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Serna, Bolea Cèlia. "Epidemiología de las fases tempranas de la infección por el VIH en pacientes ambulatorios de una zona semi-rural del sur de Mozambique." Doctoral thesis, Universitat de Barcelona, 2012. http://hdl.handle.net/10803/83499.
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Las etapas iniciales de la infección por VIH se caracterizan por elevados niveles de ARN viral, que pueden estar contribuyendo significativamente a la transmisión del virus y al mantenimiento de la epidemia. Existe poca información sobre estas etapas precoces de la infección en zonas de África donde predomina el subtipo C del VIH. Este trabajo ha caracterizado la epidemiología y los parámetros inmuno-virológicos de las fases iniciales de la infección por VIH en una zona del sur de Mozambique
La primera parte de este trabajo se enfocó en la identificación de infecciones agudas (AHI) en pacientes ambulatorios de una zona semi-rural del sur de Mozambique. En esta zona endémica de malaria, la población está habituada a acudir al hospital tras sentir síntomas febriles característicos de la malaria, pero también del síndrome retroviral agudo del VIH. Esta situación, presente en muchos países del sur de África, presenta una oportunidad de dirigir una búsqueda de casos de AHI hacia pacientes con síndrome febril. Usando esta estrategia, se describió una elevada prevalencia de AHI (3.3%) en los pacientes ambulatorios con síndrome febril. Estos pacientes mostraron elevados niveles de carga viral (CV) y de activación de las células T-CD8.
En la segunda parte de este trabajo, se caracterizó la infección reciente por VIH, definida como los primeros 12 meses desde la infección. Se encontró una baja prevalencia de infecciones recientes por VIH (11.58%) en personas que acuden voluntariamente al centro de asesoramiento para VIH del hospital. Un grupo de pacientes identificados con infección reciente por VIH mostraron, como en el caso de los AHI, elevados niveles de carga viral por encima de 105 copias/ml de plasma que fueron mantenidos durante los 10 meses de seguimiento. Estos pacientes con elevados niveles de CV representarían un mayor riesgo de transmisión del VIH, señalando la importancia en la identificación de infecciones agudas y recientes para las estrategias de prevención del VIH.
Los resultados de esta tesis reúnen información sobre la epidemiología de las fases iniciales de la infección por VIH en una zona de elevada prevalencia donde no había datos previos. Estos resultados contribuyen a la caracterización de las fases tempranas de la infección por VIH con la perspectiva de llevar a cabo intervenciones en las fases iniciales para mejorar el pronóstico del paciente y disminuir el riesgo de transmisión. Además apoyan la necesidad de más desarrollo de pruebas de diagnóstico rápido para la detección de las fases tempranas en condiciones locales.
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De, la Harpe Alana. "A comparative analysis of mathematical models for HIV epidemiology." Thesis, Stellenbosch : Stellenbosch University, 2015. http://hdl.handle.net/10019.1/96983.
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Thesis (MSc)--Stellenbosch University, 2015.ENGLISH ABSTRACT: HIV infection is one of the world’s biggest health problems, with millions of people infected worldwide. HIV infects cells in the immune system, where it primarily targets CD4+ T helper cells and without treatment, the disease leads to the collapse of the host immune system and ultimately death. Mathematical models have been used extensively to study the epidemiology of HIV/AIDS. They have proven to be effective tools in studying the transmission dynamics of HIV. These models provide predictions that can help better our understanding of the epidemiological patterns of HIV, especially the mechanism associated with the spread of the disease. In this thesis we made a functional comparison between existing epidemiological models for HIV, with the focus of the comparison on the force of infection (FOI). The spread of infection is a crucial part of any infectious disease, as the dynamics of the disease depends greatly on the rate of transmission from an infectious individual to a susceptible individual. First, a review was done to see what deterministic epidemiological models exist. We found that many manuscripts do not provide the necessary information to recreate the authors’ results and only a small amount of the models could be simulated. The reason for this is mainly due to a lack of information or due to mistakes in the article. The models were divided into four categories for the analysis. On the basis of the FOI, we distinguished between frequency- or density-dependent transmission, and as a second criterion we distinguished models on the sexual activity of the AIDS group. Subsequently, the models were compared in terms of their FOI, within and between these classes. We showed that for larger populations, frequency-dependent transmission should be used. This is the case for HIV, where the disease is mainly spread through sexual contact. Inclusion of AIDS patients in the group of infectious individuals is important for the accuracy of transmission dynamics. More than half of the studies that were selected in the review assumed that AIDS patients are too sick to engage in risky sexual behaviour. We see that including AIDS patients in the infectious individuals class has a significant effect on the FOI when the value for the probability of transmission for an individual with AIDS is bigger than that of the other classes. The analysis shows that the FOI can vary depending on the parameter values and the assumptions made. Many models compress various parameter values into one, most often the transmission probability. Not showing the parameter values separately makes it difficult to understand how the FOI works, since there are unknown factors that have an influence. Improving the accuracy of the FOI can help us to better understand what factors influence it, and also produce more realistic results. Writing the probability of transmission as a function of the viral load can help to make the FOI more accurate and also help in the understanding of the effects that viral dynamics have on the population transmission dynamics.
AFRIKAANSE OPSOMMING: MIV-infeksie is een van die wêreld se grootste gesondheidsprobleme, met miljoene mense wat wêreldwyd geïnfekteer is. MIV infekteer selle in die immuunstelsel, waar dit hoofsaaklik CD4+ T-helperselle teiken. Sonder behandeling lei die siekte tot die ineenstorting van die gasheer se immuunstelsel en uiteindelik sy dood. Wiskundige modelle word breedvoerig gebruik om die epidemiologie van MIV/vigs te bestudeer. Die modelle is doeltreffende instrumente in die studie van die oordrag-dinamika van MIV. Hulle lewer voorspellings wat kan help om ons begrip van epidemiologiese patrone van MIV, veral die meganisme wat verband hou met die verspreiding van die siekte, te verbeter. In hierdie tesis het ons ‘n funksionele vergelyking tussen bestaande epidemiologiese modelle vir MIV gedoen, met die fokus van die vergelyking op die tempo van infeksie (TVI). Die verspreiding van infeksie is ‘n belangrike deel van enige aansteeklike siekte, aangesien die dinamika van die siekte grootliks afhang van die tempo van oordrag van ‘n aansteeklike persoon na ‘n vatbare persoon. ‘n Oorsig is gedoen om te sien watter kompartementele epidemiologiese modelle alreeds bestaan. Ons het gevind dat baie van die manuskripte nie die nodige inligting voorsien wat nodig is om die resultate van die skrywers te repliseer nie, en slegs ‘n klein hoeveelheid van die modelle kon gesimuleer word. Die rede hiervoor is hoofsaaklik as gevolg van ‘n gebrek aan inligting of van foute in die artikel. Die modelle is in vier kategorieë vir die analise verdeel. Op grond van die TVI het ons tussen frekwensie- of digtheidsafhanklike oordrag onderskei, en as ‘n tweede kriterium het ons die modelle op die seksuele aktiwiteit van die vigs-groep onderskei. Daarna is die modelle binne en tussen die klasse vergelyk in terme van hul TVIs. Daar is gewys dat frekwensie-afhanklike oordrag gebruik moet word vir groter bevolkings. Dit is die geval van MIV, waar die siekte hoofsaaklik versprei word deur seksuele kontak. Die insluiting van die vigs-pasiënte in die groep van aansteeklike individue is belangrik vir die akkuraatheid van die oordrag-dinamika van MIV. Meer as helfte van die uitgesoekte studies aanvaar dat vigs-pasiënte te siek is om betrokke te raak by riskante seksuele gedrag. Ons sien dat die insluiting van vigs-pasiënte in die groep van aansteeklike individue ‘n beduidende uitwerking op die TVI het wanneer die waarde van die waarskynlikheid van oordrag van ‘n individu met vigs groter is as dié van die ander klasse. Die analise toon dat die TVI kan wissel afhangende van die parameter waardes en die aannames wat gemaak is. Baie modelle voeg verskeie parameter waardes bymekaar vir die waarskynlikheid van oordrag. Wanneer die parameter waardes nie apart gewys word nie, is dit moeilik om die werking van die TVI te verstaan, want daar is onbekende faktore wat ‘n invloed op die TVI het. Die verbetering van die akkuraatheid van die TVI kan ons help om die faktore wat dit beïnvloed beter te verstaan, en dit kan ook help om meer realistiese resultate te produseer. Om die waarskynlikheid van oordrag as ‘n funksie van die viruslading te skryf kan help om die TVI meer akkuraat te maak en dit kan ook help om die effek wat virale dinamika op die bevolkingsoordrag-dinamika het, beter te verstaan.
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Eaton, Twilla. "Epidemiology of Mycobacterium avium complex infecting AIDS patients." Thesis, This resource online, 1993. http://scholar.lib.vt.edu/theses/available/etd-03302010-020032/.
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Rose, Penelope Cathryn. "Tuberculosis treatment delay in adults and household transmission to children: a community-based study in a setting with high burden of tuberculosis and HIV." Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/16726.
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Includes bibliographical referencesBackground: Tuberculosis (TB) control depends on interrupting transmission through rapid diagnosis and treatment initiation of infectious TB cases. With increasing delay in the diagnosis and treatment of pulmonary TB, disease is likely to progress, leading to progressive lung cavitation and increased sputum bacillary load, likely increasing TB transmission. This study investigated the effect of treatment delay in adult TB patients on the risk of TB infection and disease in child household contacts. Methodology: Secondary analysis was performed using data from a community-based household contact investigation study. Cross-sectional analysis was conducted of baseline data collected at enrolment. Children aged three months to fifteen years with documented household exposure to an adult with TB were enrolled between December 2007 and June 2012. These children were screened for TB infection (Mantoux tuberculin skin test [TST] and two interferon-gamma release assays [IGRA]) and disease. Total treatment delay was measured in adult TB source cases as the time from cough onset until treatment initiation, with those reporting no cough serving as the reference category. Logistic regression models were used to evaluate the effect of total treatment delay in adults on the risk of TB infection in child household contacts, with TB disease evaluated as a secondary endpoint. Results In total 671 children were enrolled as household contacts of 290 adult TB source cases. In multivariate analysis, the odds of TST positivity increased with cough duration ≥4 weeks prior to TB treatment initiation (odds ratio (OR) = 1.77 [95% CI 1.02-3.09] for cough <4 weeks; OR = 2.74 [95% confidence interval ( CI ) = 1.39-5.40] for cough 4-12 weeks; OR = 2.39 [95% CI = 1.19-4.82] for cough >12 weeks, compared to non-coughing adult TB patients), child's age ≥5 years (OR = 4.51, [95% CI = 2.60-7.83]), sharing the same bedroom (OR = 2.17, [95% CI = 1.43-3.31]), more than one household TB contact (OR = 2.70, [95% CI = 1.35- 2 5.42]) and with household tobacco smoke exposure (OR = 2.10, [95% CI = 1.22-3.61]). Adult TB source case HIV status did not modify the association between cough duration and risk of infection in children. Results of analyses of TB infection indicated by IGRA positivity were consistent with TST results. Prevalent TB disease in child contacts was associated with source case sputum smear and culture positivity, additional household TB contacts and decreasing age of the child. Conclusions: Delays of longer than four weeks from cough onset until TB treatment initiation were associated with increased risk of TB infection in child household contacts. These findings confirm the importance of reducing delays in TB diagnosis and treatment in adults to reduce transmission, ideally to less than four weeks. Although HIV co -infected TB patients are often considered less infectious, delayed treatment initiation remained associated with TB transmission, even amongst HIV co-infected adults with TB. In addition to the traditional risk factors for developing TB disease after infection, source case exposure factors also increased the risk of exposed children developing TB disease.
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Petoumenos, Kathy Public Health & Community Medicine Faculty of Medicine UNSW. "Treatment experience and HIV disease progression: findings from the Australian HIV observational database." Awarded by:University of New South Wales. School of Public Health and Community Medicine, 2006. http://handle.unsw.edu.au/1959.4/24937.
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The Australian HIV Observational Database (AHOD) is a collaboration of hospitals, sexual health clinics and specialist general practices throughout Australia, established in April 1999. Core data variables collected include demographic data, immunological and virological markers, AIDS diagnosis, antiretroviral and prophylactic treatment and cause of death. The first electronic data transfer occurred in September 1999 followed by six monthly data transfers thereafter. All analyses included in this thesis are based on patients recruited to AHOD by March 2004. By March 2004, 2329 patients had been recruited to AHOD from 27 sites throughout Australia. Of these, 352 (15%) patients were recruited from non-metropolitan clinics. The majority of patients were male (94%), and infected with HIV through male homosexual contact (73%). Almost 90% of AHOD patients are antiretroviral treatment experience, and the majority of patients are receiving triple therapy as mandated by standard of care guidelines in Australia. Antiretroviral treatment use has changed in Australia reflecting changes in the availability of new treatment strategies and agents. The crude mortality rate was 1.58 per 100 person years, and of the 105 deaths, more than half died from HIV-unrelated deaths. The prevalence of HBV and HCV in AHOD was 4.8% and 10.9%, respectively. HIV disease progression in the era of highly active antiretroviral treatment (HAART) among AHOD patients is consistent with what has been reported in developed countries. Common factors associated with HIV disease progression were low CD4 cell count, high viral load and prior treatment with mono or double therapy at the time of commencing HAART. This was demonstrated in AHOD in terms of long-term CD4 cell response, the rate of changing combination antiretroviral therapy and factors predicting death. HBV and HCV coinfection is also relatively common in AHOD, similar to other developed country cohorts. Coinfection does not appear to be serious impediments to the treatment of HIV infected patients. However, HIV disease outcome following HAART does appear to be adversely affected by HIV/HCV coinfection but not in terms of HIV/HBV coinfection. Patients attending non-metropolitan sites were found to be similar to those attending metropolitan sites in terms of both immunological response and survival.
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Bezerra, Leila Maria Machado. "PrevalÃncia de co-infecÃÃo pelos vÃrus linfotrÃpico de cÃlulas T humanas do adulto â HTLV e vÃrus da imunodeficÃncia adquirida â HIV, no CearÃ." Universidade Federal do CearÃ, 2003. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=7673.
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No Brasil vÃrios estudos demonstraram prevalÃncia de coinfecÃÃo pelos vÃrus linfotrÃpico de cÃlulas T humanas â HTLV e vÃrus da imunodeficiÃncia humana â HIV, dentre grupos especÃficos de indivÃduos, que variou de 0,58% a 11,4%. O CearÃ, segundo dados anteriores, representa dentre os Estados do Nordeste, uma Ãrea de baixa endemicidade para a infecÃÃo pelos vÃrus HTLV. Este estudo tem por objetivo estudar aspectos clÃnicos e epidemiolÃgicos da coinfecÃÃo por HTLV e HIV, em Hospital de referÃncia para tratamento de pacientes com HIV do CearÃ. Este estudo à descritivo, do tipo transversal, realizado no perÃodo de maio de 2001 a outubro de 2002. Foram colhidas 420 amostras de sangue de pacientes soropositivos ao HIV, confirmados por Elisa e Western Blot que posteriormente foram testadas para HTLV-I/II, no Centro de Hematologia do Cearà â HEMOCE. Entrevistou-se 337 pacientes e pesquisou-se 165 prontuÃrios mÃdicos para obtenÃÃo de informaÃÃes referentes à dados sÃcio-econÃmicos, fatores de risco para HTLV, prÃticas sexuais e aspectos clÃnicos. Os resultados revelaram valor de soroprevalÃncia geral de 0,95%, distribuÃdos em 0,23% de HIV-HTLV-I e 0,47% de HIV-HTLV-II, seguido de 01 (0,23%) amostra com sorologia indeterminada. NÃo foi evidenciada concomitÃncia de infecÃÃo pelos vÃrus HTLV-I e HTLV-II. A populaÃÃo estudada concentrou maior nÃmero de pacientes na faixa etÃria de 30 a 39 anos, era predominantemente de baixa renda (67,6%), menor grau de escolaridade (44,8%) e constituÃda na sua maioria por heterossexuais (67,8%). Quanto Ãs manifestaÃÃes clÃnicas pesquisadas em 119 indivÃduos, 105 (88,2%) manifestaram doenÃa intercorrente e 14 (11,8%) foram assintomÃticos, sendo 111 (93,27%) com definiÃÃo para diagnÃstico de AIDS. Um percentual elevado dos entrevistados amamentou (38,5%), sendo baixa a exposiÃÃo ao uso de tatuagem (12,2%) e a transfusÃo de sangue (15,9%). Foi notada que a escassez no uso de drogas intravenosas (4,8%), um menor nÃmero de negros (5,6%) e maior nÃmero de preferÃncia heterossexual (67,8%), poderiam ser os principais fatores apontados como responsÃveis pela baixa prevalÃncia encontrada em nosso Estado.Several studies carried out in Brazil have shown a serum-prevalence rate of HIV / HTLV (Human Immunodeficiency - virus / Human T-Lymphotropic virus) co-infection of 0.58% to 11.4% among specific groups of individuals. Based on previous data, the State of Cearà is considered an area of low HTLV prevalence in the northeastern Brasil. This study evaluated the clinical and epidemiological aspects of the HIV / HTLV co-infection in a reference hospital for the treatment of HIV infected patients in CearÃ. A descriptive, cross sectional study was performed, in the period of May of 2001 to October of 2002. Blood samples were randomly collected from 420 HIV-positive patients, through Elisa and Western Blot tests, that later were serologically tested for HTLV-I/II in the Hematological Center of Cearà - HEMOCE. Interviews were done in 337 patients and 165 files were searched for socio-economic, risk factors for HTLV, sexual practice and clinical aspects. The results confirmed a general seroprevalence value of 0.95%, distributed as 0.23% of HIV-HTLV-I and 0.47% of HIV-HTLV-II, followed by one (0.23%) sample of undetermined serology. Concomitant infection was not evidenced by the viruses HTLV-I and HTLV-II. The population studied was more frequently 30 to 39 years old, had predominantly lower income (67.6%) and educational (44.8%) levels and were heterosexual mainly (67,8%). In 119 patients evaluated, 105 (88.2%) complained of HIV-related diseases, 14 (11.8%) were asymptomatic and 111 (93.3%) were diagnosed with AIDS. An elevated percentage was breast fed (38.5%), few had had tattoos (12.2%), and also did receive blood products (15,9%). The scarce use of intravenous drugs (4.8%), the few numbers of black individuals (5.6%) and higher numbers of heterosexuals (67.8%), were pointed as possible reasons for the low HTLV prevalence found in this research.
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Labeodan, Moremi Morire OreOluwapo. "Stochastic analysis of AIDS epidemiology." Thesis, Pretoria : [s.l.], 2009. http://upetd.up.ac.za/thesis/available/etd-10172009-112824.
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Andersson, Sören. "HIV-1 and HIV-2 infections in Guinea-Bissau, West Africa : studies of immune responses, prevailing viruses and epidemiological trends /." Stockholm, 1999. http://diss.kib.ki.se/1999/91-628-3735-4/.
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Okeke, Michael Ifeanyi. "Behaviors Related to HIV Infections in Rural Versus Urban Regions of Nigeria." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2165.
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Efforts by the Federal Republic of Nigeria and international nongovernmental agencies to reduce the impact of HIV in Nigeria have not yielded the anticipated results. This study focused on the association between attitude, religious beliefs, knowledge of HIV, sexual risk behavior, and HIV epidemiology in rural and urban Nigeria. This quantitative study used social-cognitive theory and problem theory. The study was based on the Nigerian Demographic and Health Survey (NDHS) 2013 data including a sample of 33,006 participants. Specific covariates including gender, sexual partners over the past years, age at first sexual encounter, socioeconomic status, and literacy level were obtained from the sample. Two hypotheses from each research question were tested to guide the study methodology. Linear regression results suggested that knowledge, attitude, location, and religion predicted sexual risk behavior. Muslims showed the least sexual risk behaviors compared to other religions while more positive attitudes and more knowledge increased sexual risk behaviours. Location had no significant impact on sexual risk behavior. Spearman correlation results depicted a relationship between knowledge and sexual risk behaviors of urban and rural Nigerians separately. More knowledge depicted an increase in sexual risk behaviors. The study results may be useful to Ministry of Health and program planners in constructing culturally based HIV interventions. The significant relationship between knowledge, attitude towards sex, and religious practices may be incorporated with theoretical knowledge on social-cognitive variables to enhance further understanding of the way in which individuals may engage in preventive behaviors to reduce HIV and its effects in Nigeria. Reductions in the spread of HIV/AIDS would lead to a healthy and more productive society.
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Boyd, Anders. "Clinical epidemiology of multi-viral hepatitis infection among HIV-HBV infected patients." Paris 6, 2010. http://www.theses.fr/2010PA066618.
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Ces dix dernières années, l'allongement de l'espérance de vie des patients infectés par le VIH s'est accompagné de l'apparition de co-morbidités, en particulier hépatiques, dues aux co-infections chroniques par les virus des hépatites B (VHB), C (VHC) et Delta (VHD). Alors que les patients co-infectés par le VIH-VHB sont plus à risque d'être infectés par d'autres virus des hépatites chroniques, les données concernant spécifiquement l'influence respective des co-infections VHC, VHD et VHC-VHD sur les conséquences cliniques, le suivi virologique et l'efficacité du traitement dans le contexte du VIH sont quasi-inexistantes. A l'occasion de ce travail de thèse, nous avons montré dans un premier temps que l'hépatite Delta était un facteur prédictif majeur de fibrose et cirrhose par rapport aux patients co-infecté par le VIH-VHB ou VIH-VHB-VHC. Ensuite, nous avons montré que l'infection par le VHD est associée par une suppression de la réplication du VHB et VHC, même en présence d'un traitement antiviral efficace. Cependant, la persistance de blips de charge virale suggère qu'il est indispensable de mettre en place un suivi virologique rapproché des patients porteurs de co-infections multiples. Enfin, nous avons montré que le ténofovir, un des traitements majeurs contre le VHB, influence l'évolution de la fibrose chez les patients co-infectés VIH-VHB, mais pas chez les patients porteurs du VHD. Toutes ces données portant principalement sur l'hépatite Delta ont permis d'étayer l'impact clinique, virologique et thérapeutique de cette infection et d'apporter ainsi des éléments pour guider les recommandations de prise en charge de ces pathologies.
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Berggren, Palme Ingela. "Tuberculosis and HIV interaction in Ethiopian children : aspects on epidemiology, diagnosis and clinical management /." Stockholm, 2002. http://diss.kib.ki.se/2002/91-7349-296-5/.
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Pokharel, Ubin. "Factors Associated with Sexually Transmitted Infections (STIs) and Multiple STI Co-infections: Results from the EVRI HIV Prevention Preparedness Trial." Scholar Commons, 2016. http://scholarcommons.usf.edu/etd/6131.
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Objective: The objective of this study was to describe the prevalence of sexually transmitted co-infections and assess factors associated with a single infection and co-infections.
Methods: A total of 388 women were included in this study. At enrollment of the EVRI trial women were tested for five STIs: Human papilloma virus (HPV), Chlamydia trachomatis, Neisseria gonorrhoeae, Herpes simplex virus-2 (HSV-2) and Treponema pallidum. Prevalence of STI infections and proportion of women with different combinations of co-infections were calculated. Factors associated with single infection and STI co-infection were assessed using a polytomous logistic regression model and odds ratio (OR) and 95% confidence intervals (95% CI) were reported as the measure of association.
Results: Prevalence of a single STI and concurrent STI co-infections were high. Prevalence of chlamydia was 33%, syphilis 6%, HSV-2 46% and HPV 71%. The most common STI co-infection pattern was HPV-HSV (32%), followed by HPV-chlamydia (17%). The odds of single STI compared to no STIs was significantly lower for women who had education level of grade 7 compared to women who had some college or technical education (OR 0.16, 95% CI: 0.03-0.79).The odds of a single STI compared to no STIs were significantly higher (OR 3.02, 95% CI: 1.05-8.64) and the odds of concurrent STIs compared to no infection were significantly higher (OR 3.86, 95% CI: 1.42-10.48) for women with three or more lifetime partners compared to one life time partner.
Conclusions: STIs, single and multiple concurrent infections, are common among this cohort of South African women. These results strengthen the recommendation that STI screening and treatment needs to be a component of multiple intervention strategies among high-risk women residing in communities with high STI prevalence.
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Saxton, Peter John Waring, and n/a. "HIV epidemiology and behavioural surveillance among men who have sex with men in New Zealand." University of Otago. Dunedin School of Medicine, 2009. http://adt.otago.ac.nz./public/adt-NZDU20090505.150029.
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AIMS: HIV diagnoses among men who have sex with men (MSM) in New Zealand increased from the year 2001. The aim of the thesis was to improve understandings of the causes of the increase, in order to inform HIV prevention and identify further research needs.
METHODS: Epidemiological data on HIV and AIDS diagnoses among MSM in New Zealand were examined using information from the AIDS Epidemiology Group. A programme of regular behavioural surveillance among MSM was also designed and conducted.
RESULTS: Between 1996-2005, HIV diagnoses among MSM by antibody testing where HIV infection was acquired in New Zealand revealed two distinct phases: A very low period between 1997 to 2000 in which around 21 diagnoses were recorded annually; and a resurgent period from 2001 to 2005 where annual HIV diagnoses experienced a sustained rise to 66 at the end of 2005.
New adjusted estimates indicated that known prevalent HIV cases among MSM in New Zealand increased from 437 to 588 between 1995 and 2000 (35%), and from 588 to 965 (64%) between 2000 and 2005. This reflected diverging trends from the mid-1990s: Ongoing new HIV infections among MSM which accelerated from the year 2000; and decreased deaths from AIDS due to improved antiretroviral treatments. Unless the growing number of MSM with HIV is counterbalanced by a decrease in the rate of secondary transmission from positive individuals, it will increase the number of new HIV infections. Contrary to this, when expressed as diagnosed incidence-to-prevalence pool ratios (IPRs), the average annual rate of secondary transmission was found to be increasing over time.
The behavioural surveillance programme in Auckland surveyed 812 MSM in 2002, 1220 in 2004, and 1228 in 2006. An online module in 2006 additionally surveyed 2141 MSM, 647 of whom lived in Auckland.
There were no overall changes in HIV testing over the three offline surveys, suggesting that the increase in HIV diagnoses was not an artefact of testing patterns. There were also no widespread changes in the rate of unprotected anal sex with casual sex partners, or partners described as a "fuckbuddy" or a "boyfriend", among the overall offline samples.
However, the proportion of MSM recruited offline who had recently engaged in sex with a man met through the Internet increased significantly from 2002 to 2004 (from 26.6% to 44.8%). When MSM surveyed online in 2006 were examined, they exhibited riskier behaviours compared to offline-recruited respondents. For example, rates of non-condom use and sexual partner concurrency were especially high, and testing rates were lower.
CONCLUSION: It is likely that moderate changes involving increases in unprotected sex for some MSM, and alterations to sexual networks and sexual connectivity, have combined to push the reproductive rate of HIV beyond the new epidemic threshold set by the increase in longevity from the mid-1990s. These changes need not have been great if the reproductive rate of HIV was already situated close to the epidemic tipping point. In this case, a resurgent outbreak of HIV may even have been triggered by apparently small and subtle shifts in factors influencing HIV spread.
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Navér, Lars. "Perinatal HIV-1 infection : aspects on clinical presentation, viral dynamics and epidemiology /." Stockholm, 2004. http://diss.kib.ki.se/2004/91-7349-983-8/.
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Le, Thuy. "The clinical and environmental epidemiology of Penicillium marneffei infection in Vietnam." Thesis, University of Oxford, 2015. https://ora.ox.ac.uk/objects/uuid:2328a810-672f-404f-a5a1-4b7eec6d9140.
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Infection due to Penicillium marneffei (renamed to Talaromyces marneffei in 2011) has emerged as an important public health problem over the past two decades due to the arrival of the HIV epidemic in Asia. Since 2004, P. marneffei has become the second most common pathogen isolated from routine blood culture, after Cryptococcus neoformans, at the Hospital for Tropical Diseases in Ho Chi Minh City, the largest referral centre for HIV care in southern Vietnam. The clinical epidemiology of P. marneffei infection has not been studied in Vietnam. The fundamental epidemiological questions regarding the pathogen reservoirs and risks of acquisition remain poorly understood. The diagnosis relies on isolation of the pathogen from clinical specimens and can take up to 14 days to identify, resulting in delayed initiation of therapy which is associated with worse treatment outcomes. This thesis aims to increase knowledge and understanding of the clinical and environmental epidemiology of P. marneffei infection and to improve the speed and accuracy of diagnosis of P. marneffei infection. The Précis provides a brief background and rationale for the thesis. Chapter 1 is an introductory chapter and provides an overview of the epidemiology, ecology, mycology, pathology, immunology, clinical features, diagnosis, and treatment of P. marneffei infection. Chapter 2 summarizes the incidence and features of P. marneffei admissions at the Hospital for Tropical Diseases in Ho Chi Minh City over a 13 year period. During this period, 795 patients with P. marneffei infection were identified and hospital charts were obtainable for 513 (65%) patients. The data showed clear seasonality with an increase in incidence of approximately 30% during the rainy season compared to the dry season. The clinical and microbiological features and treatment outcomes of the patients were characterised. Poor outcome, defined as death or worsening disease at hospital discharge, occurred in 28% of patients. History of injection drug use, shorter duration of illness, absence of fever or skin lesions, higher respiratory rates, and lower platelet counts independently predicted poor outcome. Chapter 3 describes an analysis of meteorological factors that determine penicilliosis incidence in Ho Chi Minh City. Humidity, rather than precipitation, was the most important factor that governs the seasonality of penicilliosis. Higher humidity was associated with increased odds of penicilliosis versus cryptococcosis admissions. The infection incubation period was estimated to be between one and three weeks. Chapter 4 describes an analysis of exposure and behavioural risk factors for penicilliosis based on a matched case control study of 205 culture-confirmed HIV-infected penicilliosis cases and 405 HIV-infected controls recruited from two major HIV referral centres in Hanoi and Ho Chi Minh City. Penicilliosis was independently associated with proximity or exposure to tropical plants and exposure to farmed animals. The geographical analysis showed that patients living in or traveling to the highland regions were at increased risk for penicilliosis in southern Vietnam. Chapter 5 describes the development of a Taqman real-time PCR assay based on a novel Mp1 gene target unique to P. marneffei for rapid detection of P. marneffei infection in patient plasma. The assay was tested in 70 plasma samples from HIV-infected patients (50 with culture-confirmed penicilliosis, 20 with other opportunistic infections) and showed a clinical specificity of 100% (20/20) and sensitivity of 70.4% (19/27) and 52.2% (12/23) prior to and within 24-48 hours of antifungal therapy administration, respectively. Chapter 6 is an overview discussion interpreting the implications of the major findings and the future direction of P. marneffei research. The work of this thesis increases knowledge of the clinical epidemiology of P. marneffei infection in Vietnam, providing essential data for the design of prospective studies to improve the diagnosis and treatment of P. marneffei infection in Asia. The data suggest that multiple environmental factors including humidity, tropical plants, farmed animals, and highland location, are important drivers of P. marneffei infection in southern Vietnam. The real-time PCR assay showed potential as a rapid ârule-in' test for P. marneffei in this pilot study and should be prospectively evaluated in a large cohort to determine if it can improve diagnostic speed and crucially, impact patient outcomes. Prevention, diagnosis and elimination all require further research to reduce the high mortality following clinical disease caused by P. marneffei in Asia.
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Truong, Hong-Ha Manh. "Molecular epidemiology of HIV-1 transmission : a case study of source partners of individuals with acute retroviral syndrome /." Thesis, Connect to this title online; UW restricted, 2000. http://hdl.handle.net/1773/9282.
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Dube, Sabada. "The epidemiology and impact of vertically acquired HIV infections and the effect of PMTCT interventions in Zimbabwe." Thesis, Imperial College London, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.534956.
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Kent, Richard John. "The molecular epidemiology of Mycobacterium tuberculosis and Mycobacterium avium complex infections in HIV seropositive patients from South East England." Thesis, King's College London (University of London), 1997. https://kclpure.kcl.ac.uk/portal/en/theses/the-molecular-epidemiology-of-mycobacterium-tuberculosis-and-mycobacterium-avium-complex-infections-in-hiv-seropositive-patients-from-south-east-england(3ff7887d-37fd-4bfe-8f07-c8e59f31080b).html.
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Nuwaha, Fred Ntoni. "Sexually transmitted infections in Uganda : implications for control /." Stockholm, 2000. http://diss.kib.ki.se/2000/91-628-4409-1/.
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Denis, Blandine. "Epidemiology of fungal infections in HIV infected individuals in France : P jirovecii pneumonia and invasive aspergillosis in FHDH ANRS CO4." Thesis, Paris 6, 2016. http://www.theses.fr/2016PA066109/document.
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Depuis la disponibilité des combinaisons antirétrovirales (cART) en 1996, l’incidence des infections opportunistes classantes SIDA (IO), dont la pneumocystose (PCP) a très fortement diminué. Malgré tout, chez les patients infectés par le VIH, la PCP était la 2ème IO la + fréquente en France en 2001-2003 et les infections fongiques, avec 1 million de nouveaux cas/an de cryptococcose, restent un problème de santé publique majeur au niveau mondial. Cependant, depuis l’ère des cART, très peu de recherches épidémiologiques sur les infections fongiques dans les pays industrialisés ont été entreprises. C’est dans ce contexte que nous avons mené une étude épidémiologique de 2 infections fongiques chez les patients infectés par le VIH en France sur la French Hospital Database on HIV ANRS CO4 (FHDH) : la pneumocystose et l’aspergillose invasive. Concernant la pneumocystose, sur la période 2004-2011, dans la base FHDH, la moitié des 1259 cas de PCP étaient survenus chez des patients qui avaient interrompus leur suivi, et, pour ceux qui avaient déjà eu une IO avant la PCP, leur mortalité était de 25% à 3 ans. Pour l’aspergillose invasive (AI), après un retour national aux dossiers des cas déclarés sur 20 ans sur la base FHDH, un comité d’experts a validé 242 cas d’AI. Les données montrent que, chez les patients infectés par le VIH, seulement la moitié des AI validées répondaient aux critères EORTC. La mortalité à 3 mois après une AI s’est améliorée après l’ère des cART et un rôle protecteur du voriconazole sur la survie à 3 mois a également été démontré pour la 1ère fois chez les patients infectés par le VIHThe advent of combined antiretroviral therapy (cART) in 1996 resulted in a dramatic fall in the incidence of AIDS-defining illness (ADI), including Pneumocystis jirovecii pneumonia (PCP). Nevertheless, PCP was the second most frequent ADI in France in 2001-2003 and fungal infections remain a major threat for HIV-infected individuals worldwide. Epidemiological data on fungal infections in the late cART period in resource-rich settings are scarce. The purpose of our work was to study changes in the epidemiology of fungal infections among HIV-infected individuals in France in the late cART period, focusing on PCP and invasive aspergillosis (IA) in the French Hospital Database on HIV ANRS CO4 (FHDH). In the FHDH, during the 2004-2011 period, half of the 1259 PCP cases occurred among HIV-infected individuals who had waning adherence to care, and for those who had a prior ADI before PCP the 3-year mortality rate was 25%. For the second study on IA, a review committee validated IA cases among all the cases that included a diagnostic code for aspergillosis (ICD-9 or ICD-10) in the FHDH over a 20-year period. Our study demonstrated that only half of validated IA cases among HIV-infected individuals met EORTC criteria. The 3-months survival rate after IA diagnosis improved after the advent of cART and a protective role of voriconazole was observed in the period after 2001
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Cakata, Zethu. "Epidemiology of sexually transmitted infections in selected primary health care centres in the Eastern Cape Province." Thesis, University of the Western Cape, 2004. http://hdl.handle.net/11394/4599.
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Magister Psychologiae - MPsychAn epidemiological study was conducted with the main goal of describing the occurrences of the various STIs in the Eastern Cape province as well as biographical factors such as age, gender, and geographical location influencing them. Ten primary health care (PHC) centres located throughout the province served as sentinel sites for surveillance data collection for a period of 3 months using Daily and Monthly Report Forms. The surveillance data was analysed using relative frequencies to determine STIs prevalence. The main findings from the present study suggest that the most frequently encountered female syndromes were vaginal discharge and lower abdominal pains and most frequent male syndrome was Urethral discharge. Other syndromes accounted for less than 10% of the STI cases observed at the PHC centres during the study. The study also indicate that more STI patients were seen at urban PHC centres compared to rural ones and that most of the STI patients seen at PHC centres were women. These findings are helpful for the Health Department in the Eastern Cape Province to effectively plan for the control and prevention of all STIs including HIV I AIDS.
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Jacobs, Graeme Brendon. "Investigation of the molecular epidemiology of HIV-1 in Khayelitsha, Cape Town, using serotyping and genotyping techniques." Thesis, Link to the online version, 2005. http://hdl.handle.net/10019/1056.
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Abati, Paulo Afonso Martins. "Análise do perfil sociodemográfico, clínico e laboratorial de pessoas com mais de 13 anos vivendo com HIV/AIDS no oeste do Pará e tendências de incidência de AIDS em Santarém." Universidade de São Paulo, 2013. http://www.teses.usp.br/teses/disponiveis/5/5134/tde-27032013-103812/.
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A infecção pelo vírus da imunodeficiência humana na Amazônia tem-se mostrado como um dos mais recentes desafios para o enfrentamento da epidemia de HIV/aids no Brasil. Estudos epidemiológicos baseados em dados de incidência mostram tendência de crescimento da epidemia na região Norte do país. O Serviço de Assistência Especializada de Santarém é referência em assistência às pessoas com HIV/aids de 25 municípios das mesorregiões do baixo Amazonas e sudoeste do Pará. Os objetivos do presente trabalho consistem em descrever as características sociodemográficas, clínicas e laboratoriais de pessoas vivendo com HIV à admissão nesse serviço de referência, comparando-as entre os períodos: 1999 a 2002(P1), 2003 a 2006(P2) e 2007 a 2010(P3) e analisar as tendências de incidência de aids em Santarém entre 1999 e 2010. As informações referentes às variáveis de interesse foram obtidas em revisão de prontuários. Foram calculados os coeficientes de incidência padronizados a partir dos casos notificados de aids em Santarém, obtidos em bases de dados nacionais e locais. A análise de tendência de incidência foi realizada por modelos de regressão polinomial. A maioria dos 527 sujeitos (62,4%) foi admitida em P3, com 24,1% e 13,5% em P2 e P1, respectivamente. Observou-se aumento significativo da participação de indivíduos não procedentes de Santarém em P3 em comparação a P1. Verificou-se diferença significativa entre os sexos com relação ao motivo de realização da testagem pelo fato do conhecimento da soropositividade do parceiro ter motivado a testagem entre as mulheres em P1 e P2. Enquanto a presença de sinais e sintomas sugestivos de HIV/aids motivou o teste em homens durante todo o período avaliado. Houve redução significativa das medianas de linfócitos T CD4+ à admissão em P3, em relação a P1 e P2. Foram notificados 336 casos novos de aids em Santarém no período de 1999 a 2010. Foi encontrada tendência significativa de crescimento da epidemia em Santarém em ambos os sexos, e nas categorias de exposição ao HIV heterossexual e homo/bissexual no sexo masculino. O crescimento da demanda assistencial no serviço de Santarém, com incremento do número de pacientes procedentes de municípios menores e, admitidos em estadios tardios da infecção, associada à tendência de crescimento de incidência de aids em Santarém no período estudado, sugerem que as intervenções programáticas implementadas na região podem ter contribuído para o reconhecimento de maior número de casos de aids, porém ainda não possibilitaram o diagnóstico mais precoce. Acredita-se que estratégias de vigilância epidemiológica de segunda geração poderiam subsidiar de modo mais eficiente as intervenções programáticas voltadas ao controle da epidemia em uma região caracterizada por apresentar fatores individuais, sociais e programáticos que conferem vulnerabilidade acrescida à infecção pelo HIV.Infection with human immunodeficiency virus within the Amazon region has been shown as one of the latest challenges confronting the HIV/AIDS epidemic in Brazil. Epidemiological studies based on incidence data show an increasing trend in AIDS incidence in the Brazilian North region. The specialized HIV/AIDS outpatient clinic of Santarém is the reference healthcare setting that provides care for people living with HIV/AIDS (PLHA) from 25 municipalities of the Lower Amazon and southwestern Pará regions. The aims of this study are to describe socio-demographic, clinical and laboratory features of PLHA at time of admission to this reference clinic, comparing them among the following periods: 1999 to 2002 (P1), 2003 and 2006 (P2) and 2007 and 2010 (P3), and to analyze AIDS incidence trends in Santarém between 1999 and 2010. Information about variables of interest was obtained by review of medical records. Standardized AIDS incidence rates were calculated, based on cases reported in Santarém, using data obtained from national and local databases. Incidence trend analysis was performed by polynomial regression. Out of 527 records, 62.4% of patients were admitted to the clinic in P3, 24.1% and 13.5% in P2 and P1, respectively. A significant increase was seen in the participation of individuals from cities other than Santarém in P3, as compared to P1. There was a significant gender difference in the reason to be tested for HIV, as women were more likely to have been tested due to a seropositive partner in P1 and P2, whereas existing signs and symptoms of HIV/AIDS predominated among men as the reason for testing throughout the study period. A significant reduction in median CD4+ cell counts at admission was noticed comparing P3 to P1 and P2. 336 AIDS cases were reported in Santarém from 1999 to 2010. An increasing AIDS incidence trend was found for both genders, and for both heterosexual and homo/bisexual among males. The increasing local demand for HIV/AIDS care, with larger numbers of cases coming from smaller cities and admitted in later stages of HIV infection, taken together with the increasing AIDS incidence trend in Santarém during the study period suggest that even though programmatic interventions may have succeeded in identifying more AIDS cases, they were not able to lead to an earlier diagnosis. We believe that the implementation of second generation surveillance strategies in this region could guide programmatic interventions for the control of the epidemic more efficiently, in a context characterized by individual, social and programmatic factors related to a high vulnerability to HIV infection.
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Korsman, Stephen Nicolaas Jacques. "Molecular epidemiology of mother-to-child transmission of HIV-1 in children at Tygerberg Hospital." Thesis, Link to the online version, 2006. http://hdl.handle.net/10019/1074.
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Silva, José Renato da. "A depressão e a adesão ao tratamento da infecção pelo HIV (vírus da imunodeficiência humana)." Universidade de São Paulo, 2005. http://www.teses.usp.br/teses/disponiveis/5/5134/tde-08102014-120748/.
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A epidemia da Síndrome da Imunodeficiência Adquirida (aids) já atingiu aproximadamente 40 milhões de indivíduos em todo o mundo. O controle adequado da infecção pelo HIV através do tratamento anti-retroviral proporciona menor resistência viral, níveis mais baixos de carga viral, diminuindo, assim, a probabilidade da transmissão do HIV. A adesão ao tratamento anti-retroviral é importante para o sucesso do tratamento. A depressão é um transtorno psiquiátrico com prevalência elevada na população geral e nos portadores do HIV/Aids. Sabe-se que a depressão é um fator limitante para boa adesão. Neste trabalho, estudou-se a associação entre a adesão e a depressão em 164 pacientes portadores do HIV/Aids, em acompanhamento médico num serviço especializado, no período de outubro de 2002 a outubro de 2003. Foram aplicados os seguintes instrumentos: SCID/DSM-IV (Strutured Clinical Interview/Diagnostic and Statistical Manual of Mental Disorders), HAM-D (Hamilton Rating for Depression), MMSE (MiniMental State Examination - Miniexame do Estado Mental), questionário sócio-demográfico, laboratorial, da doença e tratamento e questionário de adesão. A média de idade foi 39 anos, e 72% da amostra eram do sexo masculino. Mais de 85% dos pacientes se infectaram com o HIV através de relações sexuais. Apenas 7,9% eram usuários de drogas injetáveis. A média de CD4 foi 404,8 e carga viral 3,55 (log). A prevalência de depressão atual foi 17,7%, com diferença estatisticamente significante entre os mais jovens. Setenta e cinco pacientes (45,73%) apresentaram episódio depressivo passado. Dos 164 pacientes, 137 faziam uso de anti-retrovirais. Pacientes que tomavam 95% dos anti-retrovirais foram considerados pacientes que aderiram ao tratamento. A adesão foi avaliada através de questionário e 79,56% dos pacientes aderiram ao tratamento. A adesão foi maior entre os homens e os mais velhos. A carga viral também apresentou associação com a adesão e com antecedente pessoal de depressão. A adesão não mostrou associação com depressãoApproximately 40 million individuals are infected by HIV/acquired immunodeficiency syndrome (AIDS) in the word. The control of the HIV infection by the antiretroviral treatment provides lower viral resistance; lower viral load levels and diminishes the probability of the transmission of the HIV. The adherence to antiretroviral treatment is important for the success of the treatment. Depression is a psychiatric disorder with high prevalence in general population and in HIV/AIDS infected patients. Depression seems to be a limitation for good adherence. In this study, the association between adherence and depression was assessed in 164 HIV/AIDS infected patients in a specialized service, in the period of October of 2002 and October of 2003. The following instruments were applied: SCID/DSM-IV (Structured Clinical Interview/Diagnostic and Manual Statistical of Mental Disorders), HAM-D (Hamilton Rating for Depression), MMSE (MiniMental State Examination), sociodemographic, laboratorial, disease and adherence questionnaires. The mean age was 39 years-old and 72% of the sample were men. More than 85% of the patients were infected by sexual contact and 7.9% were injecting drug users. The mean of CD4 was 404.8 and viral load 3.55 (log). The prevalence of current depression was 17.7%, with higher prevalence among youngest. Seventy five patients (45.73%) had a lifetime depressive episode. Of the 164 patients, 137 were treated with antiretroviral. Patients who took at least 95% of the antiretroviral medications had been considered adhered to treatment. The adherence was evaluated through questionnaire and was presented in 79.56% of the patients. The adherence was higher among men and oldest. The viral load also showed association with adherence and lifetime depression. The adherence was not associated to depression
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De, Villiers Tania. "Characterisation of the HIV-1 subtype C Env gene and the expression of the Env protein from selected isolates in mammalian cells." Thesis, Stellenbosch : Stellenbosch University, 2003. http://hdl.handle.net/10019.1/53329.
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Thesis (MSc)--Stellenbosch University, 2000.ENGLISH ABSTRACT: At the end of 2002, human immunodeficiency virus (HIV) had infected 42 million people worldwide. The morbidity and mortality rate, as well as the epidemic proportions of the disease have led to concentrated scientific efforts to reveal the disease's pathogenesis and develop effective preventative and treatment measures. Advances have been made to inhibit viral replication by suppressing the virus' ability to replicate by developing antiretroviral treatments, although development of a save and effective vaccine is the only way to stem the pandemic. Advances in vaccine design, animal models and clinical research have led to the creation of promising candidate vaccines to counter this rampage, but most of these vaccines entering phase I-III clinical trials are based mainly only subtype B genomes. HIV-1 subtype C is the most commonly transmitted subtype worldwide, and is the predominant subtype in India, China, East and Southern Africa. A subtype C vaccine is critical for the developing nations such as South Africa, where antiretroviral therapies are largely unaffordable. The envelope gene (env) is an attractive target as immunogen to be included in a HIV vaccine. The envelope protein (Env) elicits neutralising antibodies and cytotoxic T-Iymphocyte (CTl) responses. This protein will therefore be useful in creating a humoral and cellular immune response in the host. A shortage in characterised subtype C env gene sequences from South Africa was recognised, and this study focussed on the characterisation of generated sequences, as well as the expression of selected env genes. These immunogens were created for possible use in a prime-boost vaccine modality. The env genes from recent circulating strains in South Africa were amplified by polymerase chain reaction (PCR). The genes were then cloned for sequencing and expression purposes. Phylogenetic relationships were determined by comparing the sequences to reference subtype strains and subtype C strains. Expression of the genes was assessed by Western Blot in 293 cells with HIV- 1 positive patient sera. Sequence analysis showed a more conserved third variable (V3) loop in South African subtype C sequences, with a more variable region downstream from the loop. The crown sequence (GPGQ) and positions of uncharged or negatively charged residues in the V3 loop indicated a non-syncytium-inducing (NSI) phenotype for the isolates. Phylogenetic analysis showed the sequences to all belong to the C subtype, and further that the sequences were not recombinant, which was confirmed by recombination analysis. The intersample diversity observed for strains from South Africa was significantly higher than distances observed to the subtype C consensus sequence. The South African sequences were distributed across several subclusters in a subtype C phylogenetic tree, highlighting the concept that these infections represent a more longstanding epidemic with multiple introductions from different geographic areas. Western Blot with HIV-1 positive patient sera showed the expression of uncleaved gp160 Env proteins, which were Rev dependent. This study has generated much needed subtype C South African env gene sequences that can be used as basis for modification for use as immunogens in a South African vaccine.
AFRIKAANSE OPSOMMING: Teen die einde van 2002 was 42 miljoen mense wêreldwyd geïnfekteer met die menslike immuniteitsgebrekvirus (MIV). Die dode- en sterfte syfers, asook die skaal van die epidemie, het gelei tot 'n wetenskaplike poging om die siekte se patogenese te openbaar en om effektiewe voorkomende en terapeutiese middels te ontwikkel. Vordering is reeds gemaak om die virus se replikasie te hinder deur die ontwerp van antivirale middels, alhoewel die ontwikkeling van 'n doeltreffende en veilige entstof die enigste manier is om die pandemie te stuit. As gevolg van die vordering in entstof ontwerp, diere modelle en kliniese navorsing is belowende kandidaat entstowwe wat die infeksie kan teenwerk ontwikkel, maar die meeste van hierdie enstowwe wat vir fase I-III kliniese proewe gebruik word is gebaseer op subtipe B genome. MIV-subtipe C is wêreldwide die algemeenste subtipe wat oorgedra word en is die oorheersende subtipe in lande soos Indië, China, oostelike en suidelike Afrika. 'n Subtipe C entstof word dringend benodig in ontwikkelende lande soos Suid-Afrika waar antivirale middels onbekostigbaar is. Die membraangeen is 'n aanloklike teiken om as immunogeen in 'n MIV entstof te dien. Die membraanproteïen lok neutraliserende teenliggame en sitotoksiese T-limfosiet reaksies uit. Die proteïen sal dus 'n humorale en sellulêre immuunrespons in die gasheer ontlok. 'n Tekort aan gekarakteriseerde subtipe C membraangeen volgordes van Suid-Afrika is opgemerk, en dus fokus hierdie studie op die karakterisering van gegenereerde volgordes, asook die uitdrukking van geselekteerde membraangene. Die immunogene is geskep om moontlik gebruik te word in 'n stimuleer-versterkingsenstof toedieningstrategie. Die membraangene van onlangs sirkulerende virusstamme in Suid-Afrika was geamplifiseer deur polimerase kettingreaksie (PKR). Die gene is daarna gekloneer vir beide volgordebepalings en uitdrukkingdoeleindes. Filogenetiese verhoudings is uitgewerk deur die volgordes met verwysingsstamme en subtipe C stamme te vergelyk. Uitdrukking van die gene is waargeneem in 293 selle deur die Westerse kladtegniek te gebruik met MIV-1 positiewe pasiëntsera as teenliggaam. Volgorde-analise het aangetoon dat die derde varieerbare (V3) lus meer gekonserveer is, en dat die gedeelte wat op die lus volg meer varieerbaar is. Die kroonvolgorde (GPGQ) asook posisies van ongelaaide of negatief gelaaide aminosure in die V3 lus het aangedui dat die isolate 'n nie-syncytia induserende fenotipe het. Filogenetiese analise het aangedui dat al die volgordes subtipe C is en dat die volgordes nie rekombinant is nie. Dit is ook deur rekombinasie analise bewys. Die inter-monster diversiteit van die Suid-Afrikaanse volgordes was hoër as die waargenome afstand vanaf die subtipe C konsensus volgorde. Die Suid-Afrikaanse volgordes is versprei oor verskeie subgroepe in 'n subtipe C boom, wat die konsep dat hierdie infeksies 'n meer gevestigde epidemie voorstel waar veelvuldige infeksies met verskillende geografiese oorspronge plaasgevind het beklemtoon. Die Westerse klad het ongeprosesseerde gp160 membraanproteïne aangetoon wat Rev afhanklik was. Hierdie studie het hoogs benodigde subtipe C Suid-Afrikaanse volgordes van membraangene geproduseer. Die volgordes kan as basis dien om die gene te modifiseer sodat dit gebruik kan word as immunogene in 'n entstof vir Suid-Afrika.
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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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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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Carvalho, Heraclito Barbosa de. "Dinamica de transmissão do HIV entre usuários de drogas injetáveis, na cidade de Santos, São Paulo, Brasil." Universidade de São Paulo, 1995. http://www.teses.usp.br/teses/disponiveis/5/5144/tde-14092007-111629/.
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Com a finalidade de estudar a soroprevalência do Vírus da Imunodeficiência Humana, HIV, e infecções com transmissão relacionadas, entrevistamos e colhemos sangue de 197 usuários de drogas injetáveis, UDIs, amostrados através da metodologia de \"bola de neve\" (snow-balling), da cidade de Santos, São Paulo, Brasil. Nesta cidade a estimativa de UDIs, 10.000 indivíduos, compreende cerca de 2% de sua população. Soroprevalências de HIV, hepatites B e C, sífilis e HTLV (1 ou 2) foram obtidas e comparadas com 197 doadores de sangue pareados por idade e sexo. As soroprevalências encontradas foram de 62% para HIV, 75% para HCV, 75% para HBV, 34% para sífilis, e 25% para o HTLV (1 e 2) entre os UDIs, comparado com 0%; 2%; 23%; 12% e 1% entre os doadores do banco de sangue, respectivamente. Os fatores de risco para transmissões parenterais nesta comunidade de UDIs são mais importantes que para transmissão sexual, embora a última deva ser considerada quando se planejar estratégias de controle. Além disso, estimamos a Razão de Reprodutibilidade Basal, R0, para o HIV entre os UDIs. Usando um modelo clássico para infecções transmitidas por vetores de Macdonald adaptado para \"agulhas\", o valor de R0 foi estimado em 28 e 98, considerando uma distribuição dos inóculos infectantes como homogênea ou heterogênea respectivamente . Esta estimativa foi baseada somente em parâmetros de transmissão parenteral nesta comunidade de UDIs. Usando este modelo a estimativa da soroprevalência do HIV no equilíbrio (0,67) é bem próxima à soroprevalência observada (0,62).In order to study the seroprevalence of HIV and infections with related transmission patterns, as hepatitis B and C, syphilis and HTLV (1 and 2), we interviewed and bled 197 IDUs, sampled by snow-balling and compared with 197 blood donors matched for age and sex, both groups from the city of Santos, Sao Paulo, Brazil. Seroprevalences found were 62% for HIV, 75% for HCV, 75% for HBV, 34% for syphilis and 25% for HTLV (1 or 2) among IDUs, which compare with 0.0%, 2%, 23%, 12%, and 1% for blood donors, respectively. The risk for parenterally transmitted infections in this IDUs community is higher than that for sexually transmitted one. We also estimated the Basic Reproduction Ratio, R0, for HIV among IDUs. Using a model adapted from the classical Macdonald\'s model for vector-born infection, the R0 resulted in 28 and 98, assuming an homogeneous or heterogeneous distribution of infective inoculae, respectively. This estimation was based only on parenteral transmission. Using this model the expected equilibrium for HIV seroprevalence (0.67) is close to the observed seroprevalence (0.62)
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Azevedo, Leila Strazza de. "Diferenças de Gênero e Risco para Infecção pelo HIV em Adolescentes Internos da Fundação Estadual para o Bem-Estar do Menor de São Paulo FEBEM." Universidade de São Paulo, 1999. http://www.teses.usp.br/teses/disponiveis/5/5160/tde-26042006-110406/.
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Com o objetivo de obter a prevalência de anticorpos anti-HIV e comportamentos de risco relacionados entre adolescentes infratores, foram entrevistados 1122 e 93 jovens do sexo masculino e feminino, respectivamente, internados na FEBEM (FundaçãoEstadual para o Bem-Estar do Menor de São Paulo). Ao mesmo tempo obteve-se uma amostra de sangue para sorologia. O questionário avaliou os seguintes comportamentos: prática sexual, uso de drogas ilícitas, conhecimento sobre a AIDS. A soroprevalência para o HIV foi obtida erelacionada com os comportamentos de risco por análise uni-, bi- e multivariada. A positividade para o HIV foi 2,6% e 10,3% para sexo masculino e feminino, respectivamente. O risco de transmissão parenteral foi maior que o de transmissão sexualentre meninos, sendo o contrário nas meninasIn order to study the prevalence of HIV and related risky behaviors among disadvantaged youth, we interviewed and bled, between December 1994 and April 1995, 1122 young male and 93 young female who were serving time in FEBEM, a state institution that cares for homeless and offender youth of São Paulo, Brazil. Our questionnaire covered the following areas: sexual practices and use of illicit drugs: knowledge of HIV and STDs and their prevention; and myths and beliefs about AIDS. Seroprevalence of HIV was assessed and related with risk-taking behaviors by means of uni-,bi- and multivariate analysis. We found 2.6% of the males and 10.3% of the females to be positive to HIV. The prevalence of HCV antibodies resulted in 5.9% for males and 4.6% for females, respectively. The risk for parenterally transmitted HIV among males was higher than that for sexually related transmission. The inverse relationship was found among females.
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Wheldon, Christopher. "The influence of masculinity ideology on high-risk sexual behavior among men who have sex with men." [Tampa, Fla.] : University of South Florida, 2007. http://purl.fcla.edu/usf/dc/et/SFE0002244.
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Archibald, Lennox Kenneth. "Comparative study of the epidemiology and aetiology of bloodstream infections in hospitalized adult patients in Tanzania, Malawi, and Thailand : the role of human immunodeficiency virus type 1 (HIV-1) infection." Thesis, University College London (University of London), 2005. http://discovery.ucl.ac.uk/1444535/.
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Before 1995, the frequencies of mycobacterial and fungal bloodstream infections (BSI) in human immunodeficiency virus (HIV)-infected populations in sub-Saharan Africa and Southeast Asia were unknown. Therefore, a prospective survey of febrile (oral temperature >38 C or axillary temperature >37.5 C) adult patients who presented to sentinel teaching hospitals in Tanzania (1995), Thailand (1997), and Malawi (1997 dry season and 1998 wet season) was conducted. The objectives were to (i) determine the aetiology, prevalence, and clinical correlates of BSL and (ii) characterise the role played by HIV infection. After informed consent, a detailed history was recorded for each patient followed by physical examination. Next, blood was cultured for bacteria, mycobacteria, and fungi, and tested for HIV and malaria. Data were collected for 517 patients in Tanzania, 246 in Thailand, and 471 in Malawi. Respective BSI, HIV, and malaria parasitaemia rates were: Tanzania: 28%, 55%, 9.5% Thailand: 48%, 74%, 0 Malawi dry season: 30%, 74%, 4% Malawi wet season: 28%, 73%, 31%. The most frequently isolated bloodstream pathogens were Mycobacterium tuberculosis (MTB) and non-typhi Salmonella species (NTS) in Tanzania MTB and Cryptococcus neoformans in Thailand MTB and Streptococcus pneumoniae during Malawi dry season and MTB and NTS during Malawi wet season. In each country, HIV-infected patients were significantly more likely to acquire BSI all patients with mycobacteraemia were HIV-infected. The Malawi findings are the first description of seasonal variation in the occurrence of S. pneumoniae and NTS bacteraemias. Logistic regression models yielded predictors of BSI in Thailand (HIV infection, chronic diarrhoea, lymphadenopathy, or splenomegaly) and Malawi (HIV infection, chronic fever, oral candidiasis, or acute diarrhoea). In populations with high prevalence rates of HIV infection, MTB has become the foremost cause of documented BSI. Similar season- and country-specific surveys, performed periodically in HIV-endemic regions will provide data on the aetiology and predictors of BSI, and facilitate empirical therapy of febrile illnesses.
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Etzel, Arnaldo. "Estudo das infecções pelo HTLV-I e pelo HTLV-II como fatores prognósticos em uma coorte de portadores do HIV acompanhados em Santos-SP." Universidade de São Paulo, 2004. http://www.teses.usp.br/teses/disponiveis/5/5134/tde-07102014-091147/.
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s retrovírus humanos incluem o vírus da imunodeficiência humana (HIV), agente causal da síndrome da imunodeficiência adquirida (AIDS), e os vírus linfotrópicos de células T humanas do tipo I (HTLV-I) e do tipo II (HTLV-II), estes associados etiologicamente a doenças de natureza linfoproliferativa e/ou neurodegenerativa. Apresentam as mesmas formas de transmissão, resultando em fatores comuns de risco e em sobreposição de populações expostas. Embora os três vírus sejam linfotrópicos, o HIV se apresenta com altas taxas de replicação e proporciona a morte celular em todos os estágios da infecção, enquanto o HTLV-I e o HTLV-II podem causar proliferação e eventualmente transformação celular. O efeito do HTLV-I e do HTLV-II sobre o sistema imunológico como um dos fatores que interferem na evolução da AIDS envolve um grande interesse e ainda é motivo de controvérsia. Pesquisas in vitro sugerem que o HTLV-I e o HTLV-II podem aumentar a replicação e a expressão do HIV. Alguns estudos clínico-epidemiológicos apontam na direção de que exista efeito da concomitância das infecções pelo HIV e pelo HTLV-I ou pelo HTLV-II sobre a evolução da progressão da AIDS. Em um estudo anterior, desenvolvido entre portadores do HIV atendidos no Centro de Referência em AIDS de Santos-SP, observou-se uma soroprevalência de 6,0% da infecção pelo HTLV-I e de 7,4% pelo HTLV-II, o que poderia justificar a investigação de possível modificação na evolução da história natural da infecção pelo HIV nesses pacientes co-infectados. O presente trabalho foi desenvolvido, como um estudo de coorte retrospectiva, visando a avaliar o tempo de sobrevida dos portadores do HIV na população estudada e sua associação com as infecções pelo HTLV-I e pelo HTLV-II, bem como com outros fatores prognósticos e marcadores de progressão. Dos 495 portadores do HIV acompanhados entre 1997 e 2002, em um número total de 23.031,5 pacientes-mês, foi observado que 145 pacientes evoluíram para o óbito em decorrência da AIDS. A análise multivariada pelo modelo dos riscos proporcionais de Cox indicou que o tempo de evolução para o óbito por AIDS na população estudada foi associado de forma independente à raça negra (HR ajustado 1,50 - IC 95% 1,03-2,17), com menos de três anos de escolaridade formal (HR ajustado 1,90 - IC 95% 1,12-3,25), com os linfócitos CD4+ em número inferior a 200 células/mm³ no início do estudo (HR ajustado 4,44 - IC 95% 2,70-7,31), com a classificação CDC em categoria B ou C no início do estudo (HR ajustado 3,63 - IC 95% 1,54-8,56), com a soropositividade anti-HTLV-I (HR ajustado 1,95 - IC 95% 1,08-3,52), com a soropositividade anti-HCV (HR ajustado 1,76 - IC 95% 1,20-2,60) e com o uso de esquemas terapêuticos altamente ativos (HAART) em menos de 50% do tempo de seguimento (HR ajustado 2,36 - IC 95% 1,61-3,45). Não houve associação significativa com a soropositividade anti-HTLV-II. O estudo reforça as evidências de que a infecção pelo HTLV-I constitui um fator prognóstico de menor sobrevida em portadores do HIVHuman retroviruses include the human immunodeficiency virus (HIV), etiologic agent of the acquired immunodeficiency syndrome (AIDS), and also the human T-cell lymphotropic virus types I (HTLV-I) and II (HTLV-II), which can cause lymphoproliferative and/or neurodegenerative diseases. The three retroviruses present similar transmission patterns and share common risk factors resulting in overlap of exposed populations. Although these retroviruses are all lymphotropic, HIV has a high replication rate and induces cell death throughout the course of infection, whereas HTLV-I and HTLV-II can cause cell proliferation and occasionally cell transformation. HTLV-I and HTLV-II effects on the immune system and their interference in the progression of AIDS is a matter of great interest and still controversial. In vitro studies suggest that HTLV-I and HTLV-II may increase the replication and expression of HIV. Clinical epidemiologic studies indicate possible effects of simultaneous infections by HIV and HTLV-I or HTLV-II on the progression of AIDS. In a previous study, carried out among HIV-positive patients treated at an AIDS center in Santos - SP (Centro de Referência em AIDS de Santos), a seroprevalence of 6.0% for HTLV-I and of 7.4% for HTLV-II infections was observed, what enables further investigation on a possible modification in the progression of HIV disease in co-infected patients. This study was carried out with a retrospective cohort design, aimed at evaluating the survival time of HIV-positive patients in the studied group and its association with HTLV-I and HTLV-II infections, as well as with other prognostic factors and progression markers. Four hundred and ninety-five patients were monitored between 1997 and 2002. In this period, in a total of 23,031.5 patients/month, 145 AIDS related deaths were reported. Multivariate analysis using Cox proportional hazards model showed AIDS to be associated in the studied group with the following variables: black race (adjusted HR 1.50 - 95% CI 1.03-2.17), less than three-year education (adjusted HR 1.90 - 95% CI 1.12-3.25), less than 200 CD4+ baseline cells/mm3 (adjusted HR 4.44 - 95% CI 2.70-7.31), CDC classification B or C at study onset (adjusted HR 3.63 - 95% CI 1.54-8.56), anti-HTLV-I seropositivity (adjusted HR 1.95 - 95% CI 1.08-3.52), anti-HCV seropositivity (adjusted HR 1.76 - 95% CI 1.20-2.60), use of Highly Active Antiretroviral Therapy (HAART) in less than 50% of follow-up (adjusted HR 2.36 - 95% CI 1.61-3.45). There was no significant association with anti-HTLV-II seropositivity. This study provides further evidence that HTLV-I infection is a prognostic factor leading to reduced survival time of HIV-infected individuals
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Schiesari, Júnior Arlindo. "Infecções oportunistas em portadores de HIV/AIDS da Rede Pública de Catanduva, Estado de São Paulo, Brasil." Faculdade de Medicina de São José do Rio Preto, 2010. http://bdtd.famerp.br/handle/tede/140.
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Previous issue date: 2010-11-25Hereby we present the epidemiological and clinical profile of the HIV-infected group before and during the HAART era from a tertiary care hospital catering to a large population from the Southeastern Brazilian region. A retrospective, cross-sectional and descriptive study was carried out, which involved the analysis of the medical records of patients diagnosed with HIV-1/AIDS admitted to Hospital Escola Emílio Carlos, located in the municipality of Catanduva, State of São Paulo, Brazil. In both pre-HAART and HAART periods, HIV-1 infection was more prevalent in men. Heterosexuality and secondary education were the risk facts for acquisition of the disease in the HAART period. Statistically significant association was only observed for co-infection with HIV-1/Hepatitis C in the pre-HAART era and the number of patients with opportunistic illness (OI) was lower in the HAART period. Among all these OI it is worth mentioning pulmonary pneumocystosis, since despite being frequent in the two periods, its occurrence was considerably greater in the pre-HAART era. Concerning the distribution of OI according to the HIV-1 viral load and serial count of T CD4+ lymphocytes, a significant association was observed. The association between the number of deaths by OI and the survival rate of less than 1 year in the HAART period was significant. The clinical and epidemiological picture of a specialized HIV-1/AIDS Center in a municipality in the southeastern region of Brazil is consistent with the current epidemiology of AIDS in the country. In conclusion, our results indicate that the OI are still important causes of morbi-mortality among HIV-1/AIDS infected patients in the municipality of Catanduva, particularly pulmonary pneumocystosis, tuberculosis and cryptococcal meningoencephalitis. We are aware that retrospective studies such as ours, which involve the review of patients medical records, may present some limitations arising from the scarcity or even absence of information.
Nós apresentamos o perfil clínico e epidemiológico de indivíduos portadores do HIV-1 antes e durante a era da terapia antirretroviral altamente ativa (HAART) de um hospital terciário que atende uma grande população da região Sudeste do Brasil. Estudo retrospectivo, transversal e descritivo que envolveu a análise de prontuários dos pacientes diagnosticados com HIV-1/AIDS atendidos no Hospital Escola Emílio Carlos, localizado no município de Catanduva, Estado de São Paulo, Brasil. Em ambos os períodos pré-HAART e HAART, a infecção por HIV-1 foi mais prevalente em homens. Heterossexualidade e nível de escolaridade do ensino médio foram os fatores de risco para aquisição da doença no período HAART. Associação estatisticamente significante foi observada somente para a coinfecção HIV-1/Hepatite C na era pré-HAART e o número de pacientes com infecções oportunistas (IO) foi menor no período HAART. Entre todas estas IO vale à pena mencionar a pneumocistose pulmonar, pois apesar de ser freqüente nos dois períodos, sua ocorrência foi significativamente maior na era pré-HAART. Quanto à distribuição de IO de acordo com a carga viral do HIV-1 e contagem de linfócitos T CD4 +, uma associação significativa foi observada. A associação entre o número de mortes por IO e a taxa de sobrevivência de menos de um ano na era HAART foi significativa. O quadro clínico e epidemiológico de um centro de atendimento especializado em HIV-1/AIDS em um município na região sudeste do Brasil é compatível com a epidemiologia atual da AIDS no país. Em conclusão, nossos resultados indicam que as IO ainda são importantes causas de morbi-mortalidade entre os pacientes infectados por HIV-1/AIDS no município de Catanduva, particularmente a pneumocistose pulmonar, a tuberculose e a meningoencefalite criptococócica. Estamos cientes de que estudos retrospectivos como o nosso, que envolvem a revisão de prontuários médicos, podem apresentar algumas limitações decorrentes da escassez, ou mesmo da ausência de informações.
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Brown, Monique J. "Disparities in Adverse Childhood Experiences and Sexual Health in the US: Results from a Nationally Representative Sample." VCU Scholars Compass, 2014. http://scholarscompass.vcu.edu/etd/3600.
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Background: Adverse childhood experiences (ACEs) are a major public health problem in the US, and have been linked to risky sexual behavior and psychopathology. However, studies examining the link between the wide range of ACEs and sexual health outcomes and behaviors, and the associated mediational role of psychopathology are lacking.
Objectives: The main objectives of this dissertation project were: 1) To determine the association between ACEs and sexual health outcomes and behaviors (early sexual debut, intimate partner violence (IPV) perpetration, and HIV/STIs); 2) To examine the disparities among selected populations; and 3) To assess the mediational role of psychopathology in the association between ACEs and sexual health.
Methods: Data were obtained from Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Logistic and linear regression models were used to determine the association between ACEs (neglect, physical/psychological abuse, sexual abuse, witnessing parental violence, and parental incarceration/psychopathology) and early age at sexual debut by sex and sexual orientation. Structural equation modeling (SEM) was used to determine the mediational role of psychopathology (PTSD, substance abuse, and depression) in the association between ACE constructs and IPV perpetration, and the role of psychopathology, early sexual debut and IPV perpetration in the association between ACEs and HIV/STIs.
Results: The association between ACEs and early sexual debut was generally stronger for women and sexual minorities. Among men, PTSD mediated the association between sexual abuse and IPV perpetration (z=0.004, p = 0.018). However, among men and women, substance abuse mediated the association between physical/psychological abuse and IPV perpetration: z=0.011, p=0.036 and z=0.008, p=0.049, respectively. Among men, PTSD mediated abuse (physical/psychological, and sexual) and parental incarceration/psychopathology; substance abuse mediated abuse and neglect; depression and early sexual debut mediated abuse; and IPV perpetration mediated sexual abuse, and HIV/STIs. Among women, substance abuse mediated neglect and physical/psychological abuse, and depression mediated physical/psychological abuse and HIV/STIs.
Conclusions: Intervention and prevention programs geared towards preventing sexual health outcomes and behaviors should employ a life course approach and address ACEs. Treatment components addressing PTSD, substance abuse, and depression should also be added to IPV perpetration and HIV/STI prevention programs.
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Fadul, Nada, Jacob Couturier, Xiaoying Yu, Claudia A. Kozinetz, Roberto Arduino, and Dorothy E. Lewis. "Treatment-Naïve HIV-Infected Patients Have Fewer Gut-Homing β7 Memory CD4 T Cells than Healthy Controls." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/1497.
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OBJECTIVES: The integrin α4β7 is the gut-homing receptor for lymphocytes. It also is an important co-receptor for human immunodeficiency virus (HIV) via glycoprotein (gp)120 binding. Depletion of gut cluster of differentiation (CD)4 T cells is linked to chronic inflammation in patients with HIV; however, measuring CD4 cells in the gut is invasive and not routine. As such, establishing a peripheral marker for CD4 depletion of the gut is needed. We hypothesized that α4β7 CD4 T cells are depleted in the peripheral blood of treatment-naïve patients with HIV compared with healthy controls.
METHODS: The study groups were treatment-naïve patients with HIV and uninfected controls. Subjects were included if they were 18 years or older with no history of opportunistic infections, active tuberculosis, or cancer. We collected peripheral blood and examined on whole blood using flow cytometry for the following cell surface markers: CD4, CD45RO, chemokine receptor type 5, C-X-C chemokine receptor type 4 (CXCR4), and the integrin β7. We collected demographic information, including age, sex, and ethnicity, as well as viral load (VL) and CD4 count. Two-samplettests and Fisher exact tests were used to compare the differences between the two groups. Spearman correlation coefficients were calculated between CD4 count and log10-VL and percentage of CD4+/CD45RO+/β7+and log10-VL in patients.
RESULTS: Twenty-two subjects were enrolled in the study (12 patients with HIV and 10 controls). There were no differences in age or sex between the two groups. There were more Hispanics and fewer Asians in the group comprising patients with HIV compared with the control group (7 vs 2 and 0 vs 4,P= 0.05, respectively). Patients infected with HIV had significantly lower frequencies of CD4+/CD45RO+/β7+cells (median 12%, range 5-18 compared with uninfected controls: median 20%, range 11-26,P= 0.0007). There was a statistically significant difference in the percentage of CD4+/CD45RO+/C-X-C chemokine receptor type 4+cells between patients (72%, range 60%-91%) compared with controls (79%, range 72%-94%,P= 0.04). The percentage of CD4+/CD45RO+/chemokine receptor type 5+did not differ between the group of patients with HIV and the control groups (22%, range 11%-57% vs 27%, range 14%-31%;P= 0.8, respectively). There was no correlation between percentage of CD4+/CD45RO+/β+cells and log10-VL as measured by the Spearman correlation coefficient (r= 0.05,P= 0.88) in patients infected with HIV.
CONCLUSIONS: Memory CD4 β7+cells are reduced significantly in the peripheral blood of untreated patients infected with HIV, which could be used as a noninvasive indicator of intestinal CD4 T cell loss and recovery. Further studies are needed to examine whether depletion of these CD4+/CD45RO+/β7+cells in the peripheral blood parallels depletion in the gut of treatment-naïve patients with HIV and whether levels return to control levels after treatment.
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Tchounga, Boris Kévin. "Epidémiologie, diagnostic et prise en charge de l'infection par le VIH-2 en Afrique de l'Ouest." Thesis, Bordeaux, 2016. http://www.theses.fr/2016BORD0218/document.
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Contexte : L’infection par le VIH-2 touche un à deux millions de personnes en Afrique de l’Ouest et sa prise en charge se heurte à de nombreuses difficultés. En plus des erreurs diagnostiques observées avec les tests VIH, la résistance intrinsèque du VIH-2 aux Inhibiteurs non nucléosidiques de la transcriptase inverse et sa moindre sensibilité à certains inhibiteurs de protéase, rendent complexe le traitement de l’infection. A cela vient s’ajouter l’absence de données sur la mortalité et la rétention dans les soins,dans un contexte d’émergence de résistances aux différentes classes d’ARV. Méthode : Le présent travail de thèse, s’appuie sur la cohorte ouest africaine IeDEA-VIH-2 et la biothèque qui lui est rattachée, de même que l’essai ANRS 12294 FIT-2, pour décrire les modalités diagnostiques, explorer la réponse thérapeutique et décrire la mortalité et les perdus de vue, parmi les patients vivant avec le VIH-2 en Afrique de l’Ouest.Résultats : Un quart des patients VIH-2 ou doublement infectés, testés de novo avec les algorithmes nationaux, étaient en réalité monoinfectés par le VIH-1. Les tests GenieIII et ImmunoCombII se sont avérés être de bons candidats pour un algorithme d’identification des patients VIH-2. Pour ce qui est du traitement, les patients vivant avec le VIH-2 initiaient principalement des régimes ARV à base d’IP boostés, avec une bonne réponse immunologique et virologique. Les régimes à base de trois INTI produisaient une réponse inférieure à celles des IP, tandis que les régimes à base d’IPnon boosté produisaient une moins bonne réponse. Il existe chez les patients VIH-2,une mortalité sous traitement ARV qui était précoce et élevée (5,2 /100 patient-année),associée à l’anémie et à des CD4 bas (<100/mm3) à l’initiation des ARV. L’essai FIT-2 actuellement en cours permettra d’identifier les meilleures séquences d’initiation des régimes ARV disponibles dans les pays ouest africains. Conclusion De nombreuses questions restent encore en suspens concernant le VIH-2, les études épidémiologiques, immunologiques et génotypiques permettront d’améliorer la prise en charge des patients VIH-2 vivant en Afrique de l’OuestBackground : The holistic care of the one to two million HIV-2 infected individuals in West Africa remain a concern. The frequent misdiagnosis with rapid HIV tests, in addition to the intrinsic resistance of HIV-2 to non-nucleoside reverse transcriptase inhibitors, and its low susceptibility to some protease inhibitors, make the treatment of people living with HIV-2 very challenging. The lack of data on mortality and retention in care among people living with HIV-2, as well as the emergence of resistance to most ART drugs is a great concern for the West African ART program. Method : We relied on the WADA-HIV-2 cohort, its associated biobank and the ANRS 12294 FIT-2 trial, to describe challenges in diagnosis and treatment, as well as mortality and lost to follow up, among people living with HIV-2 in West Africa. Results : One quarter of HIV-2 or dually reactive individuals, according to the national algorithms for HIV diagnosis, were found infected by HIV-1 only, and the tests GenieIII® and ImmunoCombII® showed good performances for a more accurate algorithm. Considering treatment, HIV-2 patients often initiate boosted PI based regimen, with good immunologic and virologic response. A suboptimal response was obtained with either three NRTI based regimens and unboosted PI based regimen, however worse with the first one. HIV-2 infected individuals experienced early and relatively high mortality (5.2/100 person-years), that was associated with anemia and low CD4 count (<100/mm3) at ART initiation. The results of the ongoing ANRS 12294 FIT-2 trial are expected to identify the best strategy for the optimal use of available ART regimens in West African countries. Conclusion : Many questions remain unanswered regarding HIV-2. Epidemiologic, immunologic and genotypic resistances surveys will help improving the care of people living with HIV-2 the West African region
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Collinson, Mark A. "Striving against adversity : the dynamics of migration, health and poverty in rural South Africa /." Doctoral thesis, Umeå : Epidemiology and Public Health Sciences Department of Public Health and Clinical Medicine, Umeå University, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-22056.
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Amaral, Maria Luiza Sant\'Ana Do. "Impulso sexual excessivo e comportamento barebacking em homens que fazem sexo com homens." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/5/5160/tde-12082014-150348/.
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O comportamento \"barebacking\" é definido como o intercurso sexual anal entre homens que fazem sexo com homens (HSH) que decidem intencionalmente não usar preservativos, no contexto de risco do HIV. O comportamento sexual compulsivo (CSC) pode agir na motivação do comportamento \"barebacking\", aumentando o risco de transmissão do HIV, sendo que no Brasil a prevalência do HIV entre HSH é de 10,5%. Objetivos: estimar a frequência do comportamento \"barebacking\" nos HSH compulsivos sexuais, e investigar a associação do comportamento \"barebacking\" com: infecção pelo HIV; comportamento sexual de risco; severidade do CSC; transtorno associado ao uso de álcool e drogas; grau de otimismo em relação ao tratamento do HIV; capacidade de vinculação afetiva tipo segura; consolidação da identidade; e as seguintes dimensões de personalidade: busca de novidades, esquiva ao dano, dependência de gratificação e autodirecionamento. Métodos: estudo transversal realizado em amostra de HSH que buscaram tratamento para o CSC. Participaram 55 homens compulsivos sexuais, sendo que 21 apresentavam o comportamento \"barebacking\" e 34 não. Foram avaliados em entrevista psiquiátrica para verificação dos critérios de elegibilidade (critérios de dependência de sexo e de Impulso Sexual Excessivo, diagnósticos de exclusão, nível cognitivo). Todos responderam os seguintes instrumentos: Inventário de Consolidação de Identidade, Escala de Vinculação de Adulto, Escala de Compulsividade Sexual, Escala de Otimismo/Ceticismo no contexto dos tratamentos do HIV, Inventário de Temperamento e Caráter, Instrumento de Avaliação de Risco no Comportamento Sexual, além de questões complementares quanto ao comportamento \"barebacking\" e HIV. Ainda participaram de entrevista com a pesquisadora, que teve a finalidade de investigar a intencionalidade do não uso do preservativo. Resultados: 38% da amostra apresentaram comportamento \"barebacking\", sendo que 64% apresentaram orientação homossexual e 36% bissexual, e o comportamento \"barebacking\" associou-se à homossexualidade (p < 0,05). Comparando-se indivíduos com e sem o comportamento \"barebacking\", não se encontrou diferença em relação: a transtornos relacionados ao uso de álcool e/ou drogas, ao otimismo quanto ao tratamento do HIV, à vinculação afetiva, às dimensões de personalidade esquiva ao dano e dependência de gratificação. Houve uma tendência à associação à severidade do CSC, à consolidação da identidade e à busca de novidades. Houve associação negativa com a dimensão de personalidade autodirecionamento (p < 0,001). A prevalência do HIV foi de 20% na amostra total e de 43% dentre os participantes com comportamento \"barebacking\" (p < 0,05). Conclusões: a orientação homossexual e o baixo autodirecionamento foram preditores de comportamento \"barebacking\" neste estudo, sugerindo menor autonomia, reduzida força de vontade, desorganização, baixa capacidade de controle interno, baixa autoaceitação e baixa autoestima, como característica de personalidade dos que apresentam comportamento \"barebacking\"The barebacking behavior is defined as anal intercourse among men who have sex with men (MSM) who intentionally decide do not to use condoms in the context of HIV risk. Compulsive sexual behavior (CSB) can act in motivating the barebacking behavior increasing the risk of HIV transmission, whereas in Brazil the prevalence of HIV among MSM is 10.5%. Goals: To estimate the frequency of barebacking behavior in sexually compulsive MSM, and to investigate the association of barebacking behavior with: HIV infection, sexual risk behavior, severity of CSB; substance disorders; degree of optimism regarding the treatment of HIV; ability to develop secure emotional attachment type, identity consolidation, and the following personality dimensions: novelty seeking, harm avoidance, reward dependence and self-directedness. Methods: Cross-sectional study in a sample of MSM who sought treatment for CSB. 55 sexually compulsive men participated, of whom 21 presented the barebacking behavior and 34 do not. All of them were underwent to psychiatric interview for verification of eligibility criteria (criteria for sex addiction and Excessive Sexual Drive, exclusion psychiatric diagnosis, and cognitive level). All answered the following instruments: Identity Consolidation Inventory, the Adult Attachment Scale, Scale of Sexual Compulsivity, Scale Optimism/Scepticism in the context of HIV treatments, Temperament and Character Inventory, Instrument Risk Assessment in Sexual Behavior, plus additional questions regarding the barebacking behavior and HIV. They were also interviewed by the researcher, whose purpose was to investigate the intentionality of not using condoms. Results: 38% of the sample presented barebacking behavior, whereas 64% were gay and 36% bisexual, and barebacking behavior was associated with being gay (p < 0.05). Comparing subjects with and without the barebacking behavior no difference was found in relation to: substance disorders, optimism regarding the treatment of HIV, adult attachment, personality dimensions harm avoidance and reward dependence. There was a trend toward association with severity of CSB, and the consolidation of identity and novelty seeking. There was a negative association with the personality dimension self-directedness (p < 0.001). HIV prevalence was 20% in the total sample and 43% among participants with barebacking behavior (p < 0.05). Conclusions: gay and low self-directedness predicted barebacking behavior in this study, suggesting low autonomy, reduced willpower, disorganization, low ability for internal control, low self-acceptance and low self-esteem, as personality characteristics from those presenting barebacking behavior
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Elenga, Narcisse. "L’épidémiologie de l’infection VIH chez l’adulte en Guadeloupe : étude à partir de la base de données hospitalière sur l’infection VIH (1988-2009)." Thesis, Antilles-Guyane, 2014. http://www.theses.fr/2014AGUY0786/document.
Full textAbstract:
Avec un taux d’incidence cumulée de 56 cas pour 100 000 habitants, la Guadeloupe est la deuxième région de France la plus touchée par le VIH. La plupart des publications sur le VIH/Sida en Guadeloupe sont essentiellement descriptives, issues de rapports d’activité. La base hospitalière, alimentant la Base de données Hospitalière française sur l’infection à VIH, n’a été que très peu exploitée pour la recherche. L’objectif de ce travail est d’évaluer les aspects fondamentaux de la prise en charge de l’infection VIH. Ainsi le dépistage tardif, le retard à la prise en charge spécialisée, l’interruption du suivi, les infections opportunistes et les décès sont étudiés ainsi que leurs facteurs prédictifs.Dans ce travail articulé autour de six publications, nous avons mis en évidence les points suivants : tout d’abord, le diagnostic très tardif (CD4<200/mm3) concernait 40,12 % des adultes infectés par le VIH suivis en Guadeloupe. Comparé à la France métropolitaine, ce taux est encore très élevé et souligne l’importance de poursuivre les efforts de dépistage. Pour pouvoir bénéficier d’une prise en charge précoce, le patient doit être dirigé dans un centre de traitement de l’infection par le VIH sans tarder. Or, le retard dans cette prise en charge spécialisée touchait 36 % des patients. L’analyse des éléments associés à ce retard a permis d’en identifier les facteurs de risque.Pour optimiser les résultats thérapeutiques, les patients nécessitent un suivi régulier. Ainsi, le système de santé devrait avoir comme objectif, entre autres, la rétention des patients dans le circuit de soins. Or, plus de 22 % des patients de cette cohorte étaient perdus de vue et jamais revus. Les patients plus jeunes, ceux au stade B de la classification CDC et ceux non traités par TTARV étaient plus à risque d’interruption de suivi, dès la première année suivant le diagnostic de l’infection VIH.Bien que la proportion des patients suivis sous ARV soit proche de 100 %, il en existe toujours développant un Sida. La comparaison avec la Guyane et la France métropolitaine montre que les trois premières affections classantes en Guadeloupe étaient la candidose oesophagienne, le syndrome de cachexie liée au VIH et la pneumocystose. Il existait des différences notables avec la métropole, mais aussi avec la Guyane. Ce taux élevé de syndrome de cachexie liée au VIH pose question. Derrière ce diagnostic, pourraient se cacher d’autres maladies opportunistes non diagnostiquées, mais également des différences de codage. Le recul de la mortalité avec le temps a entraîné une modification qualitative des causes de décès. Celles rapportées dans la littérature étaient les mêmes que celles observées dans notre étude. Contrairement à la métropole où le cancer représentait la première cause de mortalité, en Guadeloupe, les infections liées au Sida constituaient la première cause de décès.Ce travail de thèse s’est donc efforcé de dégager, pour l’une des régions de France les plus affectées par le VIH, quelques grands indicateurs à partir de la Base Hospitalière FHDH. Cette base ne comportait pas toujours toutes les informations souhaitées, mais le nombre substantiel d’observations donnait une puissance importante aux variables étudiées. Ces résultats, bien que confirmant souvent les connaissances empiriques des cliniciens, aura pu aider à mieux appréhender l’épidémie du VIH en GuadeloupeWith an accumulated incidence rate of 56 cases per 100 000 inhabitants, Guadeloupe is the second French region most affected by HIV. Most of the publications on HIV/AIDS were essentially descriptive, stemming from annual reports. The Guadeloupean Hospital Database on HIV was scarcely exploited for research. The objective of this work was to estimate the fundamental aspects of HIV/AIDS in Guadeloupe. So late presentation for care, delay between HIV diagnosis and first specialised consultation, follow-up interruption, incidence of depression, opportunistic infections and deaths were studied as well as their predictive factors. We were able to highlight the following points: first, the very late HIV diagnosis (CD4< 200 / mm3) concerned 40, 12 % of HIV- infected adults followed in Guadeloupe. 36 % of patients had delays between HIV diagnosis and first specialised consultation. However, more than 22 % of patients were permanently lost to follow-up and never seen again. The first three classifying affections were oesophageal candidiasis, HIV-wasting syndrome and pneumocystosis. The causes of deaths reported in the literature were similar to those observed in our study. AIDS-related infections were the first cause of deaths.This thesis work thus tried to generate, in one of the most HIV-affected French regions, some indicators from the French Hospital Database on HIV. This database often did not contain all the desired informations, but the important number of observations allowed to have high power for the studied variables. These results, although often confirming the clinicians' empirical knowledge, may help understand some aspects of the HIV epidemic in Guadeloupe
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De, Monteynard Laure-Amélie. "Infection par le VIH chez les patients migrants suivis en France." Thesis, Paris 6, 2016. http://www.theses.fr/2016PA066674/document.
Full textAbstract:
Les migrants, en particulier ceux originaires d'Afrique sub-Saharienne, représentent une part importante des personnes infectées par le VIH en France. Bien que le dépistage et la prise en charge soient de plus en plus précoces en France, un sur-risque de diagnostic tardif et d'initiation retardée du traitement est rapporté chez les migrants, particulièrement chez les hommes, par rapport aux autres personnes infectées par le VIH. Les objectifs de ce travail de thèse étaient d'étudier le délai d'initiation du traitement antirétroviral puissant en dehors de l'urgence thérapeutique (CD4>200/µL et pas de statut clinique définissant le SIDA) et d'évaluer l'efficacité biologique et clinique après initiation du traitement, selon l'origine géographique, le sexe et le groupe de transmission à VIH. Pour ce faire, les données issues de la base de données hospitalière française sur l'infection à VIH (FHDH ANRS CO4) ont été utilisées. Par rapport aux hommes nés en France ayant des rapports sexuels avec des hommes (HSH non migrants), seuls les hommes migrants originaires d'Afrique sub-Saharienne et des Antilles non Françaises avec des CD4>350/µL à l'entrée dans le soin ont une probabilité plus faible de démarrer le traitement ARV. Les délais nécessaires à l'obtention d'une couverture de santé une fois entré dans le soin ne suffisent pas à expliquer cette différence. Après initiation du traitement antirétroviral, quel que soit le stade d'avancement de la maladie et malgré la prise en compte des caractéristiques démographiques, biologiques, cliniques et thérapeutiques à l'initiation du traitement, comparé aux HSH non migrants, les migrants ont une probabilité plus faible de remonter leurs CD4. En revanche, les hommes hétérosexuels quelle que soit leur origine géographique, ont une probabilité plus élevée de moins bonne réponse virologique et d’avoir un premier évènement clinique. Un rôle majeur du niveau de CD4, du statut clinique et de l’âge à l’initiation du traitement est observé. Ces différences pourraient également être influencées par des facteurs socio-économiques, des facteurs de risques comportementaux ou le mode de vie, pour lesquels nous n’avons pas d’information dans la FHDH. Les évènements ne définissant pas le SIDA sont responsables d’une grande morbidité, avec la survenue de beaucoup d’évènements infectieux notamment. Cependant une fois entrés dans le soin et traités, hormis pour les risques d’infections ne définissant pas le SIDA plus élevés chez les migrants hétérosexuels par rapport aux non migrants hétérosexuels, il n’y a pas de différence de risque de comorbidités entre migrants et non migrants chez les hommes hétérosexuels et chez les femmes hétérosexuellesMigrants, mainly from sub-Saharan Africa (SSA), represent an important part of people living with HIV in France. Despite early screening and access to care have both increased in France, an excess risk of late diagnosis and delayed treatment initiation is reported among migrants, particularly in men, compared with other HIV-infected individuals. The objectives of this thesis were to study time between entry into care and combined antiretroviral therapy (cART) initiation, excluding late access to care, and to evaluate biological and clinical outcome after cART initiation, according to geographic origin, sex and transmission group. Data from the French Hospital Database on HIV (FHDH ANRS CO4) were used. Compared with French native men who have sex with men (MSM), only men originating from SSA and non-French West Indies with CD4>350/µL at entry into care are more likely to begin cART later. Administrative delays in obtaining healthcare coverage do not appear to be the only one responsible. After cART initiation, whatever the CD4 cell count at cART initiation, and after taking into account demographic, immunovirological, clinical and therapeutic characteristics at cART initiation, compared with French native MSM, migrants have a lower likelihood of CD4 cell recovery. However, heterosexual men, whatever the geographic origin, are more likely to have worse virological and clinical outcomes. Older age, a lower CD4 cell count and pre-existing AIDS status at cART initiation had the biggest impact on outcomes of cART but socio-economic level, and lifestyle or behavioral risk factors which are not available in the FHDH could also influence outcomes of cART. Non-AIDS defining events are responsible for a higher morbidity, with a higher incidence of severe infections. After entry into care and cART initiation, except for the risk of non-AIDS infections in heterosexual migrants than in heterosexual nonmigrants, there is no difference of comorbidities between migrants and non migrants among heterosexual men and heterosexual women
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Champenois, Karen. "VIH : comment la recherche en épidémiologie s’est orientée de l’évaluation thérapeutique au dépistage et à la prévention." Thesis, Lille 2, 2011. http://www.theses.fr/2011LIL2S043/document.
Full textAbstract:
Dans les années qui ont suivi l’apparition de l’infection par le VIH, la priorité était donnée à la recherche thérapeutique. Depuis l’introduction des trithérapies antirétrovirales en 1996, la mortalité et la morbidité liées du VIH ont fortement chuté. Cependant, l’épidémie reste très active, notamment chez les hommes ayant des relations sexuelles avec d’autres hommes (HSH), signifiant la nécessité d’un changement de paradigmes en termes de dépistage et de prévention. Cette thèse suit l’évolution d’une partie de la recherche en épidémiologie du VIH dans les pays du Nord, en s’intéressant d’abord à l’efficacité des traitements pour ensuite s’orienter vers les limites et les nouvelles stratégies de dépistage du VIH et enfin aborder le thème de la prévention. Elle regroupe cinq études épidémiologiques conduites en France.La première étude, conduite chez 175 patients infectés par le VIH-1 et naïfs de traitement antirétroviral, a montré que le lopinavir/ritonavir était efficace quelques soient les polymorphismes portés par la protéase virale. La seconde étude, basée sur un modèle économique prenant en compte l’évolution des pratiques médicales et l’impact des nouveaux traitements a montré que le coût des soins relatifs au VIH est 535000€ par patient (coût actualisé : 320700€) pour une espérance de vie de 26,5 ans dans les conditions actuelles de prise en charge. Elle met en évidence que le coût annuel d’un patient est d’autant plus élevé qu’il débute la prise en charge à un stade avancé de la maladie (21600€/an s’il accède aux soins en stade sida ou avec un taux de CD4<200/mm3 vs. 19400€ avec un taux de CD4>500/mm3, coûts non actualisés). La troisième étude portant sur 1008 patients VIH nouvellement diagnostiqués, a montré que 93% des patients avaient consulté un médecin généraliste dans les trois années qui précèdent le diagnostic de VIH et que 82% des patients inclus qui consultaient pour des symptômes associés au VIH durant cette période avaient une opportunité manquée de proposition de dépistage du VIH. De même, 55% des HSH qui mentionnaient à une structure de soins leur appartenance à ce groupe à risque, avaient une opportunité manquée de dépistage. La quatrième étude a évalué un dépistage communautaire du VIH auprès des HSH (532 HSH ont été testés dans le cadre de l’étude). Ce dépistage a atteint des personnes à risque d’acquisition du VIH dont un tiers se dépistait peu dans les autres structures de dépistage. Parmi les 15 hommes testés positif (2,8%), 12 (80%) ont reçu la confirmation de leur séropositivité pour le VIH et ont été liés aux soins (médiane des CD4 =550/mm3). La cinquième étude, basée sur un design cas-témoins et menée chez les HSH dans le Nord (53 cas de syphilis précoce et 90 témoins) a mis en évidence la fellation réceptive sans préservatif et l’utilisation de jouets sexuels anaux comme principaux facteurs de risque de la syphilis. Nos résultats montrent les limites des stratégies actuelles de dépistage et sont en faveur d’un dépistage systématique du VIH en routine dans les structures de soins primaires, d’une extension de l’offre de dépistage pour les populations à risque spécifique et d’une prévention renforcée axée sur les mesures de réduction des risques du VIH mais aussi des IST. A l’ère des traitements antirétroviraux efficaces, bien tolérés, mais coûteux, le dépistage et la prévention sont des enjeux de poids dans la maitrise de l’épidémieIn years following the onset of HIV infection, priority was given to therapeutic research. Since the introduction of highly active antiretroviral therapy in 1996, mortality and morbidity related to HIV have decreased dramatically. However, the epidemic remains active, especially among men who have sex with men (MSM), highlighting the need for changes in testing and prevention policies. This thesis presents the evolution of a part of research in epidemiology of HIV in Northern countries, focusing first on HIV treatments effectiveness then moving toward to limitations of current HIV testing strategies, new strategies of HIV testing, and finally addressing prevention. This Ph.D thesis contains five epidemiological studies conducted in France.The first study, conducted in 175 HIV-1 infected antiretroviral-naive patients, showed that lopinavir/ritonavir was efficient regardless to polymorphisms carried by the viral protease.The second study, based on an economic model accounting changes in medical practices and the impact of new drugs, showed that lifetime cost associated with HIV care is €535,000/patient (€320,700 discounted) for a life expectancy of 26.5 years under current conditions. Moreover, it highlighted that annual cost of care increases with late access to care (€21,600/year if AIDS or CD4 count <200 cells/mm3 at HIV care initiation, vs. €19,400 if CD4 count >500 cells/mm3, undiscounted costs).The third study conducted in 1,008 HIV-infected patients newly diagnosed, showed that 93% of patients had seen a general practitioner within 3-year period prior to HIV diagnosis. Of patients enrolled, 82 who sought care for HIV-related symptoms within this period had a missed opportunity for HIV testing proposition. Similarly, 55% of MSM who notified to a healthcare setting that they belonged to this risk group had a missed opportunity for HIV testing proposition. The fourth study assessed a community-based HIV testing strategy targeting MSM (532 MSM tested into the program studied). This HIV testing reached people at high risk of HIV, on third of these was little or not tested in other testing facilities. Among the 15 patients who tested positive (2.8%), 12 (80%) received confirmation and linked to care (median CD4 count =550 cells/mm3). The fifth study, a case-control study conducted in MSM in northern France (53 cases of early syphilis and 90 controls) showed receptive oral sex without a condom and anal sex toy use as the main risk factors for syphilis acquisition. Our results highlight limitations of current HIV testing strategies. They show the importance of promoting routine HIV testing in primary care settings, and extension of testing facilities that target populations with specific risk. In addition, they enhanced prevention for risk reduction measures for HIV and STIs. In the era of effective and well tolerated but expensive antiretroviral therapy, testing and prevention are significant issues in the control of the HIV epidemic
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Mouala, Christian Serge Honoré. "Coïnfection VIH et paludisme d'importation : exemple de la France." Thesis, Sorbonne université, 2018. http://www.theses.fr/2018SORUS232.
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L’interaction entre l’infection à VIH-1 et le paludisme est un problème compliqué et important dans les pays d’Afrique subsaharienne en raison de la superposition épidémiologique et géographique. Nous présentons dans ce travail l’étude de cette coinfection dans le contexte de pays développés. Ce travail présente deux contributions afin d’apporter une meilleure connaissance sur cette coinfection, plus spécifiquement de l’effet de l’infection à VIH sur le paludisme. Concernant l’étude des facteurs VIH associés à la sévérité de l’accès palustre, l’analyse a porté sur les patients VIH issus de la FHDH ANRS CO4. Nous avons observé que la sévérité de l’accès palustre était associée à un nombre de cellules T CD4 bas et que le risque d’accès palustre sévère semblait plus faible chez les patients au retour d’un séjour dans une zone d’endémie palustre à forte prévalence de chloroquino-résistance (zone 3) que dans une zone à plus faible prévalence de chloroquino-résistance (zone 2). Concernant l’étude de l’impact de l’infection à VIH et de l’état immunitaire sur l’accès palustre, l’analyse qui a porté sur la comparaison des sujets exposés au VIH et des sujets non exposés a montré une association entre l’immunodépression (CD4<350 /mm3) et la sévérité du paludisme d’importation à Plasmodium falciparum. L’absence de la chimioprophylaxie est également associée à la sévérité de l’accès palustre, justifiant ainsi l’adaptation des messages et mesures de prévention pour tous les patients, y compris pour ceux originaires des zones d’endémies palustres, dans le but de réduire la morbidité évitable liée au paludismeInteraction between Human immunodeficiency virus type 1 (HIV-1) and malaria, has been a reason for concern because of the epidemiological and geographical overlap of HIV/AIDS and malaria in Sub-Saharan Africa countries. This work presents two contributions to the understanding of this co-infection in a developed country context. Regarding the study of factors associated with HIV on severity of malaria episode, the analysis focused on patients from the French Hospital Database on HIV ANRS CO4. We observed that the severity of malaria was associated with low CD4 T cells, and the risk of severe malaria appeared lower among patients returning from an endemic area of high prevalence chloroquino-resistance (Zone 3) than those returning from area of lower prevalence of chloroquino-resistance (Zone 2). Regarding the study of the impact of HIV-infection and immune status on malaria, the analysis focused on the comparison of subjects exposed to HIV (from the FHDH) and unexposed to HIV (from Bichat hospital database) has shown an association between immunodepression (CD4 <350/mm3) and the severity of imported malaria due to Plasmodium falciparum. Absence of malaria prophylaxis was also associated with the severity of malaria episode, justifying provision of targeted and appropriately delivered preventives message for people travelling in malaria endemic areas message and preventive measures to reduce the preventable morbidity from P. falciparum malaria and the co-infection with HIV, even for subjects originating from malaria endemic areas
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Philip, Neena M. "Population-level HIV risk and combination implementation of HIV services." Thesis, 2020. https://doi.org/10.7916/d8-c1zk-0j52.
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Background:
HIV transmission is greatly reduced when antiretroviral treatment (ART) suppresses an infected person’s HIV viral load. It is unclear, however, whether the contextual risk of incident HIV is optimally reduced by widespread individual-level suppression of HIV viral load alone or in combination with other HIV prevention services. HIV service coverage and community norms can influence risk in small area geographies; and contextual factors, like gender inequality and stigma, may foster environments conducive to HIV transmission. Yet, the relationship between places with high HIV levels and the clustering of area risk factors is unknown.
The goal of this dissertation is to learn if and how a geographically focused combination implementation strategy could reduce population-level HIV risk. Analyses explored whether small area risk profiles explain area differences in HIV. The guiding hypothesis is that in high HIV prevalence settings, low HIV service uptake in a geographically defined area increases the prevalence of high HIV viremia, leading to greater HIV transmission and incident HIV.
Methods:
A systematic review was conducted to examine the association between population-level measures of HIV viral load and incident HIV infection in generalized and concentrated epidemics. Publications were English, peer-reviewed articles published from January 1, 1995 through February 15, 2019 that explicitly defined HIV viral load and assessed outcomes of HIV recency, incidence, seroconversion, or new diagnosis. Studies sampled general or key populations through population-based surveillance registries, household-based enumeration, cluster sampling, or respondent driven sampling. Descriptive statistics summarized review findings.
The Swaziland HIV Incidence Measurement Survey (SHIMS) data were used for the remaining analyses. Using a two-stage cluster-based design, a nationally representative, household-based sample of adults, ages 18-49 years was enrolled from December 2010 to June 2011 in Eswatini. Consenting adults completed an interview and received home-based rapid HIV testing and counseling. All seropositive samples were tested for HIV viral load using the COBAS AmpliPrep/Taqman HIV-1 Test, v 2.0. Adults testing HIV-seronegative were enrolled in a prospective cohort for the direct observation of HIV seroconversion, completing an interview and home-based rapid HIV testing six months later.
Multi-level latent class modeling was performed to identify statistically significant combinations of HIV risk factors and to classify the combinations into small area risk profiles. In the cross-sectional sample, linear regression with robust standard errors assessed the correlation between area profiles and places with high levels of uncontrolled HIV infection, or HIV core areas, measured by the area prevalence of detectable virus (≥20 copies/milliliter) among HIV-positive adults and among all adults, regardless of HIV status. In the prospective cohort, generalized linear regression of longitudinal data assessed the association between area profiles and places prone to new HIV infections (i.e., HIV susceptible areas), measured by area-level HIV seroconversions.
Results:
The systematic review found an evidence base primarily of lower quality studies and inconsistent HIV viral exposure measurement. Overall findings supported a relationship between increasing levels of suppressed HIV in HIV-infected populations and fewer new infections over time. Better quality studies consistently showed higher population viremia (i.e. HIV viral quantity among all persons, regardless of HIV status) associated with HIV incidence in high prevalence populations; population viral load (i.e., HIV viral quantity among only HIV-positive persons) did not show an association with incident HIV in high prevalence, general populations and was inconsistent in key populations.
To determine whether area risk profiles can pinpoint HIV core areas, latent class modeling was used to categorize 18,172 adults into one of six HIV risk types. The risk typology, classified through unique combinations of HIV service uptake and sexual risk behaviors, conveyed an adult’s propensity for HIV transmission and/or acquisition risk. The model next identified the area-level composite prevalences of HIV risk types; estimated the three most frequent, unique composite combinations; and categorized them into area risk profiles characterizing HIV risk: low-moderate acquisition risk, moderate acquisition/transmission risk, and high acquisition/transmission risk. The high acquisition/transmission areas comprised the largest proportions of highest risk transmission and acquisition types. The prevalence of detectable viremia progressively increased from low-moderate acquisition, moderate acquisition/transmission, and high acquisition/transmission profiles [17.7%, 25.4%, and 35.1%, respectively]. When compared with low-moderate acquisition areas, the prevalence of detectable viremia was 7.4% [p<.001] higher in moderate acquisition/transmission areas and 17.1% [p<.001] higher in high acquisition/transmission areas. The prevalence of detectable viral load significantly decreased from low-moderate acquisition to moderate acquisition/transmission areas [76.6% versus 68.7%, p<.001], and was significantly higher in high acquisition/transmission areas by 7.3% [p<.001], when compared with low-moderate acquisition areas.
To determine whether area risk profiles can predict HIV susceptible areas, a total of 18,172 adults were surveyed of which 4396 [24%] had detectable viremia. 11,880 [96%; n=12,357] HIV-seronegative adults enrolled in the prospective cohort and 11,155 [94%] of them completed an endline visit. Four area profiles were identified, defined by unique patterns in prevalence of HIV viremia and of sexual risk behaviors. The proportion of HIV susceptible areas progressively increased from Profiles A, B, C, and D [14.3%, 21.8%, 24.6%, and 30.8%, respectively]. HIV susceptible areas were more than twice as likely to occur in Profile D than Profile A environments [RR 2.13, 95% confidence interval (CI) (1.13, 4.00); p=0.02]. Profile D areas had prevalences of unknown partner HIV status and detectable viremia at 28% and 24%, respectively. In contrast, Profile A areas had prevalences of only 8% with unknown HIV status and 31% with detectable viremia.
Conclusion:
This dissertation shows that geographic risk profiles can explain differences in population-level HIV outcomes. Risk factors spatially cluster in predictable, meaningful combinations that can inform an area typology of HIV risk. The co-location of adults predisposed to greater HIV risk may heighten levels of uncontrolled HIV infection, thereby creating potential area sources of ongoing transmission; however, the concurrent levels of other risk factors may have more influence in reducing population-level incidence than previously considered. A composite indicator of contextual HIV risk may reveal places core to HIV transmission and susceptible to HIV acquisition. Such area profiles may help identify the combination of locally specific risk factors that readily promulgate HIV and better inform the design of place-based HIV intervention packages to enhance current strategies towards global HIV control.
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"The incorporation of viral load measures at sub-population level for modelling the HIV epidemic in Hong Kong." 2015. http://library.cuhk.edu.hk/record=b6116383.
Full textAbstract:
一個大型的多中心臨床試驗 (HPTN052) 於2011年發表研究結論，假如治療中的愛滋病患者能保持病毒載量低水平，他們傳播愛滋病予性伴侶的機會是十分輕微的。這些結論促使利用病毒載量數據去形容愛滋病流行概况及評估高效抗逆轉錄病毒療法 (HAART) 干預策略對流行概况的影響。本研究旨在應用社區病毒載量去模擬香港愛滋病流行概况。本研究收集了香港兩間主要愛滋病專科裡愛滋病患者縱向臨床數據，這些匿名的數據根據美國疾病預防控制中心所提議的人群病毒載量框架整合成流行病數據。其中社區、護理群及監測群病毒載量的計算是為了描述愛滋病流行概況，而新創的全社區病毒載量是用於估計社區裡確診與尚未確診的愛滋病感染者的集體病毒載量。香港未來愛滋病流行概況則利用決定性倉室模型模擬。異性模型透過性別分成兩個 (男女) 有聯繫的小模型，同性模型則用系統進化分析的近鄰結合法去劃分成16個獨立的小模型。除了基於現有情況模擬概況，治療、測試和混合干預策略以及外來感染的影響也被模擬。
從4362個病患中，一共收集了76,350CD4、64,412病毒載量和1042基因序列的回顧數據 (1985-2012)。當中有83%病患是男性、72%是中國人、89%是透過性接觸感染、74%曾經接受治療。能達到低病毒載量的病患百分比由1997年11%升至2012年76%，與HAART的推行情況方向一致。全社區病毒載量所顯示的上升趨勢於異性群和同性群中較其他病毒載量指標早五年出現。於2010-2020，異性群的愛滋病流行概況將維持不變，而同性群的流行概況將穩步上升但不是指數上升。干預策略中，以混合干預加上高治療保留率的策略對同性和異性群最有效，但增加重點測試對異性群比較可行，因為它舒緩了診斷延誤。另外，外來感染會影響干預策略的成效。
假如沒有包含病毒載量因素、外來感染和劃分模型，推測結果會高估流行概況，而治療覆蓋率的影響也不能被反映。基於人群病毒載量的重要性，定期收集所有專科的病毒載量數據並加以整合應該成為監測的一部份。這對於有廣泛治療覆蓋率的香港去研究流行概況是十分重要。
Introduction: In 2011, a large multicentre trial (HPTN052) concluded that HIV+ persons on treatment with suppressed viral load (SVL) have minimal risk of virus transmission to their seronegative partners through sexual intercourse. These results provided evidence for the epidemiological use of viral load data to describe the HIV epidemics and assess impacts of treatment interventions. This study aims at modelling the HIV epidemic in Hong Kong by incorporating population-level viral load measures.
Methods: Longitudinal clinical data of patients attending two major HIV specialist services in Hong Kong were collected. The anonymized data were combined, adjusted and incorporated in an epidemiologic dataset in accordance with the CDC framework of viral load measures at population level. Specifically, community, in-care and monitored viral load were calculated to describe the HIV epidemic. Full community viral load, a new measure, was developed to infer the viral load burden of both diagnosed and undiagnosed individuals in the community. The HIV epidemic was then projected in a deterministic compartmental model. Gender was used to divide heterosexual model into two interrelated sub-models, while phylogenetic analysis (neighbour-joining tree) was applied to divide men-who-have-sex-with-men (MSM) model into 16 independent sub-models. Intervention scenarios of treatment coverage, testing coverage and retention expansion, and influence of non-local infection were projected and compared by modelling.
Results: A total of 76,350 CD4 and 64,412 viral load measurements of 4362 patients, and 1042 sequences were collected retrospectively (1985-2012). Among the patients included, 89% had acquired infection through sexual intercourse, and 74% had been started on highly active antiretroviral therapy (HAART). From viral load perspective, the proportion of patients in care with SVL (≤500copies/mL) increased sharply from 11% in 1997 to 76% in 2012, coinciding with the implementation of HAART. The growth curve of full community viral load was 5 years ahead of other viral load measures of heterosexuals and MSM. In 2010-2020, the HIV epidemic in heterosexuals would neither grow nor die down while the epidemic in MSM would continue to grow steadily but not exponentially. Among scenarios examined, test-and-treat intervention with high retention rate would be the most effective strategy for controlling the MSM and heterosexual epidemic. However, increasing the HIV testing rate for high risk people would be more feasible and impactful for the heterosexual, as a result of the early detection of HIV which would otherwise become late diagnoses. Non-local infection would affect the impact of interventions on epidemic control.
Conclusion: Without the inclusion of viral load measures, non-local infection and model delineation by subpopulations, epidemiologic projection results could be overestimated. Also, the impacts of treatment coverage on epidemic cannot be reflected if viral load measure is not included for describing epidemic growth. Acknowledging the importance of viral load measure, regular collection and aggregation of viral load measurements from all HIV clinics is recommended to form part of the HIV surveillance system. Such provision is important for studying HIV epidemiology descriptively and analytically in Hong Kong where coverage of HIV care is relatively extensive.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Wong, Ngai Sze.
Thesis (Ph.D.) Chinese University of Hong Kong, 2015.
Includes bibliographical references (leaves 204-219).
Abstracts also in Chinese.
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Vargas, Kaaren Giselle. "Molecular epidemiology of Candida albicans in patients with AIDS." 1998. http://catalog.hathitrust.org/api/volumes/oclc/48227895.html.
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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.
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Massey, Jeffrey Paul. "Vertical transmission of Human Immunodeficiency Virus Type I a dissertation submitted in partial fulfillment ... for the degree of Doctor of Public Health (Hospital and Molecular Epidemiology) ... /." 1993. http://books.google.com/books?id=eEBBAAAAMAAJ.
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Cutland, Clare Louise. "Epidemiology and prevention of sepsis in young infants and the potential impact of maternal HIV infection on neonatal sepsis." Thesis, 2016. http://hdl.handle.net/10539/22516.
Full textAbstract:
A thesis submitted to the Faculty of Health Sciences, University of the Witwatersrand,
Johannesburg, in fulfillment of the requirements for the degree of
Doctor of Philosophy
Johannesburg, South Africa 2016Introduction: Neonatal infections contribute to 25% of all neonatal deaths, which account for approximately 44% of all under-5 childhood deaths globally. Pathogens responsible for sepsis in neonates and young infants can be acquired vertically prior to or during labour, or from the environment (community or hospital). This project evaluated the burden and aetiology of sepsis in neonates and young infants (≤90 days), and explored this association to in-utero exposure to human immunodeficiency virus. The study also included a specific focus on the epidemiology of invasive Group B Streptococcal disease in young infants. Additionally, we assessed the efficacy of intrapartum chlorhexidine vaginal washes for: (i) preventing early-onset neonatal sepsis; and (ii) vertical transmission of potentially pathogenic bacteria to the newborns. Furthermore, we evaluated risk factors for poor outcomes due to neonatal sepsis. Materials and methods: (i) A bacterial surveillance system was established at Chris Hani Baragwanath Academic Hospital (CHBAH) from 2004-2008 to identify young infants with bacterial sepsis hospitalised in the neonatal and paediatric wards. Medical and microbiological records were utilised to obtain clinical and laboratory data. Maternal HIV results were obtained from antenatal testing records or admission records. (ii) A blinded, randomised, placebo-controlled trial of 0.5% chlorhexidine maternal vaginal intrapartum wipes and newborn skin wipes was conducted at CHBAH between 2004 and 2007. Consented, eligible participants were randomised during labour to receive either chlorhexidine vaginal wipes or water external genitalia wipes. Newborns received either chlorhexidine full-body wipes (intervention arm) or foot wipes (control arm). Maternal and infant participants were followed up for admissions during the first month after delivery/ birth. A subset of 5144 maternal participants had an intrapartum lower vaginal swab collected, and skin swabs were collected from their newborns to assess colonisation with potentially pathogenic bacteria (Group B streptococcus, Escherichia coli and Klebsiella pneumoniae). Results: Group B streptococcus (GBS) was the most commonly isolated bacterial pathogen, causing 35.2% of culture-confirmed sepsis in infants ≤90 days, 41.6% of early-onset disease (EOD, 0-6 days), 40.5% of late-onset neonatal disease (LOD, 7-27 days) and 18.7% of young-infant community-acquired disease (YI-CAD, 28-90 days). Staphylococcus aureus (S. aureus), Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) contribute 16.2%, 12.2% and 3.4% to sepsis in young infants. Overall, incidence (per 1000 live births) of invasive GBS disease was 2.72 (95% confidence interval [95% CI]: 2.46 to 3.01), including an incidence of 1.50 and 1.22, respectively, in infants 0-6 days and 7-90 days of age. HIV-exposed infants were at greater risk of EOD (Relative risk [RR]: 1.69; 95% CI: 1.28-2.24) and LOD (RR= 3.18; 95% CI: 2.34-4.36) than HIV-unexposed infants. GBS serotypes Ia and III caused 84.0% of invasive GBS disease in young infants. Intrapartum chlorhexidine interventional wipes was not efficacious in prevention of any of: (i) vertical transmission of pathogenic bacteria (54% vs. 55%; efficacy -0.05, 95% CI: -9.5 to 7.9) to the newborns; (ii) sepsis in first 3 days of life (3% vs. 4%; p=0.65,); (iii) sepsis in the later neonatal period (both <1%; p=0.4444); or (iv) maternal puerperal sepsis(both <1%; p=0.56). Conclusion: GBS, S. aureus, E. coli and K. pneumoniae are the most commonly isolated bacterial pathogens in neonates and infants ≤90 days old. HIV-exposed infants are at greater risk of GBS sepsis. Intrapartum chlorhexidine intervention was not efficacious in reducing vertical transmission of pathogenic bacteria, neonatal or maternal sepsis. Alternative interventions to prevent sepsis in young infants, including maternal immunisation, need to be investigated in setting such as ours where there is a high prevalence of maternal HIV infection.
MT2017
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Komatsu, Ryuichi. "Epidemiology of HIV-associated risk factors and acquisition of HIV among high-risk women in southern Vietnam." Thesis, 2004. http://proquest.umi.com/pqdweb?index=1&did=775172121&SrchMode=1&sid=5&Fmt=2&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1233715905&clientId=23440.
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