M.P.H., Faculty of Health Sciences, University of the Witwatersrand, 2011 / Introduction Botswana still has the second highest HIV prevalence in the world with little indication of any significant decline. In Botswana, women are disproportionately affected: young women account for more than half (58 %) of the adults living with HIV thus indicating a significant gender disparity in HIV infection. University educated, urban young women aged 19-39 have been identified as group at particularly high risk of HIV infection. Aim This study aimed to assess knowledge and attitudes regarding HIV and AIDS and how such knowledge and attitudes have implications for participation in risky sexual behavior among female University of Botswana students in their first and fourth years of study. Methodology This study was conducted at the University of Botswana (UB) in Gaborone. Data was collected using a selfadministered questionnaire on Knowledge of HIV/AIDS and participation in Risky Sexual Behavior among female students in first and fourth year of studies at University of Botswana. Results The knowledge regarding the “window period” and infectivity during the window period was significantly lower for first year students compared to fourth years. Attitudes towards people with HIV were positive in both groups, while affirmative attitudes towards premarital sex are increasing as the students progress academically. The analyses highlight that the percentage of women who reported having been sexually active the proceeding year was significantly higher among fourth year students (82.6%) than their first year counterparts (56.9 %), (p<0.01), with the number of partners significantly higher among women in their fourth year. Significantly, 3% of first year female students stated that their partners did not want to use a condom while 7 percent of the participants themselves said that that was the case. Amongst fourth year UB female students responding, 4% said that their partners did not want to use a condom, yet 14% participant said that they themselves did not want to use one. Overall, the prevalence of self-reported STI’s was significantly higher among fourth year students when compared with first year students 19 of 155 [12.26% ]vs. 4 of 144 [2.78 %] p<0.01 . Conclusion This study explored the knowledge of HIV/AIDS and participation in risky sexual behavior amongst female students in their first and fourth years at the University of Botswana. The study supported the findings that higher levels of formal education are associated with better knowledge of how to protect oneself from HIV/AIDS transmission. Although many HIV/AIDS prevention campaigns might have contributed to educated women being knowledgeable about how to protect themselves from HIV/AIDS transmission and the importance from abstaining from risky sexual behavior, a small but significant proportion of women still do not use condoms consistently

Prevention of Human immunodeficiency virus (HIV) in South Africa includes early detection and treatment of sexually transmitted infections (STIs), as well as health promotion activities. The latter include health education programmes and the promotion of screening activities such as voluntary counselling and testing (VCT). The South African government recognises the need for creating equity for access to health care services. The 1997 White Paper for the Transformation of the Health System, stipulates one of the aims of health Policy in the new South Africa as ‘promoting equity by developing a single, unified health system’. This commitment is inclusive of the Platfontein community which comprises the two largest San-groups in South Africa: the !Xun and the Khwe who were settled on the Platfontein farm at the end of 2004. There are 3500 !Xun and 1100 Khwe currently living in the Platfontein community. A health facility, compliant with the principles of Primary Health Care (PHC), was built on the farm to render services to the Khwe and !Xun communities who were not recognised as a distinct cultural group during the Apartheid era in South Africa. For the young people in the community it was the first time they could access the formal schooling and health system in South Africa. The objective of this study was to assess the perceptions, attitudes, behaviour and knowledge levels among the school-going youth of the Platfontein community, about STIs, HIV/AIDS and the health care services that are available to them.

Thesis (M.Sc. (Med.))--University of the Witwatersrand, Faculty of Health Sciences, 2013. / Human immune deficiency virus (HIV) infection contributes to child mortality rates in South Africa. Investigations of newer technologies for improving early infant diagnosis of HIV in the South African setting could reduce child mortality as life saving treatment can be accessed early in life. This study investigated three technologies: a fourth generation rapid HIV test and two viral load (VL) platforms. Determine Combo (DC) is a qualitative fourth generation rapid test that is able to detect HIV antibodies and p24 antigen simultaneously. The performance of DC was evaluated in the field on samples from pregnant and postpartum women; in the laboratory, on stored samples from children and with the addition of heat denaturation. In the maternal DC study 90 (8 .8%) of 1019 women tested HIV positive of whom 59 (17.1% prevalence) were pregnant and 31 % (4.6% prevalence) were postpartum. The sensitivity and specificity of the antibody component of DC on plasma was 100%(Confidence Interval (CI): 95.9- 100%) and 99.8%(CI: 99.2-99.9%) respectively. Three postpartum patients tested false positive for HIV antibodies (n=2) and p24 antigen (n=1). No true positive p24 antigen was detected DC was performed on stored samples from 182 (90%) HIV-exposed and 20 (10%) HIV-unexposed children aged from birth to six years. The DC HIV antibody component returned false negative results in 2 HIV-infected children; one clinically symptomatic and one asymptomatic aged 7 and 23 months respectively. The sensitivity of DC HIV antibody was 100% (CI :94.3-100%) in infants aged 6 months and younger with a specificity of 100% (CI:81.6-100%) for all ages. Of the 61 HIV infected infants tested , the DC p24 antigen was reactive in only one clinically symptomatic infant resulting in a sensitivity for detection of HIV infection of 1.7% (CI 0.3-8.9%). A heat denaturation technique designed to improve p24 antigen detection was applied to HIVinfected samples but failed to enhance p24 antigen detection on DC. HIV viral load (VL) molecular assays are used to confirm an HIV-infected diagnosis and for VL monitoring. In South Africa, plasma is the gold standard sample for VL monitoring in infants even though dried blood spots (OBS) are the preferred specimen type in resource-constrained settings and for early infant diagnosis. The use of OBS specimens for HIV VL monitoring would convenience resource limited settings. The OBS matrix therefore requires validation to determine accuracy (for establishing diagnosis) and precision (for VL monitoring) compared to plasma VL. This study investigated the accuracy and precision limits of OBS VL on the Roche Cobas AmpliPrep-Cobas TaqMan HIV-1 v2.0 assay (CAP/CTM) and the Abbott RealTime HIV-1 assay (m2000) platforms on samples from HIV-infected adults and children. The CAP/CTM was investigated on OBS containing 751J1 blood and the m2000 was investigated using one (50IJI) and two (2x501J1) OBS. Compared to plasma VL, OBS VL from adults and children were higher in the lower range «310g,<1000copies/ml) and lower values in the higher range (>510g, >185,000copies/ml) on the CAP/CTM in the study of OBS VL accuracy. Additionally, OBS VL values were >log1.0 higher in 42/100 (42%) of adult and 16/49 (33%) of measurements from children, which will have clinical significance. On the m2000 platform, the differences between plasma and OBS VL were lower in the range >5 log and higher in the range 2 log copies/ml (100 copies/ml) to 4 log copies/ml (10000 copies/ml). Compared to plasma VL, OBS VL values were >log1.0 higher in 20/82 (24%) adult and 7/43 (16%) of measurements from children. Both platforms demonstrated 100% specificity in testing stored OBS from HIV-uninfected infants who were diagnosed negative on HIV DNA PCR. Acceptable limits for plasma VL precision is a coefficient of variation (CV) <35% and standard deviation (SO) :50.19 log. Where plasma VL :5510g, OBS VL demonstrated poor precision with CV>40% in 8/10 patients and total SO>0.30 log in 4/10 patients on the CAP/CTM. The m2000 total SO was >210g between adult plasma and OBS VLs under the 4 log copies/ml cut-off, irrespective of the number of DBS used. DBS VLs were unreliable when using precision limits used on plasma VLs on both platforms. In conclusion the DC test does not offer any advantage over currently available rapid tests in diagnosing new infection in women and children. The two VL platforms can be used to establish an HIV status in treatment naive patients in view of the 100% specificity. HIV-infected patients on treatment with undetectable plasma VL will always have detectable DBS VL on CAP/CTM, but equally undetectable DBS VL on the m2000. With DBS, the CAP/CTM assay generates higher VL values in the lower VL range than on plasma likely due to amplification of proviral DNA. Both platforms display poor intra- and inter- assay precision, using plasma VL based criteria and the variances would potentially affect clinical decision making. The acceptable limits for plasma VL precision cannot be applied to DBS VL on either platform.

Orientador: Deilson Elgui de Oliveira / Banca: Ricardo Sobhie Diaz / Banca: Celso Teixeira Mendes Júnior / Resumo: A história natural de infecção pelo HIV e a progressão para a aids podem variar entre diferentes indivíduos, possivelmente devido a fatores genéticos, entre eles os polimorfismos de nucleotídeo simples (SNPs). SNPs localizados em regiões promotoras de genes que codificam citocinas podem afetar a síntese e a regulação dessas moléculas, resultando em alterações nas respostas imunitárias. O presente estudo buscou avaliar as frequências e os possíveis efeitos de SNPs nas posições -589 e -1098 da região promotora do gene da IL-4 e SNPs nas posições -238 e -862 da região promotora do gene do TNF-α em pacientes portadores do HIV. Amostras de DNA de 157 pacientes foram obtidas através de células mononucleares de sangue periférico e a genotipagem dos SNPs foi realizada pela técnica de High Resolution Melting (HRM). Foi observado que pacientes portadores de TT em SNP/pIL-4 -589 apresentaram contagem de linfócitos T CD8 + menor em relação aos portadores de CC (p=0.0104). Além disso, portadores de TT em SNP/pIL-4 -1098 apresentaram contagem de linfócitos T CD8 + maior em comparação aos portadores de GT (p=0.0053). Em relação a SNP/pTNF-α -238, as proporções de pacientes portadores de GG e GA diferiu entre os pacientes sem HAART e pacientes com HAART e sem falha terapêutica (p=0.0205). Assim, os resultados obtidos no presente estudo fortalecem a hipótese de que SNPs em genes de citocinas podem alterar a história natural da infecção pelo HIV e o curso clínico da doença, principalmente devido a alterações no balanço da produção de citocinas pro- e antiinflamatórias. / Abstract: The natural history of HIV infection and its progression towards aids may vary considerably among different individuals, possibly due to genetic factors, such as single nucleotide polymorphisms (SNPs). In cytokines genes promoters, SNPs may affect protein synthesis and regulation, resulting in more or less efficient immune responses against HIV. The present study evaluated the frequencies and possible effects of SNPs in the IL-4 gene promoter at positions -589 and -1098 and in the TNF-α gene promoter at positions -238 and -862 in HIV-infected patients from Brazil. DNA samples from 157 patients were obtained from peripheral blood mononuclear cells, and SNPs genotyping was performed by High Resolution Melting analysis (HRM). Patients carrying TT at SNP/pIL-4 -589 had lower circulating T CD8 + cells compared to CC carriers (p=0.0104). Moreover, carriers of TT at SNP/pIL-4 -1098 had more circulating T CD8 + cells compared to GT carriers (p=0.0053). Regarding SNP/pTNF-α -238, GG and GA proportions were significantly different between patients without HAART and patients on HAART without therapeutic failure (p=0.0205). In conclusion, these results provide compelling evidence that the presence of SNPs in cytokine-coding genes do modify the natural history of HIV infection, mainly due to changes in the balance between pro- and anti-inflammatory cytokines. / Mestre

Thesis (M.Cur.) --University of Limpopo, 2011

In order to elucidate T. gondii infection in a regional hospital in southern Taiwan, serum samples were taken from 173 selected individuals. Among them, 91 serum samples were taken from uremic patients under regular hemodialysis, 34 from human immunodeficiency virus (HIV) infected patients and 48 from healthy adults. Of these 173 samples analyzed by commercial enzyme-linked immunosorbent assay (ELISA) kits including anti-T. gondii IgG and IgM, 21 were seropositive (12.1%) of T. gondii infection. Among 91 uremic patients, 11 (12.1%) were seropositive for IgG. Among 34 HIV-infected patients, 9 (26.5%) were seropositive for IgG and 3 (8.8%) were seropositive for IgM. ELISA data were tested by ANOVA and statistical significances were detected among these groups. The most common band revealed by Western blot assay was the 30 kDa antigen which appeared in 8 of 11 (72.7%) uremic IgG-positive patients and 4 of 9 (44.4%) HIV-infected patients. Serodiagnosis of T. gondii infection reveals a higher positive rate among HIV-infected patients, uremic patients under hemodialysis are also at risk for reactivation of latent toxoplasmal infection. Serological screening for anti-T. gondii antibodies among HIV-infected patients and hemodialytic patients as well as sustained follow-up to detect recent infection are extremely important.

Thesis (Ph. D.) in Biochemistry and Molecular Biology--University of Maine, 2001. / Includes vita. Includes bibliographical references (leaves 113-165).

Thesis (Ph. D.)--Ohio State University, 2004. / Title from first page of PDF file. Document formatted into pages; contains xiv, 144 p.; also includes graphics (some col.). Includes abstract and vita. Co-advisors: Lawrence E. Mathes and Maria H. Neff, Dept. of Veterinary Biosciences. Includes bibliographical references (p. 122-144).

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 7 uppsatser.

Diss. Stockholm : Karol. inst.