Dissertations / Theses on the topic 'HIV treatment'
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1
Bansi, L. K. "Treatment strategies in HIV." Thesis, University College London (University of London), 2011. http://discovery.ucl.ac.uk/1335616/.
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The introduction of highly active antiretroviral therapy (HAART) has led to significant improvements in survival and morbidity for HIV-positive patients. Though HIV can now be well managed with treatment, interlinked barriers to successful treatment are still prevalent. In particular, low adherence to therapy, resistance to drugs and drug toxicity can have a considerable impact on the success of HAART. The potential of HAART is limited from the outset if patients are infected with a drug-resistant virus. Evidence suggests that a small minority of patients are starting HAART with drugs that the virus is resistant to, and consequently, are less likely to achieve virological suppression. A large proportion of resistance tests performed after patients‟ start HAART are not followed by a switch within 4 months of the result being received. This raises questions as to why the test was performed and whether limited future drug options are of concern. A single abnormal laboratory value may be the result of random fluctuations and may not necessarily be a reason for concern over drug toxicity. I derive a more stringent definition of an ALT flare and compare this definition with that commonly found in the literature. Treatment interruptions, perhaps due to drug toxicity, should not take place when the viral load is detectable. Patients who have achieved viral suppression after interrupting treatment and who have failed a higher number of HAART regimens are at a greater risk of viral rebound, though this risk is reduced substantially as duration of suppression increases. A score to characterise laboratory abnormalities is derived and used to predict mortality. Several methods were used; I felt the most appropriate was that based on the estimates from a regression model in which the current laboratory measurements were fitted; only three routinely measured laboratory measures were needed to calculate the score.
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Decloedt, Eric Hermann. "Treatment of HIV associated neurocognitive disorders." Doctoral thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29616.
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Background
Human immunodeficiency virus (HIV) invades the central nervous system (CNS) as early as 8 days after HIV infection, causing a wide spectrum of neuropathological changes including HIV associated neurocognitive disorders (HAND). HAND is a spectrum of cognitive impairment, which in its most severe form cause marked interference with day-to-day functioning (HIV-associated dementia). Antiretroviral therapy (ART) has substantially reduced the incidence of HIV-associated dementia, but has not had an impact on the overall prevalence of HAND. The prevalence of milder stages of HAND in ART experienced individuals varies from 15 - 50%. Transporters expressed in the blood brain barrier and blood cerebrospinal fluid (CSF) barrier affect influx and efflux of drugs including antiretrovirals. Antiretrovirals that have better penetration into the CNS may result in improved cognitive function in patients with HAND, however this has not yet been conclusively shown. On the other hand, prolonged CNS exposure to high antiretroviral concentrations has been proposed as a cause of secondary decline in cognitive function as several antiretrovirals are neurotoxic. Efavirenz in particular, but also tenofovir and emtricitabine, have been shown to have direct neurotoxicity in preclinical models. Polymorphisms in genes that encode these enzymes or transporters may therefore affect antiretroviral CSF concentrations. Africans are the most genetically diverse population worldwide and South Africa has the world’s largest ART programme, with most of patients currently receiving efavirenz-tenofovir-emtricitabine. The impact of pharmacogenetic polymorphisms on the pharmacokinetics of efavirenz-tenofovir-emtricitabine CNS penetration are lacking. A number of adjunctive pharmacotherapies for HAND have been studied, including lithium. Multiple mechanisms have been suggested for the potential beneficial cognitive effect of lithium, including the inhibition of glycogen synthase kinase-3- beta, which mediates inflammation signaling pathways and neuronal apoptosis. Lithium has been used in mood disorders and other neuropsychiatric conditions for more than 40 years. In addition, lithium is a low-cost drug and widely available in public service settings in low and middle-income countries. There is a need for controlled data to evaluate the efficacy of lithium as adjunctive therapy for HAND. Finally, it is unknown whether lithium causes additive nephrotoxicity in combination with tenofovir.
Methods
We conducted a 24-week randomised placebo-controlled trial of lithium as adjunctive pharmacotherapy in participants with moderate to severe HAND established on ART for at least 6 months, with suppressed viral loads. We randomised 66 participants to lithium (n=32) or placebo (n= 34). Our primary efficacy endpoint was the change in Global Deficit Score (GDS) from baseline to 24 weeks, while our secondary endpoint was the change in proton magnetic resonance spectroscopy (1 H-MRS) brain metabolite concentrations. We collected paired plasma-CSF samples in 47 adult participants with and without HAND treated with efavirenz-tenofovir-emtricitabine. We considered 2049 single-nucleotide polymorphisms (SNPs), including SNPs known to affect plasma efavirenz exposure, from potentially relevant genes (ABCC5, ABCG2, ABCB1, SLCO2B1, SCLO1A2, ABCC4, CYP2B6 and CYP2A6) and 880 met a linkage disequilibrium (LD)-pruning threshold. We investigated genetic polymorphisms associated with CSF exposure of efavirenz and its metabolites, tenofovir and emtricitabine. The secondary objective was to explore the pharmacokineticpharmacodynamic relationships with neurocognitive performance. Finally, we investigated the change in estimated glomerular filtration rate (eGFR) in participants who received concomitant tenofovir and lithium.
Results
The median change in GDS between baseline and week 24 for the lithium and placebo arms were -0.57 (95% confidence interval [CI] -0.77, -0.32) and -0.56 (-0.69, -0.34) respectively, with a mean difference of -0.054 (95% CI -0.26, 0.15); p = 0.716. The improvement remained similar when analysed according to age, severity of impairment, CD4+ count, time on ART and ART regimen. Standard 1 H-MRS metabolite concentrations were similar between the treatment arms. The study drug was well tolerated in both study arms. There was no statistically significant difference in the reduction in eGFR or in potassium between the two arms during the 24 weeks. A model that included the composite CYP2B6 15582/516/983 genotype in univariate analyses best predicted the log10-transformed concentrations of plasma efavirenz, plasma 7-hydroxy-efavirenz, plasma 8-hydroxyefavirenz-to-efavirenz ratio and CSF efavirenz. Lower plasma 7-hydroxy-efavirenz concentrations were independently associated with CYP2A6 rs10853742, ABCB1 rs115780656 and CYP2A6 -48A→C. The CYP2A6 -48A→C polymorphism was independently associated with higher CSF 8-hydroxy-efavirenz-to-efavirenz ratio. The CYP2B6 rs2279345 polymorphism was associated with lower plasma 7-hydroxy-efavirenzto-efavirenz ratio in univariate on multivariate analyses adjusting for CYP2B6 516G→T and 983T→C. No polymorphisms were associated with CSF-to-plasma ratios of all 3 drugs, plasma or CSF 8-hydroxy-efavirenz, tenofovir or emtricitabine concentrations, or neurocognitive performance.
Conclusion
Adjunctive lithium pharmacotherapy in patients on ART with HAND was well tolerated but had no additional benefit on neurocognitive impairment. We found that 24-week treatment of HIV-infected patients with lithium and tenofovir did not result in increased nephrotoxicity. We identified novel genetic associations with plasma efavirenz, plasma 7-hydroxy-efavirenz, plasma 7-hydroxy-efavirenz-to-efavirenz ratio, plasma 8-hydroxy-efavirenz-to-efavirenz ratio, CSF 8-hydroxy-efavirenz-to-efavirenz ratio and CSF efavirenz.
3
Fialho, Renata. "Neuropsychiatric manifestations of hepatitis C treatment in HIV/HCV co-infection." Thesis, University of Sussex, 2017. http://sro.sussex.ac.uk/id/eprint/71260/.
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Hepatitis C (HCV) infection is associated with high rates of mortality and morbidity. Interferon alpha based treatment for HCV offers a good rate of viral clearance, however the associated neuropsychiatric side effects increase the risk of treatment interruption and disease progression. The HIV/HCV coinfection is of particular interest due to association with higher rates of HCV treatment side effects and earlier treatment discontinuation when compared with HCV mono-infection. Therefore, the aim of the thesis was to further explore the effect of coinfection on mood and cognition and how HCV interferon based treatment influences neuropsychiatric side effects in mono and co-infected samples. Firstly a meta-analysis was performed to explore cognitive impairment and depression in HIV HCV co-infection. The results suggested that there was consistent literature indicating that the coinfected group were more cognitively impaired and more likely to be depressed than the HCV and HIV monoinfected groups. Secondly empirical studies were conducted to analyse the profile of depression during interferon-based treatment, and explore potential risk factors, such as gender and immune profile. Co-infected patients appeared less vulnerable to the emergence of depressive symptoms during HCV treatment than HCV mono-infected patients. Additionally, neither female gender nor immune response were associated with increased vulnerability to depression. Finally, a longitudinal study investigating cognitive performance during interferon-based treatment was conducted. A significant effect of treatment on information processing speed level of executive function was observed. Overall the research reported in this thesis further clarifies the nature of interferon induced depression and cognitive effects differences between mono and coinfected groups. Having identified a neurovegetative symptom profile and speed of processing impairment of executive function during HCV treatment, the discussion considers the potential of targeted interventions via psychotropic medication and cognitive interventions to minimise the impact of these treatment effects and optimise outcomes in this clinical group.
4
Weverling, Gerrit Jan. "Measuring treatment response in HIV-1 infection." [S.l. : Amsterdam : s.n.] ; Universiteit van Amsterdam [Host], 2000. http://dare.uva.nl/document/83204.
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Hill, Alison Lynn. "Dynamics of HIV treatment and social contagion." Thesis, Harvard University, 2013. http://dissertations.umi.com/gsas.harvard:10814.
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Modern-day management of infectious diseases is critically linked to the use of mathematical models to understand and predict dynamics at many levels, from the mechanisms of pathogenesis to the patterns of population-wide transmission and evolution. This thesis describes the development and application of mathematical techniques for HIV infection and dynamics on social networks. Treatment of HIV infection has improved dramatically in the past few decades but is still limited by the development of drug resistance and the inability of current therapies to completely eradicate the virus from an individual. We begin with a synthesis of the important evolutionary principles governing the HIV epidemic, emphasizing the role of modeling. We then describe a modeling framework to study the emergence of drug-resistant HIV within a patient. Our model integrates laboratory data and patient behavior, with the goal of predicting outcomes of clinical trials. Current results demonstrate how pharmacologic properties of antiretroviral drugs affect selection for drug resistance, and can explain drug-class-specific resistance risks. Thirdly, we describe models for a new class of drugs that aim to eliminate cells with latent viral infection. We provide estimates for the required efficacy of these drugs and describe the potential challenges of future clinical trials. Finally, models and mechanisms for understanding viral dynamics are increasingly finding applications outside traditional virology. They can be used to study the dynamics of behaviors, to help predict and intervene in their spread. We describe techniques for applying infectious disease models to social contagion, drawing on techniques for network epidemiology. We use this framework to interpret data on the interpersonal spread of health-related behaviors.
6
Grint, D. "The natural history, treatment strategies and clinical outcomes of HIV/HCV coinfection." Thesis, University College London (University of London), 2015. http://discovery.ucl.ac.uk/1470765/.
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While the rate of AIDS-related death has declined, as a consequence of the effectiveness of antiviral treatment for HIV, HIV/HCV coinfection and in particular liver-related death (LRD) has assumed increasing importance. This thesis aims to analyse important epidemiological areas of HIV/HCV coinfection to improve the knowledge base of the subject and provide guidance to clinicians in a fast moving area of research. Data for this thesis are from the EuroSIDA study, which is a large multi-centre pan-European prospective observational cohort study with over 18,000 HIV-positive individuals including approaching 5,000 HIV/HCV coinfected individuals. The study was initiated in 1994 and continues to expand and diversify to meet current research needs. Results from the studies included in this thesis have shown that treatment for HIV in coinfected individuals can also have a beneficial effect on the natural course of HCV, with HCV viral load remaining stable over time in those treated for HIV compared with increasing HCV viral load in those not yet treated. The incidence of treatment for HCV has steadily increased in Europe to 4.7 per 100 PYFU in 2010, but remains low with just 25% of eligible patients receiving treatment. LRD accounts for more than a fifth of deaths in this population, with significant liver fibrosis and those triple infected with HBV at increased risk. The 5-year probability of LRD is low for those with F0/F1 fibrosis (2.2%), but increases substantially for those with F2/F3 (10.3%) and F4 (14.0%) fibrosis. With potent new treatments for HCV coming to market, it is clear that while they remain prohibitively expensive they should be targeted at those at the greatest risk of LRD. The prognostic LRD score derived here will help clinicians to make difficult decisions on who should be prioritised for HCV treatment.
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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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Bocanegra, Monica Elizabeth. "Medication Treatment and Neuropsychological Functioning in Perinatal HIV." Scholarly Repository, 2008. http://scholarlyrepository.miami.edu/oa_dissertations/74.
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This study confirmed whether children on the current treatment of choice for HIV infection, Highly Active Antiretroviral Treatment (HAART), exhibit better immune functioning than children on earlier forms of treatment, including sole exposure to Monotherapy/Combination Therapy (Mono-Combo) and "upgrading" from Mono-Combo to HAART (Conversion). It explored whether HAART protects areas of neuropsychological functioning previously found to be compromised in children perinatally infected with HIV more effectively than these earlier treatments. This study includes a unique population (i.e., predominantly minority, low SES status, and largely bilingual), and controls for a number of treatment variables that have not been previously considered. Using the Neurodevelopmental Model and the literature, it was hypothesized that more global functions (i.e., IQ indices besides processing speed) and functions developing earlier in life (i.e., language) would be less affected than more specific functions developing later in life (i.e., visual-motor integration and processing speed). Treatment groups included Mono-Combo, Converters, and HAART. Participants (N=161, 3 to 20 years) were assessed in language, visual-motor integration, processing speed, and IQ using standardized measures and procedures. Three MANCOVAS and an ANCOVA compared groups on immune and neuropsychological measures using age antiretroviral medications were started and years on antiretroviral medications as covariates. Results showed children on HAART have significantly better immune functioning than the Mono-Combo and Converter groups. Consistent with other studies that have controlled for demographic factors, language functioning was not affected by treatment type. Contrary to expectations, visual-motor integration was also not affected by treatment type. Interestingly, Converters were found to perform worse on processing speed than children only exposed to Mono-Combo or HAART. Consistent with expectations, the other IQ indices (i.e., VCI, POI, and FDI) were not affected by treatment type. Findings support the use of HAART globally to improve immune functioning. However, they also provide evidence that HAART does not more effectively protect areas of neuropsychological functioning previously found to be compromised than these former treatments, even when controlling for agents that cross the blood brain barrier, age medications were started, and years on medications. They also bring into question the possible effect of frequency and timing of regimen changes.
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Gerlach, Undine Ariane. "Interruption of antiretroviral treatment in HIV-infected children." Diss., lmu, 2004. http://nbn-resolving.de/urn:nbn:de:bvb:19-26945.
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Moyle, Graeme John. "Treatment of HIV infection with didanosive and foscarnet /." Title page, contents and abstract only, 1995. http://web4.library.adelaide.edu.au/theses/09MD/09mdm938.pdf.
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Tossonian, Haroutioun Krikor. "Treatment of HIV infection in injection drug users." Thesis, University of British Columbia, 2009. http://hdl.handle.net/2429/11885.
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The treatment of HIV infection in injection drug users (IDUs) is limited by multiple barriers which could be addressed by using strategies based on directly observed therapy (DOT) or similar programs. This thesis evaluates a systematic approach of treatment within the context of an established methadone-based DOT program. First, we compared treatment responses with DOT relative to self-administered therapy (SAT) within a longitudinal cohort study. Higher rates of virologic suppression and retention on highly active antiretroviral therapy (HAART) were achieved with regimens taken as DOT over a period of 2 years. We also compared rates of emergence of drug resistance mutations (DRMs) with DOT relative to SAT. Although DOT did not prevent the emergence of DRMs, it did not lead to higher levels of resistance. We estimated the prevalence of primary drug resistance in our antiretroviral naive IDU cohort and found it to be relatively low (4.7%) but polymorphisms in the reverse transcriptase (RT) and protease genes were very common. Mutations at RT codon 135 (frequent in our cohort) were found to have no impact on treatment responses to non-nucleoside reverse transcriptase inhibitor (NNRTI)-based therapy. However, in patients experiencing virologic breakthrough and harboring such mutations, there was more evolution of single and less evolution of multiple NNRTI mutations. We measured the incidence of hepatotoxicity in IDUs receiving nevirapine-based HAART and compared it to that measured in non-IDUs. Hepatotoxicity was observed in 15% of participants in both IDUs and non-IDUs during the first year of therapy. Hepatitis C virus co-infection, being naive to HAART and abnormal baseline alanine aminotransferase levels were associated with higher risk of hepatotoxicity. Finally, we evaluated methadone dose adjustments and treatment responses after initiating HAART. Our results demonstrated that with nevirapine and efavirenz, moderate increases in methadone dosage were required to maintain the therapeutic benefit of opiate substitution therapy, compared to no change required in patients receiving regimens containing lopinavir or atazanavir. Taken together, our data demonstrate that programmatic interventions including DOT are effective in managing HIV-infected IDUs with few if any drawbacks in terms of drug resistance, drug toxicity or interactions with other therapeutic interventions.
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Mallon, Patrick William Gerard School of Medicine UNSW. "Clinical and molecular aspects of HIV-associated lipodystrophy." Awarded by:University of New South Wales. School of Medicine, 2006. http://handle.unsw.edu.au/1959.4/33048.
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HIV-associated lipodystrophy (HIVLD) syndrome is a condition comprising abnormalities in distribution of body fat and metabolism of lipids and glucose that arises in HIV-infected patients on long-term antiretroviral therapy. This thesis describes clinical research into aspects of the natural history and treatment of HIVLD, as well as molecular research into its pathogenesis centred on subcutaneous adipose tissue. Results demonstrate HIVLD to be a treatment-induced syndrome characterised by initial gains in body fat followed by selective, progressive loss of limb fat. Exposure to thymidineanalogue nucleoside reverse transcriptase inhibitors (tNRTI) induces lipoatrophy through mitochondrial dysfunction of which inhibition of mitochondrial RNA expression, rather than mitochondrial DNA depletion, is an early feature. Mitochondrial dysfunction is associated with decreases in expression of peroxisome proliferatoractivated receptor gamma (PPAR??), an adipocyte transcription factor, which helps explain how tNRTI exposure leads to the loss of adipocyte function. Once established, lipoatrophy is characterised by mitochondrial DNA depletion, although this depletion occurs throughout the mitochondrial genome, suggesting an underlying cause other than inhibition of DNA polymerase gamma. HIVLD is a difficult syndrome to treat. Lipoatrophy is resistant to treatment with rosiglitazone, an agonist of PPAR??, which is ineffective in the setting of ongoing tNRTI therapy and mitochondrial dysfunction. Dyslipidaemia is also difficult to treat as use of pravastatin in the setting of ongoing exposure to protease inhibitors results in only modest declines in fasting cholesterol concentrations. Gains in central fat, such as that seen in patients with buffalo hump, are associated with insulin resistance and diabetes, but only occur in a relatively small percentage of treated patients, suggesting a role for genetic factors in its development. Use of strategies such as avoidance of tNRTI in firstline ART, genetic screening to identify those at risk of toxicities and targeted selection of interventions in subgroups of affected patients, may help prevent this syndrome occurring and better treat those patients in which it has already occurred.
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Mohaleni, Mamabolo Promise. "Pre-and post-HIV diagnosis help-seeking behaviour by patients receiving antiretroviral treatment at Witbank Hospital in Mpumalanga Province." Thesis, University of Limpopo (Turfloop Campus), 2013. http://hdl.handle.net/10386/1049.
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Thesis (M.A. (Clinical Psychology)) --University of Limpopo, 2013Studies have indicated that help-seeking behaviour of people living with HIV is not predictable and linear and may entail the utilization of western medicine, traditional medicine and/or complementary medicine. The aim of this study was to explore pre- and post- HIV diagnosis help-seeking behaviour by patients receiving antiretroviral treatment at Witbank Hospital in Mpumalanga Province (South Africa).A qualitative, descriptive phenomenological approach was utilized in the study. Ten participants (male = 5; female = 5, and aged between 30 and 50 years)diagnosed with HIV and who came to the hospital to collect their treatment and for medical review were interviewed using semi-structured interviews. Interpretive analysis method was used to analyse the data. The results suggest the preference for western medicine pre-and post-HIV diagnosis. The results further suggest that help-seeking behaviour is a dynamic process embedded mainly in the conceptualization of the health problem, perception of its severity, the treatment given, and social support experienced.
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Wyl, Viktor von. "HIV-1 drug resistance in the Swiss HIV Cohort study : epidemiology and impact on treatment of HIV-infected patients /." Zürich : ETH, 2008. http://e-collection.ethbib.ethz.ch/show?type=diss&nr=17726.
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Awotedu, Kofoworola Olajire. "Functional changes of the vasculature in HIV/AIDS patients on Haart and Haart Naïve HIV participants." Thesis, Walter Sisulu University, 2013. http://hdl.handle.net/11260/185.
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The present study sought to explore the functional changes that occur in the vasculature of HIV positive participants of African origin in Mthatha district of South africa which might lead to increased risk in their cardiovascular system. Available literature shows that arterial stiffness plays an important role in cardiovascular events such as stroke, vasculitis and myocardial infarction. Measurement of (aortic pulse wave velocity; PWV) provides some of the strongest evidence concerning the prognostic significance of large artery stiffening. This study was aimed at investigating the relationship between anthropometry, age, E-Selectin level, cytokine levels, haemodynamic variables, blood counts and blood lipid profile with pulse wave velocity. Some traditional cardiovascular risk factors such as alcohol, and smoking were also taken into account. This was a cross-sectional study comprising of 169 participants (62 males and 107 females). 63 were HIV negative (group A), 54 HIV positive on treatment (group B), and 52 were HIV positive not on treatment (group C). Pulse wave velocity (PWV) was assessed using the Sphygmocor Vx. Statistically, ANOVA was used for variables with normal distribution and non parametric tests were used for variables with skewed distribution. Notable significant differences were seen in the means of the following variables across all the 3 groups. Conclusion: This study showed that HIV infected patients with or without antiretroviral therapy have increase arterial stiffness which is associated with an increased cardiovascular risk. The sphygmocor is an accurate, non invassive and useful tool in the evaluation of arterial stiffness and its use in clinical practice should be encouraged. PWV and the augmentation index (AIx) are the two major non- iv invasive methods of assessing arterial stiffness. Life style modification should be incorporated into the management of HIV patients so as the continuous monitoring of their haematological and lipid profile.
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Monteiro, D'Albuquerque Polyana. "New strategies to optimize treatment for HIV-1 infection." Doctoral thesis, Universitat de Barcelona, 2015. http://hdl.handle.net/10803/311434.
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Antiretroviral therapy has dramatically reduced morbidity and mortality associated with HIV-1 infection and converted AIDS into a manageable chronic disease. During the past 15 years, antiretroviral drugs have become less toxic, more potent and more convenient, allowing the possibility of early treatment. Changing regimens in patients with viral suppression is an approach that can be contemplated to simplify treatment and improve adherence reducing the number of pills and frequency of dosing, to prevent toxicity in the short or long term, to minimize drug interactions, and also to preserve future treatment options and even to reduce costs. We conclude that the efficacy of protease inhibitors boosted with ritonavir (PI / r) monotherapy in clinical practice is consistent with data from clinical trials. Moreover, the combination of etravirine plus raltegravir is well tolerated and maintains durable viral suppression in selected patients with virological suppression. Regarding modification of PI / r regimens in virologically suppressed patients, we found that the change of PI / r for raltegravir leads to significant changes in biomarkers associated with cardiovascular inflammation, insulin resistance, and hypercoagulability. In this context abacavir / lamivudine exhibits similar efficacy and tolerability of tenofovir / emtricitabine. Replacing the drug involved is one of the strategies to handle complications of antiretroviral therapy. However, for patients with underlying resistance mutations this approach may not be feasible. In adults receiving PI / r with hypercholesterolemia and increased cardiovascular risk, we found that rosuvastatin produced greater decreases in total cholesterol and low density than switching PI / r. Finally, we observed that 11% of patients treated with raltegravir developed significant elevation of creatine kinase during treatment with raltegravir. Symptoms were rare and unrelated to the degree of creatine kinase elevation. While knowledge about non-infectious complications of HIV-1 infection continues to prosper together with the continuous improvement of antiretroviral therapy, it is possible to develop new strategies to limit their impact on people living with HIV and to assure they can age with health and quality of life.El tratamiento antirretroviral ha reducido drásticamente la morbilidad y la mortalidad asociada al VIH-1 y ha transformado el SIDA en una enfermedad crónica manejable. Durante los últimos 15 años, los medicamentos antirretrovirales se han hecho menos tóxicos, más potentes y más convenientes, lo que permite la posibilidad de un tratamiento temprano y de por vida. Modificación de los regímenes en pacientes con supresión viral es un enfoque que se puede contemplar para simplificar el tratamiento y mejorar la adherencia reduciendo la cantidad de pastillas y la frecuencia de dosificación, para prevenir la toxicidad a corto o largo plazo y mejorar la tolerabilidad, para minimizar interacciones farmacológicas, y también para preservar futuras opciones de tratamiento e incluso visando reducción de costes. La hipótesis de trabajo es que en pacientes infectados por VIH que reciben tratamiento antirretroviral eficaz es posible simplificar el tratamiento y hacerlo más tolerable mediante el uso de nuevos fármacos y de nuevas estrategias sin comprometer su eficacia virológica. En cuanto a la estrategia de simplificación, concluimos que la eficacia de los inhibidores de la proteasa potenciados con ritonavir (IP/r) en monoterapia en la práctica clínica es consistente con los datos de los ensayos clínicos. Por otra parte, la combinación de etravirina más raltegravir es bien tolerada y mantiene la supresión viral duradera en pacientes con supresión virológica seleccionados. Con respecto a la modificación de los regímenes con PI/r en pacientes virológicamente suprimidos se observó que el cambio de PI/r para raltegravir conduce a cambios significativos en biomarcadores cardiovasculares asociados con la inflamación, resistencia a la insulina, y la hipercoagulabilidad. En este contexto abacavir/lamivudina exhibe eficacia y tolerabilidad similar a tenofovir/emtricitabina. Sustitución de un fármaco implicado por otro que está mejor indicado y exhibe una potencia similar es una de las estrategia indicada para manejar las complicaciones del tratamiento antiretroviral. Sin embargo, para los pacientes con mutaciones de resistencia subyacentes este enfoque puede no ser factible. En adultos en uso de IP/r con hipercolesterolemia y aumento del riesgo cardiovascular, se encontró que la rosuvastatina produce mayores descensos en el colesterol total y el colesterol de baja densidad que la sustitución de IP/r. Finalmente, hemos observado que 11% de los pacientes tratados con raltegravir desarrolla elevación significativa de creatina quinasa durante el tratamiento con raltegravir. Sin embargo, los síntomas son poco comunes y no están relacionados con el grado de elevaciones de creatina quinasa. Mientras el conocimiento sobre las complicaciones no infecciosas de la infección por VIH-1 sigue prosperando juntamente con la mejora continua de la terapia antirretroviral, es posible desarrollar nuevas estrategias para limitar su impacto en las personas que viven con el VIH y para asegurarles que puedan envejecer con salud y calidad de vida.
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Rushing, R. Mark. "An outpatient facility for the treatment of HIV/AIDS." Thesis, Georgia Institute of Technology, 1998. http://hdl.handle.net/1853/23302.
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Cassidy, Rebecca Jane. "Changing understandings of HIV and AIDS through treatment interactions." Thesis, University of Sussex, 2011. http://sro.sussex.ac.uk/id/eprint/7603/.
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The problem of HIV internationally has many wide ranging impacts on people, communities and countries' development. In the last decade antiretroviral (ARV) treatment has emerged as the major scientific-technical solution, albeit a costly one. Access to ARV treatment is of vital importance across Africa and around the world. Resources for HIV treatment, care and support are transferred globally on a massive scale. However, how such programmes operate ‘on the ground' in different contexts is still unclear. This research contributes to understanding the experience of the people who access such treatment programmes in different contexts. This research focuses on this gap, exploring how treatment programmes are experienced, how the availability of treatment impacts both on people's experience of being HIV+ and how the availability of treatment may also change perceptions of what it means to be HIV+, both individually and at a societal level. This research focuses on the lives and experiences, particularly the treatment experiences, of people living with HIV in peri-urban Gambia. Low prevalence countries such as The Gambia can provide a compelling example of the ways in which meanings and understandings of HIV are created. Here, entering a field of health pluralism and fluid knowledge creation around HIV-infection, came large scale actors providing a high-profile ARV treatment programme through clinic-based medicine, and an effective de-pluralisation of the medical field in relation to HIV, inviting scrutiny of how such knowledge relations and differences are experienced. Although not anticipated at the outset of the research, in parallel the Gambia has become the locus of a major, politically-backed, ‘alternative' AIDS treatment programme. This has thrown the personal and societal meanings of HIV into a new and sensitive context, compelling research attention into how knowledge, status and meanings around HIV are negotiated, and how people make choices amongst different treatment options.
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Hoffmann, Toinette. "The right of the HIV/AIDS patient to treatment." Thesis, University of Port Elizabeth, 2001. http://hdl.handle.net/10948/277.
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The objective of this treatise is to establish whether a right to social security exists in South Africa, which would entitle HIV positive persons in South Africa citizens to medical care. A study was made of various articles in journals and on the Internet to determine the South African government's policy on a right to social security and to providing medical treatment. It was found that South Africa lacks an integrated, holistic approach to social security and does not guarantee the right to social security, merely the right to have access to social security. The same was found with the right to medical care. Although there seems to be a general right to medical care which extends to and includes HIV-positive patients, the state merely guarantees the right to apply for medical treatment but does not guarantee the granting thereof. It is submitted that the Department of Health's refusal to implement a vertical transmission prevention programme and the failure to offer treatment as an alternative, for whatever reason, is "penny wise and pound foolish". In the long run more money is spent dealing with pediatric AIDS. It was further found that although the government attempted to lay a groundwork with the formulation and acceptance of the national AIDS plan, the successful implementation thereof is seriously hindered due to the lack of inter- and intra-departmental collaboration, essential health services and funding.
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Holele, Pearl. "Seeing HIV through the eyes of perinatally infected adolescents living with HIV, on antiretroviral treatment." Master's thesis, University of Cape Town, 2012. http://hdl.handle.net/11427/10869.
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Includes abstract.Includes bibliographical references.
As perinatally infected adolescents living with HIV (ADLHIV) grow older and gain a greater sense of independence, disclosure issues and adherence to antiretroviral treatment (ART) have become major concerns. However, research on how adolescents view and cope with these challenges remains limited, especially in Sub-Saharan Africa. We explored ADLHIV's understanding of their infection and its perceived effects on their well-being, and ultimately, on their attitude towards life-long adherence to ART.
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Wang, Yuan Min. "In vivo and in vitro dynamics of HIV-1 in patients with and without antiretroviral treatment." Thesis, The University of Sydney, 2002. https://hdl.handle.net/2123/27848.
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Highly active antiretroviral therapy (HAART) successfully reduces plasma levels of HIV-1 RNA and improves the quality of life for HIV-infected patients. However, these clinical benefits may be limited by the emergence of multiple drug- and cross drug resistance in HIV-1, and also by the concealment of these viral variants in other sanctuary sites such as
tissues, brain, lung and other blood cell types. Furthermore, the persistence of HIV reservoirs, including latently infected resting CD4 cells, brain, lymph tissue, bone marrow and genital tract, have posed a challenge to the long—term control or eradication of HIV infected patients received HAART. To determine the effect of HAART on the distribution
of viral variants, drug resistance variants, co-receptor surface expression and co—receptormediated viral entry in treated and untreated patients, we have carried out a detailed longitudinal and a comparative study on 6 seroconverters receiving HAART, in addition to 6 antiretroviral naive patients, and four patients receiving structured treatment interruption (STI). All treated patients were followed for 26 to 36 months from the initiation of HAART. In this study we have compared the interrupted and non-interrupted HAART patients to analyze the overall molecular, biological and cellular receptor dynamics over time, and highlight the advantages and disadvantages of the two therapies.
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Masokwane, Patrick Maburu Dintle. "Prevalence of non-AIDS defining conditions and their associations with virologic treatment failure among adult patients on anti-retroviral treatment in Botswana." University of the Western Cape, 2016. http://hdl.handle.net/11394/5247.
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Magister Public Health - MPHBackground: The recognition of HIV/AIDS as a chronic life-long condition globally in recent years has demanded a different perception and an alignment to its association with other chronic diseases. Both HIV and other chronic non-communicable diseases are significant causes of morbidity and mortality. Their combined DALY contributions for Botswana would be significant if research and strategies in controlling these conditions are not put in place. Natural aging and specific HIV-related accelerated aging of patients who are on antiretroviral treatment means that age-related diseases will adversely affect this population. Princess Marina Hospital Infectious Diseases Care Clinic has been in operation since 2002. The clinic has initiated over 16 000 patients on anti-retroviral treatment (ART) since 2002. The current study estimated the prevalence of non-AIDS defining conditions (NADCs) in the attendees of the clinic in 2013. The majority of patients that attended the clinic had been on treatment for over three years with some patients more than ten years. These ART experienced patients were more likely to be susceptible to chronic non-communicable diseases, including non-AIDS defining conditions. The nomenclature used in classification of NADCs in the current study was appropriate for resource-limited settings; because the study setting offered HIV treatment under resources constraints. Aim: The current study characterised non-AIDS defining conditions, and determined their associations with virologic treatment failure in a cohort of patients that were enrolled at Princess Marina Hospital antiretroviral clinic in Gaborone, Botswana. Methods: A retrospective cross sectional study of records of patients who attended the Princess Marina Infectious Diseases Care Clinic in 2013. Stratified random sampling of a total of 228 patients’ records was achieved from a total population of 5,781 records. Data was transcribed into a Microsoft Excel Spreadsheet and then exported to Epi-Info statistical software for analysis. Results: Eighty (35%) cases of NADCs were reported/diagnosed in the study sample; with 27% (n=62) of the patients having at least one condition, 6.7% (n=17) two conditions, and 0.4% (n=1) three conditions. The top prevalent conditions were hypertension (n= 40), hyperlipidaemia (n=7) and lipodystrophy (n=7). The prevalence of NADCs on the various categories of patients compared with the total sample population was as follows: active patients (prevalence ratio= 0.70), transferred out patients (prevalence ratio = 1.24), patients who died (prevalence ratio=2.04) and patients who were lost to follow-up (prevalence ratio =2.86). The prevalence of NADCs was significantly associated with increasing age (p<0.001); having social problems (p=0.028); having been on treatment for over three years (p=0.007); an outcome of death (p = 0.03) and being lost to follow-up (p=0.007). The study showed that being controlled on second line or salvage regimen (p=0.014) and the presence of adherence problems in the past was associated with virologic failure (p=0.008). There was no association of presence of NADCs to virologic failure. Conclusions: There was significant morbidity of non-AIDS defining conditions in the Princess Marina Infectious Diseases Care Clinic shown by a prevalence of NADCs in the clinic of 35% in 2013.The significant associations of the presence of NADCs and virologic failure with outcomes of death and loss to follow-up illustrate the adverse effects that NADCs are having, and calls for strategies to address multi-morbidities in HIV patients on antiretroviral treatment.
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Hutchinson, Angela Blair. "A health technology assessment of HIV counseling and testing technologies." Diss., Georgia Institute of Technology, 2004. http://hdl.handle.net/1853/8077.
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Hedin, Anna, and Erika Karlsson. "Att leva med HIV : En studie av bemötandet av HIV-patienter." Thesis, Ersta Sköndal högskola, Institutionen för vårdvetenskap, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:esh:diva-674.
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Nako, Esther Makuena. "The experience of being pregnant and HIV positive and undergoing treatment against vertical transmission of HIV." Master's thesis, University of Cape Town, 2003. http://hdl.handle.net/11427/3441.
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Njiba, Jessica Tshiosha. "Access to HIV treatment for refugees : case study of South Africa and Uganda." Thesis, University of the Western Cape, 2015. http://hdl.handle.net/11394/5296.
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Yilmaz, Aylin. "Antiretroviral treatment of HIV-1 in the central nervous system /." Göteborg : Department of Infectious Diseases, The Sahlgrenska Academy at Göteborg University, 2007. http://hdl.handle.net/2077/4438.
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Johns, Kevin Wesley. "Cardiovascular risk in HIV-positive patients : assessment and pharmacological treatment." Thesis, University of British Columbia, 2011. http://hdl.handle.net/2429/39936.
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In countries where it is available, highly active antiretroviral therapy (HAART) has transformed HIV infection into a manageable, chronic illness rather than an ultimately fatal condition. As HIV/AIDS-related morbidity and mortality have declined, adverse metabolic effects risen in frequency due to the combined effects of HAART and HIV infection itself. Adverse effects include blood lipid elevations that, in turn, lead to increased cardiovascular risk, potentially resulting in cardiovascular disease (CVD) or death. Treatment and management of these metabolic effects is becoming paramount within the HIV-positive (HIV+) population to extend the lifespan and improve quality of life.
A variety of studies were employed in order to accurately gauge both the risk of CVD posed to the HIV+ population and the efficacy of novel and accepted treatments for metabolic abnormalities in this population. A longitudinal cohort study served to assess the incidence of important metabolic endpoints in HAART-naïve patients initiating therapy. A cross-sectional study was used to assess the prevalence of peripheral arterial disease (PAD), a largely unexplored but clinically relevant cardiovascular endpoint. Two clinical trials investigated the efficacy of treatment in HIV+ patients with elevated cardiovascular risk. One explored the effect of the anti-hyperglycemic agent rosiglitazone on carotid intima media thickness and total plaque area. The second compared the effectiveness of two treatment strategies in patients not reaching lipid targets with rosuvastatin 10 mg: increasing the dose to 20 mg or adding ezetimibe 10 mg to ongoing rosuvastatin.
Findings of the cohort study included a unique and unexpected pattern of treatment-associated lipid abnormalities in HIV+ patients initiating therapy with non-nucleoside reverse transcriptase inhibitors. A low prevalence of PAD was observed in our population of HIV+ subjects most likely secondary to the young age of the participants and factors that confounded the method of assessment. Rosiglitazone did not prove to be an effective agent at reducing surrogate markers for CVD but did have positive effects on endothelial function and inflammatory markers. Finally, the addition of ezetimibe to ongoing rosuvastatin therapy was effective at lowering relevant endpoints, including apolipoprotein B, but did not perform significantly better than a doubled dose of rosuvastatin.
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Ahmed, Naheed. "Contextualizing HIV/AIDS Prevention and Treatment Programs in Zanzibar, Tanzania." Scholar Commons, 2011. http://scholarcommons.usf.edu/etd/2978.
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International aid organizations and wealthy nations have contributed billions to combat the spread and treatment of HIV/AIDS in sub-Saharan Africa; however, these programs have been critiqued for not addressing the socioeconomic and cultural context of the epidemic, instead relying upon generalized approaches. The prevalence rate in Zanzibar, Tanzania is low in the general population, but high among vulnerable segments of Zanzibari society, resulting in interventions focusing on particular groups (e.g. sex workers, drug users, and men who have sex with men). Through interviews with government agencies, non-profit organizations, medical professionals, vulnerable populations, and HIV/AIDS patients, this paper examines how local realities inform and challenge HIV/AIDS programming in Zanzibar.
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Hadjiandreou, Marios Michael. "Mathematical modelling of HIV infection : an investigation of treatment strategies." Thesis, University of Cambridge, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.611268.
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Phalafala, Mathatho Samuel. "The effects of HIV status disclosure on antiretroviral treatment adherence." Thesis, Stellenbosch : Stellenbosch University, 2015. http://hdl.handle.net/10019.1/96973.
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Thesis (MSc)--Stellenbosch University, 2015.ENGLISH ABSTRACT: Successful antiretroviral therapy (ART) depends on appropriate use of antiretroviral agents; which ultimately prevents replication of Human Immunodeficiency Virus (HIV) thus delaying clinical progression of the disease. This study explored how HIV status disclosure affects adherence to antiretroviral therapy at Mamelodi Hospital, using a convenience sampling method with a sample size of 50 adults above 18 years who were on treatment for a minimum of two years prior to the study. An interview protocol was used to uncover patients’ demographics, sexual orientation, and HIV status disclosure, adherence to antiretroviral drugs, drug side effects, how often they missed their doses and how HIV status disclosure / non-disclosure affected their adherence to treatment. Patients’ medical records were assessed to validate and correlate the information obtained from the interviews. The scientific test results used were the CD4count and Viral loads which are used to monitor the HIV/AIDS disease progression. All partakers involved in the study made their HIV status known and reported taking their medicines regularly. The patients’ CD4 count and VL were verified, the CD4 count has shown an upward trend while the VL load showed a downward trend in keeping with patients who are adhering to ART. The majority of participants (54% or 27 patients) reported they had never skipped taking their medication. The participants also reported they had taken their medicine in front of other people and they constituted 74% (37) of the group. Of this 74%, 78.38% (29 patients) said it was because they had disclosed their status. This observation supports the fact that if you have disclosed your HIV status, you have better chances of adhering to prescribed medication. Findings from the study at Mamelodi Hospital revealed that for as long as one has disclosed their HIV status, the outcome of treatment adherence will be better. The only shortfall noted was lack of partakers who did not divulge their HIV status thus a comparison could not be done. It was acknowledged that some participants in the study might have reported disclosure of their HIV status to be in good favour of the researcher to create an impression that they are adhering to their medication. The study has confirmed the existence of a relationship between HIV status disclosure and adherence to ART.
AFRIKAANSE OPSOMMING: Suksessvolle antiretrovirale terapie (ART) hang af van die toepaslike gebruik van antiretrovirale middels, wat replikase van die MI-virus verhoed, en dus die kliniese vordering van die siekte vertraag. Hierdie studie het ondersoek hoe die bekendmaking van MIV-status die gehoorsaamheid tot ART beïnvloed het by die Mamelodi Hospitaal. ‘n Gerieflikheid-streekproef met ‘n groote van 50 volwassenes bo 18 jaar is gebruik en die deelnememers moes ten minste vir twee jaar voor die studie reeds op behandeling gewees het. Data is deur middel van onderhoude ingesamel, met die doel om pasiënte se demografiese inligting, seksuele orientasie, MIV-status, gehoorsaamheid tot ART en newe-effekte van ART in te samel. Pasiënte se mediese rekords is nagegaan om die inligting wat uit die onderhoude verkry is te bevestig. Die wetenskaplike toetse wat gebruik is, was die CD4-telling en virale lading wat gebruik word om MIV/Vigs te monitor. Al die deelnemers het hul MIV-status bekend gemaak en aangedui dat hul hul medikasie gereeld gebruik. Die pasiënte se CD4-tellings en virale lading is bevestig, die CD4-tellings het ‘n opwaartse neiging getoon terwyl die virale lading ‘n afwaartse neighing getoon het. Die meerderheid van die deelnemers (54%) het aangedui dat hul nog nooit hul medikasie oorgeslaan het nie. 74% van die deelnemers het aagedui dat hul hul medikasie voor ander mense neem - hul noem dat dit as gevolg van die feit is dat hul hul status bekend gemaak het. Dit ondersteun die feit dat mense wie hul status bekend maak beter kanse het om gehoorsaam hul medikasie te gebruik. Die studie by die Mamelodi Hospitaal toon dat solank mense hul MIV-status bekend maak, hul meer gehoorsaam is teenoor die gebruik van hul medikasie. Die studie bevestig dus die verband tussen bekendmaking van MIV-status en gehoorsaamheid tot ART.
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Bailey, H. R. "HIV-infected childbearing women in Europe : health, treatment and care." Thesis, University College London (University of London), 2013. http://discovery.ucl.ac.uk/1402416/.
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This thesis aims to investigate the health of HIV-infected childbearing women living in resource-rich and resource-constrained settings in Europe, and to examine their treatment and care in the context of contemporary policies. HIV prevalence is increasing among childbearing women in Europe and particularly in the Eastern region. Highly effective interventions for the prevention of mother-to-child transmission (PMTCT) have resulted in very low transmission rates in Western Europe, but are less available in Ukraine. This thesis uses data from the European Collaborative Study, an on-going prospective cohort study of HIV-infected pregnant women and their infants (9500 mother-child pairs in Western Europe in 1986-2012, and 9600 in Ukraine in 2000-2012), to examine missed opportunities for PMTCT. Results highlight a decline in mother-to-child transmission rates in Ukraine to 4.1% (95% CI 3.4-4.9) in 2008-2010 (vs. 1.7% (95% CI 1.1-2.5) in the Western Europe sites in 2000-2009), and the importance of maternal marginalisation to continued transmissions in both settings. In Western Europe, a substantial proportion of HIV-positive pregnant women are now conceiving on antiretroviral therapy (ART); factors associated with treatment failure during pregnancy among this group are explored. Prevalence of HIV co-infections is high in Ukraine, and this thesis uses data from a nested postnatal cohort (n=2066) to explore testing coverage and factors associated with hepatitis C virus and chlamydia co-infections. Detection and prevalence of cervical abnormalities (an important potential cause of morbidity in HIV-infected women) are also explored. An additional survey in Ukraine provides data on ART adherence during pregnancy and postnatally (n=418) and highlights gaps in information provision and support. Against a backdrop of overall improvements in HIV care, this thesis identifies groups at heightened risk of mother-to-child transmission and/or poor maternal outcomes, and informs policy for their treatment and care.
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Raifman, Julia Rebecca Goldberg. "Essays on HIV and Malaria Treatment in Sub-Saharan Africa." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:16121147.
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Malaria and HIV are the two diseases that cause the most disability and loss of life in sub-Saharan Africa. Treatments play a critical role in ameliorating the impact of these diseases on patients and their communities. This dissertation focuses on three elements of treatment: The impact of HIV treatment on childhood education, integration of HIV care and sexual and reproductive healthcare, and adherence to treatment.
In chapter one, we assessed the impact of adult HIV treatment on the educational attainment of children in the same household through a regression discontinuity analysis. Adult HIV treatment results in large gains in the educational attainment of children in the same household (intention-to-treat [ITT]: 0.30 years, p=0.017; complier average causal effect [CACE]: 1.17, p=0.036). This increase in educational attainment is important for increasing individual and community well-being and human capital.
In chapter two, we estimated the association between moving through the HIV treatment cascade and contraceptive use through a bivariate probit analysis. We find large increases in condom use among HIV-positive women as they move through the treatment cascade, with increases of 22.8 percentage points (p<0.001) among women on ART for 4-7 years relative to women who are unaware of their HIV-positive status. This finding is a positive indication of the integration of HIV care and reproductive healthcare.
In chapter three, we conducted a randomized trial to assess the impact of text message reminders on adherence to antimalarial treatment and in chapter four we estimated whether patient factors predict antimalarial treatment adherence and modify the impact of text reminders using logistic regression models. We found that a short, simple text message reminder increases adherence to antimalarial treatment (OR: 1.45, p=0.030) and that no patient factors we assessed statistically significantly predicted antimalarial treatment adherence. While adherence to treatment remains difficult to predict, short, simple text message reminders could increase antimalarial treatment adherence.Global Health and Population
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Kwanisai, Felistus. "Antiretroviral treatment : challenges experienced by HIV positive women in Zimbabwe." Diss., University of Pretoria, 2014. http://hdl.handle.net/2263/43137.
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HIV and AIDS which was discovered in the 1980s is causing havoc in many developing
countries and Sub-Saharan continent is the hardest hit. Pratt (2008:8) highlights that “the
number of people living with the disease is concentrated in the industrially developing world,
mostly in those resource deprived countries least able to afford the care of HIV-infected
people”. Zimbabwe is one of the SADC countries with the highest statistics of HIV and AIDS.
Women account for the largest number of people infected by the pandemic and this could be
as a result of the social and cultural norms which oppress women and their position in society.
Antiretrovirals (ARV’s) are the life-long drugs given to HIV-infected people to slow the
progression of the disease. There are different types of ARV regimens. Zimbabwe introduced
the ART roll-out in 2004, however the ART users face multiple obstacles in accessing ARVs.
The study targets women because they are a vulnerable group in society, specifically in
Zimbabwe. Women have been subjected to stigma, discrimination, violence, humiliation,
degradation and psychological torture when they are identified as being HIV positive. Some
are neglected and deserted by their partners and families after disclosure, as a result many are
too scared to disclose their status to families. The country’s political and economic situation
has a major impact on the HIV positive women’s access to ARV treatment. This is compounded
with the social and cultural norms and values of the people. The focus of this study is on the challenges experienced by HIV positive women with regard
to accessing ARV treatment in Zimbabwe. This study strived to understand the challenges HIV
positive women encounter in adhering and accessing to ARV treatment. The goal was to
explore the challenges experienced by HIV positive women with regard to accessing ARV
treatment in Zimbabwe. The research question of the study was: What are the challenges
experienced by HIV positive women with regard to accessing ARV treatment in Zimbabwe?
This study used a qualitative approach with a collective case study research design. The
population for this study was the African women from Zimbabwe who were infected with HIV
and AIDS. Non-probability purposive sampling was utilised in this study to select the sample
of 10 women who were living with HIV and AIDS in Masvingo District, Zimbabwe and who
were accessing ART. Specific criteria for sampling was used to select clients of two NGO’s in
Masvingo district of Zimbabwe: Batanai HIV and AIDS Service Organisation and the
Reformed Church in Zimbabwe Community Based AIDS Program.
Semi-structured one-to-one interviews were used to collect data. The researcher sought
permission of the participants to voice record their interviews and the researcher transcribed
them personally. The data gathered was analysed and theme and sub-themes were generated
from the data. The research findings were presented thereafter by providing a profile of
research participants followed by thematic analysis of the themes and sub-themes from the
transcriptions. Literature control and verbatim quotes were used to support these themes and
sub-themes. The following are the themes from this study: Theme One- Information regarding
HIV and AIDS, Theme Two- Information on ARV treatment, Theme Three- Societal and HIV
positive women’s views on HIV and AIDS, Theme Four- Experiences of being an HIV positive
woman and Theme Five- Needs identified by HIV positive women.
The conclusions of this study reflect that HIV positive women experience some challenges in
adhering and accessing ARV treatment. Disclosure, stigma and discrimination, traditional and
faith healer’s diagnosis of HIV and AIDS, access to medication for Opportunistic Infections,
food shortage, distance to ARV sites, the availability and change of ARV regimens were
amongst some of the factors which made access to ARV treatment a challenge. Recommendations from this study can be used by HIV and AIDS stakeholders to understand
the challenges and experiences by HIV positive women better. The social workers can also use
the recommendations to find ways to make their services known to the communities and also
improve their intervention and support to these women.Dissertation (MSW (Health Care))--University of Pretoria, 2014.
lk2014
Social Work and Criminology
MSW (Health Care)
Unrestricted
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Moeketsi, Ntshebo Mirriam. "Treatment and regimen change in a cohort of HIV positive patients in anti-retroviral treatment at Tshepang Wellness Clinic, Dr George Mukhari Hospital." Thesis, University of Limpopo ( Medunsa Campus ), 2010. http://hdl.handle.net/10386/218.
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Thesis (MPH)--University of Limpopo, 2010.Background: Antiretroviral therapy led to a revolution in care of patients with HIV/AIDS in a developed world. Treatment is not a cure but it also presented with new challenges of side effects, drug resistance and it also dramatically reduces rate of mortality and morbidity and it also improves quality of life to people living with HIV/AIDS, and it also now considered as manageable chronic diseases. Aim: Aim of the study is to establish and describe reasons for treatment and regimen change in a cohort of HIV positive patients on ART enrolled in the pharmaco-epidemiological survey at Tshepang wellness clinic. Objectives: is to determine reasons for treatment and regimen change, types of treatment and regimen change among patients on ART who are enrolled in pharmacoepidemiological survey at Tshepang wellness clinic. Design and Methods: Study is a retrospective cohort study, and sample size of 301 medical records of a cohort of HIV positive patients on ARVs enrolled in a longitudinal pharmaco-epidemiological survey from November 2006-May 2007 reviewed. Data extraction tool used to collect data and software called SPSS 17.0 used to analyze data and relevant themes were extracted to determine distribution of variables. Results: Results of this study indicated that 91 (85%) were males and (87.8%) 191 were females. Age was grouped as teenagers (15-25yrs), young adults (26-49yrs) and adults (50- 70yrs). Results also shows reasons of treatment and regimen change of which majority of patients 134(44.8%) changed due toxicity followed by 16 (5.4%) who changed because of pregnancy, and the other 4(1.3%) changed because of resistance, and the last 2(0.7%) which are regarded as minorities change because of T.B. Conclusion and Recommendations: Results shows that majority of pharmacovigilance patients were initiated Regimen 1 compared to other regimens. Toxicity appear as the main reason of treatment and regimen change on this study as 140(46.4%) reported toxicities (peripheral neuropathy, lactic acidosis, lipodystrophy and lipoatrophy). Implementation of monitoring of adherence needed for prevention of resistance and virological failure.
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Magoro, Mmbangiseni Terrance. "An assessment of the experiences of patients on the comprehensive HIV and AIDS care management and treatment programme in Tshwane, Gauteng." Thesis, University of Limpopo (Medunsa Campus), 2009. http://hdl.handle.net/10386/250.
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Thesis (MPH)--University of Limpopo, 2009.Background In order to provide an assessment of experiences of patients on the Comprehensive HIV and AIDS Care Management and Treatment (CCMT) programme it is essential to ascertain how accessible the CCMT programme is, moreover, is it is critical to determine the level of quality and the extent in which patients are satisfied with service provided. The study investigated and described the experiences of patients on the Comprehensive HIV and AIDS Care Management and Treatment (CCMT) programme. Purpose The purpose of the research was addressed within a quantitative approach applying descriptive designs. A self-administered questionnaire was used to collect the data that fit the objectives of the research. In this study the population applied to patients who lives in the vicinity of Tshwane District, Pretoria West and Kalafong Hospitals; Method Systematic random sampling consisted of 402 patients on the CCMT programme in three hospitals namely Tshwane District, Pretoria West and Kalafong Hospitals. Eligible participants were those who were 18 years and older and have been on the CCMT programme for 6 months or longer. Data was captured on Microsoft Excel 2007 and descriptive statistics was analysed with Stata 10. Results In this study 415 interviews were secured in all three hospitals, A total of 415 questionnaires were distributed in all three hospitals where a response of 97% was obtained, which compares favorably with the experience of other researchers. Conclusion The study reveals that the CCMT programme in Tshwane District, Pretoria West, and Kalafong hospitals is being implemented in accordance with what has been prescribed in the operational plan for the comprehensive HIV and AIDS Care, Management and Treatment for South Africa as it is accessible, of good quality with patients that are generally satisfied with service provided. Key terms: HIV and AIDS, health care, accessibility, quality, management, guidelines.
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Marais, Melanie. "A descriptive study to evaluate the effect of guidelines used by counsellors to improve adherence to antiretroviral therapy in the private sector." Thesis, University of the Western Cape, 2006. http://etd.uwc.ac.za/index.php?module=etd&.
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Södergård, Björn. "Adherence and Readiness to Antiretroviral Treatment." Doctoral thesis, Uppsala University, Department of Pharmacy, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-7282.
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Antiretroviral therapy places extraordinarily high demands on adherence, since non-adherence affects both individuals and society due to the spread of resistant viral strains. The aims of the thesis were to investigate the prevalence of adherence in Swedish HIV-infected patients, changes in adherence over time, and factors associated with adherence, including patients’ readiness to adhere. Further, to investigate the collaboration between nurses, doctors and pharmacists after the introduction of a HIV-clinic satellite pharmacy. Data were collected via two cross-sectional patient surveys in 1998 and 2002, qualitative interviews with health care personnel at a major HIV clinic, and a nation-wide, cross-sectional patient survey in 2003-2004.
The level of adherence improved from 28% in 1998 to 57% in 2002, possibly due to simplified treatment and a new multi-professional treatment model at the clinic. The proportion of adherent patients was 63% in the nationwide survey. Factors associated with adherence were high age, high quality patient-provider relationships, no drug or alcohol problems and shorter time on treatment.
A hypothesized structural equational model, using readiness and adherence as separate latent concepts, was tested and found to support readiness as a distinct factor influencing adherence.
The health care personnel believed that conventional pharmacies had several disadvantages in serving the HIV infected population. They found the HIV-clinic satellite pharmacy valuable, since it contributed to increased communication and trust between the health care professions, and improved teamwork in medication management.
In conclusion, the level of adherence increased over time, and several factors associated with adherence were identified. Improved collaboration between health care professionals may enhance treatment support, and increased attention should be given to interventions that focus on the individual’s readiness for behavioural change in order to optimize treatment outcomes.
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Weinberger, Beverley Slome Kloss Jacqueline D. "Posttraumatic stress in adolescents with HIV and its relationship with treatment adherence : the role of health beliefs /." Philadelphia, Pa. : Drexel University, 2010. http://hdl.handle.net/1860/3221.
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Ngugi, Pearl. "Response and adherence of HIV positive women to cervical cancer treatment." Thesis, Nelson Mandela Metropolitan University, 2011. http://hdl.handle.net/10948/d1014129.
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It is estimated that 6742 South African women are diagnosed with cervical cancer and 3681 women die from the disease every year. In 1993, The Centers for Disease Control declared cervical cancer an Acquired Immunodeficiency Syndrome defining illness. Apart from persistent human papillomavirus infection, HIV infection is the most common co-factor contributing to cervical cancer in South Africa. Studies have noted that in HIV positive women, there has been an occurrence of faster progression to more advanced stages of cervical cancer with high cases of treatment failure and recurrence. There is limited literature available regarding the prognosis of HIV positive women who suffer from cervical cancer. Women who are HIV positive and have cervical cancer have not been evaluated in detail regarding their response and adherence to cervical cancer treatment. Standard treatment protocols for this set of patients have not been defined. The aim of this study was to assess how HIV positive women who have been diagnosed with cervical cancer responded and adhered to cervical cancer therapy which includes: curative radiotherapy; curative chemotherapy; concurrent chemoradiation or palliative radiotherapy. The study also evaluated the effects of the concurrent use of antiretrovirals and cervical cancer treatment. This was done to determine whether invasive cervical cancer in women who were HIV positive could be managed using the same treatment protocols as patients who were HIV negative. A historical cohort design was employed for the study. The study was conducted at the Oncology Department of a tertiary level hospital located in the Eastern Cape Province, South Africa. The total sample consisted of 196 medical records of women diagnosed with cervical cancer between 2005 and 2008. One hundred women were HIV negative, 83 were HIV positive and the HIV status of 13 women could not be determined. The records were audited over a period of two years from the date of diagnosis. The term „complete response‟ referred to patients who had no recurrence of cervical cancer and no evidence of metastases after undergoing treatment. At one month following treatment there was a significant difference in the incidence of complete response between the HIV positive patients and the HIV negative patients (Chi2 = 16.4, d.f. = 1, p = 0.00005, Cramer‟s V = 0.31). The significant difference in response to treatment between the HIV positive patients and the HIV negative patients was maintained at six months after treatment (Chi2 = 15, d.f. = 1, p = 0.00011, Cramer‟s V = 0.34), 12 months after treatment (Chi2 = 20.5, d.f. = 1, p = 0.00001, Cramer‟s V = 0.37), 18 months after treatment (Chi2 = 9.8, d.f. = 1, p = 0.00173, Cramer‟s V = 0.28) and 24 months after treatment (Chi2 = 5.0, d.f. = 1, p = 0.02571, Cramer‟s V = 0.26). At each of these intervals, cases of treatment failure and metastases were significantly higher in the HIV positive women than in the HIV negative women. Although there was no significant difference in the incidence of adherence between the HIV negative women, the HIV positive women who were on HAART and the HIV positive women who were not on HAART, there was a significant difference in the incidence of the various reasons for non adherence between the various groups. These reasons included: missed scheduled appointments (Chi2 = 2.9, d.f. = 2, p = 0.02385, Cramer‟s V = 0.31); low blood count (Chi2 = 4.0, d.f. = 2, p = 0.01327, Cramer‟s V = 0.15); radiotherapy induced skin breakdown (Chi2 = 0.6, d.f. = 2, p = 0.04581, Cramer‟s V = 0.16) and radiotherapy induced diarrhoea (Chi2 = 6.9, d.f. = 2, p = 0.03118, Cramer‟s V = 0.19). According to the 2004 National Antiretroviral Treatment Guidelines, cervical cancer patients would fall into the WHO stage IV category of HIV disease thus all patients with confirmed diagnosis of invasive cervical cancer should be commenced on antiretrovirals as soon as the cancer diagnosis is made regardless of their CD4 count. However, in the current study, 13 percent (n= 83) of the HIV positive women were not on antiretrovirals. The study concluded that HIV positive women had a higher incidence of both treatment failure and metastases to cervical cancer treatment. Standard radiotherapy and concurrent chemoradiation cervical cancer treatment protocols should be still be used in both HIV negative patients and HIV positive patients so as not to compromise tumour control. Furthermore, in accordance with the antiretroviral treatment guidelines, all HIV positive patients with cervical cancer should receive antiretrovirals irrespective of their CD4 count.
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Xie, Rongbing. "Modeling Depression Treatment Strategies for Human Immunodeficiency Virus (HIV) Positive Patients." Thesis, The University of Alabama at Birmingham, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10642913.
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This dissertation empirically examines the associations between depression and HIV-related outcomes, simulates both care and outcomes under different depression care strategies, and compares the cost effectiveness of various depression care strategies to the current care strategy.
The empirical investigations reveal the negative associations between depression and HIV-related outcomes using two longitudinal patient-level databases. Furthermore, the patterns and outcomes of depression care are identified and simulated using agent-based modeling. Finally, simulated costs and effectiveness are used to evaluate different depression care strategies for reducing new HIV infections and improving quality of life.
The current standard of care for depression among patients living with HIV can be characterized as low intensity in terms of screening and treatment; enhanced depression care strategies are proposed and evaluated to be cost-saving. Recommendations are offered to enhance depression care in HIV care settings.
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Taylor, Debra Lynn. "Investigation of different antiviral strategies for the treatment of HIV infections." Thesis, Queen Mary, University of London, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.260877.
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Lawson, Zoe Frances. "Modelling the progression of treatment scenarios in the HIV/AIDS epidemic." Thesis, Cardiff University, 2005. http://orca.cf.ac.uk/56013/.
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Advances in recent treatments for HIV/AIDS patients have shown dramatic outcomes in extending the incubation period and AIDS survival time, whilst also providing significant improvements in the quality of patients' lives. This thesis establishes a model of the HIV/AIDS epidemic that incorporates the effects of treatments, in particular, the introduction of highly active antiretroviral therapy (HAART), which became widely available during 1996. The technique of compartmental modelling is employed in an attempt to reproduce observed AIDS incidence/prevalence, HIV incidence/prevalence, and deaths from AIDS data. There are movements between compartments (sub-populations affected by the HIV/AIDS epidemic) each with an associated parameter. Each sub-population has a differential-difference equation associated with it. Once these equations have been solved numerically they give a set of steady-state solutions, from which it is possible to estimate HIV/AIDS incidence and prevalence. Some parameter values within the model are obtained from surveys, census results, etc., but others are derived using a maximum likelihood estimation (MLE) procedure. The use of realistic values gives impressive results, creating a remarkable fit with routinely collected data relating to levels of HIV/AIDS incidence and prevalence in the UK homosexual population. Finally, the model is used to project levels of incidence and prevalence over the next few years, and to investigate several possible 'what-if' scenarios, with a brief investigation into the consequent cost implications.
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Jarvis, Joseph Nicholas. "Novel strategies for treatment and prevention of HIV-associated cryptococcal meningitis." Thesis, St George's, University of London, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.568720.
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Cryptococcal meningitis (CM) is a leading cause of death in HIV -infected patients in Africa. The thesis examines novel strategies for treatment and prevention of HIV - associated CM, and reports: i) A literature review of HIV -associated CM. ii) The results of a large combined cohort analysis identifying high baseline fungal burden and abnormal mental status as key determinants of mortality in patients with CM. iii) A description of the epidemiology, clinical features and outcomes of CM in Cape Town, based on a series of observational cohort studies, showing that CM is the commonest cause of adult meningitis in Cape Town, with an in- hospital mortality of ~30%, and that ART roll-out has yet to substantially reduce the number of cases or impact on in-hospital mortality. iv) A report of a randomized controlled trial demonstrating that the novel immunotherapeutic strategy of short course adjunctive IFN-y increases the rate of clearance of cryptococcal infection in HIV -associated CM. v) Results from flow cytometry and luminex analysis examining immune responses to cryptococcal infection in late stage HIV -infection, and assessing the effect of adjunctive IFN-y on the host immune response. vi) The results of a large trial demonstrating that screening for cryptococcal antigenaemia on entry into ART programmes allows the identification of patients at risk of developing CM, potentially enabling their prevention. The thesis is based on fieldwork carried out over a three-year period in Cape Town, South Africa, followed by additional laboratory work at the National Institutes of Health, Bethesda, USA and St. George's University of London.
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Human, Oliver. "Between policy and patients : protocols and practice in HIV/AIDS treatment." Thesis, Stellenbosch : Stellenbosch University, 2008. http://hdl.handle.net/10019.1/2553.
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Thesis (MA (Sociology and Social Anthropology))--Stellenbosch University, 2008.In recent years the World Heath Organisation (WHO) has recomended standardising HIV/AIDS treatment. Standardisation is based upon a particular model of what occurs within the relationship between a doctor and a patient and is propogated through the application of protocols. This thesis aims to illustrate how a doctor deals with a protocol in the face of contexts over-laden with contingency and excess which the protocol does not account for and which standardisation excludes. In other words, it explores how doctors deal with the failures and restrictions of standardised medicine. The central question this thesis aims to answer is: How do doctors on the ground deal with the standardising demands of global, as well as national, institutions in the face of highly contingent daily realities? I aim to answer this question by critically analysing the relationship between global institutions and the effects of their policies on the ground level. I argue that global organisation such as the WHO attempt to limit the particularities and contingency of local contexts in order to ensure the internal coherence of their own policies. This is made possible through ‘interpretive communities’ of experts, as well as, the relative opacity of ground level actions. However, I also illustrate how doctors applying these protocols are not merely pawns in the state’s and global health organisations schemes but rather depend upon the opacity at ground level in order to ensure the well-being of those marginalised by protocols.
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Barnes, Shelly Marie. "Investigating the Impact of Patient-Provider Communication on HIV Treatment Adherence." Thesis, University of North Texas, 2016. https://digital.library.unt.edu/ark:/67531/metadc849690/.
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Today over 1.1 million people are living with HIV/AIDS in the United States; over the last 4 decades mortality rates have decreased largely made in part because of advancement in awareness and treatment options. Treatment adherence has long been considered a vital component in decreasing HIV/AIDS related mortality and has proven to reduce the risk of transmission. However not all patients take their medicine as prescribed. This research study, sponsored by The North Central Texas HIV Planning Council explored how Patient and Provider communication impacted treatment adherence. By utilizing a mixed-methods approach survey data and semi-structured interviews were used to collect insights from both Patients and Providers. Data gleaned through the interview process provided a perspective that could not be captured by using quantitative methods alone. The results from this research yielded multiple themes related to patient and provider communication with recommendations as to how The North Central Texas HIV Planning Council could address treatment adherence, such as Providers focus on Patients perceived severity based on their understanding of disease and illness; that side-effects remain a concern for patients and should not be dismissed; and finally that the word AIDS is perceived to be more stigmatized and as such organizations providing HIV/AIDS related services should explore alternative names where the word AIDS in not included.
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Aung, Kay Tu Jittima Dhitavat. "Pulmonary tuberculosis treatment outcomes in HIV infected patients on antiretroviral therapy /." Abstract, 2006. http://mulinet3.li.mahidol.ac.th/thesis/2549/cd388/4838793.pdf.
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Frasier, Velma Asneth. "Increasing Depression Screening and Treatment for Adults Living with HIV/AIDs." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7540.
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The lifetime prevalence of clinical depression in patients living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) is approximately 22% compared to 3% to 10% in the primary care population. The nursing practice problem at the project site concerned nurses' lack of knowledge and understanding of procedures to help ensure that all patients living with HIV/AIDS were properly screened for depression and referred for further evaluation and treatment. The purpose of this project was to implement a staff education module to address the use of the PHQ-9 screening tool to identify depression in people diagnosed with HIV/AIDS. The theoretical framework for this educational module was the theory of planned behavior. The practice-focused question explored the extent to which the implementation of an evidence-based practice education model in a primary care clinic treating patients living with HIV/AIDs would increase staff knowledge on the use of the PHQ-9 tool to screen for depression. A staff education project incorporating a pretest and posttest design was conducted to determine whether a significant change existed in the test scores of the participants between the pretest and the posttest. After completion, the posttest measures showed an improvement of 35%. The implications of this project for social change might include improvement in the knowledge, attitudes, and practices of the nurses in the treatment of depression in adults living with HIV/AIDS.
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Mofokeng, Dalene. "HIV patients’ perceptions of mobile technology support in Nelson Mandela Bay, Eastern Cape." University of Western Cape, 2021. http://hdl.handle.net/11394/8050.
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Magister Commercii (Information Management) - MCom(IM)South Africa has one of the largest HIV and AIDS burdens in the world, with an estimated7.52 million people living with HIV in 2018. The antiretroviral therapy (ART) programme is the biggest and most costly programme in the country, with 3.7 million people enrolled as of 2017. The success of antiretroviral therapy is dependent on adherence to medication and long-term retention in care. It has been reported that support groups can improve the treatment adherence of patients and their retention in care. However, enrolment in adherence support groups is voluntary, and the abovementioned success thereof is dependent on the commitment of the patient to active participation in the group. It is estimated that about 80% of adults and young people own at least one mobile phone, which makes this technology suitable to improve communication and enhance interaction amongst support group members.
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Cederfjäll, Claes. "Aspects of care among HIV infected patients : needs, adherence to treatment and health related quality of life /." Stockholm, 2002. http://diss.kib.ki.se/2002/91-7349-288-4.
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