As alterações neurocognitivas associadas ao HIV-1 (HAND) são frequentes em adultos infectados pelo HIV-1 via transmissão sexual. Existe pouca informação sobre HAND em adultos infectados pelo HIV-1 via transmissão vertical. Este estudo teve como objetivos identificar a prevalência das HAND em adultos infectados por transmissão vertical assim como identificar a prevalência de depressão nessa população. Pacientes e métodos: trata-se de um estudo de delineamento transversal, realizado entre janeiro 2016 e maio de 2017, no Serviço de Extensão ao Atendimento de Pacientes HIV/aids (SEAP) da Divisão de Moléstias Infecciosas e Parasitárias do Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo. O SEAP é um serviço exclusivamente ambulatorial, localizado na cidade de São Paulo. Os critérios de inclusão foram: (i) pacientes com diagnóstico de infecção pelo HIV-1 por transmissão vertical; (ii) idade igual ou superior a 18 anos; (iii) escolaridade mínima de 4 anos; e (iv) consentimento para participar do estudo. Os critérios de exclusão foram: (i) diagnóstico concomitante de doenças neurológicas oportunistas ou condições neurológicas, previamente documentadas; (ii) uso de substâncias psicoativas; (iii) incapacidade física para aplicação dos testes, (iv) recusa da assinatura do Termo de Consentimento Livre e Esclarecido. Foram utilizados como instrumentos de pesquisa: questionário sociodemográfico, escala de ansiedade e depressão hospitalar, escala de atividades de vida diária de Lawton e bateria neuropsicológica formal. Para análise estatística foram calculadas frequência, média e desvio padrão, assim como testes qui-quadrado, anova e análise posthoc. Valores de p < 0.05 foram considerados estatisticamente significativos. Foi utilizado o programa SPSS 21.0. Resultados: foram avaliados 28 participantes: 15 (53.6%) foram do sexo feminino e a idade média e o desvio padrão (DP) foi de 22 (6.7) anos. Foi identificado HAND em 23 (82,1%) pacientes: 12 (42.9%) tiveram alteração neurocognitiva assintomática (ANI), 6 (21,4%) tiveram comprometimento neurocognitivo leve (MND) e 5 (17.9%) tiveram demência associada ao HIV-1 (HAD). A atenção, velocidade de processamento e velocidade motora foram as funções cognitivas mais comprometidas. 3 (10.7%) pacientes apresentaram depressão; 3 (60%) dos 5 pacientes com HAD apresentaram depressão. Conclusões: neste estudo encontramos elevada prevalência de HAND em adultos infectados pelo HIV-1 via transmissão vertical, chamando atenção também a elevada proporção de pacientes com HAD. Por outro lado, identificamos baixa prevalência de depressão na população total do estudo, mas a prevalência de depressão foi elevada dentre os pacientes com HAD / Neurocognitive disorders associated with HIV-1 (HAND) are common in adults sexually infected with HIV-1. There is little information about HAND in adults vertically infected with HIV-1. This study aimed to identify the prevalence of HAND in adults vertically infected with HIV-1 as well as to identify the prevalence of depression in this population. Patients and methods: This is a cross-sectional study, conducted between January 2016 and May 2017, at the Extension Service for HIV/aids Patients (SEAP) of the Division of Infectious and Parasitic Diseases of the Hospital das Clínicas of University of São Paulo Medical School. SEAP is an exclusively outpatient service, located in the city of São Paulo. Inclusion criteria were: (i) patients diagnosed with HIV-1 infected by vertical transmission; (ii) age equal to or more than 18 years; (iii) minimum schooling of 4 years; and (iv) consent to participate in the study. Exclusion criteria were: (i) concomitant diagnosis of opportunistic neurological diseases or neurological conditions, previously documented; (ii) use of psychoactive substances; (iii) physical incapacity to apply the tests, (iv) refusal to sign the Free and Informed Consent Form. The following research assessment tools were used: sociodemographic questionnaire, hospital anxiety and depression scale, Lawton daily life activity scale and formal neuropsychological battery. For statistical analysis, we calculated frequency, mean and standard deviation, as well as chi-square, anova and post-hoc analysis. Values of p < 0.05 were considered statistically significant. The SPSS 21.0 program was used. Results: 28 participants were evaluated: 15 (53.6%) were female and the mean age and standard deviation (SD) were 22 (6.7) years. HAND was identified in 23 (82.1%) patients: 12 (42.9%) had asymptomatic neurocognitive impairment (ANI), 6 (21.4%) had mild neurocognitive impairment and 5 (17.9%) had dementia associated with HIV-1 (HAD). Attention, processing speed and motor speed were the most compromised cognitive functions. 3 (10.7%) patients presented depression; 3 (60%) of the 5 patients with HAD had depression. Conclusions: in this study we found a high prevalence of HAND in adults vertically infected, also calling attention to the high proportion of patients with HAD. On the other hand, we identified a low prevalence of depression in the total study population, but the prevalence of depression was high among patients with HAD

A transmissão do VHC vem diminuindo após a implementação de diretrizes de triagem de doadores de sangue e adoção de políticas sociais para reduzir o risco de infecção em UDI, entretanto o VHC ainda constitui um grave problema de saúde pública mundial. Em torno de 10% dos pacientes infectados com VHC não referem exposição a nenhum fator de risco conhecido. Alguns estudos demonstraram a presença de RNA em diferentes secreções, sugerindo a existência de outras rotas de transmissão do VHC. Este estudo teve como objetivo analisar as relações filogenéticas de diferentes regiões genômicas do VHC de cônjuges portadores crônicos e correlacioná-las com seqüências de portadores crônicos não relacionados atendidos no mesmo ambulatório. Foram selecionados 18 pacientes (9 casais) com genótipo concordante entre eles e 42 controles (14 de cada genótipo encontrados nos casais). Foram amplificadas e seqüenciadas as regiões NS3 (~620nt) e NS5B (~360nt). As seqüências foram alinhadas usando o programa Clustal X e Bioedit 6.0.7. A presença do sinal filogenético, nas regiões estudadas, foi analisado através do mapeamento da verossimilhança pelo programa Tree-Puzzle. Os modelos evolucionários foram estimados pelo teste de razão de verossimilhança com o auxílio do programa Modeltest e utilizados para as análises das seqüências NS3, NS3+NS5B (TrN+I+G) e NS5B(TrNef+I+G). Foram empregados os métodos de distância com algoritmo de agrupamento de vizinhos e máxima verossimilhança com o algoritmo de rearranjo dos braços, seccionando a árvore em dois pedaços e ligando em outras partes, para a construção das árvores, pelo programa PAUP*4b10. Foram calculados os valores de bootstrap, com 1000 réplicas, para a verificação da sustentação de ramos nas topologias. Nas análises foram incluídas seqüências referencia do Genbank de diferentes genótipos. Todos os casais tiveram a região NS5B amplificada e seqüenciada, entretanto, não foi possível amplificar e seqüênciar a região NS3 de amostras de 2 casais. Considerando-se as três análises o sinal filogenético foi de 90.5% (NS5B - 199 nt), 92.9% (NS5B - 344 nt), 94.8% (NS3 - 619 nt ) e 96.1% (NS5B + NS3). Como esperado, o melhor sinal filogenético foi obtido com as seqüências das duas regiões concatenadas NS3+NS5B. As análises filogenéticas sugerem fortemente que os vírus dos casais 3, 4, 6, 7, e 8 têm a mesma origem. Na maioria das análises as seqüências dos vírus destes casais formaram um grupo monofilético com valores de bootstrap acima de 70. As seqüências dos outros casais, em algumas situações, apresentaram grupos monofiléticos, contudo os valores de bootstrap não foram significativos. A utilização de seqüências de duas regiões genômicas diferentes suportam a hipótese de que os vírus dos casais 3, 4, 6, 7 e 8 têm a mesma origem. A inclusão de seqüências controle, dos mesmos subtipos encontrados nas amostras dos casais, foram fundamentais para a confirmação dos resultados. Estes resultados indicam fortemente a possibilidade de transmissão entre casais. / HCV transmission has decreased with the adoption of universal blood donors screening and social policies to reduce risk of infection in IVDU, but HCV is still a worldwide health problem. The epidemiological route of infection cannot be identified in a significant proportion of patients. Some studies demonstrated the presence of viral RNA in different secretions, suggesting the existence of other routes for HCV transmission. The aim of this study was to evaluate the phylogenetical relationships among sequences from different HCV genomic regions from sexual partners of chronic infected patients when analyzed among themselves and when analyzed conjointly with sequences from virus found in non related chronic infected patients attended in the same clinic. Eighteen individuals (9 couples with stable relationship without other risk factors for HCV infection) and forty-two control patients (fourteen from each genotype found in the couples) were selected. NS3 (~620 nts) and NS5B (~360 nts) regions were amplified and sequenced. Sequences were aligned using clustal X 1.81 and Bioedit 6.0.7. Phylogenetic signal/noise ratio in the data set was investigated with a likelihood mapping analysis with the program TREE-PUZZLE. Evolutionary models were chosen by Hierarchical Likelihood Ratio Test (hLRTs) using Modeltest 3.06 and used for analyze NS3, NS3+NS5B (TrN+I+G) and NS5B (TrNef+I+G) sequences. Distance and maximum-likelihood (ML) phylogenetical analyses were performed with PAUP*4b10 and the trees were constructed with NJ and heuristic search. Tree bisection and reconnection (TBR) algorithm respectively.Robustness of trees was evaluated by analyzing 1000 bootstrap replicates. Genbank reference sequences from different genotypes were included in data analysis. Sequences from NS5B region were obtained for all samples while it was not possible to get NS3 sequences from only 2 couples. Considering the three analysis, phylogenetical signals were 90.5% (NS5B - 199 nt), 92.9% (NS5B - 344 nt), 94.8% (NS3 - 619 nt ) and 96.1% (NS5B + NS3). As expected, the best phylogenetical signal was obtained with concatened NS3+NS5B sequences. Phylogenetical analysis strongly suggested that virus from couples 3, 4, 6, 7 and 8 had a common origin. In the majority of the analysis, sequences inside these couples clustered in the same monophyletical group with bootstrap values higher than 70. For the other couples, monophyletical groups were observed but these results were not supported by the bootstrap analysis. In conclusion, using sequencing from two different viral genomic regions, we have strongly supported a common source of infection for the two members of five couples. Control sequences from the same subtypes than the couples were crucial to confirm the results. These data strongly support HCV transmission inside couples.

Introdução: O Protocol Aids Clinical Trial Group (PACTG 076), publicado em 1994, demonstrou que a utilização da zidovudina (ZDV) reduzia a taxa de transmissão materno-infantil do HIV (TMI HIV) de 25% para 8,3%. Atualmente a terapia antirretroviral (TARV) combinada associada a uma série de medidas pode reduzir a taxa de TMI HIV para menos de 2%. Embora o Ministério da Saúde preconize a adoção destas medidas, a TMI HIV ainda permanece acima dos níveis desejados, principalmente em nosso meio. De acordo com levantamento da Vigilância Epidemiológica do Município de Porto Alegre, no ano de 2012 a taxa TMI HIV foi de 2,9%. Objetivo: Avaliar os fatores que interferem na TMI HIV em um Hospital Universitário do Município de Porto Alegre/RS. Método: Trata-se de um estudo de coorte histórico, tendo como amostra 292 bebês nascidos de mulheres portadoras do HIV, cujos nascimentos ocorreram no Centro Obstétrico de um Hospital Universitário do Município de Porto Alegre/RS, entre 1º de janeiro de 2010 a 31 de dezembro de 2014. Resultados: Dos 292 bebês, cujas mães eram portadoras do HIV, 3,8% (n=11) foram contaminados. Destes 90,9% (n=10) nasceram por cesariana; 90,9% (n=10) tinham d37 semanas; 54,6% (n=6) receberam ZDV xarope isoladamente e 45,4% (n=5) receberam ZDV + nevirapina (NVP). Quatro gestantes cujos bebês foram contaminados apresentaram sífilis na gestação (36,4%). A má adesão a TARV (p<0,003), a carga viral d1.000 cópias/mL ou ignorada no 3º trimestre (p<0,001) e o CD4 <500 células/mm3 (p<0,046) no terceiro trimestre foram significativamente associados a maior TMI HIV. Conclusão: Os fatores associados significativamente a TMI HIV foram à má adesão a TARV, a presença de sífilis na gestação, a carga viral d1000 cópias e o CD4 <500 células/mm³ no terceiro trimestre. / Introduction: Protocol Aids Clinical Trial Group (PACTG 076), published in 1994, demonstrated that the use of zidovudine (ZDV) had reduced the rate of mother-tochild transmission (MTCT) of HIV from 25% to 8.3%. Currently, a combined antiretroviral therapy (HAART) associated with a number of measures can reduce the rate of MTCT to less than 2%. Although the Ministry of Health recommends the adoption of these measures, the MTCT still remains above desired levels, especially in our center. According to a survey of Epidemiological Surveillance of Porto Alegre, in 2012 the rate of MTCT was 2.9%. Objective: To evaluate the factors that interfere with MTCT from HIV-positive women who gave birth in a University Hospital of Porto Alegre/RS. Method: A historical cohort study, with a sample 292 babies from HIV infected mother whose delivery occurred at Obstetric Center of the University Hospital of Porto Alegre/RS, at period of January 2010 till December 2014. Results: Of 292 babies of women HIV positive, 3.8% (n=11) were infected. Of those 90.9% (n=10) was born by cesarean section; 90.9% (n=10) had d37 weeks; 54.6% (n=6) received only ZDV syrup and 45.4% (n=5) received ZDV+nevirapine (NVP). Four pregnant women whose babies were infected, mother had syphilis during pregnancy (36.4%). Poor adherence to HAART (p<0.003), viral load d1000 copies/mL or ignored in the third trimester (p<0.001) and CD4 <500 cells/mm3 (p<0.046) in the third trimester were significantly associated with higher MTCT. Conclusion: We conclude that the presence of syphilis in pregnancy, viral load d1000 copies/mL or ignored in the third trimester, the CD4 <500 cells/mm³ in the third trimester, poor adherence to HAART were significant factors for MTCT.

Identifying and tracking individuals affected by this virus in densely populated areas is a unique and an urgent challenge in the public health sector. Currently, mapping the spread of the Ebola virus is done manually, however with the help of social contact networks we can model dynamic graphs and predictive diffusion models of Ebola virus based on the impact on either a specific person or a specific community. With the help of this model, we can make more precise forward predictions of the disease propagations and to identify possibly infected individuals which will help perform trace – back analysis to locate the possible source of infection for a social group. This model will visualize and identify the families and tightly connected social groups who have had contact with an Ebola patient and is a proactive approach to reduce the risk of exposure of Ebola spread within a community or geographic location. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2017. / FAU Electronic Theses and Dissertations Collection

Diss. (sammanfattning) Umeå : Umeå universitet, 2009. / Felaktigt serienummer 1251. Härtill 4 uppsatser.

Source: Masters Abstracts International, Volume: 47-06, page: 3551. Adviser: Christine Markham. Includes bibliographical references.

Introduction. Previous studies have established that infants born to mothers with advanced HIV disease and co-infections are smaller, premature and have rapidly progressive HIV disease and an early death. King Edward VIIIth Hospital, in Durban, admits many sick mothers and manages a large proportion of low birth weight and ill newborns. On discharge and follow-up, the mortality and morbidity of these infants are known to be high and are related to the prematurity. How much is related to being HIV exposed is still uncertain. Aim. To determine the perinatal transmission rate of HIV-1 and mortality at 12 months in HIV exposed infants that were admitted to and discharged from the Neonatal Unit, in Durban, South Africa. Methods. In this observational study, data from the outpatient charts of HIV exposed infants that required specialised neonatal care and subsequent follow up, between the period November 2007 and December 2009, were collected. Perinatal transmission rates and mortality of these infants were compared with maternal and infant risk factors. Results. Data on 463 HIV exposed, predominantly low birth weight infants are presented. The median maternal CD4 count was 309cells/mm3 with 16.8% of mothers commenced on HAART. Maternal co-infection with TB was found in 19.2% of the cohort. Early HIV transmission occurred in 11.5% of infants and was influenced by the type of ARV exposure (None, 20%; single dose NVP, 14.3%; dual therapy, 10.6%; maternal HAART, 8.5%). The dual therapy regimen for 7 days was more protective than that for 28 days (p=0.045). HIV infection was associated with higher risk of neonatal sepsis (RR 1.6; 95% CI, 1.1-2.3; p=0.015). The mortality for the cohort at 12 months was 10%. Maternal HAART was associated with a lower mortality: 2.95% vs.10.2% (RR 3.0; 95% CI, 0.4-20.5). There was a higher mortality rate in those that were low birth weight (RR 4.2; 95% CI, 1.02-18.8; p=0.037); those that were HIV infected (RR 4.8; 95% CI, 1.9-11.6; p=0.002) and those that were breastfeeding compared to formula feeding (RR 2.7; 95% CI, 1.1-6.8; p=0.038). Discussion. Rates of HIV transmission within the PMTCT programme were similar to that reported by the Department of Health. Early maternal ARVs for PMTCT prophylaxis, prevents HIV transmission. The coverage of maternal HAART was sub-optimal. Breastfeeding was associated with a higher HIV transmission rate and was most likely associated with non-exclusive breastfeeding during neonatal admission. Recommendations. Maternal HAART or ARV prophylaxis should be commenced early in the pregnancy for the best benefits. Meticulous attention should be paid to the feeding practices of high risk HIV exposed infants admitted for specialised neonatal care. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2012.

Veterinarians often perform controlled experiments in which they inoculate animals with infectious diseases. They then monitor the transmission process in infected animals. The aim of such experiments can be to assess vaccine effects. The fitting of individual-level models (ILMs) to the infectious disease data, typically achieved by means of Markov Chain Monte Carlo (MCMC) methods, can be computationally burdensome. Here, we want to see if a vaccination effect can be identified using simpler regression-type models rather than the complex infectious disease models. We examine the use of various logistic growth curve models, via a series of simulated experiments in which the underlying true model is a mechanistic model of infectious disease spread. We want to investigate whether a vaccination effect can be identified when only partial epidemic curves are observed, and to assess the performance of these models when experiments are run with various sets of observational times.

This thesis sets out to describe and discuss male street prostitution as it occurs in Durban. The aim is to examine to what degree male street prostitutes are at risk of HIV infection, and make appropriate recommendations for HIV intervention. The field data, gathered through participant observation, revealed significant differences between the two research sites, refiecting broader race and class divisions in the South African society. At the same time, the in-depth case studies of the individual participants suggest that they share similar socio-economic life histories characterised by poverty and dysfunctional families, and hold similar world-views. The research was conducted within a social constructionist framework, guided by theories of human sexuality. Yet, sexuality was not the framework within which the male street prostitutes in Durban attached meaning to their profession. Professing to be largely heterosexual, the respondents engaged in homosexual sexual acts without considering themselves to be homosexual, reflecting and amplifying the fluid nature of human sexuality. It was, however, within an economic framework that the male street prostitutes who participated in this study understood and interpreted their profession. The sexual aspect of their activities was far less important than the economic gain to them, and prostitution was interpreted as a survival strategy, A significant finding of this research is that male street prostitutes in Durban face a considerably higher risk of exposure to HIV from their non-paying sexual partners (lovers) than from their paying sex partners (clients). The research participants all had a good knowledge of HIV and the potential danger of transmission whilst engaging in unsafe commercial sex. In their private love lives, the participants were less cautious about exposing themselves and their partners to HIV infection, hence the conclusion that the respondents face a greater threat of HIV infection from their lovers than from their clients. Finally, male street prostitutes, like female street prostitutes, do however face some risk of HIV infection as a result of their involvement with commercial sex. The illegal nature of their activities is considered to contribute to an environment conducive to the transmission of HIV, and this thesis argues for a change in the legal status of commercial sex work as a primary component of HIV intervention in this vulnerable group of men and women. / Thesis (M.A.)-University of Natal, Durban, 2000.

The purpose of this thesis was to study interactions between systemic fungal diseases and perennial plants. Using the systemic rust Puccinia minussensis on the host plant Lactuca sibirica, and the rust Puccinia pulsatillae on the host plant Pulsatilla pratensis, this thesis focused on: (i) the effects of systemic diseases on their hosts (ii) host and pathogen responses to abiotic factors, (iii) the importance of life history strategies for understanding host-pathogen interactions, and (iv) the evolutionary consequences of living in close associations. Results of greenhouse experiments showed that Lactuca sibirica had a high plasticity in growth, since it produced significantly more shoots in favourable than in unfavourable growth conditions. Both the disease levels and the number of healthy shoots (i.e. escape) were significantly higher under favourable conditions. Disease spread within the rhizome was found to be incomplete, and the risk of aecidial- infection decreased with distance from the parent. Furthermore, one isolate of the fungus had highest success and reduced the host plant biomass and shoot production more on the clone it was collected on compared to four other clones . In the field, disease levels were found to fluctuate more at localities subjected to disturbance, the host and pathogen abundances were found to be in phase and the pathogen showed no delayed response to increasing host densities. The rust Puccinia pulsatillae on Pulsatilla pratensis showed no fluctuations between years, low infection rates, and disease levels were higher in ungrazed compared to grazed sites. There was no escape from the disease in this system. A comparison of characteristics of different systemic fungi and hosts with different growth patterns indicated that the life history strategies of both host plants and pathogens need to be studied if the long-term consequences of host-pathogen interactions are to be predicted. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1993, härtill 5 uppsatser.</p> / digitalisering@umu