important cause of mortality and morbidity in both adult and paediatric patients. The estimated frequency in children from the current literature is 1-2%. The overall HIV prevalence among children 18 years of age and younger in South Africa is currently 2.9%. This series reports on medium and large vessel vasculopathy in children with HIV. Six HIV infected children seen at three Johannesburg hospitals between 2000 -2006, are described, all presenting with complications arising from medium and/or large vessel involvement. Additional cases are reviewed from the literature. A description of the clinical presentation, radiological investigations, the possible aetiology, pathophysiology and management of these patients is presented. The case series and literature review compares HIV vasculopathy and Takayasu’s arteritis. Both entities can present with multiple aneurysms and a diagnosis of tuberculosis, thus a possible link in the pathogenesis is explored. Most patients with HIV vasculopathy present while severely immunosuppressed. However, some patients in the case series and literature review present despite adequate viral suppression, suggesting the possibility of an immune-reconstitution inflammatory syndrome in the pathogenesis of this vascular complication. Medical management and in selected cases, surgery, has been used in the management of patients with HIV vasculopathy. The outcomes thus far are good.

Thesis (M.Sc. Med.) (Epidemiology and Biostatistics))--University of the Witwatersrand, Faculty of Health Sciences, 2014. / Introduction Ano-genital warts affect at least 30 million people worldwide. Ano-genital warts are caused by low risk Human Papilloma virus infections in 90% of cases. In African populations the ano-genital warts have not been adequately investigated thus our main goal was to highlight the factors associated with the occurrence of ano-genital warts among HIV infected individuals. Studies in both men and women have shown that the likelihood of getting anogenital warts is significantly increased when one is infected with HIV hence the need to investigate in this population. More over data suggests that HPV infection occur more frequently among HIV infected individuals because of the HIV associated CD4+ T-cell immune-suppression. Methods We conducted an analytical cross sectional study of routinely collected secondary medical data from Ward 21 ART clinic at the Hillbrow community centre in Hillbrow Johannesburg central. Our study participants were all HIV infected patients 16 years and older who attended the ART clinic between 01 January 2009 and 31 December 2011 and were recorded in the therapy edge database. Our outcome was clinically diagnosed ano-genital warts. We analysed data using the Chi squared test or Fischers exact test to make comparisons in bivariate analysis. Logistic regression was used to assess factors associated with ano-genital warts. Factors assessed were other STIs namely syphilis, herpes simplex virus type 2 and scabies as well as age, gender, first CD4 and employment status and ART status of a patient. The Models were assessed using the linktest and the Hosmer Lemeshow goodness of fit test. Results Ano-genital warts (AGWs) prevalence was 4% (251 out of 6634) among females and 3% (118 out 4116) among males. Prevalence of AGWs in both females and males decreased with increasing age. In females the prevalence was between 1% and 8% and in males it was between 1% and 4%. The odds of having ano-genital warts among females if one was above 25 years ranged from 1.6 to 18.3, showing an upward trend. Among females a CD4 count of less than 200 cells/ml3 was also associated with ano-genital warts occurrence, OR 1.32(1.02 - 1.72). Among males the odds of having ano-genital warts if one was not on ART were 1.53 (1.01 – 2.31) times when compared to those who were on ART. Discussion and Conclusion Prevalence of genital warts was highest among the younger age groups in both males and females and it decreased with increasing age consistent with literature. Age was strongly associated with ano-genital warts and the association became stronger with increasing age among females while no association was found among males. In line with findings from other studies we found low CD4 count of ≤ 200 cells/m3 to be associated with ano-genital warts in HIV positive females; however it was a weak association. Among males a weak association between ART status and ano-genital warts was established and none in females. This is consistent with the fact that in the post ART era there has been no substantial decline in HPV infections.

Purpose: To describe the clinical presentation, ocular complications and clinical implications of acute HZO in HIV positive patients. Method: Prospective descriptive clinical case series of 54 individuals aged 18 – 50 years with confirmed HIV infection and acute presentation of HZO. Results: A female preponderance (1.7:1) and mean age of 36.6 years (range 18 – 49 years) was recorded. The majority of patients were referred from CHC and only 28% of referred patients received appropriate antiviral treatment at the referral site. Mean duration of rash at presentation was 4.7 days (range 1 – 12 days) with 31% of patients presenting within 3 days of rash eruption. Patients attended a mean of 2.7 clinical visits. Equal proportions had known and unknown HIV serostatus at presentation. Mean CD4+ was 276 cells/mm3 (range 44 - 859 cells/mm3). 67% of patients had a CD4+ count < 350 cells/mm3. Periocular discomfort was the most common presenting symptom (70%); decreased VA (2%) was an uncommon presenting symptom. Multidermatomal involvement was uncommon (7%). At presentation normal VA was seen in 69% of patients and 94% had no global visual impairment. Corneal complications (89%) and intraocular inflammation (46%) were the most common ocular complications. Ocular complications at presentation and multiple complications were the rule (70% and 61%). Hutchinson sign was found to be of little clinical value. Visual outcome was fair, 22% of patients having residual visual impairment. Post-herpetic neuralgia was common (74%). Conclusion: HZO is a common HIV marker condition with ocular complications. It may have an application as an indication for the initiation of ARV treatment.

Thesis (M.S.)--University of Hawaii at Manoa, 2007. / Includes bibliographical references (leaves 13-17). / vii, 17 leaves, bound ill. 29 cm

Amendments appended. / Bibliography: leaves 140-165. / xi, 165 leaves : ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, Dept. of Microbiology and Immunology, 2005

Background Several case reports and studies have alluded to an increased prevalence of venous thrombosis in human immunodeficiency virus positive (HIV-positive) patients. Although a relationship between HIV infection and thrombotic disease has been suggested, the mechanisms predisposing to thrombosis have not been fully elucidated. Aim A prospective study, to determine possible coagulation factor abnormalities that could explain the predisposition to thrombosis in HIV-infected African (Black) patients, was undertaken. Method African (Black) patients, with acute upper segment deep vein thrombosis (DVT) confirmed by duplex ultrasound, were enrolled. Patients who had recognisable risk factors such as recent surgery, pregnancy or malignancy, were excluded. After informed consent, blood samples were taken for baseline tests as well as a thrombophilia screen. The control group comprised known HIV-positive African (Black) patients without DVT. Patients with DVT who were found to be HIV-negative were also analysed. Analysis was done in 2 parts: HIV-positive patients with and without thrombosis and HIV-positive and negative patients with thrombosis were compared. Results Part A: HIV-positive patients with and without thrombosis Of the 77 patients with DVT, 50 patients tested HIV-positive. These 50 patients (HIV-positive DVT-arm), as well as 56 controls (HIV-positive, no DVT), were enrolled into the study. The groups were well matched with regard to age, sex and cluster designation 4 (CD4) count. On univariate analysis, significant findings in the DVT-arm were a history of active tuberculosis on treatment, low protein C levels and a positive qualitative D-dimer, whereas on multivariate analysis, only tuberculosis and an elevated D-dimer proved to be significant. Part B: HIV-positive and negative patients with thrombosis There were 20 HIV-negative patients with DVT who met our inclusion criteria Limited assessment was done on this group owing to unavailability of some data. The mean age of the HIV positive DVT group was significantly lower than the HIV-negative group with DVT (31.78 vs. 41.45 years; p=0.005). There was no significant difference in the prevalence of tuberculosis between the HIV-positive and HIV-negative patients with thrombosis (p = 0.269). Mean protein C levels were reduced in the HIV-positive group and normal in the HIV-negative group. They were significantly lower in the HIV-positive patients compared to the negative group (p=0.02). Conclusion The findings of the study suggest a relationship between HIV, its complications and DVT. Although this study confirms HIV infection as a risk factor for thrombosis, clear pathogenetic mechanisms remain to be elucidated. In our population, tuberculosis appears to be an important risk factor predisposing patients to the development of DVT, both in the HIVpositive and negative population. Further studies will need to be done to confirm this hypothesis. / Thesis (MMed)-University of KwaZulu-Natal, Durban, 2006.

Thesis (MSc)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: In recent years, HIV-associated cancers have proven to be the bane of our time, since HIV is decimating humanity across the globe, even in the twilight of the last century. Cancer rates continue to rise in developing countries, where 95% of the world’s HIV-infected population lives, yet less than 1% have access to antiretroviral therapy. HIV-infected individuals have a higher proclivity to develop cancers, mainly from immunosuppression. An understanding of the immunopathogenesis of HIV-related cancers (HRC) is therefore a major prerequisite for rationally developing and/or improving therapeutic strategies, developing immunotherapeutics and proplylatic vaccines. In this study, we explore the pathology of HIV-related cancer malignancies, taking into account the pathogenic mechanisms and their potential for improving the treatment of management of these malignancies especially in developing countries. We mathematically model the dynamics of malignant tumors in an HIV-free environment, investigate the impact of cancer malignancies on HIV-positive patients and explore the benefits of various therapeutic intervention strategies in the management of HIV-related cancers. We present two deterministic models of infectious diseases to implement these, and they were analysed. We use HIV-related lymphomas in the Western Cape of South Africa as a case study. We validated the proposed models using lymphoma incidence data from the Tygerberg Lymphoma Study Group (TLSG), Tygerberg Hospital, Western Cape, South Africa. We show that the increasing prevalence of HIV increases lymphoma cases, and thus, other HIV-related cancers. Our models also suggests that an increase in the roll-out of the HAART program can reduce the number of lymphoma cases in the nearest future, while it averts many deaths. Furthermore, the results indicate that a highly crucial factor to consider in the prognosis of the incidence of lymphoma (and other cancer types) in HIV-infected patients is their CD4 cell count, irrespective of whether the patient has developed an HRC or not.

Thesis (MCurr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Taking into consideration the long duration of standard treatment for Mycobacterium tuberculosis (TB), the high prevalence of HIV co-infection and the growing prevalence of drug-resistant TB, there is an urgent need for improved treatment approaches for TB and HIV. However, there is inadequate information regarding the burden being placed on the Department of Health (DOH) systems by the current treatment of patients established on Antiretroviral Therapy (ART) who are newly diagnosed with TB, and by their clinical management. The aim of the study was to determine what proportion of patients established on ART were newly diagnosed with TB, and what their clinical and treatment outcomes were in different public sector settings in the eThekwini Region, KwaZulu-Natal (KZN). Approval for the study was obtained from the Human Research Committee of Stellenbosch University and from the Biomedical Research Committee, KZN. The study used a retrospective, quantitative, cohort technique at both TB and ART clinics at three sites in the eThekwini region, KZN. These sites were DOH clinics and were selected as they all had a TB clinic and a DOH-registered ART clinic. The study focused on a period of one year prior to a patient established on ART developed TB. The study population comprised all TB patients who attended the selected DOH clinics. A data collection tool was developed and pilot-tested. A small sample of patient files (n=15, representing 2% of the study population) was randomly selected; five from each site. The files and data were excluded from the main study. A total of 1824 files (579 from the TB clinics and 1245 from the ART clinics) were reviewed. The data were captured into an electronic database (EpiData Version 3.3) and analyzed using STATA (Version 11.0) with the assistance of a statistician. The findings show that of the study sample from the TB clinics (N=579), 78% (454/579) were newly diagnosed with TB. Of the new TB cases, 90% (409/454) had pulmonary TB and 71% (413/579) were HIV-positive. Nearly 50% (68/137) of the patients had commenced ART prior to TB diagnosis and treatment, and 14% (19/137) had commenced ART after TB. Of those who commenced ART prior to TB diagnosis and treatment, 29% (20/68) had commenced ART more than three months prior to acquiring TB. The findings from the ART clinics show that of the files (N=1245) reviewed, 40% (501/1245) had TB, and of these 8% (42/501) developed TB after three months or more of ART. Missing data in the patient medical files was a major challenge. The lack of recorded data about ART in the TB clinics and about TB in the ART clinics suggests suboptimal clinical management and poor integration of HIV and TB services. It was therefore not possible to derive a combined HIV-TB outcome measure. Recommendations to promote and implement the integration of TB and HIV services included policy changes and implementation, management and practice suggestions, education and training to integrate TB/HIV services and increase research to identify gaps in clinical management and to improve integration of services. / AFRIKAANSE OPSOMMING: Met inagneming van die lang duur van die standaard behandeling vir Mycobacterium tuberkulose (TB), hoë voorkoms van MIV-infeksie en die groeiende voorkoms van dwelmweerstandige TB, is daar ’n dringende behoefte aan verbeterde behandelingbenaderings vir TB en MIV. Daar is egter ’n gebrek aan inligting oor die las geplaas op die Departement van Gesondheid (DvG) se stelsels deur die huidige behandeling van pasiënte op antiretrovirale terapie (ART) wat gediagnoseer is met TB en deur hul kliniese bestuur. Die doel van die studie was om vas te stel watter persentasie van pasiënte wat op ART gevestig is, wel met TB gediagnoseer is, en wat hul kliniese en behandeling-uitkomste was in verskillende openbare-sektorinstellings in die eThekwini-streek, KwaZulu-Natal (KZN). Goedkeuring vir die studie is verkry van die Menslike Navorsingskomitee van die Universiteit van Stellenbosch en van die Biomediese Navorsingskomitee, KZN. Die studie het gebruik gemaak van ’n retrospektiewe, kwantitatiewe ‘cohort’-tegniek by beide TB en ARB-klinieke op drie plekke in die eThekwini-streek, KZN. Hierdie terreine was DvG-klinieke en is gekies omdat hulle almal oor ’n TB-kliniek en 'n DvGgeregistreerde ART-kliniek beskik. Die studie het gefokus op ’n tydperk van een jaar voor ’n pasiënt wat op ART is, TB ontwikkel het. Die studiepopulasie bestaan uit alle TBpasiënte wat die geselekteerde DvG-klinieke bygewoon het. ’n Data-insamelinginstrument is ontwikkel en getoets. ’n Klein voorbeeld van die pasiëntlêers (n = 15, 2% van die studie bevolking verteenwoordig) is ewekansig gekies: vyf uit elke plek, en die data is vervat in ’n elektroniese databasis (EpiData Version 3,3). ’n Totaal van 1824 lêers (579 in die TB-klinieke en 1245 lêers in die ART-klinieke) is ondersoek. Die data is ontleed deur gebruik te maak van Stata (weergawe 11,0) met die hulp van ’n statistikus. Die bevindinge toon dat van die studiemonster in die TB-klinieke (N = 579), 78% (454/579) met TB gediagnoseer is. Van die nuwe TB-gevalle, het 90% (409/454) pulmonêre TB gehad en was 71% (413/579) MIV-positief. Byna 50% (68/137) van die pasiënte het ART begin vóór hulle TB-diagnose en -behandeling, en 14% (19/137) ART ná TB. Van dié wat ART voor TB-diagnose en -behandeling begin het, het 29% (20/68) meer as drie maande voor die opdoen van TB met ART begin. Die bevindinge van die ART-klinieke toon dat van die lêers (N = 1245) wat bestudeer is, 40% (501/1245) TB het, en hiervan het 8% (42/501) TB na drie of meer maande van ART ontwikkel. Ontbrekende data in die pasiënt se mediese lêers was ’n groot uitdaging. Die gebrek aan aangetekende data oor ART in die TB-klinieke en oor TB in die ART-klinieke dui op suboptimale kliniese bestuur en swak integrasie van MIV- en TB-dienste. Dit was dus nie moontlik om ’n gesamentlike MIV-TB uitkomsmaatreël af te lei nie. Aanbevelings om die integrasie van TB- en MIV-dienste te bevorder en te implementer, het beleidveranderinge en -implementering ingesluit, asook bestuur- en praktykvoorstelle, onderwys en opleiding om TB-/MIV-dienste by DvG-vlak te integreer en meer navorsing om gapings in die kliniese bestuur te identifiseer en die integrasie van dienste te verbeter.

Currently, HIV/AIDS is one of the greatest threats to child survival in South Africa. It is estimated that approximately 6000 newborn babies become infected with the HIV virus monthly i.e. approximately 200 babies per day. During a 24 month period (October 1999 &ndash / October 2001), a descriptive prevalence study of the oro-facial manifestations affecting HIV-positive children was conducted in the Cape Peninsula, South Africa. The study population consisted of 268 vertically infected HIV-positive children. The study was motivated by the lack of data regarding oral mucosal lesions in children with vertically acquired HIV-infection.<br /> <br /> The study design was descriptive, and the population included consecutive, vertically infected HIV-positive patients sourced from out-patient clinics, hospital wards and special child-care facilities. The children were examined once consent was obtained from caregivers. The findings were documented using data capturing sheets. The data was captured on the Microsoft Excel program and analysed using the Epi 2000 program. The results indicated that a large proportion of HIV-infected children presented with orofacial manifestations at some stage during the course of HIV-infection. Oro-facial manifestations were observed in 70.1% of the study population. The prevalence of the most commonly observed manifestations were: oral candidiasis, 38.8% / parotid gland enlargement, 10.8% / oral ulceration, 5.6% / molluscum contagiosum, 7.8% / periodontal conditions, 3.4% / and herpes simplex infection, 0.7%.It can be concluded that in this sample of HIV-infected children, the prevalence of orofacial manifestations is higher than, and comparable with the findings of similar studies conducted in other regions of the world.

Weight loss is a common occurrence in patients with human immunodeficiency virus (HIV) and contributes to further debilitation in the acquired immune deficiency syndrome (AIDS). Wasting syndrome (WS) is defined as 10% or more unintentional weight loss from usual body weight. The etiology of WS includes alterations in metabolism, which contribute to loss of lean body mass. Cytokine driven oxidative stress may play a critical role in the metabolic pathways that lead to HIV wasting. Studies have shown that that patients infected with HIV may have a depleted antioxidant (AO) defense system, the integrity of which is needed to efficiently scavenge reactive oxygen species (ROS). It has been theorised that low AO intake may contribute to a depressed AO defense system, which drives oxidative stress (OS). In this study we examined 16 subjects who had documented WS but no active infectious process, stratified into 10 to 15% weight loss (n = 7) and over 15% weight loss (n = 9) groups, and reported on oxidative stress measures and AO intake. (Abstract shortened by UMI.)