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1
Soares, Sampaio Aletheia. „Marcadores sorológicos para os vírus da hepatite B e C em pacientes HIV-positivos atendidos no Hospital Universitário Oswaldo Cruz“. Universidade Federal de Pernambuco, 2005. https://repositorio.ufpe.br/handle/123456789/7445.
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Previous issue date: 2005A ocorrência de co-infecção pelo HIV e hepatites B e C tem sido relatada desde a era- HAART (do inglês Highly Active Antinetrovial Therapy), quando a mortalidade nas pessoas infectadas pelo HIV começou diminuir. Como conseqüência do fato de terem as mesmas rotas de transmissão, a co-infecção do HBV ou HCV em pessoas infectadas pelo HIV tem aumentado e tornou-se um problema de saúde pública. No Brasil, a prevalência média da coinfecção HIV e hepatites, encontrada pelo Ministério da Saúde é em torno de 40%, com a maioria em grupos de usuários de drogas. Freqüências variáveis de co-infecção têm sido relatadas, dependendo da população e da região estudada. O objetivo principal deste estudo foi identificar a freqüência de marcadores sorológicos para hepatite B e C em pacientes infectados pelo HIV, acompanhados em um hospital escola e os possíveis fatores associados à presença de tais marcadores. Quatrocentos e vinte e nove pacientes foram estudados, de ambos os sexos e com idade variando entre 18 a 77 anos. Os participantes respondiam um questionário específico, com características sócio-demográficas e tinham uma amostra de sangue testada para os marcadores HBsAg, Anti-HBc total e Anti-HCV, utilizando a técnica MEIA-Axym-Abbott. A freqüência encontrada de marcadores foi 10,3% para o HBsAg, 38,7% para o Anti-HBc total e 10,7% para o Anti-HCV. Dentre os pacientes, 1,4% possuíam tanto HBsAg quanto Anti-HCV positivos. Não houve associação significante estatisticamente entre as variáveis parceiro homossexual, uso de drogas endovenosas, ingesta de álcool, tatuagem ou piercing, cirurgia, procedimentos invasivos e hemotransfusão e a infecção pelo HBV, expressa pela positividade do HBsAg. A única variável que mostrou associação com infecção pelo HBV foi uso de drogas inalatórias. Nenhuma destas variáveis, incluindo, parceiro homossexual, uso de drogas endovenosas, uso de drogas inalatórias, ingesta de álcool, tatuagem ou piercing, cirurgia, procedimentos invasivos e hemotransfusão tiveram associação significativa estatisticamente com a presença do Anti-HCV. Este estudo encontrou freqüências comparáveis com outros relatados no Brasil, mas com freqüências de coinfeccção menores que aqueles das regiões Sul e Sudeste. Entretanto, nenhuma associação específica com comportamentos de risco foi encontrada neste estudo, mostrando importante diferença quando comparado com estudos realizados em outras regiões do Brasil
2
RUSSO, DARIO. „Diagnosi parallela automatizzata di infezioni virali trasmissibili per via ematica (HIV, HCV, HBV)“. Doctoral thesis, Università degli Studi di Milano, 2007. http://hdl.handle.net/2434/33618.
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Automated parallel diagnosis of viral infections transmitted in haematic tract. The aim of this study was to develop a complete system for the identification and quantification of HBV, HCV, HIV using molecular biological techniques by means of Real Time PCR. The first step was to develop a positive control, valid for all considered viruses, absolutely free from risk of infection due to the fact that they are synthetic clones. The second step of this study was to develop a complete kit in basic PCR with detection by gel electrophoresis, to identify specific sequences of viral genomes. This test uses a solid thermopolimers mix which allows retrotranscription and amplification to be performed separately in a single vial. The third step was to develop a complete kit in real time PCR to quantify the viral concentrations using, in a first phase, a simple liquid mix and, in a second phase, a solid thermopolimers mix. At the end of my ph.D study it was produced a complete system containing a positive control to check the system and to make a real time standard curve. The real innovation of this study was the development of a solid master mix that delivers a rapid but highly specific test for the 3 viruses simultaneous
3
Souza, Iury Oliveira. „Validação de ensaio imunocromatográfico para a detecção múltipla de anticorpos específicos contra HIV, HBV e HCV“. reponame:Repositório Institucional da UFBA, 2013. http://www.repositorio.ufba.br/ri/handle/ri/11787.
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CAPES
Cerca de 33,3 milhões de pessoas apresentam infecção pelo Human Immunodeficiency Virus (HIV) no mundo; 180 milhões estão infectados pelo Hepatitis C Virus HCV e estima-se que 360 milhões apresentem infecção ativa pelo Hepatitis B Virus (HBV). Outra realidade mundial é a co-infecção entre esses vírus. Os dados mostram a importância global dessas viroses e a urgência do desenvolvimento de novos ensaios de diagnóstico sensíveis, específicos, rápidos e de baixo custo, que possam atender à demanda de entidades públicas inseridas em programas para prevenção e diagnostico dessas doenças. O presente trabalho consiste em validação relativa de um novo teste imunocromatográfico desenvolvido pela empresa canadense Medmira para detecção de anticorpos específicos contra HIV, HCV e HBV. Os resultados encontrados foram extremamente favoráveis para a detecção de anticorpos específicos para HIV, apresentando 98,6% de sensibilidade e 100% de especificidade. Para o anti-HBV a sensibilidade e especificidade encontradas foram de 90,0% e 98,6%, e de 86,3% e 100%, para anti-HCV, respectivamente. Nenhuma reatividade cruzada foi encontrada e a reprodutibilidade e repetitividade foram de 100%. O índice kappa e a acurácia global do teste foram de 0,91 (0,88-0,94) e 95,5% (93,5-97,5), respectivamente. Conclui-se que o ensaio imunocromatográfico é clinicamente útil em triagens rápidas para detecção de anticorpos anti-HIV, HCV e HBV.
Salvador
4
Duvall, Melody Gayle. „HIV-specific cellular immune responses in HIV-1 and HIV-2 infection“. Thesis, University of Oxford, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.441307.
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Lindström, Anna. „Resistance to antiviral drugs in HIV and HBV /“. Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-239-X/.
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6
Costa, Cintia Bezerra Almeida. „Polimorfismo do HLA-G na coinfecção HIV/HCV“. Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/22/22132/tde-21052014-181750/.
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O objetivo geral da pesquisa foi associar os polimorfismos do gene HLA-G (região 3\' NT) com a coinfecção HIV/HCV e com os grupos (HIV, HCV e controles saudáveis). Trata-se de um estudo transversal, comparativo, descritivo. Participaram do estudo, 560 indivíduos, sendo 156 controles saudáveis, 102 coinfetados HIV/HCV, 186 infectados pelo HIV e 116 por HCV. Para a identificação dos polimorfismos, o DNA genômico foi extraído do sangue total e a genotipagem feita por PCR e visualizada em gel de poliacrilamida a 7%, no qual o polimorfismo de 14pb foi identificado, e por sequenciamento os outros sete SNPs. Os resultados sociodemográficos apontam que a amostra na sua grande maioria foi composta por indivíduos adultos e do sexo masculino. No que diz respeito à cor da pele, na comparação entre os grupos HCV e HIV/HCV, observou-se um maior número de coinfectados apresentando a cor preta e parda do que nos monoinfectados (P=0,0001). Com relação à categoria de exposição para aquisição do HIV, na comparação entre os grupos HIV e HIV/HCV, observou-se diferença significante na transmissão por via heterossexual, sendo sua frequência maior no grupo HIV (P=0,0000). No caso da comparação entre os grupos HCV e HIV/HCV, observou-se também diferença na transmissão heterossexual, sendo sua frequência significantemente maior no grupo HIV/HCV (P=0,0001). Quanto aos achados relacionados ao genótipo do HCV, na comparação entre os grupos HCV e HIV/HCV, o genótipo 1a apresentou frequência maior nos coinfectados (P=0,0001). No que diz respeito à carga viral do HIV, na comparação entre os grupos HIV e HIV/HCV, o grupo da monoinfecção apresentou maior carga viral do que o grupo da coinfecção (P=0,0350). Com relação ao grau de fibrose hepática, na comparação entre os grupos HCV e HIV/HCV, o grupo da coinfecção tem mais fibrose leve do que o grupo da monoinfecção (P=0,0009). Quanto aos polimorfismos genéticos da região 3\' NT do HLA-G, foi encontrado que o genótipo de heterozigose Del/Ins de 14 pb apresentou diferença significante nos indivíduos coinfectados pelo HIV/HCV (P=0,0216) quando comparados com o grupo controle. Em relação ao SNP +3003, a comparação dos grupos HCV e controle saudável mostrou que alelo +3003T apresentou uma frequência significantemente maior no grupo HCV (P=0,0147); o genótipo +3003C/T apresentou uma frequência maior no grupo controle (P=0,0095); o genótipo +3003T/T estava maior no grupo HCV (P=0,0095). A comparação entre os grupos HIV e HCV mostrou que a frequência do alelo +3003C estava maior no grupo HIV (P=0,0463); e o genótipo +3003T/T apresentou uma frequência maior no grupo HCV (P=0,0494). A frequência do genótipo +3187A/A estava maior no grupo HIV/HCV em comparação ao HIV (P=0,0193); e do +3187A/G estava maior no grupo HIV (P=0,0187). O genótipo +3196C/G apresentou frequência significamente maior no grupo HIV do que no controle saudável (P=0,0213). A UTR-10, na comparação entre os grupos HIV e controle, mostrou frequência maior no grupo HIV (P=0,0044); quando comparados os grupos HIV/HCV e HIV, frequência foi maior no grupo HIV (P=0,0300) e na comparação entre os grupos HIV e HCV, sua frequência também foi maior no grupo HIV (P=0,0140). A UTR-4, na comparação dos grupos HCV e controle saudável, revelou uma frequência maior no grupo controle (P=0,0147). A UTR-9, na comparação dos grupos HIV/HCV e HIV, mostrou frequência maior no grupo HIV/HCV (P=0,0460). Em relação aos dados clínicos, a presença do alelo T na posição +3035 foi significantemente associada à maior carga viral do HCV, acima de 400.000 cópias/mL (P=0,0244). Em relação aos tipos de genótipos do HCV, a presença do alelo +3027C foi associada ao subtipo 1a do HCV (P=0,0109). Adicionalmente, a presença do genótipo C/C na posição +3027 também foi significantemente associada com o subtipo 1a do HCV (P=0,0015). Ainda, o alelo A do SNP +3187 foi significantemente associado com os outros genótipos do HCV, excluindo o 1a (P=0,0369). Embora não esteja totalmente esclarecida a função do gene HLA-G, estudos têm sido desenvolvidos para melhor elucidar sua função nos contextos fisiológicos, como gestação, e patológicos, como tumores, transplantes, doenças inflamatórias e infecciosas. Tais estudos procuram ampliar o conhecimento sobre o sistema imunológico e contribuem para o desenvolvimento de novas estratégias diagnósticas e terapêuticas. Os resultados do presente estudo contribuem para a ampliação do conhecimento sobre os polimorfismos da região 3\' NT do gene HLA-G, na coinfecção HIV/HCV. Como também, na melhoria da assistência de enfermagem que deve buscar reduzir a morbimortalidade pela referida patologia. Porém, ainda há um longo percurso a ser percorrido na compreensão dos fatores imunogenéticos envolvidos na coinfecção pelo HIV/HCVThe general objective of the research was to associate the polymorphism of the gene HLA-G (region 3\' NT) with the co-infection HIV/HCV and with the groups (HIV, HCV and healthy control). It is a cross-sectional, comparative, descriptive study. 560 individuals participated of the study, being 156 healthy control individuals, 102 co- infected HIV/HCV, 186 infected by HIV and 116 by HCV. For identifying the polymorphisms, the genomic DNA was extracted from the total blood and the genotyping was made by PCR and visualized in gel of polyacrylamide at 7%, in which the polymorphism of 14pb was identified, and by sequencing the other seven SNPs. The social demographic results point that the most of the sample was composed by male adult individuals. Regarding the color of the skin, in the comparison between the groups HCV and HIV/HCV, a bigger number of co-infected with black skin and brown-skinned was observed than in the mono infected (P=0,0001). Regarding to the category of exposition for acquisition of the HIV, in the comparison between the groups HIV and HIV/HCV, a significant difference was observed in the transmission through heterosexual exposition, being its frequency bigger in the group HIV (P=0,0000). In the case of the comparison between the groups HCV and HIV/HCV, the difference in the heterosexual transmission was also observed, being its frequency significantly higher in the group HIV/HCV (P=0,0001). About the finding related to the genotype of the HCV, in the comparison between the groups HCV and HIV/HCV, the genotype 1a presented higher frequency in the co- infected (P=0,0001). Regarding to the viral load of the HIV, in the comparison between the groups HIV and HIV/HCV, the group of the mono infection presented bigger viral load that the group of the co-infection (P=0,0350). Regarding to the level of hepatic fibrosis, in the comparison between the groups HCV and HIV/HCV, the group of co-infection has a lighter fibrosis that the group of the mono infection (P=0,0009). Regarding to the genetic polymorphisms of the region 3\' NT of the HLA-G, it was found that the genotype of heterozygosis Del/Ins of 14 pb, presented significant difference in the individuals co-infected by the HIV/HCV (P=0,0216) when compared with the control group. About the SNP +3003, the comparison of the groups HCV and healthy control, it was showed that the allele +3003T presented a significant higher frequency in the group HCV (P=0,0147); the genotype +3003C/T presented a higher frequency in the control group (P=0,0095); the genotype +3003T/T was bigger in the group HCV (P=0,0095). The comparison between the groups HIV and HCV showed that the frequency of the allele +3003C was bigger in the group HIV (P=0,0463); and the genotype +3003T/T presented a bigger frequency in the group (P=0,0494). The frequency of the genotype +3187A/A was bigger in the group HIV/HCV in comparison to the HIV (P=0,0193); and of the +3187A/G was bigger in the group HIV (P=0,0187). The genotype +3196C/G presented frequency significantly bigger in the group HIV than in the healthy control (P=0,0213). The UTR-10, in comparison between the groups HIV and control, showed bigger frequency in the group HIV (P=0,0044); when compared the groups HIV/HCV and HIV, frequency was bigger in the group HIV (P=0,0300) and in the comparison between the groups HIV and HCV, its frequency was also bigger in the group (P=0,0140). The UTR-4, in the comparison of the groups HCV and healthy control, revealed a bigger frequency in the control group (P=0,0147). The UTR-9, in comparison of the groups HIV/HCV and HIV, showed bigger frequency in the group HIV/HCV (P=0,0460). Regarding to the clinical data, the presence of the allele T in the position +3035, was significantly associated to bigger viral load of the HCV, above 400.000 copies /mL (P=0,0244). About the types of genotypes of the HCV, the presence of the allele +3027C was associated with the subtype 1a of the HCV (P=0,0109). Additionally, the presence of the genotype C/C in the position +3027 was also significantly associated with the subtype 1a of the HCV (P=0,0015). Still, the allele A of the SNP +3187 was significantly associated with the other genotypes of the HCV, excluding the 1a (P=0,0369). Although the function of the gene HLA-G, is not totally clarified, studies have been developed for better elucidate its function in the physiological contexts, like gestation, and pathological, such as tumours, transplants, infectious and inflammatory diseases. These studies aim to extend the knowledge about the immunological system and contribute for the development of new diagnostic and therapeutic strategies. The results of this study contribute for enhancement of the knowledge about the polymorphisms of the region 3\' NT of the gene HLA-G, in the co-infection HIV/HCV. As well as, in the improvement of the assistance of nursing that must seek reducing the morbid mortality by the pathology referred. However, there is still a long path to be followed in the comprehension of the immunogenic factors involved in the co-infection by the HIV/HCV
7
Uccellini, L. „HOST GENETIC INFLUENCE ON HIV AND HCV INFECTIONS“. Doctoral thesis, Università degli Studi di Milano, 2013. http://hdl.handle.net/2434/215587.
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In patients with chronic hepatitis C, the hepatitis C virus (HCV) RNA level is an important predictor of treatment response. To explore the relationship of HCV RNA with viral and demographic factors, as well as IL28B genotype, we examined viral levels in an ethnically diverse group of injection drug users (IDUs). Between 1998 and 2000, the Urban Health Study (UHS) recruited IDUs from street settings in San Francisco Bay area neighborhoods. Participants who were positive by HCV EIA were tested for HCV viremia by a bDNA assay. HCV genotype was determined by sequencing the HCV NS5B region. For a subset of participants, IL28B rs12979860 genotype was determined by Taqman. Among 1701 participants with HCV viremia, median age was 46 years and median duration of injection drug use was 26 years; 56.0% were African American and 34.0% were of European ancestry (non-Hispanic). HIV-1 prevalence was 13.9%. The overall median HCV RNA level was 6.45 log10 copies/ml. In unadjusted analyses, higher levels were found with older age, male gender, African American ancestry, HBV
infection, HIV-1 infection and IL28B rs12979860-CC genotype; compared to participants
infected with HCV genotype 1, HCV RNA was lower in participants with genotype 3 or
genotype 4. In an adjusted analysis, age, gender, racial ancestry, HIV-1 infection, HCV genotype and IL28B rs12979860 genotype were all independently associated with HCV RNA. The level of HCV viremia is influenced by a large number of demographic, viral and human genetic factors.
HIV
The clinical course of HIV-1 infection is highly variable among individuals, at least in part as a result of genetic polymorphisms in the host. Toll-like receptors (TLR) play a crucial role in the host’s innate immunity and may influence HIV-1 disease progression. The transcription factor IRF-5 is an important player in the TLR-MyD88 signaling cascade. We investigated the impact of two SNPs in TLR9 gene, rs352139 and rs352140, and two SNPs in IRF5 gene, rs10954213 and rs11770589, on CD4 count, HIV viral load, and clinical progression in a cohort of HIV-infected patients. Two SNPs in TLR9 and IRF5 are in linkage disequilibrium and rs352140GA TLR9 was associated with the rapid progressors phenotype: for rs352140 GG+GA versus AA, P = 0.025, OR= 0.5479, confidence interval (CI) 0.31-0.97. No other association was found between TLR9 and IRF5 SNPs and viral load, CD4 count or other clinical data.
Rapid progression of HIV-1 infection was associated with TLR9 polymorphisms. Because of its potential implications for intervention strategies and vaccine developments, additional epidemiological and experimental studies are needed to confirm this association.
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Fontes, Adriele Souza. „Resposta específica aos antígenos da vacina anti-HPV em homens infectados pelo HIV-1“. Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/99/99131/tde-03082015-103315/.
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Introdução: A infecção pelo Papiloma Virus Humano (HPV) vem sendo reportada como uma das doenças sexualmente transmissíveis com maior incidência na atualidade, porém a sua prevalência não é bem esclarecida em homens, principalmente devido a baixa presença de sintomas. Além disso, poucos estudos foram realizados nesta população até o momento para verificar a resposta imune pós-vacinação. As hipóteses testadas serão fundamentais para aprofundar o conhecimento da imunopatogênese, da resposta vacinal em pacientes infectados pelo HIV e colaborar no desenho e estratégias de vacinação anti-HPV na população infectada pelo HIV Objetivos: Analisar a resposta específica aos antígenos da vacina anti-HPV em homens infectados pelo HIV. Métodos: Um total de 24 pacientes infectados pelo HIV que preencheram os critérios de inclusão durante o período de coleta foram vacinados pela vacina anti-HPV bivalente em três doses nos períodos: zero, dois e seis meses. Os grupos foram divididos em: Grupo Controle (Cinco indivíduos sadios, com sorologia negativa para HIV); Grupo A (Nove pacientes com CD4 <500 celulas mm³); Grupo B (10 pacientes com CD4 >=500 celulas mm³). Foram realizados ELISA para a detecção de anticorpos Anti-HPV nos momentos pré e pós-vacinação nos grupos estudados; posteriormente realizamos nos mesmos o ensaio de cultura celular para detecção de citocinas (IFN?, IL17, TNF, IL6 e IL10) pela técnica de CBA . Resultados: Obtivemos soroconversão da primeira dose da vacina para o grupo A 55,6%, grupo B 30%, grupo controle 60%; na segunda dose obtivemos para o grupo A 88,8%, grupo B 80%, grupo controle 80%, e por final a terceira dose no grupo A 88,8%, grupo B 90%, grupo controle 100%. A citocina IL 6 (perfil TH2) demonstrou níveis mais elevados, comparados entre os grupos A, B e grupo controle (p<0.001). A partir da 3° dose da vacinação observamos baixos níveis de INF-? (perfil TH1) A e B (p<0.0006). O grupo controle apresentou produção de INF- ? quando comparado com grupos A e B (p<0.001). Conclusão: Os pacientes soropositivos e grupo controle foram respondedores a vacinação anti-HPV. Foi demonstrada uma elevada produção das citocinas entre os grupos sugerindo uma imunomodulação do grupo HIV+. Esse trabalho apresenta informações relevantes que estimulam a realização de novos estudos nessa população, avaliações de reações cruzada da vacina que pode resultar em proteção a outros tipos de HPV não presentes na vacina, além de analisar por mais tempo as titulações no soro desses pacientes. Os dados do nosso estudo podem corroborar para a vacinação nessa população, diminuindo assim o risco de uma infecção, mortalidade e morbidade das doenças causadas pelo HPV em homens.Introduction: Infection with Human Papilloma Virus (HPV) has been reported as one of the sexually transmitted diseases with a higher incidence nowadys, but its prevalence must be clarified in men, mainly due to low presence of symptoms. Moreover, few studies have been performed in this population until now to verify the immune response post-vaccination. The hypothesis here suggested will be the key for better understanding of the immunopathogenesis, the vaccine´s response in HIV-infected patients and collaborate in the design and strategies of vaccination against HPV in HIV-infected population. Objectives: Analyze the specific response to antigens of HPV vaccine in HIV-infected men. Methods: A total of 24 HIV-infected patients who were in accordance with the inclusion criteria during the data collection period were vaccinated with anti-HPV bivalent vaccine in three period doses: zero, two and six months. The groups were distributed in: Control group (five healthy subjects with negative serology against HIV); Group A (nine subjects with CD4 <500 cells/mm³; Group B (10 subjects with CD4 >500 cells/mm³). ELISA was performed to detect the level of antibodies anti-HPV before and after vaccination in the studied cohort. Postenarly, cells of these groups were submitted in culture to verify citokynes production (IFN?, IL17, TNF, IL6 and IL10) using CBA methodology. Results: We obtained seroconversion after the first dose of anti-HPV vaccine: control group 60%, group A 55,6% and group B 30%. In the second dose: control group 80%, group A 88,8% and Group B 80%. And at last, the third dose: Control Group 100%, Group A 88,8% and group B 90%. IL 6 citokyne (TH2 response) was detected in higher level when compared Control, A and B groups (p<0.001). IFN? citokyne (TH1 response) was detect in low level only after the third dose of vaccination, showing relevance between A and B groups (p<0.0006). Additionally, higher IFN? production was detected when compared the control with A and B groups (p<0.001). Conclusion: HIV patients and controls (HIV-) were responders to anti-HPV vaccination. It was clear that an elevated cytokine production was detected between groups, suggesting immunomodulation of HIV + group. This work suggests relevant information that challenge: new studies in this population, verification of cross-reactions of the vaccine resulting in protection of other HPV types not present in this vaccine, and analyze for longer period the titers of anti-HPV antibodies in these patients. All together, our data can corroborate for vaccination in this population, thus decreasing the risk of infection, mortality and morbidity of the disease caused by HPV in men.
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Ekman, Evelina, und Nicole Karlsson. „Upplevelser av vårdpersonalens bemötande gentemot patienter som lever med HIV, HBV eller HCV : En litteraturstudie“. Thesis, Karlstads universitet, Fakulteten för hälsa, natur- och teknikvetenskap (from 2013), 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-83910.
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Introduktion/Bakgrund: Blodsmittor som Humant immunbristvirus [HIV], Hepatit B-virus [HBV] och Hepatit C-virus [HCV] förekommer i många delar av världen. Det finns mycket fördomar om patienter som lever med blodsmitta och patienterna kan uppleva stigmatisering och diskriminering från samhället vilket kan leda till psykisk ohälsa. Syfte: belysa hur patienter som lever med HIV, HBV eller HCV upplever vårdpersonalens bemötande. Metod: En litteraturstudie som följer Polit och Becks (2017) nio steg. PubMed, PsycINFO och Cinahl är de databaser som användes för att söka fram artiklar. 15 artiklar ingick i resultatet, tolv kvalitativa, två mixed-methods och en kvantitativ. Granskningar av artiklarna gjordes med Polit och Becks (2017) granskningsmallar för kvalitativa och kvantitativa studier. Resultat: Fyra teman identifierades till resultatet. Patienterna hade både positiva och negativa erfarenheter av bemötandet från vårdpersonal. De teman som identifierades var Attityder, Nekad vård och vårdpersonalens rädsla för smitta, Bristande sekretess samt Positiva upplevelser av bemötande. Slutsats: Det framkom att flera patienter som lever med blodsmitta hade negativa upplevelser av bemötandet inom hälso- och sjukvården, men de belyser även de positiva erfarenheter de hade av bemötande från vårdpersonal.
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Pantelic, Marija. „HIV, blame and shame : internalised HIV stigma among South African adolescents living with HIV“. Thesis, University of Oxford, 2017. https://ora.ox.ac.uk/objects/uuid:ebc47dd0-df36-4b12-93b5-4e7d43603490.
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Background: This is the first epidemiological study of internalised stigma among adolescents living with the human immunodeficiency virus (HIV) in Sub-Saharan Africa. It aims to establish predictors of internalized HIV-stigma among people living with HIV in Sub-Saharan Africa (Paper 1), develop an HIV-stigma scale for use with adolescents (Paper 2) and build and test a model of risk pathways for internalised stigma (Paper 3). The data used for papers 2 and 3 is part of the world's largest social science study of adolescents living with HIV (n=1060). Paper One systematically reviews evidence on the prevalence and predictors of internalised HIV stigma amongst people living with HIV in Sub-Saharan Africa. PRISMA guidelines were followed. An adapted version of the Cambridge Quality Checklist was used to assess the quality of the findings. A total of 18 papers were included. The prevalence of internalised stigma among adults living with HIV was 27% - 66%. The longitudinal predictors for internalised HIV stigma were poor HIV-related health and psychological distress. The review identifies two critical limitations of the literature. First, no studies on adolescents were found. One of the reasons for this may be the lack of a scale for measuring internalised HIV stigma in this population. Second, only individual-level risk factors for internalised stigma were examined. Papers 2 and 3 aim to address these limitations. Paper Two develops an HIV stigma scale with and for adolescents living with HIV. First, a multidimensional stigma scale previously used with adolescents in the US was cross-culturally adapted using semi-structured cognitive interviews with nine South African adolescents living with HIV. These data were interpreted through thematic analysis, and items were adapted in consultation with interviewees. Second, the revised version of the scale was administered to 1060 adolescents living with HIV. Confirmatory factor analysis confirmed the predicted 3-factor structure, and associations with hypothesised correlates provided evidence of validity. Paper Three develops and tests a model of risk pathways to internalised HIV stigma among adolescents living with HIV. Drawing on findings from the systematic review (Paper 1) and using the scale developed in Paper 2, both inter and intrapersonal pathways of risk from HIV-related disability to internalised HIV stigma were hypothesized. Following from modified labelling theory, interpersonal mechanisms were hypothesized to occur through maltreatment within power-unequal relationships, i.e. enacted HIV stigma and violence victimization. Hypothesized intrapersonal risks were anticipated HIV stigma and depression. Structural equation modelling enabled the grouping of theoretically related constructs and assessment of multiple, simultaneous pathways of risk. Prevalence of any internalised HIV stigma among adolescents living with HIV was 26.5%. As hypothesized, significant associations between internalised stigma and anticipated stigma, as well as depression were obtained. Unexpectedly, HIV-related disability, violence victimization, and enacted stigma were not directly associated with internalised stigma. Rather, indirect pathways via intrapersonal risks were observed. Conclusions: More than a quarter of adolescents living with HIV in this study reported experiencing some level of internalised stigma. Findings suggest a need to expand programmatic responses to internalised HIV stigma, from individualistic, clinic-based programmes to integrative, community-based approaches. Providing mental health support and reducing the maltreatment of adolescents living with HIV might interrupt pathways from HIV-related disability to internalised stigma. This highlights the potential for interventions that do not necessarily target HIV-positive adolescents but are sensitive to their needs. Such efforts must be coupled with rigorous process and outcome evaluations, and longitudinal data is urgently needed. It is hoped that the adolescent-friendly stigma scale developed within this DPhil will enable further research with this understudied population. Prior to this thesis, there were no known epidemiological studies of internalised HIV stigma among adolescents living with HIV. Moreover, the broader, adult-focused corpus of research has overlooked interpersonal risk factors. This thesis highlights the relevance of power inequalities and domination for the study of internalised HIV stigma.
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Yang, Wa. „The evolution of HIV-1 and HIV-2“. Thesis, University College London (University of London), 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.405605.
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Stewart, Tiffanie S. „Lifestyle and Biological Risk Factors for Liver Fibrosis in the Miami Adult Studies on HIV (MASH) Cohort: An HIV Infected and HIV/HCV Co-infected Population“. FIU Digital Commons, 2016. http://digitalcommons.fiu.edu/etd/2459.
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Liver disease is now a leading cause of non-AIDS related morbidity and mortality in people living with HIV (PLWH). The present study investigated the interplay between adverse lifestyle factors that are prevalent in PLWH, biological mediators of liver pathogenesis, and a non-invasive measure of liver fibrosis (FIB-4 index) in HIV mono- and HIV/HCV co-infected individuals.
The results of this investigation in the Miami Adult Studies of HIV (MASH) cohort show that the odds of liver fibrosis progression significantly increased over two years for HIV mono-infected participants who drank alcohol hazardously (OR 3.038, P=0.048), and had BMI ≥ 28kg/m2 (OR 2.934, P=0.027). Cocaine use reduced the odds of advancing one stage of liver fibrosis (OR 0.228, P=0.038), but an interaction between high BMI and cocaine use slightly raised the odds by 4.8% of liver fibrosis progression (P=0.072). HIV/HCV co-infected participants showed interactions between cocaine use and high BMI with increased FIB-4 stage (OR 4.985, P= 0.034), however no lifestyle factors could independently predict FIB-4 stage in this group.
Biological mediators previously associated with liver pathogenesis were associated with higher FIB-4 index over 2 years in a subset of (n=65) HIV mono-infected participants. Plasma measures of oxidative stress (% oxidized glutathione: OR 4.342, P= 0.046), hepatocyte-specific apoptosis (Cytokeratin-18 (CK-18): OR 1.008, P=0.021), and microbial endotoxin (lipopolysaccharide (LPS): OR 1.098, P= 0.097) were associated with having higher odds of progressing at least one stage of FIB-4 over 2 years.
The same biological mediators were also associated with liver fibrosis within HIV infected people who also had a harmful lifestyle characteristic. FIB-4 index was significantly associated with % oxidized glutathione in obese subjects (β=0.563, P=0.018), TGF-β1 in cocaine users (β=0.858, P=0.027), and CK-18 in HIV infected individuals without any adverse lifestyle factors (β=0.435, P=0.015).
Taken together, the findings of these studies describe interrelationships between HIV disease status, lifestyle, and biological mediators of liver fibrosis. The results show interactions between lifestyle conditions and the mediators of liver fibrosis may account for higher rates of liver disease in HIV infection. Research is warranted to develop personalized therapeutics for PLWH to curb the burden of liver disease.
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Lanzara, Graziela de Almeida [UNIFESP]. „Prevalência e impacto da infecção pelo GBV-C entre pacientes com HIV/AIDS e co-infectados HIV/HCV“. Universidade Federal de São Paulo (UNIFESP), 2007. http://repositorio.unifesp.br/handle/11600/23407.
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Previous issue date: 2007Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
Introdução: Ha quase dez anos surgiram os primeiros relatos que o GBV-C, um novo virus RNA apatogenico, exerceria influencia sobre a infeccao pelo HIV, protelando a progressao para aids55, 56, 17, 19,20,59-63. Entretanto, muitos estudos nao chegaram a estes resultados57, 64-66. Maior ainda e a controversia na relacao entre o HIV, o HCV e GBV-C, quando em tripla infecca06O, 66,137,139-141,144. Objetivo: Estimar a prevalencia de marcadores de infeccao pelo GBV-C entre pacientes com infeccao pelo HIV e com co-infeccao HIV/HCV e comparar os grupos, procurando identificar impacto da infeccao pelo virus G. Metodos: Estudo observacional, transversal, com inclusao prospectiva de voluntarios, que passaram por entrevista, exame fisico e coleta de sangue para determinacao de carga viral do HIV, contagem CD4, AL T, AST, GGT, HCV RNA quantitativo, genotipagem HCV, anti-E2 e GBV-C RNA. A partir dos resultados dos marcadores para GBV-C, foram alocados em grupos e comparados. Resultados: Foram incluidos 60 voluntarios, 30 infectados somente pelo HIV e 30 co-infectados HIV/HCV. A prevalencia de infeccao pelo GBV-C entre pacientes HIV-positivos (20 por cento) tendeu a ser menor que a descrita na literatura, porem a prevalencia de tripla infeccao HIV/HCV/GBV-C (27 por cento) e semelhante a relatada. A presenca de marcadores para o GBV-C se associou a maior exposicao parenteral e ao aumento da AST, isolado em pacientes HIV-positivos e em conjunto com elevacao da AL T em pacientes co-infectados HIV/HCV. Exceto pelos achados ja descritos, nao identificamos impacto do GBV-C sobre a evolucao de pacientes infectados pelo HIV e co-infectados HIV-HCV. Conclusoes: O GBV-C pode estar sendo transmitido preferencialmente pela via parenteral em nosso meio. Os maiores niveis de AST observados em associacao com GBV-C talvez sejam resultantes da infeccao de outros tipos celulares por este virus. Os maiores niveis de ALT e AST relacionados com a infeccao pelo GBV-C em co-infectados HIV/HCV talvez seja traducao da infeccao simultanea dos hepatocitos por estes tres virus. O numero reduzido de voluntarios em cada grupo certamente prejudicou a analise estatistica
Introduction: It has been almost ten years since the first studies suggesting that a new RNA apathogenic virus called GBV-C could delay the progression of HIV infection into aids55, 56, 17, 19, 20, 59-63. However, many studies couldn’t find this relationship57, 64-66. And the controversy around the simultaneous infection by HIV, HCV e GBV-C is even greater60, 66, 137, 139-141, 144. Objectives: To estimate the prevalence of GBV-C markers among patients infected with HIV and co-infected with HIV and HCV and to compare the groups, searching for differences related with GBV-C infection. Methods: Observational and prospective study. Volunteers were interviewed, had a physical examination and blood samples tested for HIV viral load, CD4 count, ALT, AST, GGT, quantitative HCV RNA, HCV genotyping, anti-E2 and qualitative GBV-C RNA. Accordingly with the results, the volunteers were divided into groups and compared. Results: 60 volunteers were included, 30 infected only by HIV and 30 co-infected with HIV/HCV. The prevalence of GBV-C markers among HIV-positive volunteers (20%) occurred in a small frequency compared to results of previous studies, though the prevalence of triple infection HIV/HCV/GBV-C (27%) was similar to what is found in the literature. The presence of GBV-C was related with more frequent parenteral exposure, higher levels of AST in patients infected only with HIV and higher levels of AST associated with higher levels of ALT in coinfected HIV/HCV patients. Conclusions: In our setting, GBV-C preferencial route of transmission may be parenteral. The higher levels of AST observed when GBV-C markers are present, may reflect the infection of other cell types by this virus. The higher levels of ALT and AST related with GBV-C in co-infected patients may reflect the simultaneous infection of hepatocytes by these three viruses. The reduced number of volunteers may have foreclosed the statistical analysis
FAPESP: Projeto 05/57611-5
BV UNIFESP: Teses e dissertações
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Mohsen, Abdul Hadi. „The epidemiology of hepatitis C and HCV-HIV coinfection“. Thesis, King's College London (University of London), 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.424448.
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Cezimbra, Helen Minussi. „ALTERAÇÕES METABÓLICAS EM PACIENTES INFECTADOS PELO HIV E HCV“. Universidade Federal de Santa Maria, 2013. http://repositorio.ufsm.br/handle/1/5862.
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On June 5, 1981, the CDC (Centers for Disease Control) first published a report of
what would be known later as Acquired Immune Deficiency Syndrome (AIDS). More
than 30 years after, universally fatal disease was carried to the level of chronic disease,
but despite numerous advances, HIV patients have shown increased risk of non-AIDSdefining
events and incomplete immune restoration, despite effective virological
control, these include morphological, metabolic and atherosclerotic changes. In this
context, co-infection with hepatitis C virus (HCV) has attracted interest due to the
cumulative and synergistic mitochondrial insults caused by coinfection and enhanced by
the use of antiretrovirals. The aim of this study was to determine the prevalence of
dyslipidemia and metabolic syndrome in patients infected with the HIV and HCV vírus,
with mono or coinfection with each virus. It is a cross-sectional study which included
127 patients, aged 21 to 72 years, 59 with HIV, 36 coinfected and 32 with HCV, males
accounted for 48% (62) and 52% female (67). There was a predominance of men among
coinfected patients (64% - 23 men and 13 women) and women in the HIV group (66% -
22 men and 37 women). The mean age was 40.6 years (38.5 years HIV, 39.6 coinfected
and 45.9 HCV). The white race occurred in 60% of the sample predominantly in all
groups. There was no difference between groups in median time to diagnosis of HIV
and HCV. To HIV group there were 27% metabolic syndrome by IDF criteria and 26%
by HOMA2-IR índex (1,4 cut-off), 63% larger waist by IDF criteria and 26%
abdominal obesity. To HIV/HCV coinfection group there were 30% metabolic
syndrome by IDF, but 54% by HOMA2-IR index, 42% larger waist, but 52% abdominal
obesity. To HCV group there were 25% metabolic syndrome by IDF and 38% by
HOMA2-IR index, 67% larger waist and 47% abdominal obesity. The presence of
hepatitis C coinfection is responsible for alarming levels of insulin resistance,
associated with a more favorable lipid profile that could act as a confounder in the
clinical diagnosis of metabolic syndrome.Em 5 de junho de 1981, o CDC (Centers for Disease Control) publicou o primeiro relato do que mais tarde seria conhecido como Síndrome da Imunodeficiência Adquirida (AIDS). Passados mais de 30 anos, a doença universalmente fatal foi conduzida ao patamar de doença crônica, mas apesar dos inúmeros avanços, os portadores de HIV vêm apresentando risco aumentado de eventos não definidores de AIDS e restauração imune incompleta, a despeito do controle virológico eficaz, estas incluem alterações morfológicas, alterações metabólicas e ateroscleróticas. Neste contexto, a coinfecção com o vírus da Hepatite C (HCV) tem despertado bastante interesse devido aos insultos mitocondriais cumulativos e sinérgicos causados pela coinfecção e potencializado pelo uso de antirretrovirais. O objetivo deste estudo foi determinar a prevalência de dislipidemia e síndrome metabólica em pacientes com infecção pelos vírus do HIV e HCV, em mono ou coinfecção por cada um dos vírus. Trata-se de um estudo transversal onde foram incluídos 127 pacientes, com idades entre 21 e 72 anos, 59 com HIV, 36 coinfectados e 32 com HCV, o sexo masculino representou 48% (62) e o feminino 52% (67). Houve predomínio de homens entre os pacientes coinfectados (64% - 23 homens e 13 mulheres) e mulheres no grupo HIV (66% - 22 homens e 37 mulheres). A média de idade foi 40,6 anos (HIV 38,5, coinfectados 39,6 e HCV 45,9 anos). A raça branca ocorreu em 60% da amostra com predomínio em todos os grupos. Não houve diferença entre os grupos no tempo médio de diagnóstico do HIV e HCV. Para o grupo com HIV houve 27% de síndrome metabólica pelos critérios do IDF e 26% pelo HOMA2-IR (ponto de corte 1,4), 63% de alteração de cintura pelos critérios do IDF, com 26% de obesidade abdominal. Para o grupo de coinfecção HIV/HCV houve 30% de síndrome metabólica pelo IDF, mas 54% pelo HOMA2-IR, com 42% de alteração de cintura, mas 52% de obesidade abdominal. Para o grupo HCV houve 25% de síndrome metabólica pelo IDF, mas 38% pelo HOMA2-IR, com 67% de alteração da cintura e 47% de obesidade abdominal. Foi possível demonstrar que a presença de coinfecção por hepatite C é responsável pela presença de níveis alarmantes de resistência insulínica, associada a um perfil lipídico mais favorável que poderá agir como confundidor no diagnóstico clínico da síndrome metabólica.
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Falconer, Karolin. „HIV-1/HCV co-infection immunity and viral dynamics /“. Stockholm, 2010. http://diss.kib.ki.se/2010/978-91-7409-762-7/.
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Stamatelatou, Anastasia. „Exploring child HIV testing decisions in mothers with HIV“. Thesis, Royal Holloway, University of London, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.604641.
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Human Immunodeficiency Virus (HIV) has received considerable attention since the 1980's. Since then worldwide attempts have been made to combat the transmission and progression of the virus. Among children, mother-to-child transmission is the most common source of infection. Current guidelines emphasize the importance of HIV testing of at-risk children to reduce mortality and morbidity. Evidence suggests the presence of barriers that may affect mothers' decision to test their children. To date, there has been no research looking at the experiences of HIV-positive mothers or the factors that influence their decision. This study aims to explore the decision-making process of HIV -positive mothers in relation to testing their children born prior to their own diagnosis. It assesses how maternal experiences affect child testing and which factors differentiate the decision-making process among mothers who delayed versus those who did not delay their decision to test their children. Seven semi-structured interviews were conducted and Grounded Theory was used. A model of the maternal decision-making process is proposed, comprised of five theoretical codes: Fearing about own and child's future; Facing barriers about child testing; Feeling more confident in child testing; Developing an understanding of child testing; Protecting the child. The model starts with maternal diagnosis and progresses through to child testing. It maps the key stages of the process; mothers experience anxiety in relation to child testing; they assess the associated risks and benefits. Some doubt the likelihood of their children having HIV and are influenced by social norms. Eventually the need to know their children's status and increased confidence in child testing motivate them to have their children tested. The findings provide evidence to inform current guidance and clinical practice, stressing the Importance of the provision of accurate information about HIV aiming to reinforce mothers' self-efficacy about child testing. The strengths and limitations of the findings are outlined. Clinical and theoretical implications, as well as suggestions for future research are discussed.
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Marston, M. „Demographic determinants of paediatric HIV in generalised HIV epidemics“. Thesis, London School of Hygiene and Tropical Medicine (University of London), 2018. http://researchonline.lshtm.ac.uk/4649895/.
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Background: Estimates of Paediatric HIV are essential for planning national HIV programs. Although there is a large amount of empirical data on the prevalence of adult HIV from antenatal clinics and national surveys there is very little HIV data for children, necessitating estimates based on knowledge of: HIV infection in pregnant women; transmission rates among pregnant and breastfeeding women according to their treatment status; and survival of infants infected in different ways. It is essential that these inputs into estimating paediatric HIV are as accurate as possible as there is little empirical data to calibrate the final estimates of prevalence of paediatric HIV. Currently there are gaps in the understanding of some of the inputs needed to estimate paediatric HIV and a potential to improve estimates as new data become available, particularly as more widespread availability of antiretroviral treatment changes the circumstances in which children become infected. Aims and Objectives: The aim of the research is to improve and fill gaps in knowledge about the HIV epidemic and thereby improve estimates of paediatric HIV. Objectives include improving estimates of survival of infected children, exploring the acquisition of HIV by women in relation to incidence during pregnancy, furthering understanding of the impact of HIV on fertility and understanding the biases inherent in different data sources. Implications: The new empirical evidence and rigorous methods developed to evaluate the inputs needed to estimate the number of children born to HIV positive women and the prevalence of paediatric HIV will produce more reliable HIV epidemic projections, and will improve information available to policy makers and programme planners.
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Howells, Jessica. „Delayed HIV testing in HIV-positive sub-Saharan Africans“. Thesis, Royal Holloway, University of London, 2014. http://digirep.rhul.ac.uk/items/8f400a67-d03b-decb-7dca-416308365ea3/1/.
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There is evidence that some sub-Saharan African individuals suspect that they are HIV positive before diagnosis but delay being tested for HIV. This increases the likelihood of being diagnosed late (with a severely compromised immune system), a phenomenon that has been observed in sub-Saharan Africans diagnosed in the UK. Late diagnosis has negative personal and public health consequences. There is a lack of understanding of the psychological processes associated with delayed HIV-testing. This study used a Grounded Theory methodology. It aimed to produce a theoretical model to explain the psychological processes associated with delayed HIV testing in sub-Saharan Africans in the UK but also how these processes changed over time and contributed to the decision to test. Seven HIV-positive sub-Saharan African individuals from a London HIV clinic and one from a HIV charity were interviewed about their experiences. Analysis led to the development of a theoretical model of delayed HIV testing. This model consisted of three theoretical codes: moving in and out of uncertainty about HIV infection; preferring not to know HIV status; and making the decision to test for HIV. Participants' HIV risk perception fluctuated and was characterised by uncertainty. This, in combination with a preference to not know their HIV status due to a number of feared consequences of being HIV-positive, deterred them from testing. Participants' thoughts and feelings about knowing their HIV status changed over time. These changes were that they: wanted certainty, had hope of being HIV-negative and/or a hope for treatment and life and preparing for and accepting a potentially positive result. The findings can inform interventions to reduce delayed testing and suggest: a) intervening with ambivalence on an individual level and b) promoting awareness of HIV c) promoting the benefits of testing/costs of not testing at a population level. The findings are discussed in relation to existing research and theory. Strengths and limitations of the study are discussed, as are clinical implications and suggestions for future research.
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Picon, Pedro Dornelles. „Apresentação rediológica da tuberculose em pacientes HIV+ e HIV-“. reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2004. http://hdl.handle.net/10183/4961.
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Introdução A AIDS trouxe mudanças na apresentação clínico-radiológica da tuberculose, com o surgimento de formas incomuns. Estas alterações vêm sendo discutidas na literatura internacional. Entretanto, o quadro clínico, radiológico e epidemiológico da apresentação pulmonar da tuberculose em pacientes infectados pelo vírus da imunodeficiência humana (HIV) em nosso meio não foi ainda completamente descrito. Pacientes e Métodos Foram estudadas as radiografias de tórax e coletados dados de prontuário de 231 pacientes com 37,7 ± 12,9 anos de idade, com tuberculose pulmonar comprovada por baciloscopia do escarro e sem história de tratamento prévio, internados no Hospital Sanatório Partenon no período de janeiro de 1997 a dezembro de 2001. Os pacientes foram divididos em grupos, de acordo com a presença ou não de infecção pelo HIV e de AIDS e de acordo com os valores de linfócitos (≤ 1500 ou > 1500 células/mm3) e de CD4 (≤ 200 ou > 200 células/mm3) no sangue periférico. Parâmetros clínicos e radiológicos foram comparados entre os grupos. Foram avaliados idade, sexo, cor da pele, estado geral, duração dos sintomas, alcoolismo, uso de drogas ilícitas, presença de diabetes melito, neoplasias ou adenomegalias superficiais e diagnóstico prévio ou atual de doenças oportunísticas associadas ao HIV. Pacientes que apresentaram adenomegalias superficiais foram considerados como tendo doença multifocal. Pacientes infectados pelo HIV (HIV +) que apresentaram doenças oportunísticas foram classificados como tendo o diagnóstico de síndrome da imunodeficiência adquirida (AIDS). As radiografias de tórax (póstero-ânterior e perfil) foram avaliadas para definir o tipo de tuberculose e a presença de adenomegalias intratorácicas associadas a lesões pulmonares, de cavidades e de derrame pleural. A tuberculose tipo primária, forma atípica em adultos, foi caracterizada pela presença de adenomegalias hilares e/ou mediastinais associadas a focos de consolidação peri-ganglionar ou no segmento anterior do lobo superior, segmento basal do lobo inferior, lobo médio ou língula. Resultados Os pacientes HIV+ eram mais jovens (34,3 ± 9,3 vs. 41,1 ± 15,0 anos; p<0,0001), utilizavam drogas ilícitas mais freqüentemente (61,3 vs. 12,5%; p<0,0001), apresentavam maior freqüência de doença multifocal (23,9 vs. 2,5%; p<0,0001) e contagem menor de linfócitos no sangue periférico (1590 ± 1077 vs. 2130 ± 974 células/mm3; p=0,0003) do que os pacientes não infectados pelo HIV (HIV-). A freqüência dos tipos de tuberculose foi diferente entre os pacientes HIV+ e HIV- (p<0,001), pela maior prevalência de tuberculose miliar, pneumonia tuberculosa e tuberculose tipo primária nos pacientes HIV+. A tuberculose tipo primária só ocorreu nos pacientes HIV+, sendo mais freqüente nos pacientes HIV+ com AIDS, nos pacientes com valores de linfócitos ≤ 1500 células/mm3 e naqueles com valores de CD4 ≤ 200 células/mm3. Os valores de CD4 foram mais baixos nos pacientes com tuberculose tipo primária [31 (3 – 71) células/mm3] do que nos com outros tipos de tuberculose (p<0,01), sem diferenças entre os demais tipos. Os pacientes HIV+ apresentaram menor freqüência de lesões escavadas do que os pacientes HIV- (70,8 vs. 91,5%; p<0,0001). A freqüência de cavidades foi ainda menor nos pacientes HIV+ com AIDS e naqueles com CD4 ≤ 200 células/mm3. Adenomegalias intratorácicas associadas a lesões pulmonares foram observadas em 20,4% dos pacientes HIV+ e em 0,8% dos HIV- (p<0,0001). Pacientes com adenomegalias intratorácicas apresentavam freqüências maiores de doença multifocal (45,8 vs. 9,2%; p<0,0001), contagens menores de linfócitos no sangue periférico (966 ± 480 vs. 1974 ± 1057 células/mm3; p<0,0001) e de CD4 [47 (3 – 268) vs. 266 (7 – 1288); p<0,0001], do que os pacientes com lesões pulmonares exclusivas. Na regressão logística múltipla, o HIV [RC = 11,5 (1,4 – 95,1); p=0,023], a doença multifocal [RC = 6,2 (1,7 – 22,2); p=0,005] e o tempo de sintomas [RC = 0,98 (0,96 – 0,99); p=0,025] estavam independentemente relacionados à presença de adenomegalias intratorácicas associadas a lesões pulmonares. Doença multifocal foi diagnosticada em 23,9% dos pacientes HIV+ e em 2,5% dos HIV- (p<0,0001), sendo mais freqüente nos pacientes com AIDS do que nos HIV+ sem AIDS (34,2 vs. 0%; p<0,0001). Pacientes com doença multifocal apresentavam contagens menores de linfócitos no sangue periférico (1244 ± 983 vs. 1966 ± 1038 células/mm3; p=0,001) do que os pacientes sem doença multifocal. Setenta e quatro por cento dos pacientes com doença multifocal apresentava contagem de linfócitos ≤ 1500 células/mm3. Na regressão logística múltipla, o HIV+ [RC = 10,4 (3,0 – 36,0); p<0,001] e a idade [RC = 0,94 (0,90 – 0,99); p=0,014] estavam independentemente associados à presença de doença multifocal. Os pacientes HIV+ sem AIDS não diferiram dos pacientes HIV- quanto aos tipos de tuberculose, quanto as freqüências de doença multifocal (0,0 vs. 2,9%; p=1,000), adenomegalias intratorácicas associadas a lesões pulmonares (2,9% vs. 0,8%; p=0,398) e lesões escavadas (88,2 vs. 91,5%; p=0,517), bem como quanto aos valores de linfócitos (2360 ± 1198 vs. 2130 ± 974 células/mm3; p=0,283). Conclusões Os pacientes HIV+ desta série apresentavam freqüência maior de adenomegalias intratorácicas associadas a lesões pulmonares, com o surgimento de formas atípicas, principalmente nos pacientes com maior grau de imunossupressão. Apresentavam ainda maior prevalência de adenomegalias superficiais, compatíveis com disseminação extratorácica da tuberculose. Em adultos, a tuberculose se caracterizava por ser uma doença unifocal, geralmente comprometendo o pulmão e sem adenomegalias intratorácicas associadas. Somente ocorria envolvimento de mais do que um órgão nos casos de tuberculose miliar e de tuberculose de excreção, quando os bacilos se disseminavam por via canalicular. Na presente série, observou-se proporção significativa de pacientes HIV+ com adenomegalias superficiais, o que pode corresponder à tuberculose multifocal. A maior freqüência dessas alterações nos pacientes com AIDS, bem como a freqüência aumentada de tuberculose miliar, corrobora com dados da literatura que demonstraram que as formas atípicas de tuberculose pulmonar e as formas graves são mais comuns em pacientes com imunossupressão avançada. A similaridade na freqüência dos tipos de tuberculose entre os pacientes HIV+ sem AIDS e os pacientes HIV- sugere que, em locais de alta prevalência de tuberculose, adultos HIV+ com apresentação clínico-radiológica usual de tuberculose, na ausência de história prévia ou atual de outras infecções oportunísticas, não devem ser classificados como tendo AIDS. Entretanto, é importante lembrar que com a introdução da highly active antiretrovial therapy (HAART), que reduziu a morbidade e a mortalidade causada pela AIDS, tem-se observado aumento nos valores de CD4 e diminuição na incidência de tuberculose em pacientes HIV+. Com isso, é possível que a tuberculose volte a se manifestar na sua forma clássica em pacientes com AIDS sob tratamento adequado. Com base nos achados do presente estudo os autores recomendam que, havendo suspeita clínica de tuberculose, a investigação prossiga, mesmo que as lesões radiológicas não sejam típicas. Ainda sugerem que, em casos de tuberculose tipo primária ou de doença multifocal, o teste anti-HIV seja realizado e, se positivo, que os valores de CD4 e a presença de doenças oportunísticas associadas sejam avaliados. Em locais onde a contagem de linfócitos CD4 não se encontra disponível, a contagem de linfócitos totais no sangue periférico deve ser realizada, uma vez que esta pode contribuir para o atendimento de pacientes com HIV e tuberculose.
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Magangane, Pumza Samantha. „Biomarker identification in HIV and non-HIV related lymphomas“. Doctoral thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/22817.
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DLBCL is the most common lymphoma subtype occurring in older populations as well as in younger HIV infected patients. The current treatment options for DLBCL are effective for most patients yet the relapse rate is high. While many biomarkers for DLBCL exist, they are not in clinical use due to low sensitivity and specificity. In addition, these biomarkers have not been studied in the HIV context. Therefore, the identification of new biomarkers for HIV negative and HIV positive DLBCL, may lead to a better understanding of the disease pathology and better therapeutic design. Initially differences in the clinicopathological features between HIV negative and HIV positive DLBCL patients were determined by conducting a retrospective study of patients treated at GSH. Subsequent to this, potential protein biomarkers for DLBCL were determined using MALDI imaging mass spectrometry (IMS) and characterised using LCMS. The expression of one of the biomarkers, heat shock protein (Hsp) 70, was confirmed on a separate cohort of samples using immunohistochemistry. Our results indicate that the clinicopathological features for HIV negative and HIV positive DLBCL are similar except for median age, and frequency of elevated LDH levels. Several clinicopathological factors were prognostic for all DLBCL cases including age, gender, stage and bone marrow involvement. In addition, tumour extranodal site was also a prognostic indicator for the HIV negative cohort. The biomarkers identified in the study consisted of four protein clusters including glycolytic enzymes, ribosomal proteins, histones and collagen. These proteins could differentiate between control and tumour tissue, and the DLBCL subtypes in both cohorts. The majority (41/52) of samples in the confirmation cohort were negative for Hsp70 expression. The HIV positive DLBCL cases had a higher percentage of cases expressing Hsp70 than their HIV negative counterparts. The non-GC subtype also frequently overexpressed Hsp70, confirming MALDI IMS data. Expression of Hsp70 correlated with poor outcome in the HIV negative cohort. In conclusion, this study identified potential biomarkers for HIV negative and HIV positive DLBCL from both clinical and molecular sources. These may be used as diagnostic and prognostic markers complementary to current clinical management for DLBCL.
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Green, Lisa A. „The Effect of HIV Knowledge and HIV Attitudes on African American Women's Decision to HIV Test“. Thesis, University of Missouri - Saint Louis, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10012849.
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Centers for Disease Control (2011a) Surveillance report revealed African American women comprised 63% of new HIV cases among women; 65% of African American women were infected with HIV transmitted by heterosexual sex; yet represent 13% of the female population in the United States. An existing data set was examined from a sample of 761 African American women with a history of drug use at high risk to acquire or transmit HIV and/or STDs to determine 751 women’s knowledge and attitudes about risky sexual behaviors, factors influencing a decision to HIV test, and the influence of sex trading on the decision to HIV test. Binary logistic regression predicted a small percentage of women’s decision to HIV test was influenced by knowledge of risky sexual behaviors (Naegelkerke R2, = .100). There were significant difference in the number HIV tests for women who reported cheating on a steady sex partner (M = 4.25, SD =7.49) versus women who did not cheat (M = 3.28, SD = 4.67), t(747) = - 2.19, p = .03. Binary logistic regression predicted a minor percentage of women’s decision to HIV test was influenced by women’s attitudes about risky sexual behavior (Nagelkerke R2 = .043). Women who agreed with the statement, I have risky drug behaviors that need changing were predicted twice as likely to be HIV tested Exp [B] = 1.829, 95% CI [1.018, 3.288]. Binary logistic regression predicted an increased 15.3% variation in the decision to HIV test is influenced by women’s knowledge to prevent HIV and attitudes about risky sexual behavior (Nagelkerke R2 = .153). Women who agreed with the knowledge item, asked their partner if they were HIV positive, were 1.3 times more likely, and women who agree with the knowledge statement, I have risky drug behaviors that need changing, increased to 1.9 times more likely to HIV test. There were significant differences in number of HIV tests for women who engaged in sex-trading versus women who do not engage in sex-trading. Tailored strategies that determine unique needs of African American women to reduce risky sex an increase HIV testing are recommended.
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Souza, Rafael Leme Cardoso. „Avaliação tecnológica do teste molecular (NAT) para HIV, HCV e HBV na triagem de sangue no Brasil“. Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/99/99131/tde-09102018-090250/.
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Após anos de debates, o teste de detecção de ácidos nucleicos (NAT) para HIV e HCV na triagem de sangue foi implementado de forma obrigatória no Brasil em 2013, e HBV, em 2016. Um dos motivos citados sobre o atraso em sua implementação foi o custo elevado que seria adicionado à sorologia e, até o momento, uma ampla avaliação econômica em saúde (AES) a respeito de sua eficiência no país não está disponível. Diversos artigos já demonstraram que a razão incremental de custo-utilidade (ICUR) do NAT em relação à sorologia varia de 0,21 a 8,84 milhões de dólares americanos (US$) para cada QALY ganho. Esta grande variação dá-se, principalmente, por diferenças entre a idade média dos receptores de sangue (RS), incidência/prevalência dos vírus entre os doadores de sangue (DS), custo dos testes e tratamentos médicos, cobertura da vacina contra o HBV e sensibilidade do teste utilizado. Assim, faz-se necessária uma avaliação abrangente desta tecnologia e sua efetividade para o cenário brasileiro. Objetivos: Realizar uma revisão sistemática (RevS) de estudos econômicos completos sobre o uso do NAT para HIV, HCV e/ou HBV no mundo; realizar a AES sobre o NAT sob a perspectiva pública brasileira; caracterizar as doações de sangue em janela imunológica no país. Métodos: Metodologia Cochrane de RevS das bases de dados Medline, Embase, LILACS, CRD, BVS ECO, Google Scholar e IDEAS; questionário aplicado aos bancos de sangue e modelo econômico on-line da International Society of Blood Transfusion (ISBT) para cálculo da ICUR do \"NAT em mini-pool de seis amostras individuais\" (MP6) versus \"testes sorológicos\" (SR) no Brasil. Resultados: Quatorze estudos de dezesseis diferentes países foram avaliados. O NAT apresentou a maior relevância nos países de baixa renda, onde há as maiores prevalências e incidências virais, menores taxas de doadores de repetição (DR) e RS mais jovens. A maioria dos estudos concluiu que o NAT, independente do vírus analisado, não é custo-efetivo. As principais diferenças entre as características dos estudos foram relacionadas aos custos médicos e idade dos RS. O maior desvio dos padrões de uma RevS foram: não incluir o racional para definição dos desfechos e o modelo utilizado e não ter claro o conflito de interesse dos autores; para esta AES, o MP6 versus SR apresentou um ICUR de US$ 231.630,00/QALY, ou seja, 26,2 vezes o PIB per capita nacional) e um ICER de US$ 330.790,00/Ano de vida ganho (AVG). A análise de sensibilidade univariada do modelo demonstrou que somente a taxa de desconto, idade do RS, custo do NAT e epidemiologia dos vírus alteraram de forma significativa o ICUR obtido, variando desde US$ 76.957,00/QALY a US$ 933.311,00/QALY; a maioria dos casos de janela imunológica no Brasil são jovens, média de 29 anos, do sexo masculino, com pelo menos o ensino médio completo e mesmo com a obrigatoriedade do Anti-HBc no Brasil, o NAT-HBV é o que apresentou o maior rendimento. Conclusões: Os jovens, principalmente, ainda buscam os bancos de sangue como locais de testagem após comportamento de risco e é de extrema importância a revisão do custo real e completo do teste NAT no Brasil para ampla abordagem da tecnologia nacional incorporada e, se necessário, revisar a forma e modelo de reembolso da mesma e permitir a defesa do bem-estar da população e do bem público.After years of discussion, nucleic acid (NAT) testing in the blood screening for HIV and HCV was implemented in Brazil in 2013 and HBV in 2016. One of the reasons cited for the delay in its implementation was the high cost that would be added to serology screening and a comprehensive economic assessment of its efficiency in the country is not yet available. Several articles have already shown that the incremental cost-utility ratio (ICUR) of NAT versus serology ranges from 0.21 to 8.84 million American dollars (US$) for each QALY gained. This large variation is mainly due to differences between the mean age of the blood recipient, viruses\' incidence / prevalence among donor population, cost of medical tests and treatments, HBV vaccine coverage, and sensitivity of the test used. Thus, a comprehensive evaluation of this technology and its effectiveness under the perspective of the Brazilian public health system (SUS) is needed. Objectives: Development of a systematic review (RevS) of complete economic studies about the use of NAT for HIV, HCV and / or HBV in the world. Conduct an economic evaluation of NAT under SUS perspective; characterize Brazilian blood donations in the serology \"window period\". Methods: Cochrane RevS Methodology of the Medline, Embase, LILACS, CRD, CRD ECO, Google Scholar and IDEAS databases; Questionnaire applied to blood banks and online economic model from the International Society of Blood Transfusion (ISBT) to calculate the ICUR for \"NAT in mini-pool of six individual samples\" (MP6) versus \"Serology Tests\" (SR) in Brazil. Results: Fourteen studies from sixteen different countries were assessed. NAT was most relevant in low-income countries, where there are the highest prevalences and viral incidences, lower rates of repeat donors and younger recipients of blood (RS). Most of the studies concluded that NAT, regardless of the virus evaluated, is not cost-effective. Differences in the characteristics of the studies were related to the costs and age of RS. The major deviations from RevS standards were: not including the rationale for selecting the outcomes and the model used and not being clear about the authors\' conflict of interest; MP6 vs SR showed an ICUR of US$ 231.630,00/QALY, 26,2 times Brazilian GND per capita) and an ICER of US$ 330.790,00/Life year gained (AVG). The univariate sensitivity analysis of the model demonstrated that only changes on discount rate, NAT cost, RS age and viruses\' epidemiology significantly altered the ICUR in a range between US$ 76.957,00/QALY and US$ 933.311,00/QALY; Most RS window period cases in Brazil are young, average of 29 years old, male, with at least high school education completed and even with the requirement of Anti-HBc in Brazil, NAT-HBV is the one that presented the highest yield. Conclusions: Young people, mainly, still seek blood banks as testing sites, especially after a risk behavior. It is extremely important to reveal the real and complete cost of the Brazilian NAT to fully evaluate its efficiency and, if needed, reassess its current reimbursement model, allowing the wellbeing defense of the population and public interest.
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Gonzalez, Mario Peribañez. „Prevalência de hipovitaminose D e fatores de risco associados em pacientes portadores de HIV, HCV e coinfecção HIV/HCV na cidade de São Paulo“. Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/5/5168/tde-09032017-115725/.
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Introdução e Objetivos: Hipovitaminose D, definida como nível sérico de 25(OH)D insuficiente é considerada pandêmica em muitas populações ao redor do mundo e está associada a comorbidades em hepatite C, infecção por HIV e coinfecção HIV/HCV. Os objetivos deste estudo são: 1) comparar a prevalência de deficiência de vitamina D (DVD) caracterizada por nível sérico de 25(OH)D < 20 ng/mL, entre pacientes monoinfectados pelo HCV, monoinfectados pelo HIV, coinfectados HIV/HCV e participantes do grupocontrole; 2) identificar fatores de risco específicos associados com DVD na população estudada. Pacientes e Métodos: Foram coletados dados clínicos e demográficos, 25(OH)D sérica, testes de função hepática e perfil metabólico durante os meses de inverno de 129 pacientes HCV monoinfectados, 118 pacientes HIV monoinfectados e 53 pacientes coinfectados HIV/HCV tratados em centros de referência na cidade de São Paulo, bem como, em 122 indivíduos saudáveis de um grupo-controle formado de pessoas não infectadas por HIV, HCV ou HBV, sem uso de suplementos de vitamina D. Resultados: A prevalência de deficiência de vitamina D ajustada por sexo, idade ( = 50), cor de pele (branco vs não branco), índice de massa corporal ( = 25), colesterol total (= 200), fração HDL colesterol ( = 40 em homens = 50 em mulheres), triglicérides (= 150), glicemia ( = 110), uso de efavirenz (sim vs não), uso de tenofovir (sim vs não) e índice HOMA-IR, foi menor no grupo HCV do que no controle e no grupo HIV (p < 0.001). Em todos os grupos, a razão de chance de DVD aumenta 1.21 [IC95%(1.01; 1.44) p=0.026] para cada ponto de aumento do índice HOMA. Efavirenz também esteve associado com maior razão de chance de DVD [3.49(IC95% 1.14-10.67) p=0.028]. Análise por regressão logística simples foi aplicada para avaliar fatores de risco associados a DVD dentro de cada grupo. Nesta análise, resultaram com associação significativa o sexo masculino, com uma menor razão de chance para DVD [RC 0,42(IC95% 0,18 - 0,96) p = 0,04] no grupo-controle e no grupo HCV [RC 0,42(IC95% 0,2 - 0,88) p = 0,02]; ainda no grupo HCV houve associação significativa entre DVD e HOMA-IR elevado [RC 5,59(IC 95% 1,37 - 22,8) p = 0,02]; e, no grupo HIV, os indivíduos que apresentaram nadir histórico de CD4 maior que 200 células/mm3 tiveram menos chance de DVD [RC 0,41 (IC95% 0,18 - 0,95) p = 0,04]. Conclusão: Uma alta prevalência de DVD foi observada em toda a população estudada, incluindo o grupo-controle, sugerindo que a apresentação de infecção por HIV e/ou HCV por si só não aumenta as chances de DVD. Por outro lado, o incremento do índice HOMA e o uso de efavirenz se destacaram como fatores de risco nesta população. Estes achados ressaltam a importância da associação da deficiência de vitamina D com outras duas condições; a resistência à insulina e o uso de terapia antirretroviral para o HIV, os quais, isoladamente ou em combinação, podem aumentar a incidência de comorbidades como o diabetes do tipo 2Background and Aims: Hypovitaminosis D, defined as insufficient serum level of 25(OH)D, is considered pandemic in many populations worldwide and is associated with co-morbidities in hepatitis C, HIV and HIV/HCV co-infection. The aim of this study is to 1) compare the prevalence of 25-hydroxyvitamin D deficiency (VDD), defined as serum levels of 25(OH)D < 20 ng/mL, among HCV mono-infected, HIV mono-infected, HIV/HCV co-infected patients and control participants and 2) identify specific risk factors associated with VDD in each group. Patients and Methods: We collected demographic and clinical data, serum 25-hydroxyvitamin D, liver function parameters and metabolic profiles on 129 HCV mono-infected, 118 HIV mono-infected and 53 HIV/HCV co-infected patients treated at reference centers in São Paulo (Brazil) as well as on 122 volunteer controls, not infected by HIV, HCV, HBV or taking vitamin D supplements. Results: VDD prevalence adjusted for sex, age ( = 50), skin color (white vs not white), body mass index ( = 25), total cholesterol (= 200), HDL cholesterol ( = 40 in men and = 50 in women), triglycerides ( = 150), glycemia ( = 110), use of Efavirenz - EFV (yes vs no), use of Tenofovir -TDV (yes vs no) and HOMA-IR was lower in HCV group than control and HIV groups (p < 0.001). In all groups, adjusted odds of VDD increases by 1.21 [CI95% (1.01-1.44)] for each unit increase of HOMA-IR. Antirretroviral therapy regimens containing efavirenz were also associated to higher odds of VDD 3.49 [CI95% (1.14-10.67) p=0.028]. Logistic regression was applied to analyze risk factors associated to VDD within each group. In this analysis male sex resulted significantly associated to lower chance of VDD [OR 0,42(CI95% 0,18 - 0,96) p = 0,04] in control group and in HCV group [RC 0,42(CI95% 0,2 - 0,88) p = 0,02]; still in HCV group, elevated HOMA-IR was significantly associated to VDD [OR 5,59(CI 95% 1,37 - 22,8) p = 0,02]; and in HIV group, individuals presenting CD4 nadir higher than 200 cells/mm3 had less chance of VDD [OR 0,41 (IC95% 0,18 - 0,95) p = 0,04]. Conclusion: High prevalence of VDD was observed across all studied population, including control group, suggesting that being infected with HIV and/or HCV per se does not increase the chance of VDD. Otherwise, VDD was positively associated with HOMA-IR increase for controls and infected patients. It is also associated to use of Efavirenz in HIV/HCV patients. This finding highlights the relevance of vitamin D deficiency association with two other conditions; insulin resistance and antiretroviral therapy, which isolated or in combination, may contribute to the incidence of comorbidities, as Type 2 diabetes mellitus
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Del-Rios, Nativa Helena Alves. „Estudo epidemiológico e molecular da infecção pelo vírus da Hepatite C em indivíduos infectados pelo vírus da Imunodeficiência Humana em Goiânia-Goiás“. Universidade Federal de Goiás, 2011. http://repositorio.bc.ufg.br/tede/handle/tede/7241.
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Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG
The hepatitis C virus (HCV) and human immunodeficiency virus (HIV) are characterized by causing chronic infections in the host. The advent of potent antiretroviral therapy has resulted in a significant reduction in the incidence of opportunist infections, and thus greater life expectancy for HIV positive patients. However, the liver disease appears as a major cause of morbidity and mortality among these patients, especially those related to hepatitis C virus. Co-infection with HCV/HIV induces a worse prognosis for both infections, which may lead to the development of AIDS, a faster rapid evolution to chronic active hepatitis and / or liver cirrhosis and death. This study aimed to investigate the epidemiology and molecular profile HCV infection in HIV-infected individuals with no prior antiretroviral therapy, seen in the referral hospital for the treatment of infectious diseases (Hospital for Tropical Diseases - Anuar Auad / HDT) in Goiania, Goiás. A total of 505 treatment naïve individuals and were referred to the HDT, from April 2009 to April 2010 were interviewed and underwent blood collection. All sera were tested for antibodies to HCV (anti-HCV) and for HCV RNA by polymerase chain reaction (PCR). Genotyping was performed by reverse hybridization by the Line Probe Assay (LiPA) method. The prevalence of anti-HCV was 4.6% (95% CI: 3.0 to 6.8). The viral RNA was detected in 65.2% (15/23) of anti-HCV positive samples. The genotypes identified were 1 (subtypes 1a and 1b) and 3 (subtype 3a). The age > 40 years, living in other states or Goiania city, surgery, injecting and non-injecting drug and anti-HBc positive (antibody to core antigen of hepatitis B virus) were associated with HCV infection after logistic regression. The data presented shows the vulnerability of the HIV sropositive population to acquisition of infectious diseases such as HCV infection. Thus, the information obtained will be essential for planning public health interventions, preventing and control of hepatitis C in this population.
Os vírus da hepatite C (HCV) e da imunodeficiência humana (HIV) causam infecções crônicas no hospedeiro. O advento da terapia antiretroviral potente trouxe uma redução da incidência de infecções oportunistas, e consequentemente, uma maior expectativa de vida aos pacientes HIV soropositivos. No entanto, as hepatopatias surgem como uma das principais causas de morbimortalidade entre esses pacientes, principalmente aquelas relacionadas ao vírus C. A coinfecção HCV/HIV induz a um pior prognóstico de ambas as infecções, podendo levar ao desenvolvimento da Aids, evolução mais rápida para hepatite crônica ativa e/ou cirrose hepática e morte. Este estudo teve como objetivo investigar o perfil epidemiológico e molecular da infecção pelo HCV em indivíduos infectados pelo HIV, sem tratamento antiretroviral prévio, atendidos no Hospital de referência para o tratamento de doenças infecciosas (Hospital de Doenças Tropicais - Anuar Auad / HDT) em Goiânia, Goiás. Um total de 505 indivíduos, virgens de tratamento, encaminhados ao HDT, no período de abril/2009 a abril/2010, foram entrevistados e submetidos à coleta de sangue. As amostras (soros) foram testadas para a detecção de anticorpos para o HCV (ELISA/LIA) e submetidas à identificação do RNA-HCV pela reação em cadeia da polimerase (PCR). A genotipagem foi realizada por hibridização reversa, pelo método Line Probe Assay (LiPA). A prevalência para anti-HCV foi de 4,6% (IC 95%: 3,0-6,8). O RNA viral foi detectado em 15 amostras, sendo todas elas anti-HCV positivas. Foram identificados os genótipos 1 e 3, com predomínio do subtipo 1a, seguido dos subtipos 1b e 3a. As variáveis idade superior a 40 anos, ser procedente de Goiânia ou outros estados, cirurgia, uso de drogas injetáveis e não-injetáveis, história de prisão e positividade ao anti-HBc foram associados à infecção pelo vírus da hepatite C, após regressão logística. Os dados apresentados revelam a vulnerabilidade da população HIV soropositiva à aquisição de doenças infecciosas como a infecção pelo HCV. Assim, as informações obtidas serão essenciais para o planejamento de ações de saúde pública para a prevenção e controle da hepatite C nessa população.
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Taveras, Janelle. „HIV Risk Behaviors, Previous HIV Testing and Positivity among Hispanic Women Tested for HIV in Florida, 2012“. FIU Digital Commons, 2017. http://digitalcommons.fiu.edu/etd/3456.
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The prevalence of female adults and adolescents living with diagnosed HIV infection continues to rise. Latina women in the United States (US) are not only disproportionately affected by human immunodeficiency virus (HIV) infection, but also underutilize HIV prevention services, such as HIV testing. Data are limited on the differences in HIV risk among Latinas by country of birth, and opportunities still exist to prevent transmission of HIV and reduce HIV-related disparities. This dissertation describes the risk behaviors, testing behaviors, and test results among women tested for HIV at public sites in Florida. Additionally, it compares these characteristics by HIV testing site type among pregnant women. Multivariable logistic regression was used to estimate the adjusted odds ratios (AOR) and associated 95% confidence intervals for the outcome variables of risk behaviors, previous testing, and positive HIV test results.
Of the total 209,954 records, 184,037 were from women not currently pregnant, of which 87,569 (45.6%) were among non-Hispanic Blacks (NHBs), 47,926 (26.0%) non-Hispanic Whites (NHWs), and 41,117 (22.3%) Latinas. Women who reported previous HIV testing had decreased odds of being Latina compared to NHW women (AOR 0.90; 95% confidence interval [CI] 0.87, 0.94), and testing event results indicate that foreign-born Latina women were significantly less likely to report partner risk (AOR 0.42; 95% CI: 0.40-0.54) than US-born Latina women. Of the 24,863 records of pregnant women, 10,199 (41.1%) were among Latinas, 6,796 (27.4%) were among NHB, and 6,631 (26.7%) were among NHW. The testing records indicated that Latina and NHB women had decreased odds of reporting partner risk than NHW women (Latina: AOR 0.20; 95% CI: 0.14-0.28; and NHB: AOR 0.14; 95% CI: 0.10-0.21), and records of women tested in prisons/jails had higher odds of reporting previous HIV testing compared to prenatal care sites (AOR 1.86; 95% CI: 1.03-3.39).
Reported risk behaviors varied by race/ethnicity and Latina country of origin. Knowledge of these differences can enhance current testing and prevention strategies for women, and aid in targeting HIV prevention messaging, program decision-making, and allocation of resources, corresponding to the central approach of High Impact Prevention and the National HIV/AIDS Strategy.
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Brauchli, Peter. „Psychoneuroimmunologie und HIV-Infektion : eine Längsschnittstudie mit HIV-infizierten Personen /“. [S.l.] : [s.n.], 1995. http://e-collection.ethbib.ethz.ch/show?type=diss&nr=11087.
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Saidy, Jasmine, und Maija Liimatainen. „HIV-positiva kvinnors upplevelser av HIV-relaterat stigma : En litteraturöversikt“. Thesis, Hälsohögskolan, Högskolan i Jönköping, HHJ, Avd. för omvårdnad, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-30382.
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Bakgrund: HIV är en viral infektion som smittar via blod, sexuell kontakt, amning och förlossning. HIV-relaterat stigma är negativa uppfattningar, känslor och attityder gentemot de som lever med HIV eller uppfattas ha det. Fokus är främst kvinnors upplevelser av HIV-relaterat stigma eftersom det är en utsatt grupp. Genom att undersöka deras upplevelser och tillämpa personcentrerad omvårdnad kan hälsa uppnås, vilket är målet för omvårdnad. Syfte: Att beskriva HIV-positiva kvinnors upplevelser av HIV-relaterat stigma. Metod: Arbetet är en litteraturöversikt över nio artiklar som granskades med kvalitetsgranskningsprotokoll. Artiklarna analyserades utifrån en deduktiv ansats med hjälp av ”Model of Stigma” gjord av Churcher.Resultat: Resultatet presenterades under fyra kategorier; vicarious, enacted, internalized och perceived stigma. HIV-relaterat stigma upplevs som en förlust av identitet, värdighet, arbete och sociala relationer. Detta medförde mycket skam för de drabbade och för att undvika detta dolde vissa sin status. Slutsatser: Kvinnornas upplevelser av HIV-relaterat stigma påverkade deras liv på många olika plan. Omgivningens attityd mot dem påverkade mycket. Bland annat den mentala hälsan hos de HIV-positiva personerna påverkades negativt av stigma. Sjuksköterskan bör därför stötta den HIV-positiva personen i att hitta en ny identitet med sjukdomen så att personen kan uppnå hälsa.Background: HIV is a viral infection which is transmitted through blood, sexual contact, perinatal transmission and breastfeeding. HIV-related stigma is negative beliefs, feelings or attitudes about an individual based on their true or perceived HIV-status. The focus is on HIV-positive womens’ experiences, because it is a vulnerable group. Health can be achieved by exploring their experiences and using personcentered care, which is the goal for nursing.Aim: To describe HIV-positive womens' experiences of HIV-related stigma.Method: A literature review was made. Nine articles were examined with quality protocols and analyzed through a deductive approach with ”Model of stigma” of Churcher.Results: The result was presented underneath four categories; vicarious, enacted, internalized and perceived stigma. HIV-related stigma was experiencd as a loss of identity, dignity, work and social relationships. It brought a lot of shame to the women and some of them hid their status to avoid it.Conclusions: The women’s’ experiences of HIV-related stigma affected their lives on multiple levels. Their surrounding context affected them a lot. Their mental health was affected negatively by the stigma. Hence the nurse should support the HIV-positive person to find a new identity with the disease in order to achieve health.
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McPherson, Deidre Estelle Kathleen. „HIV and penetrating abdominal trauma: does HIV influence the outcome?“ Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/27417.
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Background: Human immunodeficiency virus (HIV) infection and trauma are significant contributors to the burden of disease in South Africa. There is an increase in prevalence of HIV sero-positivity in trauma patients. However, there are conflicting reports about the influence of HIV in outcomes after trauma or surgery. Although HIV and the acquired immunodeficiency syndrome (AIDS) can potentially affect outcomes, there have been few studies comparing trauma outcomes in HIV positive versus HIV negative patients. To the best of our knowledge, there have been no studies to date that have compared HIV positive and HIV negative patients with penetrating (gunshot or stab) abdominal wounds requiring an explorative laparotomy. The purpose of this study was to determine whether the outcome of hemodynamically stable patients undergoing explorative laparotomy for penetrating abdominal trauma differed in HIV positive patients versus HIV negative patients. Methods: This was an observational prospective study over a 16-month period from February 2016 to May 2017. All hemodynamically stable patients with penetrating abdominal trauma requiring a laparotomy were included in the study. To evaluate the impact of HIV on outcome, the mechanism of injury, the HIV-status, age, the penetrating abdominal trauma index (PATI), and the revised trauma score (RTS) were entered into a binary logistic regression model. Outcome parameters were in-hospital death, morbidity (defined as one or more distinct complications) during hospitalization was graded as per Clavien-Dindo classification of complications, admission to intensive care unit (ICU), relaparotomy within 30 days, and length of stay longer than 30 days. Variables were sought in bivariate analysis. Results: A total of 209 patients, 94% male, with a mean age of 29 ± 10 years were analysed. Twenty-eight patients (13%) were HIV positive. The mean CD4 count in the HIV positive group was 401 ± 254. The two groups were comparable except for race; 79% were black in the HIV positive group vs. 41% in the HIV negative group. All patients underwent explorative laparotomy of which 10 (4.8%) laparotomies were negative. There were two (0.96%) deaths, both in HIV negative group. The complication rate was 34% (n=72). There was no association between CD4 count and complications (p=0.234). Twenty-nine patients (14%) were admitted to the ICU. A higher PATI, advancing age, and a lower RTS were significant risk factors for worsened outcome. After 30 days, 12 patients (5.7%) were still in hospital. PATI was the single independent predictor in multivariate analysis. Twenty-four patients (11%) underwent a second laparotomy and the PATI was again the only significant predictor of outcome. Conclusion: The incidence of HIV in our cohort is 13%, which is similar to the reported incidence of HIV in the Western Cape of 15%. There were no significant baseline differences between the HIV positive and negative groups. Our results further showed that HIV status was not an independent predictor for morbidity, admission to ICU, relaparotomy, prolonged hospital stay or mortality. The patient's HIV status does not influence their outcomes in penetrating abdominal trauma.
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Soto-Rifo, Ricardo. „Translational control of HIV-1 and HIV-2 genomic RNA“. Lyon, Ecole normale supérieure, 2010. http://www.theses.fr/2010ENSL0584.
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Les virus de la immunodéficience humaine de type 1 et 2 (VIH-1 et VIH-2) sont des pathogènes qui ont un grand impact sur la santé car plus de 33 millions de personnes sont infectées dans le monde. Les mécanismes qui contrôlent les étapes post-transcriptionelles de l’ARN génomique pendant les étapes tardives du cycle réplicatif ne sont pas très connu et donc les processus moléculaires qui permettent à l’ARN génomique de s’associer aux machineries cellulaires de traduction, transport ou dégradation restent à être déterminés. Dans ces travaux, nous avons contribué à améliorer notre connaissance sur les mécanismes qui contrôlent la synthèse des protéines à partir de l’ARN génomique de VIH-1 et VIH-2. Les résultats présentés dans ces travaux montrent que la structure d’ARN TAR joue un rôle primordial dans le contrôle des interactions de l’ARN génomique et la machinerie traductionnelle de la cellule. Nous montrons des données qui suggèrent une nouvelle étape lors du cycle réplicatif du VIH-2 dans laquelle l’ARN génomique est accumulé dans des granules cytoplasmiques avec des marqueurs des granules de stress. Nous mettons en évidence un mécanisme qui permettrait à l’ARN génomique du VIH-1 d’être exporté au cytoplasme et traduit de manière efficace grâce à l’helicase à ARN DDX3Infections by Human immunodeficiency viruses type-1 and type-2 (HIV-1 and HIV-2) have an enormous impact in Human health as more than 33 million people is living with HIV/AIDS worldwide. The mechanisms controlling post-transcriptional events during the HIV life cycle have just started to capture the attention of scientists and most of the molecular processes allowing the genomic RNA to interact with the host machineries for translation, transport or decay are still obscure or in way to be determined. In this work, we contribute to the progress in the knowledge of the mechanisms controlling protein synthesis from the HIV-1 and HIV-2 genomic RNA. Results presented here provide evidence for the TAR RNA structure as a key player in controlling the interactions between the HIV-1 and HIV-2 genomic RNA with the host translational machinery. We also provide data for a new step during the HIV-2 life cycle that involves the accumulation of the genomic RNA in cytoplasmic granules containing several stress granules components. Finally, we present evidence for a potential mechanism by which nuclear export and protein synthesis are linked during the HIV-1 replication cycle. As such, we show that DEAD-box RNA helicase DDX3, previously implicated in Rev-mediated nuclear export, is absolutely required for HIV-1 genomic RNA translation. We determined the TAR structure as the viral determinant required for DDX3 function in translation. Strikingly, we also showed that DDX3 is specifically required for HIV-2 and SIV translation but not for FIV, HTLV-1, MLV or Line-1 suggesting that this function was acquired during primate lentiviruses evolution. Taken together, results obtained during this work highlight several key aspects of the HIV-1 and HIV-2 genomic RNA post-transcriptional control that may be critical for viral replication
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Bertoldi, Alessia <1990>. „HIV e reservoir“. Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2019. http://amsdottorato.unibo.it/8875/1/bertoldi_alessia_tesi.pdf.
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Il maggiore ostacolo all’eradicazione di HIV è la presenza del reservoir virale trascrizionalmente silente ma in grado di replicare e difficilmente accessibile alla terapia. Reservoir di piccole dimensioni correlano con una prognosi migliore e una minor probabilità di rebound virologico in caso di semplificazione di terapia. La quantificazione del reservoir risulta pertanto essenziale per valutare la reale efficacia della terapia.
La quantificazione dell’HIV-DNA totale (circolare e integrato) rappresenta una metodica semplice e ampiamente utilizzata per analizzare il reservoir, nonostante ne sovrastimi le reali dimensioni includendo genomi defettivi.
Pertanto, inizialmente abbiamo ottimizzato una metodica per la quantificazione delle forme circolari di HIV-DNA. La forma circolare 2-LTR è stata misurata con successo; ciò non è stato possibile per la forma 1-LTR a causa di omologie di sequenza con il DNA genomico. Come parte di uno studio attualmente in corso, sette pazienti sono stati arruolati alla diagnosi (T0) e seguiti con prelievi a 6(T1), 12(T2), 18(T3) e 24(T4) mesi dopo l’inizio della terapia. Dati preliminari ottenuti nel primo anno (T0,T1,T2) mostrano un andamento dell’HIV-DNA totale stabile nel tempo (P>0,1); analogamente, la forma 2-LTR non mostra aumenti significativi tra T0 e T1 (P>0,5). Tuttavia, a T0 è stata osservata una differenza statisticamente significativa tra l’HIV-DNA totale e la forma 2-LTR (P<0,05).
La seconda parte dello studio si è focalizzata sul saggio TILDA, un metodo in grado di misurare esclusivamente virus competenti la replicazione. Abbiamo adattato questa metodica alle nostre condizioni sperimentali eseguendola su 3 pazienti HIV-positivi.
Infine, considerando il costante aumento dei casi di infezione con sottotipi non-B e che il saggio TILDA è stato sviluppato principalmente per il sottotipo B, il protocollo è stato modificato in modo da rilevare il sottotipo C, il più diffuso a livello mondiale. In particolare, è stato eseguito con successo su 3 pazienti infetti con il sottotipo C.Persistence of transcriptionally silent but replication-competent HIV reservoir in resting CD4+T cells constitutes the major barrier to viral eradication. Small latent reservoirs are associated to a better prognosis and predictive of less likelihood to undergo virological rebound during simplified therapy. Therefore, the amount of HIV-DNA in latently infected cells is critical to evaluate the efficacy of available regimens and avoid the potential “re-seeding” in aviremic patients. Although the quantification of total HIV-DNA (circular and integrated) overestimates reservoir size because it includes not replication-competent genomes, it represents a simple and widely used biomarker reflecting global viral reservoir. Therefore, first we optimized PCR methods for detection of circular forms of HIV-DNA in HIV-positive patients. We successfully measured the 2-LTR form, but not the 1-LTR form due to homologies with genomic DNA sequence. As part of an ongoing project on HIV-DNA, we tested our in house assay on seven PBMCs samples of treatment-naïve patients collected at 0(T0), 6(T1), 12(T2), 18(T3) and 24(T4) months after starting ART. Preliminary data on T0,T1, and T2 time points showed that total HIV-DNA is stable during time (P>0,1); likewise, the amount of 2-LTR forms did not show significant differences between T0 and T1 time points (P>0,5). However, we observed a statistically significant difference between 2-LTR form and total HIV-DNA amounts at T0 (P<0,05). The second part of this study focused on TILDA, a method that detects only transcriptionally-competent proviruses. Hence, we adapted TILDA to our experimental conditions performing the modified assay in three long-term treated patients. Moreover, considering that the frequency of non-B subtype infections is constantly increasing and TILDA has been developed based on subtype B virus sequence, we modified the protocol to detect subtype C virus, the most prevalent subtype worldwide. We successfully perform the new version of TILDA in three patients harboring subtype C viruses.
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Duhamel, Christine. „HIV et grossesse“. Saint-Etienne, 1993. http://www.theses.fr/1993STET6227.
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Davis, Katie L. „Analysis of HIV-1 variable loop 3-specific neutralizing antibody responses by HIV-2/HIV-1 envelope chimeras“. Thesis, Birmingham, Ala. : University of Alabama at Birmingham, 2008. https://www.mhsl.uab.edu/dt/2009r/davis.pdf.
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Rodriguez, Ma Del Rocio Rocha. „Fatores associados ao desenvolvimento de lesões cervicais em mulheres mexicanas“. Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/22/22132/tde-28032008-082517/.
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A compilação mais recente dos dados mundiais indica que anualmente 466.000 novos casos de câncer cervical são detectados em todo mundo. A infecção pelos tipos oncogênicos do papilomavírus humano (HPV), constitui importante fator de risco para o desenvolvimento do câncer do colo uterino. Em mulheres portadoras do vírus da imunodeficiência humana tipo 1 (HIV-1), tem sido demonstrado o aumento na prevalência e persistência da infecção por HPV oncogênicos, justificando o aumento da susceptibilidade destas mulheres para o desenvolvimento das lesões cervicais, lesões precursoras do câncer do colo uterino. Citocinas são importantes na defesa contra a infecção pelo HPV e o nível de sua produção é geneticamente determinado. A predominância de citocinas do padrão do tipo Th1, como o TNF-alfa, está associada com a regressão das lesões cervicais. Neste estudo foram analisados os fatores comportamentais, imunológicos e virais, possivelmente, associados ao desenvolvimento das lesões cervicais em 66 mulheres mexicanas, portadoras ou não da infecção pelo HIV-1, apresentando lesões cervicais. Assim, aspectos sócio-demográficos e hábitos sexuais, a identificação e a tipificação do HPV, e a detecção do polimorfismo da região promotora do TNF foram analisados. Ao avaliar os aspectos sócio-comportamentais, a maioria das mulheres estava casada legalmente ou em união consensual no momento da entrevista, com nível educacional fundamental e nível sócio-econômico baixo. Associado a isso, a maior porcentagem dos maridos eram migrantes dos Estados Unidos da América (EUA), em busca de emprego e melhores condições financeiras. O grupo de pacientes com HIV-1 que referiram utilizar a camisinha só algumas vezes ou nunca e que relataram possuir entre 2-3 parceiros sexuais foi maior do que o grupo de mulheres sem o HIV- 1. Adicionalmente, os parceiros sexuais de mulheres com o HIV-1 mantinham outras parcerias sexuais, sendo estas heterossexuais e/ou homossexuais. Todas as pacientes arroladas no presente estudo apresentavam infecção ativa por HPV e lesões cervicais de baixo grau. Os HPV oncogênicos, como os do tipo 16/18 e 35, foram significantemente mais freqüentes entre as HIV positivas em comparação às não portadoras dessa infecção. Relativo às comparações do polimorfismo do TNF, a freqüência do genótipo TNF-308 não mostrou diferenças significantes entre os grupos de pacientes. O gene da região promotora do TNF na posição -238 também foi avaliado e observamos que o alelo TNF-238G, associado à alta produção dessa citocina, apresentou significativo aumento de sua freqüência entre as pacientes com o HIV-1 em relação às pacientes sem o HIV-1. Estes resultados sugerem que as condições sócio-culturais e hábitos sexuais estão envolvidos com a vulnerabilidade para a aquisição do HIV e HPV em mulheres mexicanas. Embora as portadoras do HIV apresentem infecção ativa por HPV oncogênicos, a presença do alelo -238G, relacionado com a alta produção do TNFalfa, pode estar associado com a não progressão das lesões cervicais. Entretanto, esta interpretação deve ser realizada com cautela, pois algumas mulheres que apresentavam resultados de lesões cervicais de baixo grau morreram de câncer cérvico uterino. Este fato revela a fragilidade das análises e avaliações ginecológicas nos serviços de saúde referidos neste estudo e sugere que a alternativa de utilizar técnicas de biologia molecular para a identificação e tipificação dos tipos oncogênicos do HPV seja uma estratégia importante para os programas de prevenção do câncer do colo do útero.The most recent compilation of global data indicates that, every year, 466,000 new cases of cervical cancer are detected around the world. Infection by oncogenic types of the human papillomavirus (HPV) constitutes an important risk factor for the development of colon cancer. In women with human immunodeficiency virus type 1 (HIV-1), an increased prevalence and persistence of infection by oncogenic HPV has been demonstrated, justifying these women\'s increased susceptibility to the development of cervical lesions, which precede colon cancer. Cytokines are important in the defense against infection by HPV and its production level is genetically determined. The predominance of th1 cytokines, such as TNF-alfa, is associated with the regression of cervical lesions. This study analyzed behavioral, immunological and viral factors that may be associated with the development of cervical lesions in 66 Mexican women, infected by HIV-1 or not and presenting cervical lesions. Sociodemographic aspects and sexual aspects, HPV identification and typification and the detection of polymorphism in the region that promotes TNF were analyzed. With respect to socio-behavioral aspects, most women were legally married or lived in consensual union at the time of the interview, with basic education and low socioeconomic level. Moreover, most husbands were migrants from the United States (USA) who were looking for a job and better financial conditions. The group of HIV-1 patients who mentioned using a condom sometimes or never had having 2-3 partners was larger than the group of women without HIV-1. In addition, the sexual partners of women with HIV-1 had other hetero and/or homosexual partners. All patients included in this research presented active infection by HPV and low-grade cervical lesions. Oncogenic HPV, such as types 16/18 and 35, were significantly more frequent among HIV-positive than among HIV-negative patients. As to the comparisons of TNF polymorphism, the frequency of the TNF-308 genotype did not show significant differences between the patient group. The gene of the TNF promoting region in position -238 was also assessed. It was found that the TNF 238G allele, associated with high production levels of the cytokine, presented a significant increase in frequency among patient with in comparison with those without HIV-1. These results suggest that sociocultural conditions and sexual habits are involved in Mexican women\'s vulnerability to infection by HIV and HPV. Although the HIV patients present active infection by oncogenic HPV, the presence of the -238G allele, related with the high production of TNF-alpha, can be associated with the non progression of the cervical lesions. However, this must be interpreted with caution, as some women with low-grade cervical lesion results died of colon cancer. This fact reveals the fragility of gynecological analyses and assessments at the health services mentioned in this research and suggest the alternative of using molecular biology techniques for the identification and typification of HPV as an important strategy for colon cancer prevention programs.
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Lima, Marina de Deus Moura de. „Correlação entre a presença do HPV na boca e no colo uterino de pacientes com sorologia positiva e negativa para o HIV“. Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/23/23141/tde-29092009-091212/.
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A infecção genital pelo papilomavírus humano (HPV) corresponde a uma das doenças sexualmente transmissíveis mais frequentes no mundo. Uma preocupação dos pacientes que apresentam HPV na região anogenital diz respeito à possibilidade de disseminação desse vírus para outras partes do corpo. O objetivo geral desse estudo foi avaliar a possível correlação existente entre infecções pelo HPV na mucosa oral e no colo uterino em mulheres com sorologias positiva e negativa para o HIV. Pretendeu-se, também, identificar variáveis clínicas, demográficas e laboratoriais associadas à infecção oral pelo HPV. A amostra foi constituída por 200 pacientes do gênero feminino, sendo 100 com sorologia positiva para HIV (grupo 1) e 100 com sorologia negativa para HIV (grupo 2). As pacientes foram incluídas consecutivamente no Centro de Referência e Treinamento em DST-AIDS entre abril de 2008 a maio de 2009. Todas as pacientes assinaram um Termo de Consentimento Livre e Esclarecido e responderam a uma ficha com questionamentos sobre hábitos e comportamento sexual. Além disso, tiveram as cavidades oral e ginecológica examinadas, sendo que células superficiais de ambos os locais foram coletadas e avaliadas pela captura híbrida 2 e pela citologia em base líquida. Para comparação de variáveis qualitativas, como freqüências e proporções, foi utilizado o teste de qui-quadrado ou exato de Fisher, se necessário. Para comparação de dados quantitativos, foram utilizados os testes de Mann-Whitney ou t de Student. A análise multivariada foi executada utilizando-se o teste de regressão logística, sendo que o valor de significância estatística estabelecido foi de 5% (p<0,05). O DNA do HPV foi detectado nas amostras cervicais de 41 (41%) pacientes HIV+ e de 45 (45%) HIV- (p=0.67). Nas amostras da cavidade oral, o DNA do HPV foi observado em 11 mulheres do G1 (HIV+) e em 2 mulheres do G2 (HIV-) (OR=6,06; 95%IC=1,31-28,07; p=0,02). Os subtipos oncogênicos foram prevalentes em ambos os grupos, sendo que não foi observada diferença entre os grupos (p=0.87). Nenhuma paciente apresentou lesão macroscópica oral relacionada ao HPV, sendo que 15 (15%) mulheres do G1 (HIV+) e 17 (17%) do G2 (HIV-) apresentaram lesão macroscópica na região genital (p=0.2129). Com os resultados obtidos pôde-se concluir que nesta população não houve correlação entre a infecção pelo HPV nas mucosas oral e cervical. Além disso, as pacientes HIV+ apresentaram maior prevalência de infecção pelo DNA-HPV na boca em comparação às pacientes HIV-.Human papillomavirus (HPV) is one of the most prevalent sexually transmitted viruses worldwide with both oral and genital manifestations. The high prevalence of HPV infection among HIV + individuals provides an opportunity to elucidate the relationship between oral and cervical HPV-infection in this group of subjects. The aim of this study is to evaluate the possible association between oral and cervical infections in HIV-positive and negative patients. One hundred HIV+ (group 1) and 100 HIV- (group 2) women were recruited consecutively from a gynecologic clinic between April 2008 and May 2009. All subjects were given a cervical and oral examination. Cytological samples were evaluated by the hybrid capture 2 technique from oral and cervical scrapings. Statistical analysis was performed using chi-square test and p values < 0.05 were considered significant. HPV-DNA was detected in cervical scrapings from 41 (41%) HIV-positive subjects and from 45 (45%) HIVnegative subjects (p=0.67). In oral samples, HPV-DNA was observed in 11 subjects from group 1 and in 2 subjects from group 2 (p=0.02). High-risk HPV subtypes were prevalent in both groups and no difference between the groups was detected (p=0.87). No subject showed macroscopic oral HPV-related lesion, whereas 15 (15.00%) from group 1, and 17 (17.00%) from group 2, presented with macroscopic genital lesion (p=0.2129). HPV-DNA was more frequent in oral mucosa of HIV+ patients than HIV- (p=0,018). There was no association between oral and cervical HPV infection in HIV+ and HIV- patients. Presence of cervical lesion was not associated with oral lesion.
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Gaester, Karen Eliane de Oliveira. „Infecção do Papilomavírus Humano no fluído oral em homens infectados pelo HIV: prevalência da infecção e sua relação com os fatores de risco“. Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/99/99131/tde-05052015-141155/.
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O Papilomavírus Humano é uma das infecções sexualmente transmissíveis mais comuns no mundo. A história natural da infecção oral pelo HPV não é bem esclarecida e seus fatores de risco não são bem explorados. Pessoas imunocomprometidas, como pacientes infectados pelo HIV, apresentam maior risco para a infecção pelo HPV.Objetivo: determinar a prevalência do HPV no fluído oral de homens infectados pelo HIV e sua relação com os fatores de risco. Casuística: Um total de 283 amostras de lavado oral foram analisadas. Todas as amostras passaram por processos de lavagem, extração de DNA, amplificação do DNA por PCR convencional (MY09/11), eletroforese em gel de agarose e as amostras positivas para HPV DNA foram submetidas à genotipagem do HPV por meio de hibridização. Resultados: A genotipagem do HPV identificou a presença dos tipos 06, 16, 44, 51, 56, 58, 62, 66, 67, 69, 72, 83 e 84. O tipo mais prevalente no grupo de alto risco foi HPV-66 e no grupo de baixo risco HPV-6 e 83. Em relação aos fatores de risco, o tabagismo foi o único fator considerado significativo [OR (CI) = 10,04 (1,98 - 50,92), p>0,01] para a infecção do HPV oral em homens infectados pelo HIV em São Paulo, Brasil Discussão: A prevalência do HPV oral é altamente variável em decorrência de fatores como método de coleta e análises das amostras. Apesar de dados sobre a infecção pelo HPV em homens serem escassos, estudos mostram que grande parte dos homens brasileiros são infectados pelo vírus. O fator de risco principal é a exposição sexual de risco, porém, outros fatores são considerados como possíveis para aquisição do HPV como o tabagismo, consumo excessivo de álcool e a infecção pelo HIV. Conclusão:. A prevalência do HPV oral nos indivíduos estudados foi de 3,5%, e dentre os tipos encontrados, a maioria não são encontrados na vacina do HPV comercialmente disponível.Human Papillomavirus is one of the most common sexually transmitted infection worlwide. The natural history of oral HPV infection is unclear and its risk factors have not been explored. Immunocompromised people, as exemplified by HIV patients, are at high risk for HPV-infection. Objectives: To determine the prevalence of HPV in the oral tract of HIV-1-positive male subjects and its association with risk factors. Case series: A total of 283 oral wash samples were analyzed. All samples were processed by washing processes, DNA extraction, DNA amplification by conventional PCR (MY 09/11), agarose gel electrophoresis and HPV DNA positive samples were submitted to HPV genotyping by hybridization. Results: HPV genotyping revealed of types 06, 16, 44, 51, 56, 58, 62, 66, 67, 72, 83 and 84; major high risk HPV type identified was HPV-66 and low risk types were HPV-6 and 83. Regarding risk factors, smoking was the only risk factor considered significant [OR (CI) = 10,04 (1,98 - 50,92), p>0,01] for the oral HPVinfection in HIV-1-infected subjects in São Paulo, Brazil. Discussion: The prevalence of oral HPV is highly variable due to factors such as method of collection and analysis. Although data on HPV infection in men are scarce, studies show that most Brazilian men are infected by the virus. The main risk factors are unprotected sexual intercourse, but other factors for this infection have been described elsewhere including smoking, alcohol consumption and HIV-positive serostatus. Conclusion: the prevalence of oral HPV in the individuals studied was 3.5% and among the types analyzed, most are not found in HPV vaccine commercially available.
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Helfer, Markus. „Identifizierung von Hemmstoffen der HIV-Infektion mittels eines neuen HIV-Indikatorzellsystems“. Diss., lmu, 2011. http://nbn-resolving.de/urn:nbn:de:bvb:19-143747.
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Hedin, Anna, und Erika Karlsson. „Att leva med HIV : En studie av bemötandet av HIV-patienter“. Thesis, Ersta Sköndal högskola, Institutionen för vårdvetenskap, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:esh:diva-674.
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Andersson, Kim. „Hiv - En förstummande sjukdom? : socionomstudenters och socialsekreterares attityder till hiv-positiva“. Thesis, Högskolan Kristianstad, Sektionen för Hälsa och Samhälle, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:hkr:diva-8103.
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The aim of this study is to examine social workers' and social work students' attitudes towards people living with hiv in Sweden. I will also examine if there is a connection between knowledge and attitudes. The questions at issue are how social workers' and social work students' attitudes can assume to influence on their professional practice and what causes can affect their attitudes towards people living with hiv. The study is based on a qualitative method. The methods have been: conversational interviews with five social workers, who work with family issues and integration, and a focused group interview with four social work students. Both forms of interviews were combined with the vignette method. The theoretical framework of this study is symbolic interactionism. The result of the study indicates that both the social work students and the social workers lack adequate knowledge about hiv, however, the respondents are capable of reflecting and are able to put themselves into others' situations and therefore they will not discriminate their clients because of their disease. Results of the study also indicate that there is a great ambiguity among all of the respondents because of the lack of knowledge and adequate education.
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Martinez, Sabrina Sales. „Overweight/Obesity and HIV Disease Progression in HIV+ Adults in Botswana“. FIU Digital Commons, 2015. http://digitalcommons.fiu.edu/etd/1826.
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Studies indicate that overweight and obesity protect against HIV-disease progression in antiretroviral therapy (ART)-naïve patients. We examined retrospectively the relationship of overweight/obesity with HIV-disease progression in ART-naïve HIV+ adults in Botswana in a case-control study with 18-month follow-up, which included 217 participants, 139 with BMI 18.0-24.9 kg/m2 and 78 with BMI ≥25 kg/m2. Archived plasma samples were used to determine inflammatory markers: leptin and bacterial endotoxin lipopolysaccharide (LPS), and genotype single nucleotide polymorphisms (SNPs) of the Fat Mass and Obesity Associated Gene (FTO).
At baseline, BMI was inversely associated with risk for AIDS-defining conditions (HR=0.218; 95%CI=0.068, 0.701, P=0.011), and higher fat mass was associated with reduced risk of the combined outcome of CD4+cell count ≤250/µL and AIDS-defining conditions, whichever occurred earlier (HR=0.918; 95%CI=0.847, 0.994, P=0.036) over 18 months, adjusting for age, gender, marriage, children, and baseline CD4+cell count and HIV-viral load.
FTO-SNP rs17817449 was associated with BMI (OR=1.082; 95%CI=1.001, 1.169; P=0.047). Fat mass was associated with the risk alleles of rs1121980 (OR=1.065; 95%CI=1.009, 1.125, P=0.021), rs8050136 (OR=1.078; 95%CI=1.021, 1.140; P=0.007), and rs17817449 (OR=1.086; 95%CI=1.031, 1.145; P=0.002), controlling for age, gender, tribe, total energy intake, and activity. There were no associations of SNPs with markers of disease progression.
Leptin levels were positively associated with BMI (β=1.764; 95%CI=0.788, 2.739; P=0.022) and fat mass (β=0.112; 95%CI=0.090, 0.135; P<0.001), but inversely with viral load (β=-0.305; 95%CI=-0.579, -.031; P=0.030). LPS levels were inversely associated with BMI (OR=0.790, 95%CI=0.630, 0.990; P=0.041), and fat mass (OR=0.852, 95%CI=0.757, 0.958; P=0.007) and directly with viral load (OR=2.608, 95%CI=1.111, 6.124; P=0.028), adjusting for age, gender, smoking and %fat mass.
In this cohort, overweight/obesity predicted slower HIV-disease progression. Obesity may confer an advantage in maintaining fat stores to support the overactive immune system. FTO-SNPs may contribute to the variation in fat mass; however, they were not associated with HIV-disease progression. Our findings suggest that the obesity paradox may be explained by the association of increased LPS with lower BMI and higher viral load; while viral load decreased with increasing leptin levels. Studies in African populations are needed to clarify whether genetic variation and inflammation mediate the obesity paradox in HIV-disease progression.
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Andrae, Fredrik, und Eleonore Eriksson. „Sjuksköterskestudenters kunskap om HIV och inställningen till behovet av HIV-testning“. Thesis, Högskolan i Gävle, Avdelningen för hälso- och vårdvetenskap, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-15741.
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Introduktion: HIV-infektion medför en kronisk och progressiv sjukdom som, i obehandlad form, leder till en successiv försämring av immunförsvaret och utvecklandet av AIDS. Syfte: Att vid två lärosäten undersöka sjuksköterskestudenters kunskaper om HIV och inställningen till behovet av HIV-testning. Metod: En empirisk tvärsnittsstudie med deskriptiv och komparativ design med kvantitativ ansats. Genomförd som enkätstudie bland studenter vid Högskolan i Gävle och Uppsala Universitet (N=95), som studerade på sjuksköterskeprogrammets tredje år. Resultat: Majoriteten (88,4 %) angav korrekt att samlag med fler än en partner ökar risken att smittas med HIV. Tre studenter (3,2 %) angav felaktigt att det finns ett vaccin mot HIV-infektion. Nästan hälften (42,1 %) saknade kunskap om att glidmedel, tillsammans med kondom, inte minskar risken för HIV-smitta. En majoritet (78,9 %) rekommenderade ett HIV-test till en kvinna som haft oskyddat sex med en man. I studenternas motiveringar till behovet av ett HIV-test, framkom fyra kategorier; ”risk”, ”sexualvanor”, ”patientens oro” och ”ovisshet”. Konklusion: Sjuksköterskestudenterna hade relativt goda kunskaper om HIV. Däremot fanns betydande brister i vissa frågor. Sjuksköterskestudenternas inställning till HIV-testning överensstämmer relativt väl med gällande riktlinjer. Däremot finns ett behov att förändra ett förlegat riskgruppstänkande för att kunna ge patienter rådgivning i enlighet med den senaste kunskapen.Introduction: HIV-infection is a chronic and progressive disease that, left untreated, leads to a deterioration of the immune system and the development of AIDS. Aim: To examine nursing students´, at two universities, knowledge about HIV and their attitude towards assessing the need for a HIV-test. Method: An empirical cross-sectional study using descriptive and comparative design with a quantitative approach. Data was collected by a questionnaire among third year nursing students at the University of Gavle and Uppsala University (N=95). Result: A majority (88,4 %) answered correctly that intercourse with more than one partner increases the risk for contracting HIV. Three students (3,2 %) answered incorrectly that there is a vaccine for HIV. Nearly half of the students did not know that lubricant, combined with a condom, does not reduce the risk for contracting HIV. A majority (78,9 %) recommended a HIV-test to a woman who have had unprotected sex with a man. In analyzing the students´ explanatory statements for the need for a HIV-test, four categories emerged; “risk”, “sexual behavior”, “patients´ concern” and “not knowing”. Conclusion: The nursing students had relatively good knowledge about HIV. However, there was a significant lack of knowledge in some questions. The nursing students´ attitudes towards HIV-testing conforms relatively well with current guidelines. However, there is a need to change an outdated way of assessing the risk for HIV-infection to be able to provide counseling to patients based on current knowledge.
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Chen, Nan. „The role of HIV-1 Nef gene in HIV-mediated pathogenesis“. Thesis, University of Oxford, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.404289.
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Watkins, Gemma L. „A comparison of HIV-1 and HIV-2 gag gene expression“. Thesis, University of Warwick, 2012. http://wrap.warwick.ac.uk/45902/.
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Despite being closely related viruses with similar replication cycles, HIV-2 replicates more slowly than HIV-1 and produces fewer particles, resulting in a lower plasma viral load. Expression of the major structural gene, gag, from HIV-1 and HIV-2 proviruses was compared to investigate whether this could play a role in the difference in particle production observed between HIV-1 and HIV-2 infection. Using quantitative RT-PCR, significantly less full-length HIV-2 gag mRNA was found to be transcribed from its provirus than for HIV-1. Sub-cellular fractionation allowed us to determine HIV-1/2 gag mRNA levels in the nucleus and cytoplasm throughout a time course. RNA export of HIV-2 gag mRNA was shown to be slower than for HIV-1 gag mRNA. HIV-2 full-length gag RNA was shown to be translated much less efficiently than HIV-1 in a range of cell lines. Both HIV-1 and HIV-2 Gag have been proposed to be translated by internal ribosome entry. Shutting down capdependent translation (by poliovirus-mediated eIF4G cleavage) significantly reduced translation from both HIV-1/2 gag RNAs, with no evidence of compensatory IRES activity. This suggests that cap-dependent translation is the predominant mechanism for translation of both HIV-1 and HIV-2 RNA. Additional work explored HIV RNA-protein interactions by UV cross-linking experiments using cellular proteins. Several proteins differentially binding to HIV-1/2 5’ UTR RNAs were identified and, in particular, a 45 kDa protein binding only to the HIV-1 5’ UTR. Attempts were made to characterise the proteins binding with different affinities to HIV-1 and HIV-2 RNAs. Confocal microscopy was used to visualise HIV-1/2 Gag expression within the cell. Both HIV-1 and HIV-2 Gag expression was shown to be reduced when siRNA was used to inhibit the cellular clathrin adaptor protein AP-1. In conclusion, HIV-2 Gag gene expression was found to be less efficient than HIV-1 at the level of transcription, RNA export and translation. Future work will continue to investigate the mechanisms behind these differences.
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Cleveland, S. Matthew. „HIV-1-specific antibody responses to a plant virus-HIV chimera“. Thesis, University of Warwick, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.340090.
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Ferrand, Rashida Abbas. „Burden of HIV infection and HIV-associated morbidity in Zimbabwean adolescents“. Thesis, London School of Hygiene and Tropical Medicine (University of London), 2010. http://researchonline.lshtm.ac.uk/682408/.
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This thesis concerns the clinical epidemiology of HIV infection in Zimbabwean adolescents. Without treatment, there is a very high risk of death in the early years of life in HIV-infected infants. However, in recent years increasing numbers of adolescents have been presenting to health care services with symptomatic HIV infection and with features suggesting longstanding disease. Population-based surveys in Southern Africa have shown HIV prevalence rates among older children and adolescents to be much higher than would be anticipated if HIV-infants were not surviving early childhood. The burden and spectrum of HIV-associated morbidity among adolescents was investigated with two studies at secondary and primary care level, respectively. The main finding was of an extremely high prevalence of HIV infection at both levels of the health system, with HIV infection being the single most common cause of hospital admission and death among adolescents. Mother-to-child transmission was the most likely source of HIV infection in the majority, suggesting a substantial epidemic of older survivors of vertical HIV infection. Other countries with severe HIV epidemics may be experiencing a similar trend as their HIV epidemics mature. The lack of awareness of the possibility of survival to older childhood and adolescence with maternally-acquired, untreated HIV infection results in many missed opportunities for diagnosis, with HIV infection frequently not diagnosed until presentation with a severe HIV-related illness. The median CD4 count in 3 HIV-infected adolescents in primary care was 350cells/µl compared to a median CD4 count of 151cells/µl among hospitalised adolescents, suggesting that HIV testing in primary care identifies HIV-infected adolescents at an earlier stage of infection. Provider-initiated HIV testing and counselling in primary care was highly acceptable to adolescents and guardians. Provision of care has been adversely affected by under-appreciation of the numbers of surviving adolescents living with HIV, and the special needs of this age-group have not been distinguished from those of younger children. Young people who have acquired HIV perinatally are stigmatised by society who assume they must have acquired it through "bad" behaviour themselves, since it is not widely appreciated that long-term survival following vertical infection is possible. Immediate priorities are earlier diagnosis of HIV infection and improved management of HIV-infected adolescents. Possible areas of intervention are discussed in the final chapter. Similar studies are needed in neighbouring countries to investigate the generalisability of these findings.
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Mc, Guire Jessica Kate. „Radiological differences between HIV-positive and HIV-negative children with cholesteatoma“. Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/27435.
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Introduction: HIV-positive children are possibly more prone to developing cholesteatoma. Chronic inflammation of the middle ear cleft may be more common in patients with HIV and this may predispose HIV-positive children to developing cholesteatoma. There are no studies that describe the radiological morphology of the middle ear cleft in HIV-positive compared to HIV-negative children with cholesteatoma. Aim: Compare the radiological differences of the middle ear cleft in HIV-positive and HIV-negative children with cholesteatoma. Method A retrospective, cross-sectional, observational analytical review of patients with cholesteatoma at Red Cross War Memorial Children's Hospital over a 6 year period. Results: Forty patients were included in the study, 11 of whom had bilateral cholesteatoma and therefore 51 ears were eligible for our evaluation. HIV-positive patients had smaller (p=0.02) mastoid air cell systems (MACS). Forty percent of HIV-positive patients had sclerotic mastoids, whereas the rate was 3% in HIV-negative ears (p<0.02). Eighty-two percent of the HIV-positive patients had bilateral cholesteatoma compared to 7% of the control group (p<0.02). There was no difference between the 2 groups with regards to aeration of the middle ear cleft, bony erosion of middle ear structures, Eustachian tube obstruction or soft tissue occlusion of the post-nasal space. Conclusion: HIV-positive paediatric patients with cholesteatoma are more likely to have smaller, sclerotic mastoids compared to HIV-negative patients. They are significantly more likely to have bilateral cholesteatoma. This may have implications in terms of surveillance of HIV-positive children, as well as, an approach to management, recurrence and follow-up. HIV infection should be flagged as a risk factor for developing cholesteatoma.
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Alarcón, Soto Yovaninna. „Data science in HIV : statistical approaches for therapeutic HIV vaccine data“. Doctoral thesis, Universitat Politècnica de Catalunya, 2021. http://hdl.handle.net/10803/672179.
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The present dissertation contributes to Data Science in the Human lmmunodeficiency Virus (HIV) field, addressing specific issues related to the modelling of data coming from three different clinical trials based on the development of HIV therapeutic vaccines. The biological questions that these studies raise are identify biomarkers that predict HIV viral rebound; explain the time to viral rebound as a consequence of antiretroviral therapy (cART) stop considering the variability of data sources; and find the relationship between spot size and spot count from Enzyme-Linked lmmunosorbent spot (ELISpot) assays data. To handle these problems from a statistical perspective, in this thesis we: adapt the elastic net penalization to the accelerated failure time model with interval-censored data, fit a mixed effects Cox model with interval-censored data, and improve statistical methodologies to deal with ELISpot assays data and a binary response, respectively.
In order to address the variable selection among a vast number of predictors to explain the time to viral rebound, we consideran elastic-net penalization approach within the accelerated failure time model. Elastic-net regularization considers a possible correlation structure among covariates, which is the case of messenger RNA (mRNA) data. For this purpose, we derive the expression of the penalized log-likelihood function for the special case of the interval-censored response (time to viral rebound).
Following, we maximize this function using distinct approaches and optimization methods. Finally, we apply these approaches to the Dendritic Cell-Based Vaccine clinical trial, and we discuss different numerical methods for the maximization of the log-likelihood.
To explain the time to viral rebound in the context of another study with data from several clinical trials, we use a mixed effects Cox model to account for the data heterogeneity. This model allows us to handle the heterogeneity between the Analytical Treatment lnterruption (ATI) studies and the fact that the patients had different number of ATI episodes. Our method proposes the use of a multiple imputation approach based on a truncated Weibull distribution to replace the interval-censored by imputed survival times. Our simulation studies show that our method has desirable properties in terms of accuracy and precision of the estimators of the fixed effects parameters. Concerning the clinical results, the higher the pre-cART VL, the larger the instantaneous risk of a viral rebound. Our method could be applied to any data set that presents both interval-censored survival times and a grouped data structure that could be treated as a random effect.
We finally address two different issues that have arisen when analyzing the BCN02 clinical trial. On one hand, we fit univariate log-binomial models as an alternative to the usual logistic regression. On the other hand, we use one/two- way unbalanced ANOVA to analyze the variability of the main outcomes from the ELISpot assays across time. Although these assays are widely used in the context of the HIV study, the relationship between spot size or spot count and other variables has not been studied until now.
In this thesis, we propose, develop, and apply different statistical approaches that contributes to answer diverse clinical questions that are relevant in several clinical trials. We have tried to highlight that to be able to choose the appropriate methodology, make correct clinical interpretations and contribute to a meaningful scientific progress, a narrow collaboration with scientists is necessary. We expect that the original results from this thesis will contribute to the path of development and evaluation of a therapeutic HIV vaccine, helping to improve the way of living of HIV-infected people.La presente tesis contribuye a la ciencia de datos abordando problemas biológicos relevantes en el desarrollo de vacunas terapéuticas para el Virus de Inmunodeficiencia Humana (VIH) mediante la modelización de datos procedentes de tres ensayos clínicos diferentes. Algunas de las cuestiones suscitadas en estos estudios y que esta tesis aborda son: identificar biomarcadores para estudiar los factores de riesgo del rebote viral del VIH, explicar el tiempo transcurrido hasta el rebote viral como consecuencia del cese de la terapia antirretroviral (cART) considerando la variabilidad de las fuentes de datos y estudiar la relación entre las variables spot size y spot count en ensayos inmunoabsorbentes (ELISpot). Para abordar cada uno de estos interrogantes desde una perspectiva estadística, en esta tesis hemos adaptado una penalización de red elástica para el modelo de vida acelerada (AFT) con datos censurados en un intervalo, ajustado un modelo de Cox de efectos mixtos con datos censurados en un intervalo y mejorado las metodologías estadísticas existentes para tratar los datos de los ensayos ELISpot y de respuesta binaria, respectivamente. En primer lugar, hemos abordado el problema de tener más de cinco mil ARN mensajeros (ARNm) para explicar el tiempo hasta el rebote viral. Para ello, hemos considerado un enfoque de penalización de red elástica para el modelo de vida acelerada. Esta regularización considera una posible estructura de correlación entre las covariables, como sucede con los ARNm. Para este objetivo, primero derivamos la expresión de la función de verosimilitud penalizada considerando una respuesta censurada en un intervalo (tiempo hasta el rebote viral). A continuación, maximizamos esta función utilizando distintos enfoques y métodos de optimización. Finalmente, aplicamos estos métodos al ensayo clínico DCV2 y discutimos sobre diferentes enfoques numéricos para la maximización de la verosimilitud. En segundo lugar, para explicar el tiempo hasta el rebote viral proponemos ajustar un modelo de Cox de efectos mixtos. Dado que el tiempo hasta el rebote viral está censurado en un intervalo utilizamos imputación múltiple basada en una distribución de Weibull truncada. Este modelo nos permite controlar la heterogeneidad entre los estudios de interrupción analítica del tratamiento (ATI) y el hecho de que los pacientes tengan diferente número de episodios ATI. Según el estudio de simulación que realizamos, nuestro método tiene propiedades deseables en términos de exactitud y precisión de los estimadores de los parámetros de efectos fijos. Finalmente abordamos dos problemas diferentes dentro del ensayo clínico BCN02. Por un lado, ajustamos modelos log-binomiales univariados como alternativa a la clásica regresión logística. Por otro lado, utilizamos un modelo ANOVA no balanceado para analizar la variabilidad de los resultados principales de los ensayos ELISpot a lo largo del tiempo. Aunque los ensayos ELISpot se usan a menudo en el estudio del VIH, la relación entre variables como el spot size, spot count y otras no se había estudiado hasta ahora. En esta tesis hemos propuesto y desarrollado diferentes enfoques estadísticos que han dado respuesta a preguntas biológicas planteadas en tres ensayos clínicos. En este trabajo se destaca la importancia de que los distintos miembros de un equipo científico-multidisciplinar colaboren estrechamente, para así poder determinar la metodología apropiada, hacer correctas interpretaciones clínicas de los resultados de éste y, de esta forma, contribuir a un progreso científico significativo. Esperamos que los resultados originales de esta tesis contribuyan al desarrollo y la evaluación de una vacuna terapéutica del VIH, lo cual ayudaría notablemente a mejorar la calidad de vida de las personas infectadas por VIH.
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Steinberg, Tara C. „Predictors of Hiv-related Neurocognitive Impairment in an Hiv/aids Population“. Thesis, University of North Texas, 2012. https://digital.library.unt.edu/ark:/67531/metadc149667/.
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Although, in the United States HIV infectivity has increased, survival rates have also improved due to highly active antiretroviral therapies (HAART). Adherence to HAART successfully prevents the progression of AIDS and AIDS-related morbidity for many living with HIV. Unfortunately, HAART’s permeability into the central nervous system (CNS) is limited; thus, the prevalence of HIV-associated neurocognitive disorders (HAND) still persists. The health belief model (HBM) is the theory often used to explain and predict behavior in relation to chronic illness. This model incorporates perceptions of susceptibility, vulnerability, and severity towards a particular illness, and beliefs regarding perceived efficacy and benefits of treatment. This study expands the existing model. Many who live with HIV have a long history of negative experiences, such as stigmatization, traumatic events, and discrimination. I examined supplementary psychosocial and physiological predictor variables, such as stigma, trauma, ethnicity, general medical conditions, HIV-opportunistic infections, and falls; all relevant to disease progression in HIV. Previous researchers found links between stigma and immune function, trauma and memory, ethnicity and neuropsychological impairment, and symptom load and CNS-related alterations. Therefore, this study examined how these different psychosocial predictor variables are associated with HIV-related neurocognitive impairment. My model explained 38.6% of the variance in the outcome variable, and I found that trauma (B = -.15, OR = .87; CI 95% = .75, 1.0, p = .05), ethnicity (B = 2.2, OR = 9.0, CI 95% = 1.68, 48.48, p =.01), general medical conditions (B = .30, OR = 1.34; CI 95% = 1.0, 1.81, p = .05), and falls (B = 2.0, OR = 7.2; CI 95% = 1.1, 47.0, p = .04), were all significant predictors of HIV-related neurocognitive impairment. However, contrary to my hypothesis, HIV-related opportunistic infections and HIV-related stigma were not significant predictors of HIV-related neurocognitive impairment. I hope that my results will contribute to revisions of older health models as well as suggest avenues for primary and secondary prevention and intervention to address those living with HIV/AIDS.
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Donley, Sarah B. „HIV in the heartland : negotiating disclosure, stigma, & the HIV community“. Thesis, Manhattan, Kan. : Kansas State University, 2009. http://hdl.handle.net/2097/2320.
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Jackson, Phronie Lynn. „The Lived Experiences of HIV+ Community Health Workers Serving HIV+ Clients“. ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2986.
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Numerous studies have focused on the effectiveness of community health worker (CHW) programs in producing positive health behaviors and health outcomes for the clients CHWs serve; however, there has been a gap in the literature regarding how the health of HIV + CHWs is impacted by their jobs. A phenomenological design was used to gain insight into the lived experiences of HIV+ CHWs (HIVCHW) who provided services to HIV positive clients. Fifteen HIVCHW were recruited using criteria and snowball techniques. Data were collected via audio recorded personal interviews regarding respondents' perceptions of their work and how it impacted their own health and wellbeing. The data were organized by hand creating charts with pen and paper. Lazarus's theory of stress and coping was used to understand the data and aided in the analysis. The key findings indicated that while the majority of participants had an overall positive perception of the experience of being HIVCHWs, they also indicated that being a CHW impacted their health and well-being. Stress and stressful situations were among the impacts most often referenced by the study participants. The study is socially significant because it may offer the workforce of HIVCHWs empowerment to self-advocate for tools such as stress and time management training and mentors to support healthy work-life balance. In addition, this study may help to prevent or reduce rates of adverse health outcomes such as pain and burnout that HIVCHWs reported experiencing.