Suchergebnisse

The increasing incidence of HIV infection in the pediatric population is of concern for the practicing dentist. Long incubation periods of the virus, combined with difficulty in detection, results in many undiagnosed cases of prenatal and natal infections with HIV. As a result, many dentists will unknowingly treat HIV‐positive children. This article presents most common features of pediatric HIV infection, placing special emphasis on manifestations which affect the head, neck, and oral tissues.

ContextThere have been few longitudinal studies of cytokine production in neonatally acquired HIV‐1 infection and none in Asian or Chinese children.ObjectiveTo determine whether monitoring cytokine production could contribute to the better management of pediatric patients with HIV‐1 infection.SettingClinical Immunology Laboratory and Pediatrics Department, University Hospital, Hong Kong.PatientsTen Asian and 2 Eurasian children infected with HIV‐1 by mother‐to‐child transmission were followed for up to 5 years while on treatment with highly active antiretroviral therapy (HAART).Main Outcome MeasuresNumbers of unstimulated and mitogen‐activated cytokine‐secreting cells (IFN‐gamma, interleukin [IL]‐2, IL‐4, IL‐6, IL‐10, IL‐12, and TNF‐alpha) were measured by ELISPOT assay at frequent intervals, and correlations were sought with CD4+ and CD8+ cell counts and viral loads.ResultsMitogen‐stimulated IL‐2‐secreting cells were directly associated with recovery of CD4+ cells. Correlations with viral load were found for Con A‐induced IFN‐gamma, Con A‐induced IL‐4, and unstimulated IL‐10, suggesting that these cytokines were either suppressed by high virus levels or that higher cytokine levels suppressed virus. IFN‐gamma, IL‐2‐, IL‐4‐, and IL‐12‐secreting cells induced by PHA, Con A, and/or SAC tended to increase for the first 3‐4 years of treatment but declined thereafter.ConclusionAlterations in cytokine profiles were not associated with adverse clinical events and there was little evidence to indicate that monitoring cytokine enzyme‐linked immunospots (ELISPOTs) could contribute to pediatric patient management.

Purpose. Research examining the relationship between human immunodeficiency virus (HIV)-related risk behavior and negative affective states has netted mixed findings. The present study examined the potential moderating role of gender and sexual orientation on negative affect and HIV-related risk behavior. Design. Measures of depression, anxiety, and HIV-related risk behavior were collected from participants at the time of pretest counseling. Analysis of variance was used to examine HIV-related risk behavior as a function of negative affect levels and gender and behavioral sexual orientation. Setting. The study was conducted through a community-based, anonymous HIV counseling and testing site. Subjects. Participants included 185 consecutively recruited men and women presenting for HIV testing. Measures. Participants completed a structured interview regarding HIV-related risk behavior, the Center for Epidemiological Studies Depressed Mood Scale, and the Beck Anxiety Inventory. Results. Greater HIV-related risk behavior was associated with high levels of anxiety and moderate or high levels of depression for bisexual women. Greater HIV-related risk behavior was also associated with low levels of anxiety and mild to moderate levels of depression for bisexual men. Conclusions. The relationship between negative affective states and HIV-related risk behavior may vary as a function of gender and behavioral sexual orientation. Better understanding of the relationship between negative affect and risk behavior may be achieved through consideration of these sources of variation.

학위논문(박사)--서울대학교 대학원 :보건대학원 보건학과(보건학전공),2020. 2. 조성일. ; 연구의 배경과 목적 인간면역결핍바이러스 (Human Immunodeficiency virus, HIV) 감염은 성매개감염의 일종이고 만성 감염이다. 1985년 첫 환자가 보고된 이후 한국에서 HIV 감염인 수는 지속적으로 증가하고 있다. HIV 감염 관리를 위해서는 진단과 치료, 유지의 각각의 단계가 원활하게 이루어지는 것이 필요하며, UNAIDS (The Joint United Nations Programme on HIV/AIDS) 에서는 90-90-90 target을 목표로 하여 감염자의 90%를 진단하고, 그 중 90%를 치료하며, 90%를 바이러스가 억제된 상태로 유지하자는 계획을 세웠다. 이후 여러 나라에서 목표를 성취했다는 보고가 발표되었지만 한국에서는 아직 HIV 감염에 대한 정확한 역학 통계가 알려져 있지 않다. 한국에서 HIV 감염은 질병관리본부에서 전수 조사를 하고 있지만, 감염 사실만을 조사하고 있어 이후의 약제 복용이나 순응도에 대한 분석을 할 수 없다. 한편 한국은 국가단일 건강보험 체계를 가지고 있고, HIV 치료는 건강 보험으로 대부분 급여 진료가 행해지므로 HIV 감염인의 병원 내원과 약제 처방을 국가 전수조사 할 수 있다. 이 연구는 건강보험 청구자료를 이용하여 HIV 감염인의 국내 역학을 파악하는 것을 목적으로 한다. 세부적으로는, (1) 건강보험 청구자료를 분석하여 국내 HIV 감염인의 숫자와 역학적 특성을 기술한다. (2) 약물 소지 비율 (medication possession ratio)을 이용하여 국내 HIV 감염인의 항레트로바이러스 약물 순응도를 평가하고, 낮은 약물 순응도와 관련이 있는 인자를 알아본다. (3) 국내 HIV-매독 중복감염 현황을 건강 보험 청구자료를 분석하여 알아보고, 약물 순응도가 HIV-매독 중복감염에 미치는 영향을 평가한다. 연구 방법 (1) 건강보험 청구자료에서 수집된 2007년부터 2015년까지 HIV 진단을 받고 HIV 치료를 위해 반드시 필요한 검사를 한 사람을 연구 대상으로 정의하였다. 후천성면역결핍증후군 (Acquired Immune Deficiency Syndrome; AIDS)는 AIDS 관련 진단이 있거나 예방적 화학요법을 받는 경우로 정의하였다. 확인된 HIV 감염인의 수를 질병관리본부의 보고서와 비교하였다. (2) 건강보험 청구자료에서 확인된 2007년부터 2016년까지 HIV 진단을 받고 항레트로바이러스 복합 처방이 있는 HIV 감염인을 확인하고, 2009년부터 2016년까지 신규 감염인을 연구 대상으로 하였다. 약물 소지비율을 평가하여 95%이상 높은 약물 순응도를 보이는 대상자의 분율을 확인하고, 낮은 약물 순응도와 연관되는 인자를 확인하였다. (3) 건강보험 청구자료에서 확인된 2008년부터 2016년까지의 신규 감염인을 연구 대상으로 하였다. HIV 감염인 중 매독 진단과 치료 약제 처방이 있는 매독 중복감염 환자를 확인하였다. 대상자의 인구학적 특성과 95% 이상의 높은 약물 순응도를 보이는 환자의 비율을 중복 감염 여부를 기준으로 비교하였다. 결과 (1) 건강보험 청구자료와 질병관리본부 보고서는 HIV 감염인 수에서 10% 정도의 차이를 보였다. 그러나 나이와 성별 추이는 연간 누적 환자와 신규 환자에서 모두 비슷한 양상을 보였다. 특히 질병관리본부 보고서에서는 상당 수의 환자에서 CD4 세포 수를 확인할 수 없었던 반면에 건강보험 청구자료에서는 예방적 화학요법 처방을 이용하여 CD4 세포수가 200/mm3 미만인 환자의 수를 확인하였다. (2) 8,501 명의 신규 HIV 감염인 중에서 70.4%의 환자가 약물소지비율 95% 이상의 높은 약물 순응도를 보였다. 예방적 화학요법, 여성, 20-29세 또는 50세 이상의 나이, 악성 종양의 과거력, 낮은 사회경제적 상황, 3차 병원 이외의 종류의 병원 진료, 그리고 상대적으로 과거에 진단되는 경우가 낮은 약물 순응도와 관련이 있었다 (각각 Odds ratio 1.7, 1.6, 1.6, 1.4, 1.6, 2.1, 1.2, 1.6 to 3.8). (3) 9,393 명의 신규 HIV 감염인 중 4,536 (48.3%)가 매독 중복감염으로 치료 받았다. 높은 약물 순응도는 HIV-매독 중복감염과 통계적인 연관이 있었다 (odds ratio 1.18; 95% confidence interval 1.08–1.30; P=0.001). 이외에 남성, 세균/원충 성매개감염, 그리고 생식기 단순포진바이러스 감염 또한 HIV-매독 중복감염과 연관이 있었다. 결론 (1) 첫 번째 연구는 건강보험 청구자료를 HIV 감염인의 역학연구에 활용할 수 있다는 것을 기술하고 있다. 질병관리본부 보고서는 전체 국내 HIV 감염인의 수에 대한 통계를 제공하며, 건강보험 청구자료는 이들의 병원 진료 현황을 보여준다. 특히 본 연구를 통해 AIDS 환자에 대한 추가적인 정보를 알 수 있다. 건강보험 청구자료와 질병관리본부 보고서의 두 가지 자료를 종합하여 이용하면 진단된 HIV 감염인을 치료로 연계하는 것에 도움을 받을 수 있다. 두 가지 자료를 종합하여 HIV 감염인 관리 체계를 구축할 수 있을 것이다. (2) 두 번째 연구는 건강보험 청구자료를 분석하여 이상적인 약물 순응도를 보이는 국내 HIV 감염인의 분율을 기술하고 있다. 연구 결과에 따르면 우리나라에서 항레트로바이러스 약물을 복용하는 환자들의 높은 약물 순응도를 보이는 비율은 다른 선진국과 비교했을 때에 양호하다. 낮은 약물 순응도와 관련이 있는 여성과 10대 그룹에는 약물 순응도를 높이기 위한 관심이 필요하다. (3) 세 번째 연구는 국내 HIV-매독 중복감염의 현황을 기술하고 있다. 높은 약물 순응도는 오히려 매독 중복감염과 관련이 있어 HIV 바이러스 억제가 되는 상태에서도 콘돔을 사용한 안전한 성관계에 대한 강조가 여전히 필요하다. ; Introduction and Objective Human immunodeficiency virus (HIV) infection is a sexually-transmissible chronic infection, the occurrence of which has increased continuously in Korea. Each step of the diagnosis, engagement in antiretroviral therapy (ART), and care maintenance is necessary to control an HIV infection. However, epidemiological data on the achievement of these steps are not well-established in Korea. This study was conducted to investigate the epidemiology of HIV infection in Korea, using nationwide claims data from the Korean National Health Insurance database. The objectives are as follows: (1) To identify the number of annual HIV infections and their epidemiological characteristics in Korea through an analysis of the national claims data and evaluate the usefulness of these data for an epidemiological study of HIV infection in Korea. (2) To identify medication adherence for ART among those diagnosed with HIV in Korea and determine risk factors for suboptimal adherence via the medication possession ratio (MPR). (3) To identify the percentage of HIV-syphilis coinfection in Korea and risk factors for HIV-syphilis coinfection by using national claims data. Methods (1) Using the National Health Institute database, we established two surveillance systems to yield the prevalence and incidence of HIV infection in Korea from 2007 to 2015. We then compared these results to those reported in the Korea Centers for Disease Control and Prevention (KCDC) registry, based on positive laboratory tests. (2) We estimated ART adherence among incident HIV-infected individuals and investigated factors affecting low medication adherence using the national health insurance claims data from 2007 to 2016. The MPR was used to measure medication adherence and risk factors for suboptimal adherence were identified by multivariable logistic regression analysis. (3) This study was retrospective in nature, using the claims database of the NHI system from 2008 to 2016. The clinical characteristics of people living with HIV with or without syphilis coinfection were analyzed. People with HIV and syphilis coinfection were divided into two groups based on an MPR cutoff of 95%: an optimal ART adherence group and a suboptimal ART adherence group. Results (1) The number of patients who visited hospitals recorded in the KCDC registry differed by about 10%. However, age and sex trends by year were comparable to the number of existing and newly diagnosed cases reported by the KCDC. In particular, the claims data provided a more accurate estimate of the number of patients with a CD4-positive T cell count of less than 200/mm3, while much of those data were missing in the KCDC registry. (2) Of the 8,501 newly diagnosed HIV-infected individuals identified during 2009-2016 with at least one ART prescription, 5,981 (70.4%) patients had adequate adherence to ART (defined as MPR ≥ 95%). Women (odds ratio [OR] 1.6), age under 20 and same or over 50 compared to 30–39 (OR 1.6, 1.4), a history of malignancy (OR 1.6), lower socioeconomic status (OR 1.2), not visiting a tertiary-level hospital (OR 1.2), and being diagnosed in the earlier years (OR for 2009 3.7-2015 1.7) were found to be risk factors for lower adherence. (3) Of the 9,393 people living with HIV, 4,536 (48.3%) were diagnosed with a syphilis coinfection. Optimal adherence to ART was independently associated with a syphilis coinfection (OR 1.18; 95% confidence interval 1.08–1.30; P=0.001). Male gender, having a bacterial or protozoan sexually transmitted disease, and having a genital herpes viral infection were also identified as risk factors for an HIV-syphilis coinfection. An HIV-syphilis coinfection was still associated with an optimal adherence >95% to ART even after the definition of syphilis infection has been limited since the diagnosis of HIV infection. Conclusions (1) The first study found that the claims data are valuable in estimating the epidemiology of people living with HIV/acquired immunodeficiency syndrome visiting the hospital. The KCDC registry reports the total number of people living with HIV and the claims data shows their hospital visits. A combination of the two databases can be used as a tool to connect diagnosed people living with HIV to the treatment they require. We suggest building a matched HIV surveillance system linking the claims data and the nationwide registry built by the government. (2) The results from the second study indicate that health authorities should take modifiable and unmodifiable barriers into consideration, in order to establish a sustainable monitoring system at the national level and to improve adherence. (3) The results from the third study suggest that the occurrence of unsafe sex is independent of medication adherence. Although HIV is unlikely to be transmitted when the viral load is controlled, consistent use of condoms is needed to prevent a syphilis infection. ; Abstract 1 Contents 6 List of Tables 8 List of Figures 10 Chapter 1. Introduction 11 Chapter 2. Usefulness of the Korean National Health Insurance database in establishing surveillance systems of treatment cascade for HIV infection 19 2-1. Introduction 20 2-2. Materials and Methods 21 2-3. Results 28 2-4. Discussion 39 Chapter 3. Adherence to antiretroviral therapy and factors affecting low medication adherence among incident HIV-infected individuals during 2009–2016: A nationwide study 45 3-1. Introduction 46 3-2. Materials and Methods 47 3-3. Results 53 3-4. Discussion 65 Chapter 4. Association of HIV-syphilis coinfection with optimal antiretroviral adherence: A nation-wide claims study 72 4-1. Introduction 73 4-2. Materials and Methods 75 4-3. Results 79 4-4. Discussion 87 Chapter 5. Discussion and Conclusion 91 References 98 Abstract in Korean 104 ; Doctor

Myanmar is one of the highly affected countries by tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection. We aimed to review the coverage of TB/HIV integrated services as well as to document the performance of this integrated services. A retrospective program review was conducted using the aggregated data of the National TB Programme (NTP) from 2005 to 2016. In Myanmar, TB/HIV services were initiated in seven townships in 2005. Townships were slowly expanded until 2013. After that, the momentum was increased by increasing the government budget allocation for NTP. In 2016, the whole country was eventually covered by TB/HIV services in different types of integration. Antiretroviral therapy (ART) coverage among HIV-positive TB patients remained low and it was the only significant difference among the three types of integration. Barriers of low ART coverage need to be investigated to reduce the burden of TB/HIV.

Background.: The Joint United Nations Programme on HIV/AIDS (UNAIDS) has set a "90-90-90" target to curb the human immunodeficiency virus (HIV) epidemic by 2020, but methods used to assess whether countries have reached this target are not standardized, hindering comparisons. Methods.: Through a collaboration formed by the European Centre for Disease Prevention and Control (ECDC) with European HIV cohorts and surveillance agencies, we constructed a standardized, 4-stage continuum of HIV care for 11 European Union countries for 2013. Stages were defined as (1) number of people living with HIV in the country by end of 2013; (2) proportion of stage 1 ever diagnosed; (3) proportion of stage 2 that ever initiated ART; and (4) proportion of stage 3 who became virally suppressed (≤200 copies/mL). Case surveillance data were used primarily to derive stages 1 (using back-calculation models) and 2, and cohort data for stages 3 and 4. Results.: In 2013, 674500 people in the 11 countries were estimated to be living with HIV, ranging from 5500 to 153400 in each country. Overall HIV prevalence was 0.22% (range, 0.09%-0.36%). Overall proportions of each previous stage were 84% diagnosed, 84% on ART, and 85% virally suppressed (60% of people living with HIV). Two countries achieved ≥90% for all stages, and more than half had reached ≥90% for at least 1 stage. Conclusions.: European Union countries are nearing the 90-90-90 target. Reducing the proportion undiagnosed remains the greatest barrier to achieving this target, suggesting that further efforts are needed to improve HIV testing rates. Standardizing methods to derive comparable continuums of care remains a challenge.

Abstract Background Only governments sensitive to the demands of their citizens appropriately respond to needs of their nation. Based on Professor Amartya Sen's analysis of the link between famine and democracy, the following null hypothesis was tested: "Human Immunodeficiency Virus (HIV) prevalence is not associated with governance". Methods Governance has been divided by a recent World Bank paper into six dimensions. These include Voice and Accountability, Political Stability and Absence of Violence, Government Effectiveness, Regulatory Quality, Rule of Law and the Control of Corruption. The 2002 adult HIV prevalence estimates were obtained from UNAIDS. Additional health and economic variables were collected from multiple sources to illustrate the development needs of countries. Results The null hypothesis was rejected for each dimension of governance for all 149 countries with UNAIDS HIV prevalence estimates. When these nations were divided into three groups, the median (range) HIV prevalence estimates remained constant at 0.7% (0.05 – 33.7%) and 0.75% (0.05% – 33.4%) for the lower and middle mean governance groups respectively despite improvements in other health and economic indices. The median HIV prevalence estimates in the higher mean governance group was 0.2% (0.05 – 38.8%). Conclusion HIV prevalence is significantly associated with poor governance. International public health programs need to address societal structures in order to create strong foundations upon which effective healthcare interventions can be implemented.