Highly-active antiretroviral therapy (HAART) has improved the prognosis of HIV-infected individuals. Unfortunately it has also been associated with impaired functional capacity and development of metabolic perturbations which increases health risk. This study tested the hypothesis that a combined cardiorespiratory and resistance exercise training (CARET) intervention may result in significant health benefits in HIV-infected individuals receiving HAART. Thirty-seven HIV-infected men and women, predominantly of lower socioeconomic status (SES), were recruited and randomly assigned to: 1) a group of moderate-intensity CARET for three months or 2) a control group receiving no exercise intervention for three months. At baseline and following the intervention, physical characteristics (body weight, body mass index, waist circumference, and blood pressure), physical fitness variables (estimated VO2max and one repetition maximum for upper and lower body), metabolic variables (fasting glucose and serum lipids), immune functioning (CD4+ T Cell count, CD4/CD8 ratio, and HIV RNA viral load), and quality of life (SF-36 Health Survey) were measured. Exercise participants evidenced increases in estimated VO2max (21%, p < 0.01), upper body strength (15%, p < 0.05), and lower body strength (22%, p < 0.05), while showing reductions in waist circumference (-2%, p < 0.05), and fasting glucose (-16%, p < 0.05). While the control group showed a significant decrease in CD4+ T cell count (-16%, p < 0.05) from baseline, the exercise group maintained a more stable count following training (-3%, p = 0.39). Finally, the exercise participants showed self-reported improvements in physical (11%, p < 0.03) and mental (10%, p < 0.02) quality of life. In conclusion, our study demonstrated that a three-month supervised and moderate intensity CARET program performed three times a week, can result in significant improvements in physical characteristics, physical fitness, metabolic variables, and physical and mental quality of life. Furthermore, the same intervention resulted in more favorable immunological responses following training in HIV-infected individuals of lower SES. Key words: Highly active antiretroviral therapy, HIV, combined aerobic and resistance exercise training, cardiorespiratory fitness, muscular strength, and immune functioning.

<p>In the era of AIDS, food and nutrition are becoming more of a priority for many households and communities. This is more so now that treatment is available for people infected with HIV and AIDS. Food and nutrition are fundamentally intertwined with HIV transmission and the impacts of AIDS. Evidence of the ways in which food insecurity and malnutrition may interfere with the effectiveness of antiretroviral therapy is well documented. Aim: The purpose of the study was to inform improvements in food security interventions for PLWHA through an investigation of existing food security interventions in the Khomas Region, Namibia.</p>

<p>Background: HIV/AIDS affects the health of millions of people world wide. According to the Joint United Nations Program on HIV/AIDS [UNAIDS], the number of people living with HIV globally has risen from 26 million in 2001 to 33.2 million in 2007. It is estimated that 2.5 million people were newly infected with HIV in 2007. The introduction of anti-retroviral therapy [ART] has brought hope to millions of people living with HIV and AIDS. More recently, the increased availability of treatment in many countries including Namibia has dramatically improved survival rates and lowered the incidence of opportunistic infections among HIV patients. Adherence to antiretroviral therapy (ART) is a fundamental attribute of excellent clinical HIV care and a key aspect in determining the effectiveness of treatment. Strict adherence to ART is vital to maintain low viral load and to prevent the development of drug resistant virus. Poor adherence is one of the key obstacles to successful ART for HIV positive patients. Literature has shown that there are various factors that hinder adherence to ART such as patient, service, community, family, socio-economic and work-related factors. Aim: This study aimed to describe the experiences of patients in the ART programme at Katutura State Hospital, Communicable Disease Clinic (CDC), in the Khomas region of Namibia and to explore factors that contribute to poor adherence.</p>

<p>The study utilized a qualitative case study design to explore the problem of poor access to ART in Benue State. PLWHAs, policy makers, program managers and health workers were involved in an effort to describe the factors influencing access to ART in the State. Semi structured interviews, exit interviews and focus group discussions were used. To analyse the findings, categorization was done into facilitators and barriers to access, in addition to the ways respondents believe these barriers can be overcome. Other sub-themes were also identified and sorted. Themes were linked to direct quotes from the respondents. Additional literature review was done to review available information on the themes identified. Facilitators of access included free cost and increased number of sites / beneficial effects of ART / disclosure, membership in a support group and having a treatment partner. Barriers included stigma and discrimination / hunger, poverty, transportation and opportunity costs / hospital factors / non-disclosure / inaccurate knowledge and perceptions about HIV and ART / certain religious beliefs and advice / coverage, capping of services and fear of non-availability of ART. In addition to stigma, patients bypass closer ART access points to further away hospitals because of business opportunities / financial assistance / perceived better standard of care and hope that a cure, when found, will be more accessible to patients in bigger hospitals.</p>

Major advances in highly active antiretroviral therapies (ARVs) have extended the lives of people living with HIV, but there still remains an increased risk of death by cardiovascular diseases (CVD). HIV proteins and ARVs have been shown to contribute to cardiovascular dysfunction with effects on the different cell types that comprise the arterial wall. In particular, HIV-1 transactivating factor, Tat, is a cationic polypeptide that binds to endothelial cells, inducing a range of responses that have been shown to contribute to vascular dysfunction. It is well established that hemodynamics also play an important role in endothelial cell mediated atherosclerotic development where upon exposure to low or oscillatory shear stress, such as that found at branches and bifurcations, endothelial cells contribute to proteolytic vascular remodeling, by upregulating cathepsins, potent elastases and collagenases. The results of this work demonstrate that upregulation of cathepsins in vivo and in vitro is caused by a synergism between pro-atherogenic shear stress and HIV-1 proteins, elucidates pathways that are activated by HIV-1 Tat and pro-atherogenic shear stress - leading to cathepsin-mediated ECM degradation, and identifies cathepsins as novel biomarkers to monitor the adherence of patients on efavirenz- and tenofovir-containing antiretroviral regimens.

Background: Since the beginning of 21st century, several Asian countries started implementing their national free antiretroviral therapy (ART) programs to tackle one of the most striking public health issues in Asia – HIV/AIDS. Despite the efforts being made, the treatment coverage remains as low as 44% in 2010. Previous studies have identified financial constraint is a major barrier in accessing ART and an important reason of poor ART adherence in Asia. The purpose of this literature review is to explore the extent of financial burden experienced by people living with HIV (PLHIV) where free ART policy is implemented, and to provide valuable information for policy-making in reducing financial barriers and improve uptake of ART. Methods: Literature search was performed by entering keywords in PubMed and Medline. Articles were screened and selected for in-depth review according to the inclusion and exclusion criteria. A process on data synthesis was performed on the final eligible papers. Results: Five studies from four Asian countries describing the out-of-pocket health expenditure incurred by PLHIV during the delivery of ART were included in this review. Findings: Out of all direct medical costs, the cost of drug was most important in contributing to the total costs for patients without health insurance, while the cost of transportation was more important for patients covered by health insurance. Direct medical costs increased with advancing stage of disease. Rural patients would have spent up to 1,173% of their monthly income per capita, or more than 100% of their total household expenditure even when ART was provided free-of-charge. Patients have also highlighted free ARV drugs were sometimes not available in the health facility and they had to turn to the private market. Hence, the extent of financial burden in this review might be underestimated. Conclusion: Based on the data available, we concluded that increased accessibility of free ART should be accompanied with sustained ARV drugs supply and increased financial support for PLHIV. / published_or_final_version / Community Medicine / Master / Master of Public Health

HIV/AIDS remains one of the most pressing challenges facing South African society. South Africa has the highest number of people living with HIV as well as the highest number of people on HIV treatment globally, yet only 37% of persons eligible for treatment have access to treatment. The advent of HAART ushered in a new era in the treatment of HIV infection. HIV infection was no longer a life threatening terminal illness, HIV/AIDS became a chronic manageable disease. The full clinical benefit of HAART can only be achieved with near perfect adherence i.e. > 95%. This means taking the medication exactly as prescribed; on time, no missed doses, every day, lifelong. No other chronic medication requires such stringent adherence rates for optimal therapeutic benefit, which may mean the choice between life and death. Achieving near perfect adherence poses a serious challenge to health service providers and persons on treatment as typical adherence rates for medication prescribed over long periods are in the 50 – 75 % range. Persons on HAART live with the additional burden of drug resistance and limited treatment options if near perfect adherence rates are not achieved. The purpose of this qualitative study was to explore the factors that influence adherence to HAART. These factors may be related to the person, the health care team and system, the treatment regimen, the social and economic environment or to the effects of HIV disease. Factors may either negatively or positively influence a person’s ability to adhere optimally to their prescribed treatment. A small sample of thirteen participants were purposefully selected for this study. Data was collected using in-depth interviews which were tape recorded and transcribed for thematic analysis. The value of this study is that it may assist health care providers, persons on treatment and the health care system to better comprehend the challenges of lifelong optimal adherence to HAART. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2011.

Approximately 29.1% of South African women of childbearing age tested HIV positive during their first antenatal visit in 2006 (DoH, 2007). This rate of HIV amongst the women of childbearing age reinforces the importance of understanding the management of HIV during pregnancy. During antenatal visits the general health of the woman and her unborn baby is assessed and managed. Management includes antiretroviral therapy to the HIV infected women with a CD4 count below 200 cells/mm3, while women with a CD4 count above 200 cells/mm3 receive a single dose of nevirapine with the onset of labour provided to them by their local clinics. Currently, in Potchefstroom, women receive antenatal care at local primary health-care clinics and antiretroviral drugs at the antiretroviral clinic. There is little or no collaboration between the various clinics and the question arises if the needs of the women are being met. The aim of the research was to promote the health of HIV positive pregnant women by providing insight into the needs of these women and to formulate recommendations for antenatal care. The specific objective is to explore and describe the needs of HIV positive pregnant women regarding antenatal care. An explorative, descriptive, contextual design, following a qualitative approach was used during the research. Semi-structured interviews were used to collect data. Interview questions were compiled from the research problems. Before the commencement of data collection, permission was obtained from the district health manager and Potchefstroom Hospital. A total of sixteen (16) HIV positive women were interviewed after informed consent had been obtained. Data analysis was done after each session and themes were categorised according to the women's needs. From the interviews it was found that each woman has her own specific needs regarding antenatal care. The needs of the participants followed a similar pattern and for this reason it could be divided into various categories. These categories include a need for support, a need for education, a need for improved services and a need for a non-judgemental environment. Conclusions were drawn and recommendations were made for nursing practice, nursing education and nursing research. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2008.

There is an increasing number of patients failing second line highly active antiretroviral therapy (AZT, DDI and LPV/r) in South Africa, where HIV-1 subtype C predominates. Mutations at gag cleavage sites (CS) have been found to correlate with resistance mutations in protease (PR). Therefore, it is important to collect data on subtype C protease and gag sequences from patients as these mutations may affect the efficacy of protease inhibitor (PI) containing drug regimens. In this study, 30 subtype-C infected second-line failures were genotyped using the ViroSeqTM resistance genotyping kit and the gag region from these isolates were then characterised. These sequences were then compared to 30 HIV-1 subtype C infected first-line failures (PI-naïve) and subtype B, C and group M naïve sequences that were downloaded from the Los Alamos Sequence Database. Amino acid diversity at the CS was measured using Mega version 4.0. To investigate the effect of CS mutations on replication capacity, a mutation was introduced by site-directed mutagenesis (Stratagene’s QuikChange Site-Directed Mutagenesis kit). Of the 30 second-line failures that we genotyped, only 16 had resistance mutations in PR and 23 in gag. The most frequent major PI mutations were: I54V/L, M46I, V82A, and I84V and in gag CS were V390L/I and A431V. Interestingly the A431V mutation significantly correlated with protease mutations M46I/L, I54V and V82A. The virus carrying the A431V mutation in vitro was found to have a lower replication capacity compared to the wild type. These findings emphasize the need for further investigation of gag mutations and their contribution to the evolution of HIV resistance to PIs. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2010.

<p>In the era of AIDS, food and nutrition are becoming more of a priority for many households and communities. This is more so now that treatment is available for people infected with HIV and AIDS. Food and nutrition are fundamentally intertwined with HIV transmission and the impacts of AIDS. Evidence of the ways in which food insecurity and malnutrition may interfere with the effectiveness of antiretroviral therapy is well documented. Aim: The purpose of the study was to inform improvements in food security interventions for PLWHA through an investigation of existing food security interventions in the Khomas Region, Namibia.</p>