Дисертації з теми "HIV infections Laos Epidemiology"
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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.
Повний текст джерелаDe, la Harpe Alana. "A comparative analysis of mathematical models for HIV epidemiology." Thesis, Stellenbosch : Stellenbosch University, 2015. http://hdl.handle.net/10019.1/96983.
Повний текст джерелаENGLISH 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.
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/.
Повний текст джерелаRose, 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.
Повний текст джерелаBackground: 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.
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.
Повний текст джерелаBezerra, 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.
Повний текст джерелаSeveral 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.
Labeodan, Moremi Morire OreOluwapo. "Stochastic analysis of AIDS epidemiology." Thesis, Pretoria : [s.l.], 2009. http://upetd.up.ac.za/thesis/available/etd-10172009-112824.
Повний текст джерелаAndersson, 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/.
Повний текст джерелаOkeke, Michael Ifeanyi. "Behaviors Related to HIV Infections in Rural Versus Urban Regions of Nigeria." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2165.
Повний текст джерелаBoyd, Anders. "Clinical epidemiology of multi-viral hepatitis infection among HIV-HBV infected patients." Paris 6, 2010. http://www.theses.fr/2010PA066618.
Повний текст джерелаBerggren, 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/.
Повний текст джерелаPokharel, 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.
Повний текст джерелаSaxton, 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.
Повний текст джерелаNavér, 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/.
Повний текст джерелаLe, 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.
Повний текст джерелаTruong, 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.
Повний текст джерелаDube, 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.
Повний текст джерелаKent, 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.
Повний текст джерелаNuwaha, Fred Ntoni. "Sexually transmitted infections in Uganda : implications for control /." Stockholm, 2000. http://diss.kib.ki.se/2000/91-628-4409-1/.
Повний текст джерелаDenis, 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.
Повний текст джерелаThe 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
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.
Повний текст джерелаAn 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.
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.
Повний текст джерелаAbati, 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/.
Повний текст джерелаInfection 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.
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.
Повний текст джерелаSilva, 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/.
Повний текст джерелаApproximately 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
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.
Повний текст джерелаENGLISH 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.
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.
Повний текст джерелаTakaidza, 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.
Повний текст джерелаIn 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.
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/.
Повний текст джерелаIn 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)
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/.
Повний текст джерелаIn 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.
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.
Повний текст джерелаArchibald, 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/.
Повний текст джерелаEtzel, 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/.
Повний текст джерелаHuman 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
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.
Повний текст джерелаHereby 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.
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.
Повний текст джерелаFadul, Nada, Jacob Couturier, Xiaoying Yu, Claudia A. Kozinetz, Roberto Arduino та 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.
Повний текст джерелаTchounga, 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.
Повний текст джерелаBackground : 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
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.
Повний текст джерелаAmaral, 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/.
Повний текст джерелаThe 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
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.
Повний текст джерелаWith 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
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.
Повний текст джерелаMigrants, 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
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.
Повний текст джерелаIn 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
Mouala, Christian Serge Honoré. "Coïnfection VIH et paludisme d'importation : exemple de la France." Thesis, Sorbonne université, 2018. http://www.theses.fr/2018SORUS232.
Повний текст джерелаInteraction 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
Philip, Neena M. "Population-level HIV risk and combination implementation of HIV services." Thesis, 2020. https://doi.org/10.7916/d8-c1zk-0j52.
Повний текст джерела"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.
Повний текст джерела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.
Vargas, Kaaren Giselle. "Molecular epidemiology of Candida albicans in patients with AIDS." 1998. http://catalog.hathitrust.org/api/volumes/oclc/48227895.html.
Повний текст джерелаKwon, 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.
Повний текст джерелаMassey, 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.
Повний текст джерелаCutland, 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.
Повний текст джерелаIntroduction: 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
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.
Повний текст джерела