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

Thesis (Ph. D.)--University of Washington, 1999. / Vita. Includes bibliographical references (leaves 92-115).

Thesis (Ph. D.)--University of Washington, 1996. / Vita. Includes bibliographical references (leaves [115]-128).

Thesis (Ph. D.)--University of Washington, 2007. / Vita. Includes bibliographical references (leaves 155-209).

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.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / This systematic review and meta-analysis tries to determine whether there is an association between the use of protease inhibitors (PIs) and the incidence of diabetes mellitus (DM) and/or metabolic syndrome (MS) in HIV-infected patients. A systematic literature search was performed using MEDLINE/PubMed, CENTRAL, LILACS, and EMBASE. Included articles were observational studies published on or prior to November 2015 that met specific inclusion criteria. Pooled relative risks (RRs) and hazard ratios (HRs) were calculated. Nine articles met the inclusion criteria, describing 13,742 HIV patients. Use of PIs was associated with the development of MS (RR: 2.11; 95% CI 1.28–3.48; p-value 0.003). No association between the use of PIs and development of DM was found: the HR for the incidence of DM among patients using PIs was 1.23 (95% CI 0.66–2.30; p-value: 0.51) and the RR was 1.25 (95% CI 0.99–1.58; p-value 0.06). Use of PIs in HIV-infected patients is associated with an increased risk of MS. No evidence of an increased risk of DM was found. However, because MS is a precursor to DM, it is possible that studies with a longer follow-up duration are needed in order to detect an association between PI use and onset of DM. / First, we would like to thank our families for all their support. Second, we would like to thank the Universidad Peruana de Ciencias Aplicadas, the Health Sciences Department, and the School of Medicine for their support and for all the tools they have provided throughout this process. Finally, we want to thanks to Dr Gwenyth O. Lee and Dr Daniela E. Kirwan for their comments. / Revisión por pares

Carta al editor / Revisión por pares

>Magister Scientiae - MSc / The aim of this study is to investigate the perceived stigmatization of and discrimination against people who are HIV positive or people who are living with AIDS. One questionnaire was used to collect qualitative and quantitative data. Data collection was conducted for a period of three weeks in the Eastern Cape province at the Zwartwater area in Lady Frere and at the Queenstown (Frontier) Hospital. A sample of 170 (of the 900) females was interviewed, of which 100 were sequentially sampled from the community and 70 were sequentially sampled whilst they were queuing at the Queenstown (Frontier) Hospital for care. Households from the rural area were selected by visiting every fourth house on the route linking the houses in this area. At the hospital, selection started at the back of the queue and every sixth person was selected and interviewed. Scores were calculated for knowledge and attitudes towards people who are HIV positive and towards people who have AIDS. It was found that knowledge and attitude scores did not differ between the various age groups tested. It was furthermore found that an increased knowledge score improved attitudes towards people who are HIV-positive or have AIDS.

Made available in DSpace on 2014-06-11T19:29:32Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-06-22Bitstream added on 2014-06-13T18:39:11Z : No. of bitstreams: 1 figueiredo_as_me_botfmvz.pdf: 290159 bytes, checksum: 38ae46f390705b8d387a7ef9c78d6040 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / O Vírus da Imunodeficiência Felina (FIV) é um lentivírus que causa uma síndrome de imunodeficiência em gatos domésticos. O FIV tem sido particularmente utilizado em estudos de resistência viral aos análogos de nucleosídeos devido a Transcriptase Reversa (TR) apresentar propriedades físicas, catalíticas e sensibilidade às drogas semelhantes à TR do HIV. Os objetivos desse trabalho foram tratar com AZT gatos naturalmente infectados com o FIV, fazer o monitoramento da carga viral e DNA proviral por PCR em tempo real e monitoramento genético por seqüenciamento. Dos 12 animais infectados, 6 receberam o AZT na dose de 10mg/kg/dia e 6 receberam placebo. Durante 96 dias de tratamento, o plasma e sangue destes animais foram analisado com relação à carga viral e concentração relativa de DNA proviral utilizando-se a técnica de quantificação relativa por PCR em tempo real com SYBR Green, desenvolvida por nossa equipe. Além disso, foi realizado o sequenciamento genético da região que codifica a TR de 3 dos animais. Foi realizada com sucesso a padronização da PCR em tempo real para quantificação relativa do FIV. Não houve diferença estatisticamente significativa da carga viral ou do DNA proviral entre os grupos tratado e controle. O seqüenciamento genético revelou a presença de lisina na posição 41 do sítio ativo da TR. A presença deste aminoácido confere até 4 vezes menor sensibilidade ao AZT em mutantes do HIV. Por possuir alta estabilidade genética, supomos que os vírus dos demais animais não sequenciados possuem também a 41-lisina A presença da 41-lisina pode ser uma das possíveis explicações para a falha do tratamento com AZT. Outra hipótese é a de que a dose fornecida não foi adequada. / Feline Immunodeficiency Virus (FIV) is a lentivirus which causes a progressive disruption of the host's immune functions. FIV has been particularly used as a model for studies in retroviral resistance to nucleoside analogs because its similarities in physical properties, catalytic and sensitivity in comparison with HIV/RT. The aims of this work were to treat cats naturally infected with FIV, quantify viral load and proviral DNA by real time quantitative PCR with SYBR Green and analyze the viral nucleotide sequence. From 12 animals naturally infected, 6 received AZT at a dose of 10mg/kg/day and 6 received placebo. During 96 days of treatment, viral load and concentration of proviral DNA were measured by relative quantitative real time PCR developed by our staff. The nucleotide sequence of the RT encoding region was also achieved for 3 animals. The real time PCR relative quantification was successfully standardized for FIV. There was no significant statistical difference between treated and control groups. The nucleotide sequence revealed a lysine at position 41 on the enzyme active site. This lysine confers 4-fold decreased sensitivity to AZT in HIV RT-mutants. FIV subtype B has high genetic stability and we purposed that the other virus not sequenced have the same amino acid and hypothesized that this mutations can be one of the reasons determining the failure of the treatment. The other hypothesis is that the dose was not adequate.

Um dos problemas mais crÃticos relacionados à coinfecÃÃo HIV/Tuberculose (TB) à a mortalidade associada. A infecÃÃo por HIV tem contribuÃdo para o aumento do nÃmero de casos de TB e ainda tem sido responsÃvel pelo aumento da mortalidade entre os pacientes coinfectados. Fortaleza, situada no Nordeste do Brasil, à um dos centros urbanos com maior incidÃncia de TB no paÃs. O presente trabalho avaliou caracterÃsticas clÃnicas, epidemiolÃgicas e fatores de risco relacionados a mortalidade por TB em pacientes coinfectados com HIV/Aids, maiores de 12 anos, residentes na cidade de Fortaleza-CE. Realizou-se estudo retrospectivo, descritivo e de caso-controle. Foram revisados dados em 262 prontuÃrios dos pacientes com TB ativa acompanhados em quatro ambulatÃrios de referÃncia para HIV/Aids em Fortaleza entre os anos de 2004-2008. O perfil desses pacientes à caracterizado por adultos jovens, baixa escolaridade, sendo comuns os hÃbitos de etilismo (41,98%), tabagismo (33,59%) e uso de drogas ilÃcitas (26,72%). A maioria (65,65%) apresentou TB pela primeira vez. Quanto à apresentaÃÃo clÃnica, a TB pulmonar foi observada em 50% dos casos. A maioria (62,98%) foi submetida a internamento hospitalar durante o tratamento da TB. O uso de antirretrovirias foi mais frequente nos casos que evoluÃram para cura ou tÃrmino de tratamento (88,0%). A letalidade foi de 11,45% e o coeficiente de abandono de 16,03%. Na anÃlise univariada, o indivÃduo separado/viÃvo tem 3,7 vezes mais chance de Ãbito por TB, e 100% dos casos novos foram a Ãbito. Exame de raio-X alterado apresentou uma proporÃÃo de 31% de Ãbitos. O diagnÃstico de HIV devido à TB foi fator protetor ao Ãbito (OR=0,25). A mÃdia da carga viral antes da TB foi superior no grupo dos casos (p=0,04). O inicio da TARV foi outro fator protetor para o Ãbito (OR=0,11). No modelo final da regressÃo logÃstica mÃltipla, observou-se que o indivÃduo que nÃo teve resposta ao tratamento tem 9,9 (p=<0,01) vezes mais chance de evoluir para Ãbito e o indivÃduo que nÃo iniciou o antiretrovirais tem 10,1 (p=<0,01) vezes mais. Estes resultados sÃo importantes para o planejamento e desenvolvimento de aÃÃes voltadas para o controle da TB nos pacientes com infecÃÃo por HIV/Aids em Fortaleza. / One of the most critical problems related to HIV / tuberculosis (TB) coinfection is the associate mortality. HIV infection has contributed to the increase in the number of TB cases and has even been responsible for the increased mortality among coinfected patients. Fortaleza, located in Northeastern Brazil, is one of the urban centers with the highest incidence of TB in the country. This research evaluates clinical, epidemiological characteristics and risk factors related to mortality from TB in patients coinfected with HIV / AIDS, aged 12, residents in the city of Fortaleza. It was performed a retrospective, descriptive and case-control study. Database were reviewed in 262 charts of patients with TB active treated at four clinics reference to HIV / AIDS in Fortaleza between the years 2004-2008. The profile of these patients is characterized by young adults, low education, and common habits of alcoholism (41.98%), smoking (33.59%) and illicit drug use (26.72%). The majority (65.65%) showed the first time TB. In the clinical presentation, pulmonary TB was observed in 50% of cases. The majority (62.98%) underwent hospitalization during treatment of TB. The use of anti retrovirias was more frequent in patients who progressed to cure or end of treatment (88.0%). The mortality rate was 11.45% and the coefficient of abandonment of 16.03%. In univariate analysis, the individual separated / widowed have 3.7 times greater risk of death from TB, and 100% of new cases died. X-ray examination showed a changed ratio of 31% of deaths. The diagnosis of HIV due to TB was a protective factor against death (OR = 0.25). Mean viral load before TB was higher in the case group (p = 0.04). The start of ART was another protective factor for death (OR = 0.11). In the final model of logistic regression, we found that the individual who had no response to treatment is 9.9 (p = <0.01) times more likely to lead to death and the individual who has not started antiretroviral 10.1 (p = <0.01) more times. These results are important for planning and development of actions for the control of TB in patients with HIV infection / AIDS in Fortaleza.