3. Electronic Theses and Dissertations (ETDs) - All submissions
Permanent URI for this communityhttps://wiredspace.wits.ac.za/handle/10539/45
Browse
39 results
Search Results
Item Genotypic characterisation of South African human immunodefiency virus type l isolates(2003) Hunt, Gillian. M.This study was conducted to investigate the genetic diversity of human immunodeficiency virus type 1 in South African individuals. Blood was collected from 58 HIV-1 seropositive adult individuals during the period between 1996 and 1999 attending clinics across Johannesburg, South Africa. These samples were subtypedby heteroduplex mobility assay in the env and gag regions, and the sutype designations confirmed by sequencing and phylogenetic analysis.Item Investigation of the role of human parvovirus B19 in chronic anaemia of hiv infected TB patients(1994-09-30) van Niekerk, Albetus. Bernhardus. Willer.This study was undertaken to determine the role of human parvovirus B19 (B19) in chronic anaemia of HIV infected TB patients. Patients were selected from an existing databank of 307 patients included in a MRC HIV/TB study. Twenty-nine patients, 15 coinfected with HIV/TB and 14 infected with TB only, were identified for further evaluation. These patients’ sera were subjected to serological and DNA detection studies using IgG and IgM ELISA methods and a nested polymerase chain reaction (PCR) assay.Item Tobacco smoking as a potential risk factor for pulmonary tubercolosis A meta-analysis(2001-12-29) Chipeta, John, Benson.Objective. The aim of this paper was to systematically evaluate available evidence on tobacco smoking as a risk factor for pulmonary tuberculosis. Methods. Relevant reports were identified by a systematic electronic search of Medline, Pubmed, Nioshtic, Toxline and Embasse. Methodological quality of all selected publications was assessed using a standardized checklist. Information was collected on all major study characteristics. Inter-study heterogeneity was examined qualitatively and statistically using the DerSimonian and Laird method. Results. Five case-control studies and 1 cohort study were included in the systematic review. All the 6 studies revealed a relationship between tobacco smoking and pulmonary tuberculosis. Heterogeneity across studies hampered overall statistical pooling of results, however pooled risk ratios for sub-groups were determinedItem A randomised study to compare radical concurrent chemoradiation against radical radiotherapy, as a treatment of cancer of the cervix in HIV infected patients(2009-11-24T13:49:53Z) Msadabwe, Susan CitonjeObjectives Cancer of the cervix is one of the commonest cancers in South African females. Up to 30% of patients are HIV positive. The addition of chemotherapy to radiotherapy has been shown to significantly improve local control and survival and concurrent chemoradiation is the standard treatment for locally advanced cancer of the cervix. There is very limited literature available concerning the tolerance and efficacy of this treatment in HIV positive patients. This study aims to assess the acute toxicity of combined modality treatment in these patients. This study is part of a multicenter International Atomic Energy Agency sponsored study. Materials and methods Patients with FIGO stage IB2 to IIIB (without hydronephrosis) cervical cancer and who are HIV positive, were randomized to receive radiotherapy alone or chemo-radiation. All patients received 46 Gy in 23 fractions external beam radiation and high-dose-ratei brachytherapy 8 Gy x 3 fractions. Chemotherapy consisted of bolus Cisplatin 30mg/m2 weekly given concurrently with the radiotherapy. Acute treatment toxicity was documented weekly during treatment. Results 64 patients were recruited to the study. 31 patients were randomized to the chemoradiation arm and 33 patients to the radiation alone arm. Of the 64 patients recruited to the study, 6 in the chemoradiation arm and 5 in the radiation only arm did not receive any treatment and were therefore not evaluated. Stage IIB was the most common stage. The mean CD4 count was 410 in the chemoradiation arm vs. 358.4 in the radiation only arm at randomization. Only 6 patients were on antiretroviral therapy at start of treatment, 3 in each arm. The number of chemotherapy cycles received by patients in the chemoradiation arm ranged between 0 and 5 cycles. A total of 96 chemotherapy cycles were administered, with a median of 4 cycles per patient. Overall, at least 76% of patients received at least 4 cycles of chemotherapy. The full five intended courses of cisplatin were administered in 10 (40%) patients. Chemotherapy was not administered most commonly due to toxicity (renal, leucopaenia), other reasons being logistical and non compliance. The principle major adverse effects observed were leucopaenia and cutaneous reactions.Item A pilot study to investigate the muscle strenght of children infected with HIV(2009-10-14T11:25:32Z) Zeijlstra, Carolyn Ruth MichellePaediatric Human Immunodeficiency Virus (HIV) remains a significant challenge to children and caregivers in South Africa. Although the availability of antiretroviral (ARV) therapy has improved, it is not yet universally accessible. Rates of transmission from mother to child thus remain high and the virus widely uncontrolled. One aspect affecting children infected with HIV is that of muscle strength. For children weakness has been inferred by way of developmental studies in young children infected with HIV. Impaired performance in activities such as standing, walking, stair-climbing and jumping have been noted. These gross motor activities require higher muscle outputs and strength against gravity. This study sought to ascertain the feasibility of a full study on muscle strength in children infected with HIV. It analysed the effect of HIV on muscle strength, height and weight of those children receiving and not receiving highly active antiretroviral therapy (HAART). Children were recruited from Harriet Shezi Children’s HIV Clinic at Chris Hani Baragwanath Hospital, Soweto, Gauteng Province, South Africa. The study population included a group of children receiving HAART (n=16) and a group of children not receiving HAART (n=16). A once off test of muscle strength was administered to each child using a hand-held dynamometer. A demographic questionnaire and the Household Economic and Social Status Index (HESSI) were administered to their primary caregiver. Results showed the sample population to be of low socio-economic status (average score=54%) and the children to be underweight and short for their age (p<0.001). The CD4 count of the group on HAART was significantly higher than the group not receiving HAART (p<0.05). The group not receiving HAART was significantly stronger than the HAART group (p<0.05). Length of time having received HAART and muscle strength showed no significant correlation (p=0.647). No significant correlation was shown between CD4 count and muscle strength in the group receiving HAART (p>0.1). A significant negative correlation was shown between CD4 count and muscle strength in the group not receiving HAART (p<0.05). As statistically significant normative muscle strength data for children not infected with HIV in this age group fails to exist, the study was unable to ascertain a quantitative measure of weakness in these children. Comparison of those values available, however, showed normative values to be double that of children who participated in the study. The implications of these findings are that as one observes this group of children’s CD4 count drop, so too does their muscle strength. HAART, once initiated, stems the decrease in muscle strength over a period of time but does not reverse it. Furthermore, children and caregivers who participated in this study were faced with the adversities of poor socioeconomic status, limited access to medication and ARV treatment and inadequate nutritional intake, most of which were largely beyond their immediate control. This pilot study has indicated the feasibility and importance of a full study to investigate the muscle strength of children infected with HIV. Further research is needed to establish the impact of earlier administration of HAART on muscle strength. The effect of exercise on the muscle strength of children who are infected with HIV has yet to be documented. The implication of these factors on gross motor development in children infected with HIV has yet to be investigated.Item Adolescents' experiences of living with HIV and AIDS.(2009-06-11T08:30:46Z) Black, Linda AnneA growing body of research exists that examines the nature of i n tervent ions aimed at educa ting adolescents in t e rms of HIV and AIDS (Campbell, 2003; Campbell & McPhail, 2002; Van Dyk, 2001). However, there appears to be a grave pauci ty of l i t e rature that explor es the impact of HIV and AIDS on adolescents’ psychological and emotional functioning. Adolescents who live in the af t e rmath following the death of a parent, or parents often have to deal with rejection from thei r community, and are often confronted with significant emo t ional, educa tional and psycho-social challenges. These cha llenges continue to pose enormous threat to the development of a healthy s e lf-concept (Foster & Germann, 2002). These adolescents continue to be marginalized as their voices remain largely s i l e n t in contemporar y research . Using a combination of Art therapy, and narr ative creation, twenty-eight adolescents participated in a group intervention intended to facilitate, empower and encourage meaning making processes, and to f ac i l i t at e both oral and wr i t ten communica tion about the i r exper iences of living wi th HIV and AIDS. Findings suggest that while adolescents living with HIV and AIDS continue to have significant emotional, physiological, and social cha l lenges on a daily basis, their stories espouse great hope, determination and resilience.Item Outcome of HAART in patients with tuberculosis in the Themba Lethu clinical cohort(2009-05-21T13:07:51Z) Akiy, Zeh ZacheausIntroduction: The burden of disease due to HIV/AIDS and tuberculosis remains great for many countries around the world. Continuing attention must be devoted to these epidemics if we ever hope to one day contain their devastating effects on humankind. The objective of this study is to; to evaluate and compare cohort treatment outcomes of HIV infected TB patients and HIV infected non-TB patients treated with HAART at the Themba Lethu Clinic between 1st April 2004 and 1st April 2007. To measure outcomes in CD4, viral load, hemoglobin, liver function tests, weight, BMI, loss to follow up and death and to compare this outcomes between HIV patients who have had TB and HIV patients who have never had TB. Materials and Methods: information collected of patients for three years shall be used to carry out analysis. A total of 5818 patients were included in the cohort sample. 19.23% (1,048) of the patients had been diagnosed with TB at some point in time while 80.77% (4,770) had never been diagnosed with TB. Mean baseline CD4 cell counts were 113.47cells/mm3 for non TB patients and 88.85cells/mm3 for those who have ever had TB. This baseline CD4 counts are considered 2 months prior to ARV start and 1 month post the start of ARV. Baseline means for weight, BMI, AST and ALT were also taken into consideration by the two patient groups. Clinical out come was assessed and evaluated by comparing incidence of designated end points either as survival or failures. Incidence of deaths and loss to follow up was also compared in the two groups of patients. Results: Among HIV non TB patients, incidence rate of them having CD4 counts greater than 200 was at 36.47 persons per 10000 person days while for the patients who had been diagnosed with TB incidence of CD4 rising to above x 200 was lower at 34.19persons per 10000 person days. A rate ratio of 0.94 (95% CI 0.85 - 1.03) showed no true difference in the two groups. When looking at deaths in the two groups of patients, incidence in those who had TB was 3.84 deaths per 100 patient years and 4.16 deaths per 100 patient years for the non TB group with RR 0.93 and CI 0.66 - 1.28. Differences in incidence and outcomes were noticed in Hb gain, weight and BMI change, Liver function test changes over time and loss to follow up “defaulters”. Survival curves were modeled to show trend of change and log rank test were used to ascertain equality of survival curves. Where log rank p. values < 0.05 were noticed among survival curves of weight, BMI, AST, ALT, Hb and Loss to follow up. This again showed differences in weight, BMI, hemoglobin, AST, ALT and loss to follow up while no statistical differences were recognized between the two groups of patients when considering changes in CD4, deaths and Viral load over time as log rank test failed to reject the null hypothesis of similar curves. Conclusion: Data indicated that similarity and differences between HIV TB patients and HIV non TB patients could vary along certain outcomes. But one sure point is both groups of patients had an equal chance of staying alive when properly treated with ARV/HAART.Item The impact of HIV on clinical-microbiologic features and mortality among patients with invasive nontyphoidal Salmonella infection in South Africa(2009-05-18T13:05:35Z) Mtandu, RugolaIntroduction: Nontyphoidal Salmonella (NTS) has been associated with HIV from the outset of the HIV pandemic. The few NTS studies done in Africa and America have not documented the impact of HIV on clinical-microbiologic features and mortality in patients with NTS infection. This study determined the association between HIV serostatus and mortality proportion, clinical presentation, length of hospital stay, frequency of invasive NTS infection recurrence, NTS serotypes and estimated the population attributable fraction of mortality due to HIV among patients with invasive NTS infection in South Africa. Methods: Secondary data from enteric diseases national surveillance in South Africa from 2003 to 2006 were analysed as a cross sectional study. A total of 1 398 subjects with known HIV serostatus were obtained after data cleaning. Data analysis was done in Stata using chi squared test for categorical variables and Wilcoxon rank sum test / Kruskal- Wallis test for continuous variables. Logistic regression models were used to quantify the associations, and adjust for confounders and effect modification. Population attributable fraction was calculated to quantify the impact of HIV on mortality. Results: Majority (82.26%) of patients were HIV positive. The frequency pattern of HIV positive serostatus in different age groups coincided with that of invasive NTS. The overall mortality was 32.00%. HIV positive patients had a higher proportion (35.79 %) of mortality than HIV negative patients (15.55 %) (P<0.001). Fifty five percent of deaths in this study population were attributed to HIV infection. In multivariate models, HIV positive patients were more likely than HIV negative patients to die (OR = 2.50, 95% CI 1.69- 3.70), to develop lower respiratory tract infection (LRTI) (OR = 1.89, 95% CI,1.34- 2.65), to have recurrence of invasive NTS (OR = 3.90, 95% CI 1.41-10.77), to stay less than 16 days in hospitals (OR = 1.61, 95% CI, 1.08-2.40) and to be infected with Salmonella serotype Typhimurium infection (OR = 2.59, 95% CI 1.91-3.51). There were no significant differences in temperature, cardiac arrest, meningitis and site of specimen isolation (p>0.05). Discussion: The major limitation to this study was poor data quality of the surveillance system, including missing HIV serostatus hence the findings cannot be generalized to patients with unknown HIV status. Conclusion: HIV infection is common among patients with invasive NTS and is associated with excess mortality, LRTI, fewer than 16 days of hospital stay, recurrent invasive NTS infection and Salmonella Typhimurium. It is important for clinicians to rule out HIV infection in patients with invasive NTS especially those presenting with LRTI and Salmonella Typhimurium infection in addition to recurrent NTS infection, which is a wellknown feature associated with HIV. Recommendation: Since these patients received antimicrobials and had considerable mortality, the first line treatment of invasive NTS should be reviewed especially to HIV positive patients by investigating resistance patterns and conducting a clinical trial of newer and effective antimicrobials.Item Assessing the determinants of sexual risk-behaviour amongst young men in rural South Africa to inform male-oriented HIV prevention programming(2009-05-04T11:20:33Z) Anifowoshe-Kehinde, Adebimpe WasilatNo abstract or preliminary pages submitted on diskItem A comparison of HIV status among women who visit antenatal clinics with those who do not.(2009-03-06T07:50:48Z) Niwemahoro, CelineFor monitoring the spread of HIV epidemic, both national population-based surveys and antenatal clinics (ANC) are used. However, in all cases, there are potential biases. Bias associated with ANC data includes whether the pregnant women who attend public ANC are representative of all pregnant women. Reduced fertility among HIV-infected women, selection for sexual activity and under-representation of smaller rural sites in surveillance systems are other factors that may be source of biases (Boerma et al. 2003 & Walker et al. 2003). So, the question arising is how women who attend ANC could be representative of the general female population. Evidently, not all women become pregnant and not all pregnant women attend ANC. This research project has been designed to address those biases especially in Rwanda and Malawi. It focused on investigating the significance of this bias by doing a comparative analysis of sero prevalence between both those using ANC and those who do not. This study, therefore, intends to test whether women attending ANC may be representative to the general female population of both Rwanda and Malawi using respectively 2004 MDHS and 2005 RDHS. Using statistical techniques with the aid of STATA software program, univariate, bivariate and logistic regression (bivariate and multivariate) were performed for 11321 women in Rwanda and 11698 in Malawi aged between 15 and 49. However, among them, those who had live birth in last five years prior to the surveys were the most interested on in this study; that is especially, 5390 in Rwanda and 7304 in Malawi. Besides, HIV status of respondents was an important variable. Considering both women who had live birth and those who did not have live birth, I find that women who had live birth in Rwanda are 0.62 times less likely to be HIV positive and 0.48 times less likely to be infected for those who had live birth in Malawi. When controlling for women who had live birth, I find that in both countries women who use ANC are less likely to be infected compared to those who do not (0.53 times less likely in Rwanda and 0.58 times less likely in Malawi). Based on these findings, relying only on data from ANC may lead to biases in HIV prevalence estimates; particularly referring to 2004 MDHS and 2005RDHS. Besides, considering the level of significance of the difference between HIV status between those who use ANC and those who do not, I find that this is not identical in Rwanda (5% level of significance) and in Malawi (10% level of significance). Thus, these results suggest, briefly, that not only the degree of ANC data representativeness is changing depending on various stages of HIV epidemic as Fylkesnes said (1998), but also is affected by the amount of women who had live birth and their respective HIV status. In fact, this difference may be based on the fact that in Malawi, HIV prevalence is high compared to Rwanda and those who had live birth were in high percentage comparing to Rwanda.