The Human Immunodeficiency Virus (HIV) which causes Acquired Immunodeficiency Syndrome (AIDS) has caused a global scare with mainly poor African countries suffering the greatest burden. Treatment of HIV is more of palliation rather than cure such that there is no room for treatment interruption if treatment goals are to be met. Antiretroviral treatment is associated with short term and long term side effects which have the potential to negatively impact on the high levels of adherence to treatment that is required to maintain virological suppression and may eventually lead to development of drug resistance and treatment failure. This research aims to identify the extent to which these side effects, through possible poor adherence, impact on treatment successes by measuring the risk that side effects contribute towards treatment failure. Methods Secondary data analysis was conducted on a cohort of patients who initiated ART between 2004 and 2010 at a large tertiary facility in Johannesburg. Patients who were switched to second line ART due to treatment failure were identified. Assessment of side effects on adherence was done. The hazards of side effects among patients switching and not switching to second line were calculated using Cox proportional hazards regression adjusting for other socio-demographic and clinical predictors for treatment failure. Interaction between side effects, gender, age and that of side effects and adherence was investigated. Time dependent covariates were also investigated. Confounding was controlled using multivariate Cox regression analysis. Results There were 5285 patients in the baseline cohort with multiple entry points who contributed 16035 person-years of follow up. The cohort consisted of 63.2% females and 36.8% males. Of these 85.9% were initiated on stavudine (d4T)- based regimen, 7.1% on tenofovir (TDF), 6.3% on zidovudine (AZT)-based regimen and 0.7% on other regimens. The median and mean time at risk per subject was 2.2 and 2.3 years respectively. A total of 770 episodes of side effects due to first line ART were experienced with some patients recording multiple side effects at different time points. Adherence data were found to be missing and incoherent in some of the regimen dosages and could not be used to objectively compare patients. There were 430 patients who were switched to second line ART due to treatment failure. Relative to the group of no side effects, the adjusted hazard ratios for mild, moderate and severe side effects were 1.40 (95% CI=0.94-2.09) p=0.10; 1.72 (95% CI=1.35-2.20) p<0.01 and 1.24 (95% CI=0.65-2.35) p=0.52 respectively. Therefore, overally side effects did not seem to play a role in the time to switch to second line ART. Sex, baseline CD4 cell count, the period during which ART was initiated and the time between date of testing HIV positive and date of initiating were significantly associated with the time to switching to second line ART. Conclusion The study informs that side effects overally may not play a significant role in switching patients from first line to second line ART with the exception of moderate side effects. However, patients who experience side effects should be closely monitored and adequately counselled to help them cope with the side effects so that optimal adherence levels are maintained. Availability of adherence scores or additional information on pills that should have been taken on periods during which pills were reported to have been missed would have made the research more valuable by allowing objective comparison of adherence among patients.

The role that amniotic fluid (AF) may play in HIV vertical infection is unresolved. We used the FIV-infected cat model to study this question. We hypothesized that AF may be a source of fetal infection if the virus is present in the fluids. However, virus neutralizing (VN) antibodies in AF may limit vertical transfer. Fetuses were delivered from FIV-infected queens by cesarean section at early and late gestation. AFs were aspirated from intact fetal membranes and tested for viral antigen and RNA and for FIV-specific antibody. Randomlyselected samples were tested for VN activity using a syncytium reduction assay. Neither FIV antigen nor RNA was detected in any AFs. AFs and parallel serum samples from early and late pregnancy were positive for FIV-specific antibody. VN activity was detected in three early-term AFs and a parallel serum, but not late-term AFs. AF appears to play no appreciable role in FIV vertical transmission.

Background The development of HIV preventive measures in Thailand has led to a decrease in prevalence in HIV-infected persons. During 2021 there was an estimated number of 520 000 people living with HIV in Thailand amongst adults over 15 years and an estimated number of 2000 children between 0 to 14 years old. Studies have shown that the current obstacles with HIV prevention in Thailand is correlated with HIV-related stigma and therefore being at risk to retrieve the infection. Non-governmental organizations (NGOs) and research groups, are important actors in HIV prevention.  Aim The aim of this study was to examine experiences of HIV preventive work in children, adolescents and young adults among staff in an HIV prevention-oriented organization and a research group in Thailand.  Method A qualitative design was used, and seven semi-structured interviews were conducted with a convenient selected sample. Participants were conveniently recruited from two different population groups, two participants from an HIV prevention-oriented organization and five participants from a research group in a clinical HIV-unit. The interviews were transcribed and analyzed through a content analysis with an inductive approach.  Results Three main categories were identified: Success factors in HIV prevention, Barriers to HIV prevention and Future directions. Eight subcategories were identified: Access to HIV testing, Access to information, Sharing experiences, Collaboration between agencies working with HIV prevention, Decrease in Stigma, Limitations in time and money, Difficulties in adherence to HIV prevention and Stigmatization in HIV. Conclusions HIV prevention needs to be more accessible. Today HIV testing is available for free, however, there are still obstacles to preventive work that ought to be considered, stigmatization and discrimination are such barriers. Future directions in preventive work are increased accessibility to HIV prevention.

Purpose: To recognize and raise awareness about the psychosocial status and health outcomes in older adults living with HIV. Method: A literature search was conducted from the disciplines of nursing and medicine using the CINAHL, PubMed, and Medline databases. Inclusion criteria: articles exploring older adults who are HIV positive and factors related to depression, suicide and available healthcare resources. Exclusion criteria: articles including individuals under the age of 50 infected with HIV/AIDS and articles focused entirely on physiologic principles of HIV/AIDS. Results: In older adults living with HIV/AIDS, the literature review disclosed a comprehensive gap between identifying this age group as 'at risk', lack of communication between health care providers and older adults concerning sexual activity and/or status, and recurring psychosocial components related to lack of resources and standards of care among older adults living with HIV/AIDS. An unbalanced amount of research has focused on the care and prevention of HIV/AIDS among young adult populations, while a limited amount of research is geared toward detection, prevention and interventions for HIV/AIDS in older adults. Findings suggest that HIV/AIDS is a syndrome of bias based on age and/or gender by health care providers. Solutions to this epidemic must begin with an all inclusive plan that investigates the prevention, identification and intervention across the lifespan. Discussion: As the country ages and the population of older adults increase, nurses will encounter an increasing number of older adults living with HIV/AIDS. In order to competently provide quality care to older adults with a positive HIV/AIDS status, further research is needed to bridge the gap of literature connecting psychosocial aspects of care and accompanying health outcomes.

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Natural killer (NK) cell deficiency (NKD) occurs when an individual’s major clinical immunodeficiency derives from abnormal NK cells and is associated with several genetic etiologies. Three categories of β actin-related diseases with over 60 ACTB variants have previously been identified, none with a distinct NK cell phenotype. An individual with mild developmental delay, macrothrombocytopenia, susceptibility to infections, molluscum, and EBV-associated lymphoma had functional NK cell deficiency for over a decade. A de novo ACTB variant encoding G342D β actin was identified and was consistent with the individual’s developmental and platelet phenotype. This novel variant also was found to have a direct impact in NK cells, as its expression in YTS (YTS-NKD) cells caused increased cell spreading in lytic immune synapses created on activating surfaces. YTS-NKD cells were able to degranulate and perform cytotoxicity, but demonstrated defective serial killing owing to prolonged conjugation to the killed target cell and thus were effectively unable to terminate lytic synapses. G342D β actin results in a novel mechanism of functional NKD via increased synaptic spreading and defective lytic synapse termination with resulting impaired serial killing leading to overall reductions in NK cell cytotoxicity.

by Au Yuk Sin. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1995. / Includes bibliographical references (leaves 100-113). / Chapter Chapter 1 --- Introduction / What is AIDS? --- p.1 / Situation in the World --- p.2 / Situation in Asia --- p.4 / Chapter Chapter 2 --- The AIDS Situation in Hong Kong --- p.8 / Historical Development of the AIDS Programme in Hong Kong --- p.8 / The Hong Kong AIDS Campaign (1987-1994) / Problem Definition Phase --- p.10 / Implementation Phase / Objectives --- p.11 / Targets --- p.12 / Channels --- p.12 / Media Package --- p.15 / Budget --- p.15 / Timing --- p.16 / Evaluation Phase / Non-Government Organisations (NGOs) / The Hong Kong AIDS Foundation --- p.16 / AIDS Concern / Hong Kong Ten Percent Club --- p.17 / The Horizons --- p.17 / The AIDS Trust Fund --- p.17 / Chapter Chapter 3 --- Theoretical Framework / Revised Protection Motivation Theory --- p.19 / Information / Persuasion Model --- p.22 / Review of Relevant Research Findings on Protection Motivation Theory --- p.24 / Chapter Chapter 4 --- Literature Review / Global Research on AIDS / Positive Results --- p.27 / Mixed Results --- p.28 / Minimal Effects --- p.30 / Evaluation of Research Findings --- p.31 / Local Research on AIDS / CNTA Survey (Wave II)(May 1987) --- p.32 / CNTA Survey (Wave III)(March 1988) --- p.32 / KABP Study (February 1992) --- p.33 / HKIPM Survey (February 1992) --- p.34 / Survey on the Effectiveness of the APIs on AIDS (November 1992) --- p.35 / Evaluation of the School Education Programmes on AIDS (September-December 1993) --- p.36 / Evaluation of Local Research --- p.37 / Chapter Chapter 5 --- Methodology / Design --- p.38 / Sample --- p.40 / Hypotheses --- p.41 / Measurement --- p.44 / Chapter Chapter 6 --- Findings --- p.46 / Chapter Chapter 7 --- Discussion --- p.62 / Chapter Chapter 8 --- Conclusion --- p.73 / Appendix 1 Tables --- p.77 / Appendix 2 Organisational Structure of Hong Kong's AIDS Programme1994 --- p.83 / Appendix 3 (a) Questionnaire (English) --- p.84 / Appendix 3 (b) Questionnaire (Chinese) --- p.92 / Appendix 4 Field Report --- p.99 / Bibliography --- p.100

A imunodeficiência comum variável (ICV) é uma imunodeficiência primária de origem heterogênea, definida como uma diminuição de pelo menos dois isótipos de imunoglobulinas, a falta de resposta anticórpica a imunizações e a exclusão de outras causas primárias de hipogamaglobulinemia. A ausência de níveis adequados de anticorpos em pacientes com ICV resulta em infecções bacterianas recorrentes, mais freqüentes no trato respiratório e digestivo, que podem levar a seqüelas sinusais e pulmonares. Nos últimos 6 anos iniciou-se a descoberta de genes relacionados à causa de doenças com o fenótipo de ICV, como os genes de TACI, BAFF-R, CD19 e ICOS. Dentre as alterações imunológicas, podemos também relatar deficiência de células B de memória (CD19+IgM-IgD-CD27+), levando a distúrbio de comutação isotípica e redução da secreção de imunoglobulinas. Atualmente tal característica vem sendo utilizada para classificar a ICV. No decorrer do presente trabalho pudemos observar que pacientes com ICV apresentam alterações na expressão de CD27 não somente em células B, mas também em células T, além de resposta linfoproliferativa ao estímulo de PHA reduzida. O CD27 consiste em uma molécula da família TNF presente constitutivamente em células T e após ativação em células B. Sua atuação na resposta imune está relacionada com a proliferação e co-ativação de células T específicas que atuam na interação T-B, na resposta de células B dependente de T. Dessa forma deficiências na via de CD27 podem resultar em defeitos nos mecanismos de comutação isotípica e de diferenciação de células B do centro germinativo, assim como de células de memória. Essas características podem ser observadas em modelos murinos de deficiências de CD27/CD70. Nossos achados permitem que uma nova janela se abra para o estudo da ICV. A avaliação dos distúrbios associados a defeitos de sinalização de CD27/CD70 em humanos pode se tornar uma nova ferramenta para a compreensão de uma deficiência tão pouco esclarecida. Tal enfoque pode eventualmente contribuir para o desenvolvimento de novos tratamentos, atuando diretamente na molécula em questão. Além disso, sugerimos também a utilização da fenotipagem das moléculas CD27 em linfócitos B e T, além da IgM e IgD de membrana para a caracterização da ICV, mais a análise da molécula CD154 para exclusão de outras imunodeficiências / Common variable immunodeficiency (CVID) is a primary immunodeficiency disorder of heterogeneous origin, defined by a decrease of at least two immunoglobulin isotypes, lack of antibody response to immunization and the exclusion of other causes of primary hypogammaglobulinemia. The absence of adequate levels of antibodies in patients with CVID results in recurrent bacterial infections, most frequently in the respiratory and digestive tract, which can lead to sinusal and lung sequels. Over the past six years the discovery of genes related to the phenotype of CVID began, such as the genes of TACI, BAFF-R, CD19 and ICOS. Among the immunological changes, there is impairment of memory B cells (CD19+/IgM-IgD-CD27+), leading to disturbance of isotypic switching and reduced secretion of immunogobulins. Currently this feature has been used to classify CVID. During the present study we observed that patients with CVID present changes in the expression of CD27 not only in B cells, but also in T cells, and reduced lymphoproliferative response to PHA. CD27 molecule is a member of the TNF family present constitutively in T cells, and after activation in B cells. Its importance in the immune response is related to the proliferation and co-activation of specific T cells that act in T-B interaction, in the T cell dependent B cells response. Thus disturbances in the CD27 pathway can result in defects in isotypic switch and differentiation of germinal center B cells, as well as memory cells. These characteristics can be observed in murine models of CD27/CD70 deficiency. Our findings allow a new approach for the study of CVID. The evaluation of defects in CD27/CD70 signaling in humans might become a new tool for understanding an incompletely understood disease. Such an approach may contribute to the development of new treatments, acting directly on the molecule in question. In addition, we also suggest the use of phenotyping of CD27 molecules on B and T lymphocytes, in addition to membrane IgM and IgD to characterize CVID, associated to the analysis of the molecule CD154 to exclude other immunodeficiencies