The ability to accelerate the accumulation of favorable combinations of mutations renders recombination a potent force underlying the emergence of forms of HIV that escape multi-drug therapy and specific host-immune responses. In this study, a mathematical model is developed that describes the dynamics of the emergence of recombinant forms of HIV following infection with diverse viral genomes. Mimicking recent in vitro experiments, target cells simultaneously exposed to two distinct, homozygous viral populations are considered and dynamical equations are constructed that predict the time-evolution of populations of uninfected, singly infected, and doubly infected cells, and homozygous, heterozygous, and recombinant viruses. Model predictions capture several recent experimental observations quantitatively and provide insights into the role of recombination in HIV dynamics. Comparisons of data from single round infection experiments with model predictions of the probability with which recombination accumulates distinct mutations present on the two genomic strands in a vision, indicates that »8 recombinational strand transfer events occur on average (95% confidence interval: 6-10) during reverse transcription of HIV in T cells. Model predictions of virus and cell dynamics describe the time-evolution and the relative prevalence of various infected cell subpopulations following the onset of infection observed experimentally. Remarkably, model predictions are in quantitative agreement with the experimental scaling relationship that the percentage of cells infected with recombinant genomes is proportional to the percentage of cells co-infected with the two genomes employed at the onset of infection. The model developed thus presents an accurate description of the influence of recombination on HIV dynamics in vitro. When distinctions between different viral genomes are ignored, the model reduces to the standard model of viral dynamics, which successfully predicts viral load changes in HIV patients undergoing therapy. The model developed may thus serve as a useful framework to predict the emergence of multi-drug resistant forms of HIV in infected individuals.

Chronic liver disease (CLD) is a leading cause of morbidity and mortality in HIV-infected individuals. The purposes of this study were to determine the prevalence and etiologies of CLD in an urban HIV-infected population and to identify CLD risk factors. We conducted a retrospective chart review of 799 HIV-infected patients seen at four New Haven health centers from 2002 to 2003. We applied the New Haven County Liver Study definition to identify patients with CLD. 65% were male, 44% were African American, and 23% were of Hispanic ethnicity. The mean age was 45 years. 30% had a history of alcohol abuse. 35% reported injection drug use as their HIV risk factor. Heterosexual contact and men having sex with men (MSM) were reported in 31% and 16% of cases. 50% of patients had a diagnosis of AIDS. 60% percent of patients had CLD. Over 50% of cases of CLD were attributed to chronic hepatitis C (HCV), either alone or with coexisting alcoholic liver disease. Alcoholic liver disease alone, hepatitis B virus (HBV), HAART-induced liver disease, and non-alcoholic liver disease (NAFLD) accounted for smaller percentages. 84% of patients were on HAART, but only 3.6% of patients with positive HCV or HBV serologies were on treatment for CLD. 75% of patients received pneumococcal and influenza vaccines, but only half of eligible patients received hepatitis A and B vaccines. In multivariate analysis, alcohol abuse and positive HCV status were associated with CLD. CLD is prevalent in our population. Preventive care and treatment for CLD are being overlooked in many. Vaccines, treatment for viral hepatitis, and strategies for reducing drug and alcohol abuse are priorities.

The study sought to determine the prevalence and the risk factors for malnutrition in 88 HIV positive children less than 18 months attending Hospital Paediatric ARV Clinic (HPAC). The study used quantitative methods. A questionnaire was administered to the child’s caregiver to assess infant, caregiver and socio-economic risk factors for malnutrition after written consent had been obtained. The history of the patient was extracted from the HIV patient care booklet. Nutritional status was assessed using WHO standard growth charts in children and body mass index (BMI) in adults.

<p>Background-Namibia has a high HIV and malnutrition burden. HIV increases the risk of&nbsp / malnutrition and malnutrition results in rapid progression of the disease and worsening malnutrition. Nutrition plays an important role in the management of an HIV positive child. Optimal nutrition delays disease progression, improves immune function and the effectiveness of antiretroviral drugs thereby improving the quality of life of the child. Early identification of children at risk of malnutrition is therefore essential to prevent malnutrition in HIV positive children. Methodology-The study sought to determine the prevalence and the risk factors for malnutrition in 88 HIV positive children less than 18 months attending Hospital Paediatric ARV Clinic (HPAC). The study used quantitative methods. A questionnaire was administered to the child&rsquo / s caregiver to assess infant, caregiver and socio-economic risk factors for malnutrition after written consent had been obtained. The history of the patient was extracted from the HIV patient care booklet. Nutritional status was assessed using WHO standard growth charts in children and body mass index (BMI) in adults. Results- The study showed that 56.8% of children were wasted (14.8% had severe wasting), 52.3% were stunted (18.2% had severe stunting) and 69.3% underweight (20.5% were severely underweight). This level of malnutrition is much higher than the rates of 8% wasting, 29% stunting and 17% underweight in the general paediatric population. Malnutrition in children was associated with fewer number of working adults per family, frequent illnesses in the child, low level of caregiver education, caregiver unemployment, low household income and lack of adequate food in the family. Children of malnourished caregiver were more likely to be underweight. Conclusions- The results showed a high prevalence of malnutrition (56.8%wasting, 52.3%stunting and 69.3% underweight) among HIV positive infants attending the HPAC. The study showed that poverty and food insecurity were strongly associated with malnutrition in children. This therefore&nbsp / highlights the urgent need to address poverty to reduce malnutrition in the community. Although the study did not show any statistically significant association between feeding practices and malnutrition in children, health workers should encourage HIV positive mothers to breastfeed their infants as per the WHO and Namibian antiretroviral therapy guidelines (2010). Recommendations - There is need to train health workers to identify and manage malnourished children early. Linkages with social services must be improved and strengthened to help reduce poverty in the community.</p>

<p>Many studies have reported low cure rates for multidrug-resistant tuberculosis (MDRTB) patients and MDR-TB patients co-infected with human immunodeficiency virus (HIV). However, little is&nbsp / known about the effect of HIV infection and antiretroviral therapy on the treatment outcomes of MDR-TB in South Africa. Therefore, the objectives of the study are: to find out whether HIV infection&nbsp / and interactions between ARVs and second line anti-TB drugs have an impact on the following MDR-TB treatment outcomes: cure rate and treatment failure at Brewelskloof Hospital. MDR-TB&nbsp / patients were treated for 18-24 months. The study was designed as a case-control retrospective study comparing MDR-TB treatment outcomes between HIV positive (cases) and HIV negative&nbsp / patients (controls). Patients were included in the study only if they complied with the following criteria: sensitivity to second line anti-TB drugs, MDR-TB infection, co-infection with HIV (for some&nbsp / of them), male and female patients, completion of treatment between 1 January 2006 and 31 December 2008. Any patients that presented with extreme drug-resistant tuberculosis (XDR-TB)&nbsp / were excluded from the study. Data were retrospectively collected from each patient&rsquo / s medical records. There were a total of 336 patients of which 242 (72%) were MDR-TB patients and 94&nbsp / (27.9%) MDRTB co-infected with HIV patients. Out of the 242 MDR-TB patients, 167 (69.2%) were males and 75 (30.7%) were females. Of the 94 patients with MDR-TB co-infected with HIV, 51&nbsp / (54.2%) males and 43 (45.7%) females. Patients with multidrug-resistant tuberculosis co-infected with HIV who qualify for antiretroviral therapy were treated with stavudine, lamivudine and&nbsp / efavirenz while all MDR-TB patients were given kanamycin, ethionamide, ofloxacin, cycloserine and pyrazinamide. The cure rate of MDR-TB in HIV (+) patients and in HIV (-) patients is 34.5%&nbsp / and 30 % respectively. There is no significant difference between both artes (pvalue = 0.80). The MDR-TB cure rate in HIV (+) patients taking antiretroviral drugs and in HIV (+) patients without&nbsp / antiretroviral therapy is 35% and 33% respectively. The difference between both rates is not statistically significant. The study shows that 65 (28.0%) patients completed MDR-TB treatment but&nbsp / could not be classified as cured or failure, 29 (12.5%) patients failed, 76 (32.7%) defaulted, 18 (7.7%) were transferred out and 44 (18.9%) died. As far as treatment completed and defaulted is concerned,&nbsp / there is no significant statistical difference between HIV (+) and HIV (-) The number of patients who failed the MDR-TB treatment and who were transferred out is significantly higher in the HIV (-)&nbsp / group than in the HIV (+) group. Finally the number of MDR-TB patients who died is significantly higher in the HIV (+) group). The median (range) duration of antiretroviral therapy before starting&nbsp / anti-tuberculosis drugs is 10.5 (1-60) months. According to this study results, the MDR-TB treatment cure rate at Brewelkloof hospital is similar to the cure rate at the national level. The study also&nbsp / hows that HIV infection and antiretroviral drugs do not influence any influence on MDR-TB treatment outcomes.</p>

Human Immunodeficiency Virus (HIV) has become a global pandemic with at least 25 million deaths and no cure. One of the most important targets to inhibit this virus is HIV-1 protease (PR), which is required to cleave the viral proteins needed for maturation of the virus after it invades and replicates in the host cell. There are nine protease inhibitors that are used in AIDS treatment. The virus loses susceptibility to these inhibitors by drug resistance due to mutations. The goal of the project is to examine the highly drug resistant HIV PR P51 in its complex with inhibitors. In this experiment we expressed and purified HIV PR P51 protein. We performed protein crystallization with inhibitors Tipranavir, Amprenavir, Darunavir, and Saquinavir to obtain the structure of the protease and the inhibitors in their complexes. Future analysis of the crystal structures will help with the development of successful therapeutic inhibitors.

This thesis presents data on two separate areas relevant to the prevention of HIV and sexually transmitted infection (STI) transmission in homosexual men. These data arise from the community-based Health in Men (HIM) cohort of HIV-negative homosexual men in Sydney. First, the association of circumcision status with HIV and STIs was examined. Older age, ethnicity and country of birth were demographic factors independently associated with circumcision status. Self-report was a valid measure of circumcision status in this population. Overall, being circumcised was associated with a non-significant reduced risk of HIV seroconversion in the HIM cohort (HR 0.76, 95% CI 0.41-1.41, p=0.381). Among the one-third of participants predominantly practising the insertive role in anal intercourse (AI), being circumcised was associated with a significantly reduced risk of HIV infection (HR 0.15, 95% CI 0.03-0.80, p=0.026). Circumcised HIM participants also had a lower risk of incident syphilis (HR 0.35, 95% CI 0.15-0.84, p=0.019), however circumcision status had no significant effect on the remainder of prevalent and incident STIs examined. Second, risk factors for pharyngeal gonorrhoea and chlamydia were investigated. The BD ProbeTec nucleic acid amplification test (NAAT) had a positive predictive value (PPV) for pharyngeal gonorrhoea diagnosis of only 30.4% (95% CI 25.2-36.1%) when compared to a previously validated NAAT targeting the gonococcal porA pseudogene. Pharyngeal gonorrhoea was common in HIM, mostly occurred without concurrent anogenital infection and may frequently spontaneously resolve. Infection was independently associated with younger age (p-trend=0.001), higher number of male partners (p-trend=0.002), contact with gonorrhoea (p<0.001) and insertive oro-anal sex with casual partners (p-trend=0.044). Pharyngeal chlamydia was less common but a high prevalence/incidence ratio suggested that infection may persist in the pharynx for long periods. Pharyngeal chlamydia was independently associated with receptive penile-oral sex with casual partners (p-trend=0.009). In conclusion, circumcision may have a role as an HIV prevention intervention among the subgroup of homosexual men who predominantly practise insertive rather than receptive AI. Regular screening of the pharynx including a validated supplemental NAAT for gonorrhoea diagnosis may prevent much transmission to anogenital sites, whereas chlamydia occurs too infrequently in the pharynx to recommend routine screening in homosexual men.

Thesis (M.S.)--Uniformed Services University of the Health Sciences, 2006 / Typescript (photocopy)

Thesis (Ph. D.)--Cornell University, August, 2007. / Vita. Includes bibliographical references (leaves 165-176).

Bakgrund: Ungefär 37 miljoner människor lever med HIV idag. HIV förknippas ofta med starka känslor och påverkar den drabbade personens liv negativt på många sätt. Att vårda en person med HIV är påfrestande för sjuksköterskan och det finns en kunskapsbrist som försvårar arbetet. Den personcentrerade vården är viktig i sjuksköterskans arbete och innebär att alla personer ska vårdas med samma förutsättningar. Syfte: Beskriva sjuksköterskans upplevelse av att vårda personer med HIV. Metod: Litteraturöversikt med tolv kvalitativa artiklar. En induktiv ansats tillämpades. Dataanalysen utgick från Fribergs femstegsmodell. Resultat: Tre huvudkategorier och nio subkategorier hittades. Huvudkategorierna var: “Utmaningar i omvårdnadsarbetet”, “Utmaningar i bemötandet” och “Utmaningar i sin egen utsatthet”. Resultatet visade att sjuksköterskan upplevde rädsla relaterat till HIV, vilket ofta berodde på okunskap. Sjuksköterskan upplevde också diskriminering på grund av sitt arbete med HIV, då det fanns en stigmatisering gentemot HIV i samhället. Arbetet med HIV innebar både psykisk och fysisk stress för sjuksköterskan. Slutsatser: För att överkomma de hinder som uppstår i vårdandet av personer med HIV krävs det mer kunskap. Det är av vikt att sjuksköterskan redan under utbildning får adekvat kunskap om HIV. / Title: Nurses experience of caring for people with HIV. Background: About 37 million people live with HIV today. HIV is often associated with strong emotions and have a negative affect at the person’s life. Caring for a person with HIV is hard on the nurse and there’s a lack of knowledge that complicates the work. The person-centered care is important in the nurse's work and means that they should care for all persons in the same way. Aim: Describe the nurses’ experience of caring for people with HIV. Method: Literature review with twelve qualitative articles. An inductive approach was applied. The data analysis was based on Fribergs five step model. Results: Three main categories and nine subcategories were found. The main categories were: "Challenges in nursing", "Challenges in the personal treatment "and "Challenges in their own vulnerability". The result shows that the nurse experiences fear related to HIV, which is often due to lack of knowledge. The nurse also experiences discrimination because of her/his work with HIV, as there’s a stigma against HIV in society. The work of HIV involves both mental and physical stress for the nurse. Conclusions: In order to overcome the obstacles that arise in the care of people with HIV, more knowledge is needed. It is important that the nurse receives adequate knowledge of HIV during education.