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

HIV/AIDS is one of the largest health problems the world is currently facing. Even with anti-retroviral therapies (ART), many resource-constrained countries are unable to meet the treatment needs of their infected populations. ART-distribution methods need to be created that prevent the largest number of future HIV infections. We have developed a compartment model that tracks the spread of HIV in multiple two-sex populations over time in the presence of limited treatment. The model has been fit to represent the HIV epidemic in rural and urban areas in Uganda. With the model we examine the spread of HIV among urban and rural regions and observe the effects of preferential treatment to rural areas on the spread of HIV in the country as a whole. We also investigate the effects of preferentially treating women on the spread of HIV. We find that preferentially treating urban women produces the most dramatic effect in reducing the number of infected male and females in rural and urban areas.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2002. / Härtill 6 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 5 uppsatser.

Thesis (M.P.H.M.)--Mahidol University, 2000.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A prevenÃÃo à um meio eficaz pra lidar com o HIV/Aids e a igreja como rede comunitÃria de saÃde à um cenÃrio propÃcio à construÃÃo cultural de adolescentes no que se refere à adoÃÃo de comportamentos sexuais seguros, pois adota postura cautelosa ao demonstrar valorizaÃÃo nas relaÃÃes sexuais com responsabilidade e, principalmente, com respeito a si e ao outro. O estudo apresenta como objetivo geral favorecer um espaÃo crÃtico-reflexivo voltado para o HIV/Aids, junto aos adolescentes que fazem parte de um grupo da Igreja CatÃlica no municÃpio de TianguÃ-CearÃ, com base no pensamento de Paulo Freire. Trata-se de uma pesquisa-aÃÃo, realizada no perÃodo de maio a agosto de 2009. Os sujeitos foram dez adolescentes inseridos em grupos de jovens da RenovaÃÃo CarismÃtica CatÃlica. Como instrumentos para coleta de dados utilizou-se um formulÃrio de entrevista, observaÃÃo-participante, registro fotogrÃfico, filmagens e registro em diÃrio de campo. Como mÃtodo e tÃcnica foram utilizados o CÃrculo de Cultura para articular a dimensÃo coletiva e interativa da investigaÃÃo no desenvolvimento da pesquisa-aÃÃo. Deste modo foram realizados oito CÃrculos de Cultura construÃdos de acordo com as seguintes etapas: descoberta do universo individual e coletivo, problematizaÃÃo com fundamentaÃÃo teÃrica, desconstruÃÃo de conceitos com reflexÃo teÃrica-prÃtica, (re)construÃÃo coletiva, sÃntese da vivÃncia, avaliaÃÃo de cada cÃrculo e outra avaliaÃÃo final, para estes momentos foi necessÃrio a seleÃÃo dos temas e criaÃÃo de situaÃÃes para problematizaÃÃo de acordo com a realidade percebida. Os cÃrculos consideraram os pressupostos do MÃtodo Paulo Freire, como: diÃlogo, participaÃÃo, reflexÃo teÃrico-prÃtica, valorizaÃÃo do conhecimento, respeito à cultura, acesso a conteÃdos relacionando-os à realidade e autonomia para realizaÃÃo de escolhas pautadas na reflexÃo crÃtica da realidade vivida. A anÃlise e interpretaÃÃo dos resultados privilegiaram a discussÃo dos dados, de acordo com a sequÃncia dos CÃrculos, considerando a experiÃncia vivida pelo grupo e o diÃlogo com a literatura realizada pela pesquisadora-animadora. Neste sentido os adolescentes refletiram acerca dos temas: HIV/Aids, castidade, sexualidade e prevenÃÃo no contexto religioso, momentos que permitiram a desconstruÃÃo e (re)construÃÃo de conceitos e (prÃ)conceitos. A realizaÃÃo do cÃrculo de cultura como estratÃgia educativa e investigativa com adolescentes inseridos na Igreja vem despertar a influencia que a Igreja exerce nesse grupo, quando realiza ensinamentos relacionados à castidade e fidelidade compreendidas como comportamentos a serem adotados e consequentes meios de prevenÃÃo ao HIV/Aids, o silenciamento desta a respeito da sexualidade, a desvalorizaÃÃo das informaÃÃes sobre o uso do preservativo por parte dos adolescentes e o reconhecimento da necessidade de mais conhecimento que contemplem os temas que emergiram no estudo. Assim, os enfermeiros precisam utilizar metodologias emancipatÃrias que favoreÃam o diÃlogo pautado na confianÃa e respeito entre educador/educando, fortalecendo uma relaÃÃo de amizade para a reflexÃo, envolvendo a adoÃÃo de comportamentos sexuais seguros em adolescentes inseridos na igreja. / Prevention is an effective means for working with HIV / AIDS and the church as a network of community health is a setting conducive to the cultural construction of adolescents with regard to the adoption of safe sexual behaviors, it adopts cautious to demonstrate the value of sex with responsibility and especially with respect to self and other. The study has as main objective to promote a critical and reflective area facing the HIV / AIDS with teens who are part of a group of the Catholic Church in the city of TianguÃ-CearÃ, based on the thought of Paulo Freire. This is a research- action, carried out between May and August 2009. The subjects were ten adolescents placed in youth groups of Catholic Charismatic Renewal. The instruments for data collection used a form of interview, participant observation, photographic records, filming and recording in the field diary. As the method and technique were used Circles of Culture to articulate the collective dimension of interactive research in the development of action research. Thus were carried out eight circles of culture constructed in accordance with the following steps: discovery of the Universe individual and collective problematization and theory, deconstruction of theoretical concepts and practice, collective (re) construction, summary of the experience, evaluation of each circle and one final assessment for these periods was necessary to select the themes and creating situations for questioning in accordance with the perceived reality. The circles considered the assumptions of the Paulo Freire method, such as: dialogue, participation, theoretical and practical value of knowledge, respect for culture, access to content relating to the reality and autonomy to carry out choices based on critical reflection of the reality . The analysis and interpretation of results have concentrated on the discussion of the data, according to the sequence of circles considering the experience of the group and the dialogue with the literature carried out by the researcher. In this sense the adolescents reflected on the themes: HIV / AIDS, chastity, sexuality and prevention in the religious context, moments that led to the deconstruction and (re) construction of concepts and (pre) concepts. The completion of the circle of culture as educational and investigative strategy with adolescents from the church is awakening to the influence that the church plays in this group when its teachings are related to teaching of the chastity and fidelity understood as behaviors to be adopted and the resulting means of preventing HIV / AIDS , the silencing of the church about sexuality, the devaluation of information on condom use by adolescents and recognition of the need for more knowledge that address the issues that emerged in the study. Therefore nurses need to use methodologies that promote emancipatory dialogue founded on the trust and respect between teacher / student, strengthening a relationship of friendship to the reflection about the adoption of safe sexual behaviors in adolescents in the church.

Magister Public Health - MPH / Globally, approximately 600,000 infants each year are born with HIV infection in Sub-Saharan Africa as a result of mother to child transmission (MTCT) (UNAIDS, 2001). Whereas there is significant progress in reduction of mother to child transmission of HIV in Uganda, the Western Region of Uganda has low rates of PMTCT service utilization. The progress has been hampered by many factors including low male involvement (MOH, 2005). The main objective of this study was therefore to identify some of the factors that discourage men from participating in PMCT services in this region. The study was conducted in Kibaale District in the Western Region of Uganda for a period of one month in mid 2009. Data was collected using a qualitative methodology. The tools that were used for data collection were key informant in-depth interviews and focus group discussions (FGDs) guides. Data was collected from PMTCT service providers, women of reproductive age group and men whose partners had given birth during the last year (2008). For the focus groups, a purposive sample of men and women who had some children born in 2008, followed by random sampling from the list of potential subjects was used to select participants. The study sample comprised of three FGDs of women who had given birth in year 2008 and male partners of women who had also given birth in 2008. Each FGD consisted of eight participants. One FGD was with women only, the other with men only, while the third was with both men and women.

This study presents a qualitative analysis of the dichotomy between official HIV and AIDS policy and its implementation in a Human Rights based, United Nations (UN) agency, located in South Africa. The study demonstrates that although HIV and AIDS policy is an intrinsic part of the commitment of this large organisation, the implementation of the policy, in the form of a Workplace Wellness Programme supported by budgetary resources, is weak and incomplete. The thesis integrates detailed vignettes in drawing attention to how personnel in the South Africa office perceive and experience the implementation of HIV and AIDS policy. Additionally, the voices of bureaucrats are also integrated in an effort to interrogate management attitudes and mindsets on matters of policy and treatment of staff. The study explores staff members’ sense of being stigmatised and discriminated, when living with the virus and their responses to it. In this, I bring a personal perspective to the study, by relating my own views of living with a potentially life-threatening disease to the views of the participants in the workplace in which the study is conducted. Classical Weberian and contemporary accounts of ‘bureaucracy’ and the organisational ‘rule book‘ are drawn upon. It is argued that whilst the value systems and politics of managers in the United Nations system lead them to be defined as progressive, some of the practices within their own institutions are contradictory, indifferent and manipulative leading to the perpetuation of discrimination and anxiety amongst HIV-positive staff. Thus, human agency and ingenuity supersedes organisational structure and the rigour of organisational policies and rules. The contradictions highlighted necessitate a careful scrutiny of organisational dynamics, within the wider international development scenario, and organisational introspection within individual UN offices vis-à-vis HIV and AIDS policy implementation. It is envisaged that the study will induce the commissioning of a larger study carried out by an independent body and funded by the United Nations, enabling the validation and enhancement of the argument presented in the case study and provide more recommendations for the way forward for the United Nations. / Thesis (DPhil)--University of Pretoria, 2010. / Sociology / unrestricted

Magister Chirurgiae Dentium (MChD) / MChD (Oral Pathology) minithesis, Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, University of Western Cape Among malignant lesions, lymphoma ranks second only to squamous cell carcinoma in frequency of occurrence in the head and neck. Lymphomas in HIV patients' are second in frequency to Kaposi's sarcoma as AIDS-defining tumours. About 50% of lymphomas in HIV patients are extranodal and more than half of these occur in the head and neck area. The number, variety and diagnostic complexity of lymphoma cases that have primarily arisen in the head and neck region has steadily increased in the surgical pathology service of the National Health Laboratory Services (NHLS) - Tygerberg. This observation is particularly relevant in the context of increasing HIV infection rates in the population of South Africa as demonstrated by a study in 2006 conducted by the Medical Research Council of South Africa. This is a retrospective study using the records of cases of head and neck lymphomas diagnosed at NHLS-Tygerberg over the last five years. The aim of this study is to investigate the prevalence of head and neck lymphomas (HNL) at NHLS-Tygerberg from January 2002 to December 2006. The objective of this study is to determine the frequency and types of HNL and to determine, if possible, an association between the incidence of HNL and the HIV status of the patients. Trends of prevalence in terms of gender, referral centres, HIV status, age of patients and site of presentation are also examined. The results of this study show an increase in the number of patients with HNL from January 2002 to December 2006. A significant increase is noted in the number of HIV positive patients documented each year, from 17% in 2002 to 33% in 2006. Western Cape- urban (WC-U) remains the largest referral center. A notable increase is seen, each year, in the number of patients referred to Tygerberg-NHLS from the Eastern Cape (EC) and Western Cape- rural (WC-R) areas. A significant number of HIV positive patients are referred from the Eastern Cape and Western Cape rural areas. The average age of disease presentation in the HIV positive group of patients is 35 years with the unknown group being 46 years and the HIV negative group being 54 years. The main categories of lymphoma that presented in HIV positive patients are plasmablastic lymphoma (PBL) and diffuse large B-celllymphoma (DLBCL), which together form 56% of cases. 26% of cases are Hodgkin's lymphoma (HL); the second largest group of HNL cases. Burkitt's lymphoma (BL) consists of 8% of cases. 7% of cases are T-cell lymphomas. 3% of cases are Mantle zone lymphomas. No cases of SLL and Follicular lymphomas (FL) are described in this group of patients. DLBCL and HL form 27% each of the cases in patients with a negative HIV status. A significant number of Follicular lymphomas (15%), small lymphocytic lymphoma (SLL) (9%), MALT (7%), and T-cell lymphomas (8%) are identified. No PBL are seen in this group of patients. The incidence of HNL at NHLS-Tygerberg has increased over the last five years. This trend parallels that seen in other developing countries such as Tanzania, Nigeria, Thailand and India. This increase is possibly due to an increase in the number of referrals to our center, an increase in the overall population of the Western Cape, an increase in the number of HIV positive patients and the high incidence of EBV infection in the general population of the Western Cape. Social issues, such as poverty, lack of adequate education, female dependence on partners, rural communities and the non-availability of anti-retroviral drugs (ARV) and highly active anti-retroviral therapy (HAART) to most of the population that require these drugs, are considered major contributing factors. A trend is noted in the increased number of female patients diagnosed each year with HNL. A predominance of DLBCL was identified in our series. This is consistent with previous reports and studies on HNL. The number of biologically aggressive lymphomas, such as DLBCL, Plasmablastic and Burkitt's lymphomas diagnosed each year, has also significantly increased. These were prevalent mainly in the HIV positive group of patients who were also younger compared to the HIV negative patients. The documented findings of this study will serve as a guideline for the estimation of head & neck lymphoma burden and risk assessment at NHLS- Tygerberg.

Student Number : 0106135V - MA research report - School of Human and Communitiy Development - Faculty of Humanities / The mass media persistently thrusts the awareness of risk of HIV/AIDS into our lives. The question is: how do people respond to this increased awareness and how do people cope with living in what has been termed ‘the risk society’? This can only be investigated within a given social and cultural context, in order to examine how individuals make sense of a perceived imminent crisis. This research has highlighted the prominent phenomenon of a widespread sense of personal invulnerability when faced with risk: the ‘not me’ dynamic in response to the negative Social Representations that surround this disease. Social representations Theory is a useful psychological framework as it approaches the study of perceptions of HIV risk by highlighting the emotional factors which are key to the human responses of risk while at the same time concentrating on the role of cognitive processing in the development of representations of social phenomena. The results from the HIV Knowledge, Perceptions & Practices questionnaire survey in this cross-sectional study with 200 Johannesburg university students indicate that while the large majority of the participants know a great deal about HIV, this knowledge is highly impacted upon by the Social Representations that exist around this virus. It is believed that the Social Representations surrounding HIV (death, pollution, the evil perpetrator etc.) can act as a barrier between intellectual knowledge of HIV and the related behaviour to reduce the risk of infection by distorting one’s perception of susceptibility of infection through the process of ‘othering’.