Human Immunodeficiency Virus Type I, or HIV, is one of the most well-known and well-researched viruses in the world. The current standard of care for HIV infected individuals is an antiretroviral drug therapy regiment, or ART, started immediately after diagnosis. While this treatment is generally quite effective at keeping the viral load low and stopping the progression from HIV infection to AIDS, patients receiving ART therapy still have a lower life expectancy than uninfected individuals. Many times, the cause of death in these patients is not the common opportunistic pathogens and cancers linked to HIV and AIDS, but chronic health conditions that develop. One of these conditions that is seen in many of the HIV infected patients undergoing the antiretroviral therapy is cardiovascular disease, such as atherosclerosis and myocardial infarction. Research shows that one of the key players in developing these conditions in HIV patients is the chronic inflammation caused by the immune system attempts to control the level of the virus. By studying the links between HIV, inflammation, and cardiovascular disease, we may be able to find solutions to the development of chronic disease in HIV patients on antiretroviral therapy.

No abstract available. / Dissertation (LLM)--University of Pretoria, 2013. / gm2014 / Centre for Human Rights / unrestricted

Magister Public Health - MPH / Background-Namibia has a high HIV and malnutrition burden. HIV increases the risk of 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'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 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. / South Africa

Master of Public Health - MPH / For more than two decades now, the acquired immune deficiency syndrome (AIDS) and its etiological agent, the human immunodeficiency virus (HIV), has been a growing challenge that affects all segments of the global population. Voluntary HIV counseling and testing (VCT) is one of the many prevention and control strategies adopted globally and by the Government of the Republic of Zambia. VCT is the process by which an individual undergoes counseling to enable him/her to make an informed choice about being tested for the human immunodeficiency virus (HIV). This decision must be entirely the choice of the individual and he or she must be assured that the process will be confidential. VCT is a key component of both HIV prevention and care programs. Although VCT is increasingly available in Zambia through public health facilities, VCT only or stand-alone sites and mobile counseling and testing services, there is still great reluctance among many people to be tested. Aim: This study explored factors affecting the utilization of VCT services in Mwense District, Zambia. Methodology: An explorative, qualitative study was conducted. Data was collected through focus group discussions with community members, and key informant interviews with lay counselors and health care workers. Thematic analysis of transcribed data was done to elucidate knowledge and awareness of HIV/AIDS and VCT services, factors facilitating uptake and barriers to utilization of VCT services and suggestions for improving VCT uptake. Results: The study found that HIV/AIDS was recognized as a major problem in the communities and that participants were aware of the availability and benefits of HIV counseling and testing services. The main reasons for seeking an HIV test included facilitating sexual behavior change to avoid infection, re-infection or infecting others with HIV. Facilitators to uptake of VCT services include accessing information on HIV/AIDS and other care and support services such as prevention of mother to child interventions, peer and social support systems, home-based care and early treatment with antiretroviral therapy if one is HIV positive. Community members indicated that VCT was an entry point to reaching out to the family and community for on-going counseling, which would lead to reduction in HIV/AIDS stigma and discrimination. Several barriers to VCT were identified by the participants. At individual level, barriers included: the fear of the ramifications of a positive test; fear of HIV/AIDS stigma and discrimination; doubt about the existence of HIV and AIDS; and fear of loss of control of life circumstances and destiny. Health facility level barriers included concerns about confidentiality of HIV-test results, familiarity with service providers, lack of promotional activities of the VCT services, shortage of testing logistics and commodities, and human resource shortages both in terms of numbers and confidence to promote VCT services. Community levels barriers included cultural beliefs and customs, gender imbalances, religious beliefs and stigma. Conclusions: There is urgent need for community sensitization about VCT and its benefits in HIV/AIDS control.

Magister Artium (Social Work) - MA(SW) / Botswana is experiencing high levels of HIV prevalence rate at 16.9% among the general population, 4.5% among adolescents aged 10-14 and 4.7% among adolescents aged 14-19. Adolescents are in a critically stage between childhood and adulthood and undergo a lot of developmental changes physically, sychologically and emotionally. The scourge of HIV/AIDS has also brought with it multiple challenges to adolescents as those who are HIV positive have to adhere to all the health requirements of being HIV positive and at the same time being pressurised by the societal expectations. Stigmatisation and discrimination are experienced as barriers against the fight towards HIV which is seen a major factor among adolescents. The aim of the study was to explore and describe adolescents’ perceptions and experiences of anti-retroviral therapy at a tertiary hospital in Francistown, Botswana. The study followed a qualitative research approach with an exploratory descriptive research design. Purposive sampling was used to recruit participants. Participants were school going adolescents aged between 13 and 19 years, who are on antiretroviral therapy and going for reviews at a tertiary hospital in Francistown, Botswana. Data were gathered though face to face semi structured interviews with each of the 24 participants. Data were analysed thematically. The following four themes emerged during the analysis: i. “ARVs control but don’t cure”; ii. “Why did it happen to me?-the reality of using ARVs”; iii. “I don’t want to take them for the rest of my life”; and iv. “No man is an island”, which addressed the research objectives. The findings led to the conclusion that, despite the fact that HIV has been around for over two decades and ARVs has been around for more than a decade, adolescents living with HIV still faces challenges such as stigmatisation due to social as well as clinical factors and adjusting to a lifelong treatment which made it difficult for them to adhere to their treatment. However, adolescents are happy as they are living a healthy and a fruitful life as a result of the ARVs. Ethical considerations were adhered too. Furthermore the findings of the study could assist the Ministries of Health, Education, Local Government and Rural Development to address these challenges experienced by the adolescents in the development of social programmes to improve the livelihood of the adolescents living with HIV/AIDS.

The purpose of this study was to estimate disparities in late human immunodeficiency virus (HIV) diagnosis and all-cause mortality among varying populations of HIV-positive Latinos, and to identify neighborhood-level predictors. Florida HIV surveillance data for years 2000–2011 were merged with 2007–2011 American Community Survey (ACS) data. Multilevel logistic regressions were used to estimate adjusted odds ratios (aOR) for late HIV diagnosis (acquired immunodeficiency syndrome within 3 months of HIV diagnosis). Multilevel weighted Cox regressions were used to estimate adjusted hazard ratios (aHR) for mortality. Of 5522 Latinos diagnosed 2007–2011, males were at increased odds of late diagnosis compared with females (aOR 1.37, 95% confidence interval [CI] 1.13-1.67). Associated factors included residing in the lowest quartile of neighborhood education for females, and in the 3 highest quartiles of unemployment for males. Foreign-born compared with United States (US)-born Latinos were also at risk (aOR 1.24, 95% CI 1.08-1.42). Among foreign-born, residing in areas with

Les cancers représentent une cause importante de morbidité et de mortalité chez les personnes vivant avec le VIH. Ce travail s’est inscrit dans l’étude des déterminants immunologiques et virologiques du risque de cancer au sein de la Cohorte ANRS CO3 Aquitaine. Ces facteurs de risque ont été étudiés à l’aide de modèles de Cox à entrée retardée et variables dépendantes du temps dans deux études de cohorte. Une étude cas-témoins nichée dans la Cohorte Aquitaine a recherché à l’aide de modèles de régression logistique conditionnelle un rôle du cytomégalovirus (CMV) dans le risque de cancer.Entre 1998 et 2006, 4 194 patients ont présenté 251 cancers. Une charge virale >500 copies/mL était un déterminant du risque de cancer classant sida (Risque Relatif [RR] = 3.3, Intervalle de Confiance à 95% [IC] : 2.1–5.2, p <0.001) ainsi qu’un taux de lymphocytes CD4 (CD4) <200 cellules/mm3 (RR=6.3, IC : 4.2–9.4, p <0.001). Un taux de CD4 <500 était associé à un risque augmenté de présenter un cancer non classant sida (RR=2.1, IC : 1.4–3.1, p <0.001). Parmi 2 864 patients ayant présenté 16 hépatocarcinomes, un taux courant de CD4 <500 était un facteur de risque de cancer (RR=10.3, IC : 1.3–82.8, p=0.03), mais pas la durée cumulée d’exposition antérieure à des CD4 <500 (p=0.8).Une ADNémie plasmatique à CMV positive n’était pas associée au risque de cancer (p=0.54) chez 143 cas et 284 témoins.Ces résultats sont en faveur du maintien chez les personnes vivant avec le VIH d’une charge virale plasmatique indétectable et d’un taux de CD4 >500 cellules/mm3, si besoin à l’aide des traitements antirétroviraux, afin de prévenir le risque de cancer en plus des mesures préventives traditionnelles. / Persons living with HIV are at higher risk of malignancies. In addition to traditional determinants, deleterious effects of immunological or virological parameters are speculated in this population. The objective of this thesis was to study immunological and virological risk factors for cancer in the ANRS CO3 Aquitaine Cohort of persons living with HIV. Extended Cox proportional hazard models with delayed entry and time-updated variables were used in two cohort studies, and the role of the cytomegalovirus (CMV) in the risk of cancer was assessed in a nested case control study with conditional logistic regression models.Between 1998 and 2006, 4,194 patients presented 251 cancers. Plasma HIV RNA >500 copies/mL and a CD4 cell count (CD4) <200 cells/mm3 were associated with a higher risk of AIDS-defining cancer: (Hazard Ratio [HR]=3.3, 95% Confidence Interval [CI]: 2.1–5.2, p <0.001) and (HR=6.3, CI: 4.2–9.4, p <0.001), respectively. CD4 <500 was associated with a higher risk of non-AIDS-defining cancer (HR=2.1, CI: 1.4–3.1, p <0.001). Among 2,864 patients who presented 16 hepatocarcinomas, current CD4 <500 was a risk factor for cancer (HR=10.3, CI: 1.3–82.8, p=0.03), but not the cumulative exposure to CD4 <500 preceding the current measurement (p=0.8). Positive plasma CMV DNAemia was not associated with the risk of cancer among 143 cancer cases and 284 control patients (p=0.54).These results suggest that maintaining an undetectable plasma HIV RNA viral load and a CD4 cell count above 500 cells/mm3, if needed by prescribing antiretroviral treatment, should prevent cancer occurrence among HIV-infected patients, additionally to the traditional prevention policies

(ENG) This thesis summarizes the results of a project dedicated to adaptive immune system of patients with partial DiGeorge syndrome caused by deletion of 22q11.2. The introduction sets the DiGeorge syndrome into a broader context of international pathophysio- clinical classification of primary immunodeficiencies and goes into detail describing its history, causes, clinical phenotype, therapeutic options and changes of the immune system. The attached manuscripts illustrate the premature aging of the T cell population, but also impaired development of B cells with low class-switched memory and high naïve subpopulations, along with high serum levels of BAFF, a B cell survival factor. The surprising lack of T independent marginal zone- like (MZ-like) B cells is reflected in decreased natural anti-α-Gal antibodies. The faulty B cell maturation and imperfect germinal center response is not caused by a deficit of follicular helper T cells, which are in fact increased in DiGeorge syndrome patients, and in most cases doesn't lead to hypogammaglobulinaemia. Despite the high incidence of autoimmune disease, in particular thyroiditis and thrombocytopenia, and a trend towards hypergammaglobulinaemia in adolescence and adulthood, we saw normal proportion of regulatory T cells (Tregs) and normal expression of...

Infection with the human immunodeficiency virus (HIV) in the adolescent/young adult population of the United States is a serious, growing problem. The current HIV risk-reduction strategies for adolescents have been less than effective in stemming the tide of infection. This ineffectiveness can be linked to failure of making developmentally appropriate risk-reduction informational material and reliance on condom-based interventions, which have an unacceptably high failure rate. A critical analysis of current models of HIV-risk reduction should be undertaken to create more developmentally appropriate and effective methods.

This descriptive study aimed to determine the knowledge, attitudes and practices about AIDS among Sexually Transmitted Disease (STD} clinic attenders in the Cape Peninsula. A questionnaire containing open and closed questions in the appropriate language (English, Afrikaans or Xhosa) was administered by trained clinic staff to 306 patients in 9 of the 29 STD Clinics in the region. The study was requested by the local authorities to initiate and improve AIDS education programmes within the STD clinics. 306 patients were interviewed in 9 clinics. The median age of attenders was 25 years. The median period of residence in the peninsula was 7 years. Knowledge of AIDS is reasonably good when tested by true/false questions but much worse when tested by open questions. Knowledge bears little relationship to practice. There is inadequate awareness of the asymptomatic carrier state, the incurability of AIDS and ways to prevent AIDS. Sexual practice is high risk. Condom use is extremely low especially in the African areas where only 9,6% used a condom in the past year. Prostitution is perceived to be a common occurrence in attenders' communities. There is a low perception of risk to self. The most important beliefs militating against condom use are that they are unacceptable to partners and peer group. More information about AIDS was requested by 90% of patients and a strong preference was expressed for programmes to be conducted in the patient's home language. This study supports the urgent need for an AIDS education and counselling programmes for patients with STD's in the region. Recommendations include the need to address the emotions, attitudes and beliefs that affect behaviour as well as to convey knowledge. Condom acceptability poses a major problem that will need to be addressed. Patients with STDs represent an extremely important core group for HIV transmission to others in the community and need specific attention and resources.