Dissertations / Theses on the topic 'Anti-HIV treatment'
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1
Kang, Yuanxi, and 康元曦. "Mechanism study of novel CCR5 antagonists and their potential as anti-HIV-1 microbicides." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B47849393.
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R5-tropic HIV-1 is predominantly transmitted during unprotected sexual contacts, rendering CCR5 antagonist as an attractive agent not only for antiretroviral therapy but also for prevention. Here, we report two 1,3,3,4-tetrasubstituted pyrrolidine embodied compounds, TD-0232 and TD-0680, as novel small molecule CCR5 antagonists and investigate their specificities, potencies and underlying mechanisms. We found that both TD-0232 and TD-0680 inhibited a diverse group of R5-tropic HIV-1 and SIV strains in both single-cycle infectivity assays and live viral PBMC assays. When compared to other CCR5 antagonists, such as TAK-779 and the only FDA-approved Maraviroc, TD-0680 displayed the highest potency with EC50 values at the subnanomolar levels (range 0.09nM-2.29nM). TD-0232 and TD-0680, but not Tenofovir, a nucleoside reverse transcriptase inhibitor, completely blocked envelope-mediated cell-cell fusion and subsequent viral transmission. Critically, TD-0680 was potent at inhibiting the replication of a TAK-779/Maraviroc-resistant HIV-1 variant in PBMCs at a subnanomolar concentration.
Interestingly, despite binding to a similar transmembrane pocket of CCR5, TD-0232 and TD-0680 functioned differently as revealed by site-directed mutagenesis and drug combination assays. Based on the sequence homology, we constructed a CCR5 molecule model using the crystallized CXCR4 as a template. By docking of CCR5 antagonists with CCR5, we identified a unique binding mode of TD-0680, which has not been described previously. TD-0680, with an exo-configuration, extended its interaction with the ECL-2 region of CCR5 in a protruding manner, thereby interrupting the interaction between the virus and its co-receptor more effectively. In an antibody recognition assay, we confirmed that TD-0680 had an enhanced inhibitory activity against the anti-ECL2 monoclonal antibodies binding.
Furthermore, we investigated the antiviral activities of TD-0232 and TD-0680 that were formulated into a thermo-reversible acidic microbicide gel. Both drugs were stable in the acidic gels and could be released rapidly for long lasting and potent antiviral activities. Although human semen could enhance the infection of HIV-1, it did not seem to affect the potencies of the TD-0232 and TD-0680 gels.
In summary, our findings suggest that TD-0232 and TD-0680 can be further developed not only as anti-HIV-1 agents for therapeutic purposes but also as potent microbicides for the prevention of sexual transmission of R5-tropic HIV-1.published_or_final_version
Microbiology
Doctoral
Doctor of Philosophy
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Aung, Kay Tu Jittima Dhitavat. "Pulmonary tuberculosis treatment outcomes in HIV infected patients on antiretroviral therapy /." Abstract, 2006. http://mulinet3.li.mahidol.ac.th/thesis/2549/cd388/4838793.pdf.
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Harnett, Siobhán Margaret. "In vitro anti-HIV activities of Sutherlandia frutescens and Lobostemon trigonum extracts." Thesis, University of Port Elizabeth, 2004. http://hdl.handle.net/10948/347.
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Currently, the approved anti-HIV drugs on the market only target the three HIV enzymes: reverse transcriptase, protease and more recently, integrase. Due to the limited nature of the current therapy, it is possible that a multi-drug resistant virus can emerge. The main concerns in developing countries however, are the expense and availability of the drugs and because of this, it is essential to investigate all alternatives. Traditional medicine offers many advantages as compared to allopathic treatment in so far as being relatively cheaper, accessible and it is broadly accepted in the population groups of the developing countries. Little is known though, of the exact efficacy and toxicity of these remedies so it is vital that these possible leads be investigated thoroughly. For the purpose of this study, two plants, Sutherlandia frutescens and Lobostemon trigonum were studied to ascertain their potential anti-HIV activity. Sutherlandia has received international attention as a possible cheap herbal remedy to improve the health of AIDS sufferers. Anecdotal evidence from health workers claim that HIV- infected patients on Sutherlandia treatment have shown improved CD4 counts, decreased viral loads and a general improvement in well-being. Extracts were prepared from dried leaves and flowers in methanol, ethanol, acetone, methylene dichloride or distilled water. Sulphated polysaccharides have been described extensively in literature with regards to their anti-HIV activity, so as a form of dereplication; an ethanol precipitation was performed on the aqueous extracts to remove sulphated polysaccharides. A toxicity study was performed on all crude extracts using uninfected peripheral mononuclear blood cells (PBMCs) isolated from whole blood. To measure anti-HIV activity, HIV-infected PBMCs were cultured with each of the crude extracts and cell viability measured using the tetrazolium salt, XTT. HIV-infected CEM-NKR-CCR5 cells were also used and supernatant from the viral studies was tested for the HIV antigen p24. xii Results varied greatly between assays but with the inclusion of a point-scale system to evaluate the extracts it was clear that overall the organic extracts of the Sutherlandia flowers, especially the acetone extract (SFA), showed great anti-HIV potential. SFA in every case decreased p24 levels and in the toxicity study did not decrease cell proliferation. With the HIV-infected PBMCs SFA actually helped improve cell proliferation despite the infection. To determine the specific anti- HIV activity, all crude extracts were tested for inhibition of HIV-I reverse transcriptase, the glycohydrolase enzymes: a-glucosidase, ß-glucosidase, ßglucuronidase, HIV-I integrase and HIV-II protease. No significant inhibition was seen with these experiments except for the HIV-I RT assay. The aqueous extract of the Lobostemon leaves produced an inhibitor of HIV-RT with a very low IC50 value of 0.049mg/ml. Some inhibitory effect was lost with the removal of the sulphated polysaccharides and the addition of BSA to the assay, but still 64% inhibition of the HIVRT remained, which confirmed that the inhibitor could be something novel, and not of the polysaccharide or tannin compounds.
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Cederfjäll, Claes. "Aspects of care among HIV infected patients : needs, adherence to treatment and health related quality of life /." Stockholm, 2002. http://diss.kib.ki.se/2002/91-7349-288-4.
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Moeketsi, Ntshebo Mirriam. "Treatment and regimen change in a cohort of HIV positive patients in anti-retroviral treatment at Tshepang Wellness Clinic, Dr George Mukhari Hospital." Thesis, University of Limpopo ( Medunsa Campus ), 2010. http://hdl.handle.net/10386/218.
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Thesis (MPH)--University of Limpopo, 2010.Background: Antiretroviral therapy led to a revolution in care of patients with HIV/AIDS in a developed world. Treatment is not a cure but it also presented with new challenges of side effects, drug resistance and it also dramatically reduces rate of mortality and morbidity and it also improves quality of life to people living with HIV/AIDS, and it also now considered as manageable chronic diseases. Aim: Aim of the study is to establish and describe reasons for treatment and regimen change in a cohort of HIV positive patients on ART enrolled in the pharmaco-epidemiological survey at Tshepang wellness clinic. Objectives: is to determine reasons for treatment and regimen change, types of treatment and regimen change among patients on ART who are enrolled in pharmacoepidemiological survey at Tshepang wellness clinic. Design and Methods: Study is a retrospective cohort study, and sample size of 301 medical records of a cohort of HIV positive patients on ARVs enrolled in a longitudinal pharmaco-epidemiological survey from November 2006-May 2007 reviewed. Data extraction tool used to collect data and software called SPSS 17.0 used to analyze data and relevant themes were extracted to determine distribution of variables. Results: Results of this study indicated that 91 (85%) were males and (87.8%) 191 were females. Age was grouped as teenagers (15-25yrs), young adults (26-49yrs) and adults (50- 70yrs). Results also shows reasons of treatment and regimen change of which majority of patients 134(44.8%) changed due toxicity followed by 16 (5.4%) who changed because of pregnancy, and the other 4(1.3%) changed because of resistance, and the last 2(0.7%) which are regarded as minorities change because of T.B. Conclusion and Recommendations: Results shows that majority of pharmacovigilance patients were initiated Regimen 1 compared to other regimens. Toxicity appear as the main reason of treatment and regimen change on this study as 140(46.4%) reported toxicities (peripheral neuropathy, lactic acidosis, lipodystrophy and lipoatrophy). Implementation of monitoring of adherence needed for prevention of resistance and virological failure.
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Magafu, Mgaywa Gilbert Mjungu Damas. "Assessment of health-related quality of life of adult highly active anti-retroviral therapy recipients at the Kagera Regional Hospital Tanzania." Thesis, University of Western Cape, 2009. http://hdl.handle.net/11394/3743.
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Magister Public Health - MPHHRQOL of HAART recipients at the Kagera region hospital was generally lower than that of the general population. However, their general health perceptions and mental health status were comparable to those of the general population, suggesting effectiveness of HAART in improving some subjective experiences of HIV morbidity. Chronic diseases were the main factor negatively affecting HRQOL of recipients.
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Oluoch, Okumu Fredrick. "Synthesis and characterization of bimetallic silver and platinum nanoparticles as electrochemical sensor for nevirapine, an anti-HIV drug." Thesis, Cape Peninsula University of Technology, 2016. http://hdl.handle.net/20.500.11838/2319.
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Thesis (DTech (Chemistry))--Cape Peninsula University of Technology, 2016.Bimetallic silver-platinum (Ag-Pt) nanoparticles (NPs) were synthesized via simultaneous reduction of varying mole fractions of metal precursors H2PtCl6.6H2O and AgNO3 by sodium citrate. Kinetics rates of were as follows; Ag NPs (0.079 s-1), Ag-Pt NPs 1:1 (0.082 s-1) and Pt NPs (0.006 s-1). The UV visible spectrum of Ag NPs exhibited a characteristic absorption band while Pt NPs and Ag-Pt bimetallic NPs exhibited no absorption peaks. Successful formation of both monometallic and bimetallic NPs was confirmed via transmission electron microscopy (TEM); selected area electron diffraction (SAED) and energy dispersive X-ray (EDX) analysis. TEM images depicted core-shell arrangement in the bimetallic (BM) NP ratios (1:1, 1:3 and 3:1) with an average particle size of 21 nm. The particle size trend where monometallic Ag NPs (60 nm) > Pt NPs (2.5 nm) while in the BM ratios Ag-Pt NPs 1:1 (25 nm) > Ag-Pt NPs 1:3 (20.7 nm). X-ray diffraction (XRD) patterns depicted crystallinity in all the synthesized NPs with confirmation of the face centred cubic structure formation. Transducers were fabricated by drop casting the nanoparticless on the glassy carbon electrode (GCE) and their electrochemical properties studied via cyclic voltammetry (CV). High diffusion coefficient (D) and surface coverage reported were Ag NPs (6.70 cm2 s-1, 54.49 mol cm-2 ) and Ag-Pt NPs 1:1 (0.62 cm2 s-11.85 mol cm-2). Electrochemical band gaps ranged from 1.45 to 1.70 eV while the Tauc’s model band gaps of nanoparticles were found in the range of 2.48 to 3.84 eV. These band gaps were found to be inversely proportional to particle size, which was attributed to the quantum confinement effect. Both optical and electrochemical band gap portrayed similar trend as well as an increase in the BM NP relative to monometallics. These nanoparticles band gaps are within semiconductor range for most materials. The electrochemical behaviour and surface characteristics were studied using 0.1 M PBS solution by scan rates variations for the diffusion coefficient determination of modified electrodes which ranged from 0.62 to 6.10 x 10-5 cm2 s-1. Laviron’s approach for parameters such as apparent charge transfer rate constant, ks, and charge transfer coefficient, α, for electron transfer between NPs and GCE were investigated using CV. The values of electron-transfer coefficients ranged from 0.1 to 0.7 while the charge transfer rate constant values ranged from 0.74 to 31.13 s-1.
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Cantrell, Ronald Alexander. "Diagnosing antiretroviral treatment failure in resource-limited settings." Thesis, Birmingham, Ala. : University of Alabama at Birmingham, 2008. https://www.mhsl.uab.edu/dt/2008p/cantrell.pdf.
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Tshikalange, Thilivhali Emmanuel. "n vitro anti-HIV-1 properties of ethnobotanically selected South African plants used in the treatment of sexually transmitted diseases." Pretoria : [s.n.], 2007. http://upetd.up.ac.za/thesis/available/etd-07032008-121613/.
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Odumosu, Olusegun Murtala. "Adherence to anti-retroviral treatment amongst HIV positive gay men and other men who have sex with men in Tshwane." University of Western Cape, 2019. http://hdl.handle.net/11394/7658.
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Master of Public Health - MPHGay men and other men who have sex with men (MSM) and a subset within this group who are people who inject drugs (PWID) face difficulties when trying to access humanimmune deficiency virus (HIV)/ anti-retroviral treatment (ART) services and adhere to ART, due to the intersecting forms of oppression they face. Current interventions to address adherence to ART are mostly bio-medical in nature, and support the presumption that individual-level factors are the most pertinent barriers to adherence to ART. This mini-thesis presents findings from a qualitative study that explored individual, health systems and structural factors that shape experiences of adherence to ART amongst gay men and other MSM and a subset within this group who are PWID
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Lu, Hang. "The synthesis and structure-activity relationship study of azo dye related HIV replication inhibitors : Part 2: Plant isolation of signalling pathways inhibitors as anti-cancer agents." Diss., Georgia Institute of Technology, 1994. http://hdl.handle.net/1853/27436.
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Cawood, Leanne. "Patient default risk as a barrier for achieving organisational excellence / by Leanne Cawood." Thesis, North-West University, 2008. http://hdl.handle.net/10394/3662.
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HIV/AIDS is the world's most urgent public health challenge. It is the leading cause of death for young adults worldwide. There is as yet no vaccine and no cure. The high unemployment rate and poverty experienced in South Africa contribute to the high HIV/AIDS infection levels experienced in the country. With the vast majority of HIV/AIDS cases and the growth in the number of people infected who will look towards publicly funded hospitals for medical care, the financial strain on government hospitals and pharmacies will be severe, not only as a result of the sheer number of people seeking healthcare, but also because healthcare for HIV/AIDS patients is more expensive than for most other conditions.
Antiretroviral treatment is the main type of treatment for HIV/AIDS. It is not a cure, but it can stop people from becoming ill for many years. The treatment consists of drugs that have to be taken every day for the rest of a patient's life. Antiretroviral treatment has complex and rigorous dosing requirements. The aim of antiretroviral treatment is to keep the amount of HIV/AIDS in the body at a low level. This stops any weakening of the immune system and allows it to recover from any damage that HIV/AIDS might have caused already.
Medication compliance means taking the medications exactly as prescribed by the doctor for the amount of time intended. Medication noncompliance, on the other hand, means taking medications in any way other than what the doctor prescribed. While noncompliance may not seem like a big deal, it can have serious consequences. The challenge of optimizing adherence to anti-retroviral treatment remains paramount in the treatment of HIV/AIDS.
The purpose of this study is to establish the cost of a patient defaulting anti-retroviral treatment per month, and to determine the financial and economic impact that defaulting patients has on General de la Rey and Thusong Hospital Complex Pharmacies. The study further aims to prove that the risk of patient defaulting is a barrier to achieve organisational excellence through healthcare delivery.Thesis (M.B.A.)--North-West University, Potchefstroom Campus, 2009.
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Ruanjahn, Ganigah. "Improving adherence to highly active anti-retroviral therapy (HAART) among people living with HIV/AIDS in northern Thailand." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2007. https://ro.ecu.edu.au/theses/319.
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Background: This study explored the experiences of people living with HIV/AIDS (PLWHA) in a region of Northern Thailand and Key Informants (Kls). The principal aim of the study was to gain an in-depth understanding of the factors contributing to non-adherence in patients taking Highly Active Anti-Retroviral Therapy (HAART). The data from both PL WHA and Kls were integrated and. analysed to provide an intervention programs aimed at improving adherence in patients commencing HAART. The study itself was divided into three Phases: Phase One was an in-depth exploration of the barriers and ways of improving adherence, Phase Two comprised a series of interventions aimed at patients starting HAART for the first time and Phase Three evaluated the effectiveness of these interventions. Study Population: The study population in Phase One comprised a cohort of 32 HIV infected patients who were over 18 years old and had taken HAART for at least 6 months. Another cohort was comprised 21 Kls who had experience working with HIV care and patients taking HAART. In Phase Two, the population comprised 22 HIV infected patients who were commencing HAART for the first time. After 3 months these same participants were reinterviewed for Phase Three of the study to assess the effectiveness and acceptability of the interventions. Methods: Both qualitative and quantitative data collection methods were used in the study. The qualitative component used a multiple case study approach to explore and describe the experiences of patients receiving HAART. The study was strengthened by the inclusion of in-depth interviews with Kls with extensive knowledge and experience with HIV/AIDS and HAART programs. The quantitative component comprised a demographic survey of both the patients and Kls. This demographic data was used to provide descriptive statistics of the research population and assist with the interpretation of the qualitative data. Results: The findings from Phase One identified a number of interventions that could realistically be implemented to improve medication adherence on patients commencing HAART for the first time. The Phase Three findings showed there were improvements in the patient's adherence to HAAR T during the 3 months of implementing the interventions. The study identified a number of recommendations that Health Care Providers (HCPs) and policy makers could implement to improve medication adherence rates in patients taking HAAR T. The recommendations also included suggestions for future research, Conclusion: The financial and social burden of PL WHA presents an urgent challenge to policy-makers and Health Care Providers to identify sensitive and cost effective management strategies to support such patients and their families. One of the most crucial challenges is to develop interventions that enable patients to gain optimum benefit from the new advances in HIV treatment. A key factor in optimising the benefits of HIV treatment is improving adherence to treatment. The findings from the present study outline a number of interventions that can be cost effectively implemented to improve adherence to HAART and the quality of life of people living with HIV/AIDS.
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Trillo, Diaz Liliana. "Protection of access to essential treatment for people living with HIV/AIDS in Uganda from a human rights perspective." Diss., University of Pretoria, 2005. http://hdl.handle.net/2263/1170.
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"Although the number of new infections has dramatically decreased during the last ten years, portraying this country [Uganda] as the 'AIDS miracle', the number of people already infected and progressing to AIDS is increasing. Acces to anti-retroviral (ARV) drugs, as well as to medicines for treatment of opportunistic infections (TOI), is essential for people living with HIV/AIDS (PLWHA) to enjoy their right to life and health. Although access to these essentail medicines forms part of the core content of the right to health, which states should be able to provide irrespective of their available resources, slightly more than half of the people in need in Uganda were accessing them in June 2005. Of 63,896 PLWHA accessing ARVs, still 83.5 percent are paying the medicines out of their pockets. This is despite the fact that Uganda receives funds from various sources, among which Global Fund to Fight AIDS, Tuberculosis and Malaria (GF) and the US President's Emergency Plan for AIDS Relief (PEPFAR). Although the cost of ARV treatment in Uganda has dramatically decreased since 1997, the price of treatment remains still unaffordable for most Ugandans. ... This study comprises five chapters. The present chapter exposes the problem, the objectives of the study and the research questions, reviews the literature available on the subject, outlines the study's structure, proposes a methodology and points out the study's limitations and relevance. Chapter two sets out the international legal framework of the study. It oulines the scope of the right of PLWHA to access to essential treatment under different international instruments of relevance for Uganda and its connection with other human rights. The chapter also assesses the implications of this right for state and non-state actors. Chapter three sets out the national legal, policy and judicial framework. It explores the action taken by the various branches of the government in addressing the international obligations with regard to access essential treatment. This chapter will also look at the role played by other relevant stakeholders in the realisation of this right in Uganda. Chapter four analyses the various obstacles that impede the realisation of this right at national level, taking into account the globalisation process, the political situation of Uganda, as well as other socio-economic factors. Chapter five provides the final conclusions and recommends legal, judicial and administrative channels towards the realisation of the right to access essential treatment for OLWHA in Uganda." -- Introduction.Thesis (LLM (Human Rights and Democratisation in Africa)) -- University of Pretoria, 2005.
[Prepared under the supervision of] Dr. Ben Kiromba Twinomugisha, Makerere University
http://www.chr.up.ac.za/academic_pro/llm1/dissertations.html
Centre for Human Rights
LLM
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Roberts, Hannah E. "Modelling HIV dynamics and evolution : prospects for viral control." Thesis, University of Oxford, 2016. https://ora.ox.ac.uk/objects/uuid:1e2c153f-bd52-4da2-a1d2-47008687fd09.
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The human immunodeficiency virus (HIV) epidemic is far from over. Antiretroviral therapy (ART) is effective at suppressing viral replication within a patient but it must be taken daily and is life-long. Therefore, the development of a therapy that could induce drug-free remission or constitute a functional cure is a key focus of HIV research. In this thesis I explore three mechanisms which could lead to more individuals being able to control their viraemia in the absence of ART: (1) T-cell immunity, (2) early initiation of ART, and (3) viral evolution. Firstly, a strong HIV-specific T-cell response has been linked to rare cases of spontaneous viral control, but the extent to which this arm of the immune response contributes to viral control is debated. Several types of data are used to answer this question, including the rate at which the virus evolves to escape the CD8+ T-cell response. I study the frequency of incident immune escape in the largest cohort used for this purpose to date. Secondly, some patients, with characteristics dissimilar to spontaneous HIV controllers, are able to control the virus for years after the interruption of ART that was initiated early in infection. I use mathematical models to investigate a new hypothesis for the differing outcomes of early- and late- initiated ART. Thirdly, since HIV is a relatively new infection of humans it is still adapting to its new host. Recent studies suggest that the virus could be evolving towards decreased virulence at the population level. I study whether the widespread administration of ART has the potential to alter the course of virulence evolution and might result in a further attenuated virus. I conclude by discussing the implications of these results for viral control at the individual level and also for population level epidemic control.
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Ngandu, Jean Pierre Kabue. "Coreceptor expression and T lymphocyte subset distribution in HIV-infected and TB co-infected South African patients on anti-retroviral therapy." Thesis, Stellenbosch : University of Stellenbosch, 2009. http://hdl.handle.net/10019.1/2219.
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Thesis (MScMedSc (Pathology. Medical Virology))--University of Stellenbosch, 2009.ENGLISH ABSTRACT: In 2007, AIDS caused an estimated 2.1 millions deaths worldwide; about 70% in sub-Saharan Africa. HIV preferentially targets activated CD4 T cells, expressing the major HIV receptor CD4, as well as the major chemokine coreceptors CCR5 and CXCR4. These coreceptors play a prominent role during HIV cell entrance phase, HIV transmission and also disease progression. They have been found to be differentially expressed by CD4 T cell subsets. Tuberculosis coinfection may enhance immune activation in vivo thus accelerating HIV disease progression and has become a major challenge in the control of TB in Africa. Introduction of HAART has reduced disease progression to AIDS, as well as risk of further morbidity and mortality. HAART results in a rapid decline of viral load and an initial increase of peripheral CD4 count, however little is known on the effect of HAART in regulation of coreceptor expression, immune activation status and CD4 T cell subset distribution in HIV infection and HIV/TB coinfection. This study is a cross-sectional analysis of coreceptor expression, immune activation status and CD4 T cell subpopulation distribution in South African HIV and HIV/TB coinfected patients before and after ARV. A total of 137 South African individuals were investigated, comprising 15 healthy normal donors (healthy subgroup), 10 patients with active pulmonary tuberculosis (PTB subgroup), 33 HIV-1 positive patients without active PTB (HIV subgroup), 23 positive patients with active PTB (HIV/PTB subgroup), 36 HIV-1 positive patients on ARV (HIV on ARV subgroup) and 20 HIV-1 positive patients with active PTB on ARV (HIV/PTB on ARV subgroup). CD4 absolute count and plasma viral load were determined for all donors. Freshly isolated PBMC were classified by flow cytometry into the following CD4+ T lymphocyte subsets: naïve (CD45+, CD27+), effector memory (CD45-, CD27-), central memory (CD45-, CD27+), and effector (CD45+, CD27-). Coreceptor expression and activation status was assessed by CCR5, CXCR4 and CD38 expression on CD4 T cell subsets. HIV, TB and HIV/TB coinfection was associated with a decrease in percentage CCR5+ T cells as compared to healthy controls, with the HIV/TB group showing the most extensive decrease. In treatment naive patients, CD4 T cells showed elevated surface expression of CCR5 and CD38 as determined by mean fluorescence intensity in HIV/TB co-infection compared to HIV infection alone. The percentage of antigen-experienced cells was higher in the HIV/TB co-infected group compared to the HIV group. The percentage of naïve T cells was decreased in both the HIV infected and the HIV/TB co-infected groups compared to healthy controls. HIV patients with more than 6 months of ARV showed decreased CCR5 and CD38 surface level expression in the HIV and the HIV/ TB co-infected subgroups. An increased percentage of naïve T cells was observed in the HIV infected subgroup, but not in the HIV/TB subgroup, similarly, a decreased percentage of antigen-experienced cells was observed in the HIV subgroup, but not in the HIV/TB co-infected subgroup. A positive correlation was found between CCR5 and CD38 expression, and CXCR4 and CD38 expression (Spearman coefficient of correlation respectively: r=0.59, p<0.001 and r=0.55, p<0.001). Furthermore we found plasma viral load positively associated with CD38 expression (r=0.31, p<0.001) and percentage activated CCR5+ expressing CD4 T cells positively related to viral load (r=0.31, p<0.001). Percentage naïve CD4 T cells was positively associated with CD4 count (r=0.60, p<0.001) and negatively correlated to viral load (r=-0.42, p<0.001). These results indicate that TB coinfection exacerbates certain aspects of dysregulation of CD4 T cell homeostasis and activation caused by HIV infection. In addition, ARV-associated decrease in coreceptor expression, immune activation status and a normalisation of CD4 T cell subset distribution was observed in HIV infected individuals, but not in HIV/TB coinfection. Despite viral suppression after ARV treatment, the decline in the immune activation marker CD38 and coreceptor CCR5 expression, increase in percentage naïve CD4 T cells and decrease of antigen-experienced cells did not reach the levels displayed in the healthy control group. This may indicate that ongoing (albeit reduced) T cell immune activation may occur in the presence of ARV. Further longitudinal studies are needed to closely monitor immune activation during ARV treatment. This study highlighted an association of TB disease with immune activation in HIV infection, the importance of T-cell activation in HIV pathogenesis and its impact on ARV treatment. Further studies are needed to identify causative factors that may lead to a persistent immune activation status during ARV treatment, and how TB coinfection confounds normal responses to ARV.
AFRIKAANSE OPSOMMING: In 2007 was ongeveer 2.1 miljoen sterftes wêreldwyd veroorsaak deur VIGS; ongeveer 70% in Sub-Sahara Afrika. CD4 T selle is die hoof teiken van MIV, aangesien dit die primêre CD4 reseptor, sowel as een of beide van die vernaamste chemokien koreseptore CCR5 en CXCR4 vrystel. Hierdie koreseptore speel ‘n prominente rol wanneer die MIV die sel binnedring, asook tydens MIV oordrag en verloop van die siekte. Dit word ook deur verskillende fraksies van CD4 T selle vrygestel. Gelyktydige TB infeksie mag immuunaktivering in vivo verhoog en dus die siekeproses versnel. MIV het ‘n groot uitdaging geword in die beheer van TB in Afrika. Bekendstelling van HAART het die ontwikkeling van VIGS vertraag, asook die risiko van verdere morbiditeit en mortaliteit. HAART veroorsaak ‘n vinnige afname in virale lading ‘n toename in CD4 telling, hoewel die spesifieke invloed van HAART op die regulering van koreseptor vrystelling, immuunaktivering en verspreiding van CD4 fraksies in MIV en MIV/TB infeksies nog onduidelik is. Hierdie studie het gepoog om koreseptor vrystelling, immuunaktiveringstatus en die verspreiding van CD4 subpopulasies in pasiënte met MIV en MIV/TB voor en na ARV behandeling te ondersoek. ‘n Totaal van 137 Suid-Afrikaanse individue is ondersoek en die studiegroep het bestaan uit 15 normale persone (gesonde subgroep), 10 pasiënte met aktiewe pulmonale TB (PTB subgroup), 33 MIV positiewe pasiënte sonder PTB (MIV subgroep), 23 MIV positiewe pasiënte met aktiewe PTB (MIV/PTB subgroep), 36 MIV positiewe pasiënte op ARV (MIV op ARV subgroep) en 20 MIV positiewe pasiënte met aktiewe PTB op ARV (MIV/PTB op ARV subgroep). Absolute CD4 telling en virale ladings was bepaal vir alle deelnemers. Vars geïsoleerde perifere bloed mononukleêre selle is geklassifiseer deur middel van vloeisitometrie as die volgende CD4 T limfosiet subgroepe: naïewe selle (CD45+, CD27+), effektor geheueselle (CD45-, CD27-), sentrale geheueselle (CD45-, CD27+), en effektor selle (CD45+, CD27-). Koreseptor vrystelling en aktivering was beoordeel volgens CCR5, CXCR4 en CD38 vrystelling op CD4 T sel subgroepe. HIV, TB en MIV/TB ko-infeksie is geassosieer met ‘n afname in die persentasie CCR5+ T selle, vergeleke met gesonde kontroles, waar die MIV/TB subgroep die grootste afname getoon het. In onbehandelde pasiënte het die CD4 T selle verhoogde vrystelling van CCR5 en CD38 op die oppervlakte getoon en dit is bevestig deur die gemiddelde fluoresserende vii intensiteit in die MIV/TB subgroep vergeleke met die subgroep met slegs MIV. Die MIV/TB subgroep het verder ook ‘n verhoogde persentasie totale geheue T selle getoon vergeleke met die MIV subgroep. Die persentasie naïewe T selle was egter verlaag in beide die MIV en MIV/TB subgroepe vergeleke met normale kontroles. MIV pasiënte wat langer as 6 maande op ARV behandeling was in beide die MIV en MIV/TB subgroepe, het ‘n verlaagde vrystelling van CCR5 en CD38 op die oppervlakte van die CD4 selle getoon. ‘n Verhoogde persentasie naïewe T selle het in die MIV subgroep voorgekom, maar nie in die MIV/TB subgroup nie. ‘n Soortgelyke tendens is gevind waar die persentasie totale geheueselle verlaag was in die MIV subgroep, maar nie in die MIV/TB subgroep nie. ‘n Positiewe korrelasie is gevind tussen CCR5 en CD38 vrystelling, asook CXCR4 en CD38 vrystelling (Spearman korrelasie koëffisiënt: r=0.59, p<0.001 en r=0.55, p<0.001 onderskeidelik). Verder het die plasma virale lading ‘n positiewe assosiasie getoon met CD38 vrystelling (r=0.31, p<0.001) en die persentasie geaktiveerde CCR5+ vrystellende CD4 T selle met virale lading (r=0.31, p<0.001). Die persentasie naïewe CD4 T selle het ‘n positiewe assosiasie getoon met CD4 telling (r=0.60, p<0.001) en ‘n negatiewe korrelasie met virale lading (r=-0.42, p<0.001). Volgens hierdie resultate vererger TB ko-infeksie sekere aspekte van die disregulasie van CD4 T selhomeostase en aktivering as gevolg van MIV infeksie. Verder kon ‘n ARVgeassosieerde afname in koreseptor vrystelling, immuunaktivering en normalisering van CD4 T sel fraksies bespeur word in die MIV subgroep, maar nie in die MIV/TB subgroep nie. Ten spyte van virale onderdrukking veroorsaak deur ARV behandeling, het die afname in die immuunmerker CD38 en koreseptor CCR5, toename in die persentasie naïewe CD4 selle en afname in totale geheue CD4 T selle nie die vlakke van die normale kontrolegroep bereik nie. Dit is moontlik dat volgehoue verlaagde T sel immuunaktivering nog steeds mag plaasvind in die teenwoordigheid van ARV. Verdere longitudinale studies is nodig om immuunaktivering tydens ARV behandeling te monitor. Hierdie studie het die belangrikheid van T sel aktivering in MIV patogenese en dit impak daarvan op ARV behandeling beklemtoon. Verdere studies is nodig om moontlike oorsake of bydraende faktore te identifiseer wat tot volgehoue immuunaktivering tydens ARV behandeling kan lei, asook tot mate waartoe TB ko-infeksie kan inmeng met die normale werking van ARV behandeling.
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Rode, Noluvo. "The prevalence of depression in HIV positive individuals who are on anti retro-viral treatment (ART) conducted at a selected primary health care (PHC) clinic in Khayelitsha, Cape Town." University of the Western Cape, 2020. http://hdl.handle.net/11394/7279.
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Magister Curationis - MCurDepression is defined as a psychiatric condition, wherein a person experiences extreme sadness, social withdrawal, and expresses self-deprecating thoughts. Across the world, millions of people with Human Infectious Virus (HIV) suffer from depression each year. Depression is regarded as the most common disabling medical condition that affects both HIV-positive and HIV-negative individuals, globally. It is further reported that depression is the most common neuropsychiatric disturbance observed in HIV infected individuals. In South Africa, the prevalence of depression symptoms among Antiretroviral Therapy (ART) clients is reported to be 25.4%. However, depression among this group is often underdiagnosed and untreated in Primary Health Care settings. The need for routine screening is encouraged by studies confirming that depression and anxiety disorders accelerate the progression of HIV disease. Methods A quantitative descriptive research design was used. The study population included 1 440 males and females, aged eighteen years and over, who were HIV positive and received ART at the Clinic. A randomly selected sample of 372 respondents were recruited, but 110 had to be excluded because of eligibility issues; therefore, 262 respondents completed the Beck Depression Inventory (BDI) questionnaire. Mann-Whitney U test, Fisher’s exact test and the Spearman Rank test were used to analyse the data, using GraphPad Prism software. Depression symptoms were evaluated, using BDI, and a score of -> 10 indicated depression. Results Of the 262 respondents, 52% had club membership, compared to 48%, who were only on ART. There were significantly more female respondents (44%) involved in Adherence Clubs, as opposed to their male counterparts (8%), a difference of 36% overall (p=0.016). In summary, the number of individuals, who were suffering from some form of depression, enrolled in ART Adherence Clubs was 8.4% of the total sample, compared to 10% of those who were not in ART adherence clubs. The overall prevalence of depression in this current study was 18.4 %, which was in line with other studies conducted in a South African context, and a similar setting. Clinical depression status represents the main outcome of interest in this research project. The model category was 0-10, which indicated that a significant majority, 69.5%, n= 182, of the enrolled respondents were classified as healthy, in terms of clinical depression status. Beck depression scores were consistent across gender. Depression seemed to be more severe in the 35-44 age category. Fisher’s exact test confirmed the absence of any statistical difference between ART club membership and their depression status. Spearman rank correlation coefficient of -0.02 indicates a very low association between length of HIV seropositivity and Beck Depression score. Conclusion This is the first study reporting on the prevalence of depression, in relation to HIV infection, as well as ART treatment, and the associated adherence programme in Cape Town. Further research on a similar topic is recommended, using other instruments in the same geographic area.
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Von, Pressentin Klaus Botho. "A Medical audit of the management of cryptococcal meningitis in HIV patients in the Cape Winelands (East) district, Western Cape, South Africa." Stellenbosch : Stellenbosch University, 2010. http://hdl.handle.net/10019.1/37562.
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Stellenbosch University. Faculty of Medicine and Health Sciences. Interdisciplinary Health Sciences. Family Medicine and Primary Care.Thesis (MFamMed) -- Stellenbosch University, 2010.
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ENGLISH ABSTRACT: Introduction: This thesis summarises the findings of a medical audit on the management of Cryptococcal Meningitis (CM). The study population of HIV positive adults (N = twenty five) were admitted during November 2009 – June 2010 to five hospitals of the Cape Winelands (East) District, Western Cape, South Africa. In the context of the HIV pandemic, CM has become the most common cause of community-acquired meningitis, and has poor outcomes if left untreated. The South African HIV Clinician Society has published treatment guidelines in 2007. These guidelines have been used by the audit team to compile a list of measurable criteria (with set targets) to evaluate the structure, process and outcome of CM management. A pilot audit (2008) at the regional hospital has demonstrated that certain target standards were not met. Aims and Objectives: The aim was to improve the quality of the clinical care of HIV-patients diagnosed with CM in the Cape Winelands (East) district. The objectives included the review of the audit criteria and target standards, demonstrating improvement in quality of CM care at the Level 1 and 2 hospitals, identifying new interventions based on the findings and providing recommendations to the health facilities. Methods In 2009, the researcher formed a new audit team, reviewed the audit criteria and held teaching interventions based on the national treatment guidelines. An intervention, based on the findings of the pilot audit, aimed at improving the clinical team’s adherence to the treatment guidelines. Results The audit identified the following areas that did not meet the target standards: the availability of Amphotericin B (Ampho B) and spinal manometers; the use of manometry in all initial lumbar punctures (LPs); completing fourteen days of the required Ampho B treatment; renal monitoring in patients on Ampho B; commencement of antiretroviral treatment (ART) by week four; and, the two-month survival figures post-diagnosis. The re-audit at the Level 2 hospital highlighted the need for improved medical record keeping to aid the audit process. Arrangement of inpatient ART counselling happened more consistently at the Level 1 hospitals. Adherence to the ART target and measures to prevent Ampho B related morbidity is comparable to that of the Level 2 hospital. The audit has also provided insight to the researcher and audit team on the practical challenges of conducting a prospective data collection technique across different care settings. Recommendations Level 1 hospitals should continue to manage CM patients. The availability of spinal manometers and closer adherence to renal monitoring require attention. Formal feedback to the audit team and clinical teams is planned. A multimodal interdisciplinary Quality Improvement approach (such as an integrated care pathway) is recommended and a future re-audit is encouraged to assess improved adherence to the CM management guidelines. The buy-in of stakeholders (management, health care workers and patients), the ongoing support of an audit team and a committed Quality Improvement environment will allow the medical audit process to become ingrained in the South African public healthcare setting.
AFRIKAANSE OPSOMMING: Inleiding Hierdie tesis bied ‘n opsomming van die sleutelbevindinge van ‘n mediese oudit van Cryptokokkale Menigitis (CM) sorg. Die studie groep van MIV-positiewe volwassenes (N = vyf-en-twintig) het binne-pasiënt behandeling ontvang gedurende November 2009 tot Junie 2010 in vyf hospitale van die Kaapse Wynland (Oos) distrik. In die konteks van die MIV pandemie het CM die mees algemene oorsaak van gemeenskapsverworwe meningitis geword, en het swak uitkomste indien onbehandeld. Die Suid-Afrikaanse HIV Clinici Vereniging het in 2007 behandelingsriglyne gepubliseer. Hierdie riglyne het die oudit span gebruik om ‘n lys van meetbare kriteria (met teiken standaarde) saam te stel om die struktuur, proses en uitkoms fasette van CM sorg te evalueer. ‘n Proef oudit (2008) by die streekshospitaal het getoon dat sekere teiken standaarde nie behaal was nie. Doelstelling Die doelstelling was om die kwaliteit van kliniese sorg van MIV-pasiënte met CM (in die Kaapse Wynland (Oos) distrik) te verbeter. Die doelstelling sluit in die hersiening van die oudit kriteria, die bevesting van verbetering in kwaliteit CM sorg by vlak 1 en 2 hospitale, identifisering van nuwe ingreep-moontlikhede gebaseer op die bevindinge en die verskaffing van toepaslike aanbevelings aan die gesondheidsorg fasiliteite. Metodes Die navorser het in 2009 ‘n nuwe oudit span gevorm, die oudit kriteria hersien en opleidingsingrepe geskoei op die nasionale riglyne gefasiliteer. Opleidingsingrepe, gebaseer op bevindinge van die proef oudit, het ten doel gehad dat die kliniese span die nasionale riglyne nakom. Resultate Die oudit het die volgende areas uitgelig waar daar nie aan die teikenstandaarde voldoen was nie: the beskikbaarheid van Amphotericin B (Ampho B) en spinale manometers; die gebruik van manometrie in alle aanvanklike lumbaal punksies (LPs); voltooi van die veertien dae Ampho B behandelingsteiken; nierfunksie monitoring van pasiënte op Ampho B; aanvang van anti-retovirale behandeling teen week vier; en, die twee maande oorlewing post-diagnose syfers. Die opvolg oudit by die vlak 2 hospitaal bevestig die belang van verbeterde kliniese notas om die oudit proses te vergemaklik. Die reël van binne-pasiënt ART berading gebeur meer bestendig in Vlak 1 hospitale. Bereiking van die ART teiken en maatreëls om Ampho B verwante morbiditeit te voorkom, is vergelykbaar met die bevindinge by die vlak 2 hospitaal. Die oudit het die navorser en die oudit span ingelig rakende die praktiese uitdagings om ‘n prospektiewe data insamelingsmetode te poog in verskillende kliniese kontekste. Aanbevelings Vlak 1 hospitale kan steeds CM pasiënte versorg. Die beskikbaarheid van spinale manometers en deeglike nierfunksie monitering sal die behaling van teiken standaarde vergemaklik. Formele terugvoer aan die oudit span en kliniese span word beoog. ‘n Multimodale interdissiplinêre Kwaliteitsverbeterings benadering (soos ‘n geïntegreerde sorgplan) word aanbeveel en ‘n toekomstige oudit word aangemoedig om verbetering in toepassing van die CM riglyne te evalueer. Dit is belangrik om die sleutelspelers (bestuur, gesondheidswerkers en pasiënte) te betrek. Verder word voortgesette ondersteuning van die oudit span en ‘n toegewyde omgewing van kwaliteitsverbetering aanbeveel. Sodoende sal die oudit proses in Suid-Afrikaanse publieke sorg geintegreer word.
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Morphet, Marilynn Norma. "Method for identification of effective first-line treatment for HAART naïve HIV/AIDS patients." Thesis, Queensland University of Technology, 2002.
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Mashao, Mapula Mercy. "The effect of highly active anti-retroviral treatment on glucose and lipid metabolism in human immunodeficiency virus positive patients at clinics in the Polokwane Local Municipality,Limpopo Province,South Africa." Thesis, University of Limpopo, 2016. http://hdl.handle.net/10386/1684.
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Thesis (MSc. (Physiology)) -- University of Limpopo, 2016Relevance: An increase in the number of HIV positive patients receiving HAART raises important concerns about the metabolic impact of these regimens. The treatment effectively reduces viral load and increase CD4+ count; unfortunately it seems to disrupt carbohydrate and lipid metabolic pathways thereby increasing the risk for CDL by placing an already chronically ill HIV population at risk of more chronic diseases. As a developing country, accessibility to safer regimens of HAART is limited thus patients exposed to toxicities from long term exposure to sub-optimal regimens are even at greater risk. The aim of this study was to assess the long term effects of HAART on biochemical parameters and body composition as an indication of carbohydrate and lipid metabolism. Methods: A prospective cohort of 87 patients receiving HAART for 12 months or more was conducted at baseline and follow-up. Venous blood was collected after an overnight fast. An automated enzymatic colorimetric test was used to analyse plasma glucose and serum TC, HDL-C and TG. The LDL-C levels were calculated from TC and HDL-C. Leptin levels were analysed using human leptin radioimmunoassay kit. Insulin was analysed using an automated access ultrasensitive insulin assay. Anthropometric measurements were taken for the determination of body fat distribution and BMI. All statistical analyses were performed using SPSS version 23. Results: Total cholesterol, LDL-C, and waist circumference significantly decreased from baseline to follow-up (p<0.05). Triglycerides and LDL-C levels were significantly affected by durations between 24–47 and 49–72 months respectively. There were no significant changes in the mean levels of leptin observed within the two lines of regime. Mean leptin levels were 11.36±8.52 ng/ml and 9.67±6.42 ng/ml at baseline and follow-up respectively. Furthermore, the duration of HAART significantly affected BMI and WC at 49–72 months. Patients that met the criteria for diagnosis of DM were only found in PI containing regimens at 6.3% and 5.9% baseline and follow-up respectively. In the first line regimen, the prevalence of DM was only found at follow-up. Conclusion: The present study demonstrated that longer duration between months 49–72 has significant negative effects on the glucose and lipid metabolism of HIV positive patients. The study also highlighted that patients on combinations containing PIs and NRTIs such as stavudine and zidovudine are at higher risk of developing metabolic diseases.
University of Limpopo
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Takaidza, Isaac. "Modelling the optimal efficiency of industrial labour force in the presence of HIV/AIDs pandemic." Thesis, Cape Peninsula University of Technology, 2012. http://hdl.handle.net/20.500.11838/1305.
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Thesis (DTech (Mechanical Engineering))--Cape Peninsula University of Technology, 2012In this thesis, we investigate certain key aspects of mathematical modelling to explain the epidemiology of HIV/AIDS at the workplace and to assess the potential benefits of proposed control strategies. Deterministic models to investigate the effects of the transmission dynamics of HIV/AIDS on labour force productivity are formulated. The population is divided into mutually exclusive but exhaustive compartments and a system of differential equations is derived to describe the spread of the epidemic. The qualitative features of their equilibria are analyzed and conditions under which they are stable are provided. Sensitivity analysis of the reproductive number is carried out to determine the relative importance of model parameters to initial disease transmission. Results suggest that optimal control theory in conjunction with standard numerical procedures and cost effective analysis can be used to determine the best intervention strategies to curtail the burden HIV/AIDS is imposing on the human population, in particular to the global economy through infection of the most productive individuals. We utilise Pontryagin’s Maximum Principle to derive and then analyze numerically the conditions for optimal control of the disease with effective use of condoms, enlightenment/educational programs, treatment regime and screening of infectives. We study the potential impact on productivity of combinations of these conventional control measures against HIV. Our numerical results suggest that increased access to antiretroviral therapy (ART) could decrease not only the HIV prevalence but also increase productivity of the infected especially when coupled with prevention, enlightenment and screening efforts.
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Sifanelo, Gloria Monica. "An assessment of the effectiveness of primary health care services in addressing HIV/AIDS by providing anti-retroviral treatment : the case of Du Noon clinic in the Western health sub-district of the city of Cape Town." Thesis, Stellenbosch : University of Stellenbosch, 2010. http://hdl.handle.net/10019.1/5436.
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Thesis (MPA (Public Management and Planning))--University of Stellenbosch, 2010.ENGLISH ABSTRACT: The accessibility of anti-retroviral drugs to patients and families affected by HIV and AIDS, and the affordability of these drugs, have been challenges to the Du Noon community in the Cape Peninsula. The aim of the study was to assess the effectiveness of primary health care services in addressing HIV/AIDS in the light of these challenges. The focus was on patients registered on the ARV programme and who were receiving treatment at Du Noon Clinic. Interviews were conducted with 15 groups of 10 patients each using a patient questionnaire. During these interviews qualitative and quantitative data were gathered and secondary data was used for quantitative analysis. The results that the data analysis yielded are in keeping with the hypothesis that the HIV/AIDS programme is effective in meeting the needs of the HIV/AIDS patients of Du Noon. After content analysis of qualitative data, two themes related to patient satisfaction emerged: positive and negative feelings that were categorised as satisfied and not satisfied with the service. Most often noted was the feeling of satisfaction with the services rendered at the clinic and that the staff were helpful. The staff rendering the service were also satisfied with the kind of service offered to the patients, but were dissatisfied with the allocation of resources. An increase in enrolment figures of patients was noted in the statistical analysis for the period 2004-2008 with 1,018 patients registered. The statistics illustrate the linear tendency in the enrolment of patients, which indicated the accessibility and affordability of the service.
AFRIKAANSE OPSOMMING: Geredelike toegang tot en die bekostigbaarheid van anti-retrivorale middels (ARM’s) vir pasiënte en families wat deur MIV en VIGS aangetas is, is ‘n uitdaging vir die Du Noon-gemeenskap in die Kaapse Skiereiland. Die doel van die studie was om die doeltreffendheid van primêre gesondheidsorgdienste te bepaal wanneer MIV/VIGS aangespreek word. Die fokus is op geregistreerde pasiënte wat die ARM-program volg en behandeling by die Du Noon Kliniek ontvang. Met behulp van ‘n pasiëntevraelys was onderhoude met 15 groepe van 10 pasiënte elk gevoer. Tydens hierdie onderhoude is kwalitatiewe data versamel en vir kwantitatiewe analise was sekondêre data aangewend. Die resultate wat uit die data analise verkry was, strook met die hipotese dat die MIV/VIGS-program doeltreffend is om die behoeftes van die pasiënte en die gemeenskap van Du Noon aan te spreek. Nadat ‘n inhoudsanalise van die kwalitatiewe data onderneem was, het twee temas rakende positiewe en negatiewe gevoelens – gekategoriseer as tevrede en nie tevrede nie – ten opsigte van die gelewerde diens na vore getree. Veral die gevoel van tevredenheid teenoor die diens gelewer by die kliniek en die personeel as behulpsaam, is opgemerk. Die personeel wat die diens lewer, was ook tevrede met die diens wat aan die pasiënte gelewer word, maar was ontevrede oor die toekenning van hulpbronne. By die statistiese analise is ‘n toename in die inskrywingsgetalle deur pasiënte waargeneem. Toename in inskrywingsgetalle deur pasiënte is gemerk in statistiese analise van 2004 - 2008, met 1,018 pasiënte geregistreer. Die statistiek het die lineêre tendens toegelig ten aansien van die inskrywing van pasiënte wat die toeganklikheid en bekostigbaarheid van die diens uitbeeld.
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Ncana, Lundi. "Evaluating the referral system between Cecelia Makhiwane Hospital ART unit and its feeder sites, (Zone 2, 8 and 13 clinics)." Thesis, Stellenbosch : University of Stellenbosch, 2010. http://hdl.handle.net/10019.1/5386.
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Thesis (MPhil (Industrial Psychology. Africa Centre for HIV/AIDS Management))--University of Stellenbosch, 2010.ENGLISH ABSTRACT: Purpose of the study. The primary purpose of the study was to evaluate the referral system between CMH ART unit and its feeder sites, and assess the staff perception and patient.s satisfaction about the latter with the intention of improving and shaping it. Research design A non-experimental descriptive type of quantitative research was used in conducting a cross sectional survey to evaluate the referral system between CMH ART unit and its feeder sites. Data was collected through open and closed ended questionnaires handed to the respondents to fill and return back to the researcher. Findings The results revealed lack of management support and supervision of the system; absence of standard operative procedure to follow when down referring patients; insufficient staffing; congested waiting rooms and long waiting hours. Conclusion The down referral process began without the completion of planning with all involved stakeholders because of the pressure to implement the decision to down refer, staff at the feeder clinics although trained on ART care, but not experienced enough to manage the large influx of patients on ART were left alone to manage patients on HAART. Simple measures like communication between facility staff and patient education should be adopted to improve the system.
AFRIKAANSE OPSOMMING: Doel van die studie Die primêre doel van die studie was om die verwysing stelsel tussen die CMH ART eenheid en sy voeder werwe te evalueer, asook om die personeel se persepsie en pasiënte se tevredenheid oor die laasgenoemde te evalueer met die voorneme om dit te verbeter en verwerk. Navorsingsontwerp 'n Nie-eksperimentele beskrywende aard van kwantitatiewe navorsing is gebruik in die uitvoering van' n kruis deursnee-opname om die verwysing stelsel tussen CMH ART eenheid en sy voeder werwe te evalueer Data is ingesamel deur middel van oop en geslote geëindig vraelyste uitgedeel aan die respondente om in te vul en terug te keer na die navorser. Bevindings Die resultate blyk 'n gebrek aan ondersteuning van die bestuur en beheer van die stelsel; die afwesigheid van standaard operatiewe prosedure om te volg wanneer pasiënte af verwys word; „n tekort aan personeel; oorgelaaide wagkamers en lang wag ure. Gevolgtrekking Die af verwysing proses het sonder die voltooiing van die beplanning met alle betrokke belanghebbendes begin as gevolg van die druk om die uitvoering van die besluit om af te verwys te implementeer. Personeel by die voeder klinieke, alhoewel opgelei in ART sorg, maar sonder die nodige onderving om die groot instroming van ART pasiënte te behandel, was alleen gelos om die pasiënte op HAART te behandel. Eenvoudige maatreëls soos die kommunikasie tussen die fasiliteit personeel en die opvoeding van pasiente sal moet goedgekeur word om die stelsel te verbeter.
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Laborde-Balen, Gabrièle. "Au-delà du traitement du sida : une anthropologie de l’échec thérapeutique au Cameroun." Thesis, Aix-Marseille, 2016. http://www.theses.fr/2016AIXM3116/document.
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Alors que l’accès aux traitements antirétroviraux se généralise dans les pays en développement, l’émergence de résistances virales, liées aux échecs thérapeutiques, constitue une menace sur un plan individuel et collectif. Au Cameroun, la prévention, la détection et la prise en charge des échecs thérapeutiques se heurtent à différentes contraintes. A travers une approche anthropologique, cette thèse explore le contexte et les déterminants des échecs thérapeutiques. Le défaut d’observance est la principale cause de leur survenue. Les équipes médicales et psychosociales font face à l’absence de guides et de procédures adaptées. Aussi l’annonce de l’échec est-elle souvent associée à une culpabilisation des patients, auxquels les soignants attribuent la seule responsabilité de l’échec. L’adaptation des structures est limitée. La prise en charge médicale et psychosociale est focalisée sur le démarrage du traitement et le changement de traitement, mais le suivi à long terme est inexistant. La perception, par les patients, des médicaments antirétroviraux, est perturbée par la survenue de l’échec. L’échec redéfinit les relations de pouvoir et de confiance entre les soignants et les patients. L’attitude des soignants oscille entre compassion et réprobation, alors que l’échec renforce la dépendance des patients. Cette thèse vise à contribuer aux réflexions anthropologiques sur les médicaments, le système de santé et les relations soignants-soignés mais aussi à contribuer à l’amélioration de la prise en charge des patients en échec, pour préserver l’efficacité des thérapies antirétrovirales, sur laquelle repose l’espoir, d’éradiquer un jour l’épidémieWhen antiretroviral treatment becomes widespread in countries in the Global South, the emergence of viral resistance related to treatment failures is a threat for individuals and the general public. In Cameroon, various constraints hinder the prevention, detection and case management of treatment failures. Through an anthropological approach, this dissertation explores the context and determinants of treatment failures. Nonadherence is the main cause of their onset. Medical and psychosocial teams must face a lack of suitable guidelines and procedures. Also, notification of the failure is often associated with placing blame on patients, on whom caregivers assign sole responsibility for the failure. Adaptation in facilities is limited. Medical and psychosocial care is focused on starting treatment and making changes in treatment, but long-term follow-up does not exist. Patients’ perceptions of antiretrovirals are hampered by failures. The failure redefines power relationships and trust between caregivers and patients. Caregivers’ attitudes vacillate between compassion and condemnation, while the failure reinforces the patients’ dependence. This dissertation aims to contribute to the anthropological discussion on medicines, the health system and the caregiver-patient relationship as well as to improve care for patients with treatment failure to ensure the continued effectiveness of antiretroviral therapies that underlie any hopes of one day eradicating the epidemic
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Wang, Aiqin. "Anti-retroviral activity of lavendamycin analogs." Virtual Press, 1996. http://liblink.bsu.edu/uhtbin/catkey/1036177.
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Lavendamycin, an aminoquinolinedione antibiotic is similar to streptonigrin, an antibiotic with known antiretroviral activity. Their applicability as drugs is limited due to their high toxicity to mammalian cells. A series of novel analogs of lavendamycin has been recently synthesized. In initial screening, three of the analogs showed significant inhibitory activity toward the reverse transcriptase (RT) of the avian myeloblastosis virus (AMV) and exhibited little or no animal toxicity and relatively low cellular cytotoxicity.In this study, we determined the anti-retroviral activity of nine analogs by assessing their anti-reverse transcriptase(anti-RT) activity in comparison to streptonigrin. Using both the human immunodeficiency virus (HIV) and AMV reverse transcriptase in vitro we found that the analogs exhibited significant anti-RT activity. The inhibitory activity of the analogs was dose dependent, and they had different effects on the two enzymes. At 30 µM seven of the analogs inhibited HIV-RT activity by 50% or more. At this concentration, two of the analogs were significantly more effective than streptonigrin. AMV-RT was more sensitive toward both streptonigrin and several of the analogs than was HIV-RT. Furthermore, combination of azidothymidine (AZT)-triphosphate (TP) and several of analogs showed synergistic inhibitory effects at low doses.Department of Biology
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Masokwane, Patrick Maburu Dintle. "Prevalence of non-AIDS defining conditions and their associations with virologic treatment failure among adult patients on anti-retroviral treatment in Botswana." University of the Western Cape, 2016. http://hdl.handle.net/11394/5247.
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Magister Public Health - MPHBackground: The recognition of HIV/AIDS as a chronic life-long condition globally in recent years has demanded a different perception and an alignment to its association with other chronic diseases. Both HIV and other chronic non-communicable diseases are significant causes of morbidity and mortality. Their combined DALY contributions for Botswana would be significant if research and strategies in controlling these conditions are not put in place. Natural aging and specific HIV-related accelerated aging of patients who are on antiretroviral treatment means that age-related diseases will adversely affect this population. Princess Marina Hospital Infectious Diseases Care Clinic has been in operation since 2002. The clinic has initiated over 16 000 patients on anti-retroviral treatment (ART) since 2002. The current study estimated the prevalence of non-AIDS defining conditions (NADCs) in the attendees of the clinic in 2013. The majority of patients that attended the clinic had been on treatment for over three years with some patients more than ten years. These ART experienced patients were more likely to be susceptible to chronic non-communicable diseases, including non-AIDS defining conditions. The nomenclature used in classification of NADCs in the current study was appropriate for resource-limited settings; because the study setting offered HIV treatment under resources constraints. Aim: The current study characterised non-AIDS defining conditions, and determined their associations with virologic treatment failure in a cohort of patients that were enrolled at Princess Marina Hospital antiretroviral clinic in Gaborone, Botswana. Methods: A retrospective cross sectional study of records of patients who attended the Princess Marina Infectious Diseases Care Clinic in 2013. Stratified random sampling of a total of 228 patients’ records was achieved from a total population of 5,781 records. Data was transcribed into a Microsoft Excel Spreadsheet and then exported to Epi-Info statistical software for analysis. Results: Eighty (35%) cases of NADCs were reported/diagnosed in the study sample; with 27% (n=62) of the patients having at least one condition, 6.7% (n=17) two conditions, and 0.4% (n=1) three conditions. The top prevalent conditions were hypertension (n= 40), hyperlipidaemia (n=7) and lipodystrophy (n=7). The prevalence of NADCs on the various categories of patients compared with the total sample population was as follows: active patients (prevalence ratio= 0.70), transferred out patients (prevalence ratio = 1.24), patients who died (prevalence ratio=2.04) and patients who were lost to follow-up (prevalence ratio =2.86). The prevalence of NADCs was significantly associated with increasing age (p<0.001); having social problems (p=0.028); having been on treatment for over three years (p=0.007); an outcome of death (p = 0.03) and being lost to follow-up (p=0.007). The study showed that being controlled on second line or salvage regimen (p=0.014) and the presence of adherence problems in the past was associated with virologic failure (p=0.008). There was no association of presence of NADCs to virologic failure. Conclusions: There was significant morbidity of non-AIDS defining conditions in the Princess Marina Infectious Diseases Care Clinic shown by a prevalence of NADCs in the clinic of 35% in 2013.The significant associations of the presence of NADCs and virologic failure with outcomes of death and loss to follow-up illustrate the adverse effects that NADCs are having, and calls for strategies to address multi-morbidities in HIV patients on antiretroviral treatment.
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Jaffer, Ambereen. "Evaluation of a Mobile Health Intervention to Improve Anti-Retroviral Treatment Retention in South Africa." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1347.
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South Africa has one of the highest HIV prevalence rates globally, with nearly 2.5 million people accessing antiretroviral treatment (ART) at the end of 2013. Retaining patients on ART has become a major problem in this country. When patients no longer show up for ART for unknown reasons, they are considered lost to follow-up (LTF). LTF is the highest contributor to ART attrition. This study, guided by the health belief model, evaluated the effectiveness of a technology-based, mobile health (mHealth) appointment reminder intervention on LTF among patients accessing ART services. The study ascertained differences in 6- and 12-month LTF rates between patients enrolled in the mHealth intervention (n = 832) and those in the standard of care comparison group (n = 918). A quantitative, retrospective cohort approach was used to answer the research questions using binary logistic regression analyses. The mHealth intervention was found to be significantly linked to lower likelihood of 6- and/or 12-month LTF among patients. There were 2 other key findings: a positive correlation between pregnancy and LTF, and a positive correlation between viral load increases and LTF. This study added evidence to the existing literature on the effectiveness of using mHealth-based interventions to improve HIV/AIDS care. Based on these findings, professionals should pay special attention to pregnant women and those clients with increasing viral loads to ensure they are not LTF. Positive social change that may result from this study is better health outcomes for patients on ART due to reduced risk of HIV related complications and other illnesses. This awareness would improve the lives of the patients, and positively impact their families, communities, and ultimately the global community, by reducing the overall impact of HIV disease.
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Felino, Isabel Teixeira de Melo Campos. "Do anti-retroviral treatments encourage individuals to get tested for HIV/AIDS in Sub-Saharan Africa?" Master's thesis, NSBE - UNL, 2011. http://hdl.handle.net/10362/10072.
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A Work Project, presented as part of the requirements for the Award of a Masters Degree in Economics from the NOVA – School of Business and EconomicsIn many Sub-Saharan African countries, governments and international aid agencies have made progress towards a universal antiretroviral treatment coverage. However, a great proportion of HIV infected individuals is not aware of its HIV status and do not take advantage of the benefits from knowing their status. This project aims to analyze the impact of a country antiretroviral treatment coverage on the individuals` decision to get tested for HIV, and thus on their demand for knowing their HIV status. I find a positive relation between individual decision to get tested and antiretroviral treatment, suggesting that individuals are more likely to perform the HIV test where antiretroviral treatment is widely available.
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Atwine, Daniel. "Improving TB management and control through innovative shorter anti-tuberculosis regimens." Thesis, Montpellier, 2017. http://www.theses.fr/2017MONTT041/document.
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Le traitement actuel de la tuberculose chimio-sensible est de 6 mois, ce qui est beaucoup trop long et entraine des défauts d’adhésion au traitement, des échecs thérapeutiques par sélection de bactéries résistantes. Puisque dans le futur proche, aucun nouveau traitement ne permettra de raccourcir la durée de traitement, d’autres voies doivent être recherchées, entre autres l’augmentation de la posologie de rifampicine (R) au-delà des 10 mg/kg actuellement recommandés qui pourrait permettre un traitement de 3-4 mois.Notre travail, réalisé dans le cadre d’essais cliniques, a consisté d’une part à étudier la tolérance d’une dose élevée de R au sein du traitement antituberculeux standard chez des patients tuberculeux séronégatifs ou séropositifs pour le VIH, et d’autre part l’interaction entre une double dose de R (20mg/kg) et le traitement antirétroviral, en particulier l’efavirenz (EFV). Enfin un autre axe de recherche a consisté à étudier si la négativation des cultures de crachat à 2 mois pouvait être un marqueur de l’efficacité du traitement antituberculeux dans les essais cliniques. Afin de répondre à ces objectifs, les études suivantes ont été réalisées.Une étude ouverte, de Phase II, randomisée, contrôlée (RIFATOX) a été mise en place (Bolivie, Pérou and Ouganda). Trois cent patients tuberculeux, séronégatifs pour le VIH ont été randomisés entre 3 schémas thérapeutiques se différenciant par la posologie de la R durant les 16 premières semaines : R à 10, 15 ou 20 mg/kg. La fonction hépatique et la réponse bactériologiques ont été monitorées. La toxicité hépatique n’était pas plus importante à dose élevée de R. En utilisant les résultats des patients ougandais, nous avons montré que la négativation des cultures à deux mois était influencée par le type de milieu de culture utilisé, avec négativation plus importante en milieu solide qu’en milieu liquide pour les traitements avec dose élevée de R. Ces résultats nous amènent à recommander que le même milieu de culture soit utilisé dans tous les sites lors d’essais multicentriques visant à étudier l’efficacité de traitement antituberculeux.Une étude bibliographique « systématique » a été réalisée afin de colliger les informations existantes sur l’efficacité, la tolérance et les interactions pharmacocinétiques de l’EFV associé au traitement antituberculeux à posologie standard dans les pays à forte endémie. Vingt-deux articles publiés entre 2006 et 2016 ont été sélectionnés. Aucune relation entre des concentrations élevées d’EFV et la survenue d’effets indésirables neurologiques ou hépatiques n’a pu être mise en évidence.Au vu de ces informations, un essai pharmacocinétique de phase 2, ouvert (ANRS12292 RIFAVIRENZ trial) a randomisé 97 patients tuberculeux vivant avec le VIH et naïfs de traitement antirétroviral entre 3 bras de traitement : R20mg/kg+EFV 600mg, R20mg/kg +EFV 800 mg et R10mg/kg+EFV600mg (bras contrôle). R était associé au traitement antituberculeux à posologie standard et EFV associé à deux analogues nucléosidiques (tenofovir+lamivudine) a été initié 2-4 semaines après le traitement antituberculeux. Après 8 semaines de suivi, tous les patients ont reçu les traitements à posologie standard. Des prélèvements sanguins ont été réalisés pour étudier la pharmacocinétique de l’EFV associé à R ou administré seul (4 semaines après arrêt du traitement antituberculeux). Malgré une légère diminution des concentrations d’EFV dans le bras R20 mg/kg+EFV 600mg, les concentrations sont restées dans la zone des concentrations thérapeutiques. Quelque soit le bras de traitement, le traitement a été bien toléré. Cependant s’il n’y avait pas de différence sur l’efficacité virologique mesurée à 12 semaines, elle était diminuée à 24 semaines dans le bras R20 mg/kg+EFV 600mg. La pertinence clinique de ce résultat est en cours d’évaluation pour que des patients tuberculeux vivant avec le VIH puissent être inclus dans de futurs essais de phase 3The recommended 6-month treatment for drug-susceptible tuberculosis (DS-TB) is too long, hence threatening patient adherence, with resulting treatment failure and drug-resistance. Consequently, this complicates efforts towards achieving the TB control and elimination goal. Currently, no new drug is expected in the short term for reducing treatment duration. We hypothesized that optimization of the current treatment regimen with use of high-dose rifampicin (R), above the 10mg/kg current dose, might result in a shorter TB treatment duration (3-4 months). Clinical trials were conducted to investigate two research areas: first, Safety of high-dose R in HIV-negative TB and in HIV-TB coinfected patients; secondly, drug-drug interaction between high-dose R and antiretroviral drugs. A 3rd research area addressed the use of 2 months sputum culture conversion as surrogate marker for treatment efficacy in TB trials.A Phase II, open-label randomized controlled trial (RIFATOX) was conducted with sites in Bolivia, Peru and Uganda. Three hundred HIV-negative smear-positive TB patients were randomised between three regimens differing only by R dose during the first 16 weeks of the standard 24 weeks treatment: R at 10 mg/kg and two high-R doses (15mg/kg or 20mg/kg). Liver function and bacteriological response were monitored. There was no significant increase in hepatotoxicity with high-dose R. Using data from the cohort of patients from the Ugandan site only, we showed that month-2 culture conversion, a commonly used surrogate marker in phase 2 trials was influenced by the culture method used with significantly higher conversion rates noted with solid versus liquid media within patients on high-R dose regimens. We therefore recommend use the same culture method across sites within multi-centric TB trials.We conducted a systematic review to gather existing information on the pharmacokinetics, adverse effects and efficacy of efavirenz (EFV), the most commonly used antiretroviral drug, co-administered with R-based TB regimens among high TB/HIV-burden countries. Twenty-two articles published between 2006 and 2016 were analyzed. With the use of 600mg EFV daily, plasma concentrations on average were above the minimum therapeutic concentrations during R co-administration with good safety and efficacy. No clear relationship between supratherapeutic EFV concentrations and occurrence of neurological and hepatic adverse events was observed.Then, we conducted a phase-2, randomized, open-label pharmacokinetic trial (ANRS12292 RIFAVIRENZ trial) among 97 DS-TB patients and antiretroviral therapy (ART)-naïve Ugandan patients. These were randomized between 3 drug regimens: 2 using R (20mg/Kg) with ART initiation 2-4 weeks later with EFV600mg/day or 800mg/day) and a control regimen using R10mg/kg and EFV600mg/day. At 8 weeks, all patients were switched to standard R and EFV doses. All patients had intensive pharmacokinetic sampling 4 weeks after EFV-R co-administration, and 4 weeks after R discontinuation. Despite a trend of lower EFV concentration when the R dose was doubled, concentrations remained within the therapeutic window. Treatment with high-dose R was well tolerated. Virological efficacy was high during the first 12 weeks on ART but reduced in the R arms after 24 weeks. We conclude that, use of high-dose R at 20mg/Kg is safe and could be evaluated in larger trials towards shortening of treatment for DS-TB patients. Due to late virological failures in patients on R 20 mg/kg and standard EFV dose, comprehensive efforts through additional research are needed to fast-track the inclusion of TB-HIV co-infected patients in phase 3 trials
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Mukose, Aggrey David. "Factors Influencing the Acceptance of Directly Observed Therapy in the Delivery of Anti-retroviral Drugs for Treatment of Human Immunodeficiency virus in Urban Uganda." Case Western Reserve University School of Graduate Studies / OhioLINK, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=case1207188411.
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Agyeman-Yeboah, Joana. "A best-practice guideline for facilitating adherence to anti-retroviral therapy for persons attending public hospitals in Ghana." Thesis, Nelson Mandela University, 2017. http://hdl.handle.net/10948/13603.
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The retention of persons on an HIV programme has been a global challenge. The success of any strategy to optimize adherence to anti-retroviral therapy (ART) depends on the intensive and effective adherence counselling and strategies. It is important to research whether persons receiving anti-retroviral therapy in public hospitals in Ghana are receiving the needed service that would optimize their adherence to the anti-retroviral therapy. Therefore, this study explored and described the experiences of healthcare professionals providing care, support and guidance to persons on ART at public hospitals in Ghana, as well as the best-practice guideline that could contribute to facilitating the ART adherence of patients. This study also explored and described the experiences of persons living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) on ART, regarding their adherence to the therapy. The study was organized into three phases. In Phase One: a qualitative, exploratory, descriptive and contextual design was employed. The research population included healthcare professionals, providing services at the HIV clinic at the public hospitals in Ghana, namely the Korle-Bu Teaching Hospital; the 37 Military Hospital and the Ridge Hospital. The healthcare professionals comprised of doctors, nurses, pharmacists and trained counsellors employed in any of the three public hospitals. Persons receiving ART at any of the three public hospitals were also part of the research population. Semi-structured interviews were conducted with healthcare professionals and persons receiving ART. Data were collected from healthcare professionals in relation to their experiences regarding the provision of ART services, their understanding of evidence-based practice and best-practice guidelines, as well as data on the experiences of persons receiving ART in relation to their adherence to the therapy. The data were analysed using Creswell’s six steps of data analysis; and the coding of the data was done according to Tesch’s eight steps of coding. Trustworthiness was ensured by using Lincoln and Guba’s framework which comprised credibility, transferability, dependability, confirmability and authenticity. Ethical principles such as beneficence and non-maleficence, respect for human dignity, justice, veracity, privacy and confidentiality were considered in the study. In phase two, the literature was searched by using an integrative literature review approach and critically appraising the methodological quality of the guidelines in order to identify the best available evidence related to adherence to ART. In Phase Three, a best-practice guideline for facilitating adherence to ART was developed for public hospitals in Ghana based on the findings of the empirical research of Phase One and the integrative literature review in Phase Two. The guideline was submitted to an expert panel for review; and it was modified, according to the recommendations of the panel.
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Gonçalves, Vera Lúcia de Sousa. "O preço da longevidade: Uma reflexão sobre a adesão à terapêutica anti-retroviral no sujeito infectado pelo VIH." Master's thesis, Instituto Superior de Psicologia Aplicada, 2008. http://hdl.handle.net/10400.12/569.
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Dissertação de Mestrado em PsicossomáticaA presente investigação tem como objectivos principais: (1) reflectir sobre o fenómeno da adesão à terapêutica anti-retroviral (TARV); (2) compreender o funcionamento psicológico do sujeito infectado pelo VIH, nomeadamente no que concerne aos seus mecanismos de defesa e sua influência na adesão ao tratamento e (3) avaliar a presença de alexitimia no sujeito infectado, e sua relação com padrões de má adesão à terapêutica. 0 Delineamento do Estudo consistiu na Observação Participativa e na realização de um Estudo de Caso. Na primeira, são descritos alguns dados a partir da observação feita ao longo de um estágio de dezasseis meses no Serviço de Doenças Infecciosas do Hospital de Santa Maria, sendo referenciados alguns casos de doentes com dificuldades ao nível da adesão à TARV. No segundo, os instrumentos utilizados foram a Entrevista Clínica, o Inventário de Mecanismos de Defesa (DMI) e a Escala de Alexitimia de Toronto (TAS-20). Na análise dos dados da observação e dos casos referenciados, percebemos a multifactonalidade e complexidade do fenómeno da adesão. Foram expostos casos que se pautaram por alguma diversidade e nos quais a adesão incluía factores individuais, familiares, sociais, assim como factores relacionados com própria doença e tratamento. No Estudo de Caso apresentado, não verificámos uma influência directa dos mecanismos de defesa utilizados no comportamento face à terapêutica, assim como não se observou uma relação entre a presença de alexitimia e a não adesão à terapêutica. Consideramos assim que a adesão ao tratamento anti-retroviral é intrinsecamente dinâmica e determinada por uma matriz de factores interrelacionados, que se altera com o tempo, à medida que os próprios factores, bem como a adesão em si mesma, se transformam. Compreender os comportamentos de adesão implica considerar a rede complexa de condicionantes, tendo a noção de que se influenciam mútua e reciprocamente, bem como considerar todo o contexto psicossocial do indivíduo, as suas necessidades diárias e as experiências relacionadas com a doença.
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Krastinova, Evguenia. "Prise en charge du VIH au stade de la primo-infection." Thesis, Paris 11, 2015. http://www.theses.fr/2015PA11T013/document.
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Depuis 2013, le traitement « universel » est recommandé en France. Le moment de l’initiation thérapeutique est une question qui reste cependant d’actualité pour les patients se présentant en primo-infection. Cette thèse s’attache à étudier la prise en charge thérapeutique du VIH au stade de la primo-infection (PIV) sous différents angles :1) le suivi par les cliniciens des recommandations d’initiation des traitements antirétroviraux depuis 1996 en fonction de l’évolution de ces recommandations; 2) l’impact d’un traitement ARV transitoire en PIV sur la réponse immuno-virologique lors de la reprise du traitement et 3) l’identification de nouveaux biomarqueurs comme facteurs pronostiques de progression de l’infection VIH. La majorité des travaux présentés dans cette thèse repose sur les données de la cohorte ANRS PRIMO qui comporte environ 1 500 patients infectés par le VIH inclus en PIV entre juin 1996 et décembre 2013, dans 94 hôpitaux français. Tous les patients étaient naïfs de traitement antirétroviral à l'inclusion.La première partie de la thèse analyse la mise en œuvre des recommandations d’initiation du traitement ARV entre 1996 et 2010 par les médecins en France, dans deux situations distinctes : au stade chronique et lors de la primo-infection par le VIH-1. Nous avons montré que les recommandations d’initiation du traitement ARV étaient largement suivies. Néanmoins, il existe un effet d’inertie dans leurs applications lors des changements de recommandation. Il reste à améliorer le délai de mise sous traitement lorsque le taux de CD4 atteint le seuil recommandé. Au stade chronique, le traitement était plus fréquemment initié chez les patients présentant un critère d’initiation dès le diagnostic d’infection par le VIH (96%), que chez les patients qui atteignaient un critère d’initiation au cours du suivi (78%, p<0.001). Nous avons identifié comme facteurs de risque de ne pas être traité en phase chronique malgré une indication de traitement : une charge virale < 5log (versus >5), un plus faible niveau d’éducation et des conditions de vie précaires.L’impact de l’interruption d’un traitement antirétroviral initié en PIV sur la restauration des CD4 après reprise du traitement a été exploré en modélisant l’évolution des CD4 avec des modèles linéaires à effets mixtes avec intercept et pente aléatoires. Les patients qui avaient initié un traitement ARV pendant la phase chronique avaient une meilleure réponse immunologique que les patients reprenant un 2ème traitement après un traitement transitoire en PIV : à 36 mois, les gains en √CD4 cellules/mm3 et en pourcentage de CD4 étaient significativement plus élevés. Cependant, il s’agissait de différences modestes en termes cliniques, qui ne conduisent pas à recommander d’arrêter la recherche clinique sur les arrêts de traitement cherchant à induire des contrôleurs post traitement. Après un état des lieux des mécanismes complexes d’activation/inflammation du système immunitaire pendant la primo-infection nous avons cherché à identifier de nouveaux biomarqueurs prédictifs de l’évolution de l’infection. Le taux de sCD14 (marqueur d’activation monocyte/macrophage et marqueur indirect de translocation microbienne) au moment de la PIV a été identifié comme marqueur potentiel de prédiction du déclin des CD4 et du risque de mortalité d’origine cardio-vasculaire. En conclusion, bien que des progrès considérables aient été réalisés dans la prise en charge du VIH, d'autres études sont nécessaires pour optimiser et adapter le traitement au profil du patient dès les premiers stades de l’infection VIHIn France, since 2013, HIV treatment has been recommended for all HIV-infected patients independently of their CD4 count. However, when to start anti-retroviral (ARV) treatment is still an issue. This thesis aims to explore the therapeutic management of HIV at the stage of PHI in different aspects: 1) we explored how physicians in France have applied the evolving guidelines for ART initiation since 1996 2) the impact of a transient ARV treatment at PHI on immuno-virological response during 2nd treatment and 3) identification of new biomarkers prognostic of HIV progression.Most of the work presented in this thesis is based on data from the ongoing ANRS PRIMO cohort that enrolled more than 1 500 HIV infected patients enrolled at PHI since June 1996 in 94 French hospitals. All patients were antiretroviral therapy naive at baseline.The first part of the thesis analyzes the implementation of the recommendations of ARV treatment initiation between 1996 and 2010 by physicians in France, in two distinct situations: in the chronic HIV-1 infection and during primary HIV-1 infection. We have shown that the recommendations of ARV treatment initiation were widely followed. Nevertheless, there was inertia in guidelines application when changes in the recommendations took place. The time to treatment when CD4 cell counts reach the threshold to treat can be improved. 96% of the patients initiated ART when they had a CD4 cell count below the threshold to treat at entry, while treatment was less timely initiated when the CD4 threshold was reached during active follow-up (78%, p <0.001).We identified as risk factors for not being timely treated in chronic phase despite an indication for treatment: a viral load <5log (versus> 5), a lower education level and poor living conditions.The impact of ARV interruption after a first treatment initiated at PHI on the CD4 count restoration after resumption was explored by modeling the evolution of CD4 cells with linear mixed effects models with random intercept and slope. Patients who initiated ARV treatment during the chronic phase had a better immune response than patients who initiated a second course treatment after a transient ART at PHI: at 36 months, the gains in √CD4 cells / mm3 and CD4 percentage were significantly higher. However, this difference was clinically modest and further research on treatment interruptions seeking to induce post-treatment controllers is still an issue but only in research settings and under close medical surveillance. After an overview of the complex mechanisms of activation / inflammation of the immune system during primary infection we sought to identify new predictive biomarkers of disease progression. The level of sCD14 (marker of monocyte/macrophage activation and an indirect marker of microbial translocation) at the time of PHI was identified as predictive marker of CD4 decline and of risk of cardio-vascular mortality. In conclusion, although considerable progress has been made in the management of HIV, further studies are needed to optimize and adapt the treatment to the patient profile in the early stages of HIV infection
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Fonteh, Pascaline Nanga. "Chrysotherapy: evaluating gold compounds for anti-HIV activity." Thesis, 2009. http://hdl.handle.net/10210/2505.
Full textAbstract:
M.Sc.Background: The continuous emergence of drug resistant strains of HIV as a result of errors made by reverse transcriptase coupled with undesirable side effects of available drugs, latency problems, cost etc, warrants the continuous search for new drug candidates. Chrysotherapy which is the use of gold compounds for the treatment of various ailments has been practiced since 2500 BC. The use of gold compounds such as auranofin for the treatment of rheumatoid arthritis has lead to remission of this disease. Gold compounds such as auranofin not only prevented the progression of arthritis but also increased the CD4+ count of an HIV positive patient who was not on antiretrovirals. These compounds have been implicated in the treatment of cancers, autoimmune diseases and microorganism infections. Objectives: In this work, novel gold compounds were evaluated with the aim of identifying lead compound(s) that can eventually serve as anti-HIV agents. Materials and Methods: Eleven gold (I) phosphine complexes, four of their corresponding ligands (compound without gold atom), and a gold (III) complex were tested for the ability to inhibit reverse transcriptase (RT) and protease (PR) in direct enzyme assays. Uptake of the compounds by host cells was evaluated with inductively coupled plasma atomic emission spectrometry (ICP-AES). Potential toxicity of the gold compounds was screened for by viability dyes and flow cytometry assays. To determine inhibition of whole virus by other mechanisms in addition to RT or PR, p24 production by infected cells was evaluated. Prior to all these analysis, stability of compounds in solution was determined by 31P nuclear magnetic resonance (NMR) and UV-visible spectroscopy. Results: The compounds were shown to be stable in solution over a one week period and were taken up by both continuous cell lines and primary cells. Eight of the gold compounds significantly inhibited HIV-1 reverse transcriptase at concentrations of 25 and 250 μM while four compounds and the four ligands did not. In a fluorogenic assay against HIV-1 PR, four of the gold compounds demonstrated inhibitory activity. The gold compounds were toxic to cells lines but not to primary cells. One of the complexes (EK231) significantly reduced p24 (p=0.0042) production at a concentration of 25 μM. Conclusion: Data provided here suggests that the therapeutic benefits of these gold containing compounds as potential HIV-1 reverse transcriptase and protease inhibitors should be considered.
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Fraser, Shona. "Memory functioning in HIV positive adolescents receiving anti-retroviral treatment." Thesis, 2014.
Find full textAbstract:
In 2007 it was reported that an estimated 33 million people worldwide were living with the
Human Immunodeficiency Virus (HIV). Of this, 35% (approximately 11.5 million) live in
South Africa, most of whom were infected with HIV by mother to child transmission. Due to
government legislation, until 2004, South Africans had limited access to Antiretroviral
(ARV) treatment at and after birth. As a consequence, treatment of HIV was, at this time,
only in government facilities, initiated after the clinical presentation of immune deficiency.
This study compared the memory functioning of low socio-economic seropositive
adolescents that were on a managed anti-retroviral programme to that of a contrast group that
were HIV negative. The groups were matched for age, gender, demographics and educational
level. The relative impact of variables such as duration of ARV treatment, drug regimen,
WHO stage at diagnosis and CD4+ count were all considered.
Performance on a comprehensive neuropsychological battery was compared between the HIV
positive group and their typically developing counterparts both in terms of memory functions
as well as other cognitive processes that may have an effect on memory. The HIV positive
group performed significantly below their HIV negative peers in processing speed, holistic
processing, and spatial processing as well as specific visual functions such as visual
constructional skills, visual recall ability, disruptions in both storage and retrieval of
visuospatial information, and visual spatial working memory. No significant differences were
found between the groups on tasks measuring verbal memory and verbal learning ability
indicating that the neurocognitive profile of clade C HIV has a different presentation from the
other clades.
The findings suggest that the preferential effect HIV has on the frontostriatal circuits in the
brain impacts memory processes due to the destructive impact of the virus on the myelination
of these circuits. As a result of the higher degree of white matter tracts in the right
hemisphere, holistic and integrative processing is impaired and visuospatial functions are
affected whereas verbal processes are largely spared. The resulting neurocognitive profile is
similar to that of nonverbal learning disorders and may benefit from similarly constructed
interventions such as placing more emphasis on verbal learning strategies and limiting
dependence on visual information for HIV positive pupils.
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Wong, Wai-Kwan Tim, University of Western Sydney, College of Arts, and School of Psychology. "The ‘Lazarus experience’ : people with HIV making sense of their lives in the post-treatment era." 2007. http://handle.uws.edu.au:8081/1959.7/15541.
Full textAbstract:
The medico-scientific advances made in the treatment of HIV and AIDS, which emerged in the mid 1990s, were significant. The Highly Active Anti-Retroviral Treatments (HAART) or anti- HIV treatments have been positioned as resources that changed the way HIV is now medically and socially constructed. Although HIV remains incurable, it is now constructed as a chronic disease that is treatable, manageable and people are no longer positioned as living with a ‘death sentence’. The research on which this thesis is based explores the subjective lived experiences of people with HIV living in urban Australia in the context of this change. The effects that the treatments have had on corporeality have also changed the ways people are now living with HIV in the post-treatment era. It is an era in which treatments for HIV are taken-for-granted, but issues, doubts and concerns relating to treatment use are firmly embedded in the everyday life of people with HIV. The findings suggest that whilst AIDS-related mortality has decreased since the availability of effective treatments, the notion of ‘quality of life’, as subjectively constituted and defined, is an ongoing negotiation that is predicated on people locating meaningfulness in their everyday lives. Despite the decreased threat of failing health and death, the findings also suggest that people are continuing to be confronted by, and therefore positioned as, having to make sense of complex issues embedded in living with a disease for which there is no cure.Doctor of Philosophy (PhD)
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Wong, Wai-Kwan (Tim). "The 'Lazarus experience' : people with HIV making sense of their lives in the post-treatment era." Thesis, 2007. http://handle.uws.edu.au:8081/1959.7/15541.
Full textAbstract:
The medico-scientific advances made in the treatment of HIV and AIDS, which emerged in the mid 1990s, were significant. The Highly Active Anti-Retroviral Treatments (HAART) or anti- HIV treatments have been positioned as resources that changed the way HIV is now medically and socially constructed. Although HIV remains incurable, it is now constructed as a chronic disease that is treatable, manageable and people are no longer positioned as living with a ‘death sentence’. The research on which this thesis is based explores the subjective lived experiences of people with HIV living in urban Australia in the context of this change. The effects that the treatments have had on corporeality have also changed the ways people are now living with HIV in the post-treatment era. It is an era in which treatments for HIV are taken-for-granted, but issues, doubts and concerns relating to treatment use are firmly embedded in the everyday life of people with HIV. The findings suggest that whilst AIDS-related mortality has decreased since the availability of effective treatments, the notion of ‘quality of life’, as subjectively constituted and defined, is an ongoing negotiation that is predicated on people locating meaningfulness in their everyday lives. Despite the decreased threat of failing health and death, the findings also suggest that people are continuing to be confronted by, and therefore positioned as, having to make sense of complex issues embedded in living with a disease for which there is no cure.
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Hurinanthan, Vashka. "Anti-HIV activity of selected South African medicinal plants." Thesis, 2013. http://hdl.handle.net/10321/916.
Full textAbstract:
Submitted in complete fulfilment for the Degree of Doctorate of Technology (Biotechnology)--Durban University of Technology, 2013.South Africa has the largest number of people infected with HIV/AIDS. It also has more than 30 000 species of plants and many of these have a long tradition of medicinal use. It is highly likely that the treatment for HIV will come from this traditional knowledge. The need for effective preventative and therapeutic agents for HIV remains an urgent global priority. The aim of this study was to screen selected South African medicinal plants for anti-HIV activity and to identify and characterise an active compound from a plant that can be used for HIV treatment. The aqueous and methanolic extracts of the roots, leaves, flowers and stems of thirty eight plant species (108 extracts) were screened for anti-HIV activity. The plants which had anti-HIV activity were further screened for anti-reverse transcriptase activity. Thirty-two extracts exhibited varying degrees of anti-HIV activity. Cleome monophylla, Dichrostachys cinerea and Leonotis leonurus aqueous leaf extracts had anti-HIV-1 reverse transcriptase activity. The aqueous extracts of D. cinerea showed the best anti-HIV activity with a Selectivity Index of 43.5 and significant anti-HIV-1 reverse transcriptase activity. Crude phytochemical screening of D. cinerea showed that it had tannins, saponins, flavonoids and alkaloids but did not contain any phlobatannins, terpenoids, steroids or phenols. D. cinerea displayed a high degree of free radical scavenging activity with an IC50 of 25 μg/ml, therefore the anti-HIV activity could be attributed to the flavonoids present in the plant. Bio-guided fractionation was used to isolate and purify the active compound from the D. cinerea extract. Compounds were isolated by thin layer chromatography and were tested for anti-HIV-1 and anti-reverse transcriptase activity. From these results the active compound was identified, and purified using preparative TLC. The active compound was characterised by High Performance Liquid Chromatography, Ultraviolet-visible spectrophotometry, and Ultra Performance liquid chromatography coupled to MS/MS. Structural elucidation was performed using Nuclear Magnetic Resonance. From these results, it was deduced that the compound isolated from D. cinerea was a catechin. In this study we show that the catechins present in D. cinerea are responsible for the anti- HIV-I activity and inhibits the reverse transcriptase activity which is a key factor in the progression of HIV. Potentially, these results can be used to develop a new drug for the treatment of HIV or as a cost effective therapeutic agent in treating HIV-infected individuals with oxidative stress.
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Zimuwandeyi, Memory. "Synthesis of peptidomimetic compounds as potential anti HIV and malaria agents." Thesis, 2015. http://hdl.handle.net/10539/18565.
Full textAbstract:
A thesis submitted to the Faculty of Science University of the Witwatersrand
Johannesburg in fulfillment for the requirements of the degree of Master of Science.
14 May 2015.Peptidomimetic compounds have been shown to exhibit both anti-HIV and anti-malarial activity. A multicomponent reaction was used to create a library of peptidomimetic compounds with an α-hydroxy-β-amino acid unit. The Passerini reaction between an aldehyde, carboxylic acid and isocyanide was used to prepare compounds containing both ester and amide functionalities. These compounds were then subjected to a deprotection-acyl migration strategy giving rise to the target compounds. This approach, known as the Passerini Amine Deprotection Acyl Migration (PADAM) sequence was successfully used to create a library of novel peptidomimetic compounds. From this library, 22 compounds were tested for activity against HIV and malaria. The Passerini reaction gives rise to a product containing a new stereogenic centre, and as the starting aldehyde used (N-Boc-phenylalaninal) has a stereogenic centre, the products were isolated as a mixture of diastereomers. Our research was also focused on finding ways of influencing the stereoselectivity of the reaction and the separation of the resulting diastereomers. The diastereomeric ratio of the Passerini products was found to be approximately 2:1 for all the reactions performed. This ratio could be modified slightly when using certain carboxylic acids and isocyanides that were either very bulky or had a stereogenic centre. Attempts to enzymatically resolve the diastereomeric products were not successful after trials using a library of 25 lipase enzymes. However, use of preparative HPLC enabled the successful separation of most of the diastereomeric mixtures, affording compounds with high purity. X-ray crystallography enabled us to identify the major diastereomers as having the R,S configuration, whilst the minor diastereomers had the S,S configuration at the two stereogenic centres. A possible explanation for the observed stereoselectivity is based on the Felkin-Anh chelation control model. It suggests that mono-protected amino aldehydes follow a chelation controlled mechanism in nucleophilic addition reactions. Chelation occurs, albeit in the form of hydrogen bonding, between the NH and carbonyl oxygen. The library of compounds was tested for activity against both HIV-1 and malaria. Only three compounds showed moderate activity against the malaria parasite, inhibiting parasitic growth by 37-42% at 5 μM respectively. Significantly, all of the active compounds contained an adamantyl moiety. Unfortunately no anti-HIV activity was seen for any of the compounds tested in the HIV-assay.
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Rice, Jessica Dawn. "Attention and concentration functions in HIV-positive adolescents who are on anti-retroviral treatment." Thesis, 2014.
Find full textAbstract:
Approximately 11.5 million Human Immunodeficiency Virus (HIV)-positive individuals were living in South Africa in 2007, many of whom were infected via mother-to-child transmission. The current study aimed to compare the attentional and concentration functioning of 30 seropositive adolescents on managed anti-retroviral (ARV) programmes, with a comparable group of 71 seronegative adolescents. The results showed that the uncorrected errors on trial 1; self-corrected errors on trial 2; time taken, uncorrected and self-corrected errors on trial 3 of the Stroop Colour-Word Interference Test; and the errors on the Trail Making Test Part B were significantly poorer in the seropositive sample. The results also indicated that the clinical variations in the HIV-positive sample, including the age at which ARVs were commenced; duration of ARV treatment; World Health Organisation (WHO) stage at diagnosis; starting and current CD4+ counts; and starting viral load, but with the exception of the current viral load, impacted significantly on test performance.
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"Investigation of the anti-HIV effects and underlying mechanisms of Chinese medicines." 2013. http://library.cuhk.edu.hk/record=b5884436.
Full textAbstract:
Cheng, Baohui.Thesis (Ph.D.)--Chinese University of Hong Kong, 2013.
Includes bibliographical references (leaves 206-221).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Abstracts also in Chinese.
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Maganlal, Urvashi. "Executive function performance in HIV positive adolescents of anti-retroviral treatment in Johannesburg, South Africa." Thesis, 2014.
Find full textAbstract:
Executive Function is conceptualized in this study as the ability to form (the planning functionality obtained through initiation and working memory), maintain (response selection and the ability to self-regulate and inhibit) and switch (cognitive flexibility, mental tracking, organization and sequencing) mental processes in order to effect a positive outcome. The present research is a quasi-experimental study embedded in the Positivist tradition that sets out to empirically evaluate the Executive Function profile of seropositive adolescents (n = 29) emerging from a low socio-economic background and currently on a managed ART programme when compared to a healthy contrast group (based on age, socio-demographic and educational system). As a quantitative study, Executive Function was operationalized through the use of multiple tests of Executive Function such as the Delis-Kaplan Executive Function Colour Word Interference Test (D-KEFS CWIT), the Wisconsin Card Sorting Test (WCST) and the Trail Making Test Part B (TMT-B). As the study formed part of a larger study that included additional neurocognitive tests, including the WISC-R, selected subtests from the WISC-R were used to validate specific arguments relating to the study. The results showed that HIV positive adolescents were inclined to have poorer Executive Function performance especially under situations of higher cognitive load when compared to the unaffected group. The implications of these results are discussed in this research.
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Brink, Mnandi. "Evaluation of botanical extracts with immune enhancing and /or anti-HIV activity in vitro." Thesis, 2011. http://hdl.handle.net/10210/3945.
Full textAbstract:
M.Sc.To successfully intervene in the HIV/AIDS pandemic, knowledge of the pathogenesis of the disease and factors that stimulate or inhibit viral replication are crucial. Plants are expected to produce antiviral compounds since viruses form one of the major groups of plant pathogens. The objective in this project was to investigate the effects of 6 plant extracts on immune responses as well as evaluate their potential anti-HIV activity. Plant species tested were: Hypoxis hemerocal/idea, Elephantorrhiza elephantina, Spirulina platensis, Echinacea purpurea, Echinacea pal/ida and Cannabis sativa. Extracts were prepared via 24 hour extraction or 12 hour reflux in H20, methanol and ethanol in a 1:5 ratio. The crude extracts were analysed by TLC and HPLC and shown to consist of complex related mixtures of compounds. Using LC-MS, partial identification of methanol extracts revealed the following expected compounds: 9- octadecenoic acid (E)- in Hypoxis hemerocallidea, 4H-1-benzopyran-4-one,2-(3,4- dihydroxyphenyl)-7 -(13-D-glucopyranosyloxy)-5-hydroxy- in E/ephantorrhiza e/ephantina, ethanol,2-butoxy-,phosphate in Spirulina platensis, 2-propenoic acid,3-(3,4-dihydroxyphenyl)- in Echinacea purpurea, 2-propenoic acid,3-(3,4-dihydroxyphenyl)- in Echinacea pal/ida and ~-9- tetrahydrocannabivarin in Cannabis sativa tincture. Viability assays using tetrazolium salts (XTT) gave a qualitative picture of events allowing us to assess host cell responses and extract toxicity. Extracts exhibited intrinsic absorbances at some visible wavelengths but did not interfere at the wavelengths used in this viability assay. Having analysed cell viability it was thought prudent to report on the type of cell death induced by either HIV or the extracts, so Annexin-V (indicator of apoptosis) and PI (indicator of necrosis) detected by flow cytometry was employed. Results obtained revealed that cells were driven towards necrosis rather than apoptosis. None of the extracts showed significant in vitro toxicity in CEMss, CEMNKR. U937, Jurkat and PM1 cells or ex vivo in PBMC at a concentration range of 1000f..lg/ml-4f.!g/ml. Viability assays were also an indirect indication of HIV's effect on the cells. As for the effect of extracts on the immune system, IL-2 secretion was stimulated by most of the extracts. The effect of plant extracts on HIV activity was also investigated by looking at core protein levels (p24 was generally decreased by methanol extracts), reverse transcriptase activity (no detectable influence) and envelope glycoprotein levels (gp120 levels were only marginally reduced). It appears that Echinacea purpurea, Echinacea pal/ida and Spirulina platensis have immune enhancing abilities, while Hypoxis hemerocallidea, Elephantorrhiza e/ephantina and Cannabis sativa have dual purposes by enhancing both immunity and inhibiting HIV activity.
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Altmann, André [Verfasser]. "Bioinformatical approaches to ranking of anti-HIV combination therapies and planning of treatment schedules / André Altmann." 2010. http://d-nb.info/1005539871/34.
Full text
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Lugongolo, Masixole Yvonne. "Using sodium bisulphite treatment and PCR to construct mammalian anti-HIV-1 long hairpin RNA expression cassettes." Thesis, 2012. http://hdl.handle.net/10210/4686.
Full textAbstract:
M.Tech.RNA interference (RNAi) is a gene silencing mechanism that uses short RNA duplexes to block gene expression. This mechanism has been widely explored to determine functions of genes. Furthermore, this phenomenon has been used to silence unwanted genes such as viral genes. RNAi has been successfully employed in non-mammalian organisms such as plants, where long dsRNAs (more than 30 bp) have been used without inducing non-specific effects. However, in mammalian cells, cytoplasmic dsRNAs of more than 30 bp trigger non-specific induction of many genes, which may result from the activation of dsRNA-dependent protein kinase (PKR) and 2’,5’-oligoadenylate synthetase (2’,5’-OAS), via the interferon response pathway. In this study, we describe a novel and simple strategy to overcome nonspecific effects induced by longer RNA duplexes. This strategy uses sodium bisulphite which is a mutagen that deaminates cytosine residue to uracil residues in order to introduce mutations in the sense strand of the duplex. Introduction of these mutations results in the formation of G:U pairings between the sense and antisense strands of the long hairpin RNA. RNA duplexes with mismatches have been shown to be able to prevent interferon induction in mammalian cells. According to the obtained results, long hairpins RNA with and without mismatches were unable to inhibit the expression of the target region, which was the U5 region of the HIV-1 subtype C LTR. The U5 region of the LTR is actively involved in the reverse transcription of HIV-1. Therefore silencing of this region would have led to the inhibition or reverse transcription blockage. Furthermore, data showed that the interferon response was induced when using these long hairpin RNA duplexes. Due to the sensitivity of mammalian cells, the action of sodium bisulphite could have stimulated certain genes of the interferon pathway. Even though hairpins constructed in this study were unable to prevent the induction of the interferon response pathway and also could not silence the target, this strategy of using sodium bisulphite has a great potential as shown by its ability to induce changes in cytosine residues and leaving other nucleotides unchanged.
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Negash, Tefera Girma. "Personal factors influencing patients' anti-retroviral treatment adherence in Addis Ababa, Ethiopia." Diss., 2011. http://hdl.handle.net/10500/5090.
Full textAbstract:
This study attempted to identify personal (patient-related) factors influencing anti-retroviral therapy (ART) adherence in Addis Ababa, Ethiopia. A quantitative, descriptive, cross-sectional and analytical design was used. Structured interviews were conducted with 355 ART patients.
The findings revealed that stigma, discrimination, depression and alcohol use negatively affected patients’ ART adherence levels. However, patients’ knowledge levels had no influence on their ART adherence levels, contrary to other researchers’ reports.
Addressing stigma and discrimination at community levels might enhance patients’ abilities to take their medications in the presence of others. Healthcare professionals should be enabled to diagnose and treat depression among ART patients during the early stages. Non-adherent ART patients should be counseled about possible alcohol abuse.Health Studies
M.A. (Public Health with specialisation in Medical Informatics)
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Musvipwa, Faith Mary. "The influence of traditional healing practices on anti-retroviral treatment adherence in Vhembe District, South Africa." Thesis, 2019. http://hdl.handle.net/11602/1426.
Full textAbstract:
PhD (Sociology)Department of Sociology
The purpose of the study was to investigate the influence of traditional healing practices on anti-retroviral treatment adherence in Vhembe District. This qualitative study used an explorative design to envisage the aim. A cross-sectional snowball sample was used to draw a sample of 9 participants from the 4 municipalities of Vhembe District. The data collection methods were; in-depth interviews, focus group discussions and key informants’ interviews. The 3 data collection techniques ensured triangulation for more complete and well-validated outcomes of the study. The researcher used the Van Manen method to analyse data. Contrary to popular belief that THPs promote non-adherence among people living with HIV/AIDS (PLWHA), the study found out that the majority of Traditional Healing Practitioners (THPs) encourage and positively influence PLWHA to adhere to anti-retroviral treatment. Apart from a minority of participants who claimed to cure HIV/AIDS, the majority acknowledged and admitted that traditional healing practices do not cure HIV/AIDS but it only heals opportunistic infections. As a result, the majority of THPs influences PLWHA to adhere to anti-retroviral therapy (ART). However, the positive influence of THPs is challenged by individual and social-cultural factors that are beyond THPs’ control which influence treatment adherence such as; traditional and cultural beliefs, side effects of ARVs, nurses’ attitude, inconveniences, lack of transport, personal choices, lack of trust in ARVs and fear of loss of the Disability Grant. It is on this backdrop that study findings prompted devising of a model and a 5 phase support program for intervention.
NRF
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Ratshihume, Phumudzo Terrence. "Factors contributing to clients defaulting anti-retroviral treatment at Matoks Capricorn District, Limpopo Province." Diss., 2018. http://hdl.handle.net/11602/1067.
Full textAbstract:
MPHDepartment of Public Health
Background: The provision of antiretroviral treatment for people living with HIV/AIDS has encountered many challenges associated with poor adherence in South African and other countries in Africa as a whole including globally. Taking ARVs Properly has shown to reduce viral load to a level where the virus becomes undetectable and these results in an increase of CD4 count cells. These decreases chances of oppotunistic infections but it requires a proper adherence and compliance to treatment which seems to be difficult to most patients on ART. Purpose: The study investigated factors contributing to clients defaulting antiretroviral treatment. Methodology: A qualitative explorative cross-sectional study design was conducted at Matoks in Capricon District, in the months of May, June and July 2017. A purposive sampling method was used to select 19 respondents whom where willing to voluntrily participate in the study from a population of People Living With HIV/AIDS (PLWHV). An indepth face to face interview was used to collect data, guided by a central question and probing. It was then analyzed by the use of eight steps of Tesch. Results: The findings revealed that women were more defaulters than men. Shortages of antiretroviral treatment and most clients were unable to collect ART on time due to lack of transport to the clinic and the long distance from their perspective homes to the clinic. Socio economic conditions and indegenious health beliefs were some of factors identified. Recommendations: extensive health education and promotion should be intensified to reach all community members of Matoks and PLWHA in terms of HIV/AIDS care and consistent taking of treatment that clients who live far away from the clinic will be able to collect the ARV treatment nearer to their place of residents.
NRF
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Ramatowski, John W. "Evaluation of HIV treatment and prevention programs in South Africa with recommended future actions." Thesis, 2020. https://hdl.handle.net/2144/41162.
Full textAbstract:
The outbreak of Human Immunodeficiency Virus (HIV) is one of the largest public health challenges in history. South Africa disproportionately bears the burden of HIV infections with an estimated 7.7-million people living with HIV. Although a comprehensive treatment and prevention program has been enacted in the country, the health gains achieved by these interventions have fallen short of targets set by the United Nations Programme on HIV/AIDS. Significant proportions of the population are unaware they have contracted HIV and knowledge about HIV transmission is generally lacking. For patients accessing HIV treatment services, adherence to prescribed regimens is a principal barrier to positive health outcomes. These challenges are further compounded by the development of resistance to HIV treatments.
Between 2017-2022, South Africa will implement the four-generation ‘National Strategic Plan on HIV, Tuberculosis, and Sexually Transmitted Infections.’ This framework outlines interventions that will address the biomedical, behavioral, and structural barriers that have sustained HIV transmission while accelerating health advances for people living with HIV. As a result of this integrated approach and the targeted intervention population, South Africa operates the largest HIV treatment program in the world. Evaluation of South Africa’s HIV treatment and prevention activities are needed to ensure the enacted programs continually meet the needs of the population as they change over time. Additionally, program evaluation ensures limited resources are allocated in a judicious manner. Collectively, these evaluations can result in program alterations that deliver the maximum health benefit for all South African citizens.
Upon analysis of the South Africa’s National Strategic Plan, several flaws in current program delivery, funding allocations, and accountability actions are immediately evident. The four generation Plan does not include specific steps outlining the exact actions that should be followed by local health officials. The Plan architects failed to incorporate key recommendations from previous investigations there were specific to the South African HIV care delivery model. If these shortcomings persist, South Africa is unlikely to meet proposed HIV reduction targets set by global health organizations.
From this analysis, several amendments are recommended to the current plan, including the application of artificial intelligence behavioral mapping for at risk populations and the reallocation of funding to condom distribution, medical-male circumcisions, and social behavior change activities. These amendments represent actionable items that can spur health advancements for the HIV treatment and prevention program in South Africa.2022-06-08T00:00:00Z
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Kwon, Jun-Wook. "Modeling the impacts of an anti-HIV drug treatment program on the HIV epidemic a dissertation submitted in partial fulfillment ... for the degree of Doctor of Public Health (Epidemiology) ... /." 1997. http://catalog.hathitrust.org/api/volumes/oclc/68800665.html.
Full text