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Full-Text Articles in Medicine and Health Sciences
Identifying The Factors Influencing Hiv Testing And Safe Sex Practices: An Ecological Approach, Shekwonya Evelyn Samuel
Identifying The Factors Influencing Hiv Testing And Safe Sex Practices: An Ecological Approach, Shekwonya Evelyn Samuel
All ETDs from UAB
Introduction: HIV (Human Immunodeficiency Virus) is a sexually transmitted infection (STI) that is still a major health issue in the United States and the world. Emerging adults are more likely to engage in risky sexual behaviors such as multiple sexual partners and unprotected sex. HIV testing contributes to ending the HIV epidemic by identifying at-risk individuals and promoting early diagnosis.Methods: Secondary data analyses of the City Health II dataset were conducted to 1) identify the association between HIV testing and risky sexual behaviors among Black/African American emerging adults ages 18-25 years living in Birmingham metro area, 2) use social network …
Perceptionf Of Multipurpose Prevention Technologies Aimed At Hiv/Sti/Unintended Pregnancy Among African American Women In The Deep South, Kristina Wilbekin Walker
Perceptionf Of Multipurpose Prevention Technologies Aimed At Hiv/Sti/Unintended Pregnancy Among African American Women In The Deep South, Kristina Wilbekin Walker
All ETDs from UAB
Sexual and reproductive health (SRH) needs for women are not being met globally. In addition to efforts towards providing widespread access to currently available contraceptives and sexually transmitted infection (STI) treatment or prevention products, another focus is the development of multipurpose prevention technologies (MPTs). These MPTs are combination methods that prevent pregnancy, and protect against HIV and/or additional STIs. The objective of this dissertation research was to assess factors related to sexual and reproductive decision-making that may influence interest in MPTs and inform MPT implementation strategies for African and African American (AA) women. The first aim of this research, I …
Navigating Missed Visits In Hiv Primary Care: Exploring Risk Factors Associated With Missed Visits, Jiaying Hao
Navigating Missed Visits In Hiv Primary Care: Exploring Risk Factors Associated With Missed Visits, Jiaying Hao
All ETDs from UAB
The HIV care continuum is a public health model that outlines the steps or stages people with HIV go through from diagnosis to achieving and maintaining viral suppression. Retention in care, a key component of the HIV care continuum, is critical in achieving good health outcomes for people with HIV (PWH) and preventing HIV transmission. Consistent HIV care is essential for the health of PWH as a part of retention in care. De-spite no standard measure for retention in care to PWH, the missed (no-show) vis-its/appointments is one of the most commonly used methods for evaluating retention in HIV care. …
Determining The Impact Of Immune Dysregulation On Cd4 T Cell Responses To Hiv-1 And Sars-Cov-2, Jacob K. Files
Determining The Impact Of Immune Dysregulation On Cd4 T Cell Responses To Hiv-1 And Sars-Cov-2, Jacob K. Files
All ETDs from UAB
CD4+ T cells, often referred to as helper T cells, play a crucial role in the formation of antiviral immune responses following infection and vaccination. However, this can be disrupted by various forms of immune dysregulation. Many groups have described how HIV-1 adaptation and immune escape can lead to dysregulated HIV-specific immune responses. Our lab has previously shown that predicted HLA-II associated HIV-1 adaptation leads to dysregulated, poorly immunogenic CD4+ T cell responses in HIV-1 infection. Here, we focus on the impact of this HLA-II associated viral adaptation in the setting of HIV-1 vaccination. We show that HLA-II associated, vaccine-matched …
Novel Hiv Adaptation Strategy Against Host Cd8 T Cell Immunity, Kai Qin
Novel Hiv Adaptation Strategy Against Host Cd8 T Cell Immunity, Kai Qin
All ETDs from UAB
Since the 1980s, HIV infection has caused millions of death and tremendous economic losses worldwide. Despite great scientific advances, the only effective therapy to date, antiretroviral therapy (ART), merely delays disease progression yet cannot eradicate viral infection. Therefore, an effective HIV vaccine that can prevent the acquisition of infection would be a desirable alternative. The critical role of CD8 T-cell immunity in HIV infection has been well documented and therefore not surprisingly a great deal of effort has been focused on developing an effective CD8 T-cell based HIV vaccine. However, by far, such CD8 T-cell based HIV vaccine trials have …
Vagal Mediated Heart Rate Variability And Cognitive Impairments In Hiv-Seropositive Women, William C. Nicholson
Vagal Mediated Heart Rate Variability And Cognitive Impairments In Hiv-Seropositive Women, William C. Nicholson
All ETDs from UAB
Regardless of sufficient viral suppression, HIV exerts an ongoing inflammatory process that promotes chronic autonomic nervous system (ANS) dysfunction, accelerates physiological aging, and increases the risk of developing a spectrum of cognitive disorders (known as HIV-associated neurocognitive disorders [HAND]). Given this, identifying pathological mediators of this inflammatory response could provide insight into the mechanisms driving HAND. The vagus nerve (indexed by vagal-mediated heart rate variability [vmHRV]) could provide such a mediator as it regulates ANS activity via reciprocal cardio-neural pathways, which regulate inflammation and homeostasis. Vagal dysfunction is associated with persistent inflammatory signaling (e.g., stress or inflammatory-based disorders [such as …
Hpv And Hsv Associated Clinical Conditions Among People Living With Hiv-1 Infection, Yuanfan Ye
Hpv And Hsv Associated Clinical Conditions Among People Living With Hiv-1 Infection, Yuanfan Ye
All ETDs from UAB
This dissertation research focuses on investigating health burdens of HPV- and HSV- associated clinical conditions (CC) in people living with HIV-1 infection (PLWH) in the Southeastern United States. I designed a retrospective study using the UAB 1917 HIV Clinic Cohort. Electronic health records of PLWH attending the clinic for HIV-care between January 2006 and March 2019 were obtained and reviewed. I first examined incidence rates and trends of anogenital HPV- and HSV-associated CC. Then I adopted a new algorithm to group longitudinal CD4 cell counts based on their trajectories. I compared it with nadir and median CD4 cell counts in …
Occupational Health Outcomes In Women Living With And At Risk For Hiv, Jenni Wise
Occupational Health Outcomes In Women Living With And At Risk For Hiv, Jenni Wise
All ETDs from UAB
Women living with HIV (WLWH) are now able to work and need to work to attain the fruitful benefits of employment. Regardless of the need for income, employment provides esteem, confidence, structure, social support, and is associated with improved physical and psychological outcomes. Yet, in spite of the documented benefits associated with employment, an estimated 60% of WLWH are not employed. Thus, occupational disparities among WLWH contribute to disparities in health and quality of life among this population. While the historical trajectory of HIV is unique compared to other populations with chronic disease, evidence suggests that gender-specific difference in socioeconomic, …
Diet, Physical Activity, And Healthy Aging In People Living With Hiv, Josh Newson Muhammad
Diet, Physical Activity, And Healthy Aging In People Living With Hiv, Josh Newson Muhammad
All ETDs from UAB
As life expectancy for people living with HIV (PLWH) has increased, healthy aging in this community has become an emerging public health concern. Although the benefits of adopting healthy diets and regular physical activity are well-documented, implementing strategies for lifestyle modifications among older PLWH remains a challenge. The complex milieu of social, physiological and economic burdens encountered by PLWH exposes this population to increased risk for adverse health outcomes, especially from preventable metabolic diseases. The interaction of diet, physical activity and social determinants of health in persons who are HIV positive is an understudied area. The aim of this dissertation …
Development And Pilot Testing Of A Behavioral Intervention For Chronic Pain Tailored To Individuals With Hiv, Jessica Merlin
Development And Pilot Testing Of A Behavioral Intervention For Chronic Pain Tailored To Individuals With Hiv, Jessica Merlin
All ETDs from UAB
Background. Chronic pain is a common and disabling comorbidity in individuals living with HIV. Behavioral interventions are among the most effective and safe nonpharmacologic treatments for chronic pain. However, the success of a behavioral intervention is influenced by how well it is tailored to the target population’s biological, psychological, and social context. Given well-documented psychosocial vulnerabilities among persons with HIV, it is critical to develop a behavioral intervention for chronic pain tailored to this population. Objective. To use qualitative methods to investigate patient preferences for the structure and delivery of a behavioral intervention for chronic pain in individuals with HIV. …
Germline Restriction Of B Cell Receptor Repertoire Influences Antigenic Epitope Recognition And Primary Antibody Deficiency Pathogenesis, Yuge Wang
All ETDs from UAB
Part I. Mouse Studies Complementarity determining region 3 of the immunoglobulin (Ig) H chain (CDR-H3) lies at the center of the antigen binding site where it often plays a decisive role in antigen recognition and binding. Amino acids encoded by the diversity (DH) gene segment are the main component of CDR-H3. Each DH has the potential to rearrange into one of six DH reading frames (RFs), each of which exhibits a characteristic amino acid hydrophobicity signature that has been conserved among jawed vertebrates by natural selection. A preference for use of RF1 promotes the incorporation of tyrosine into CDR-H3 while …
Examining Hiv-Associated Symptom Burden And Microbial Translocation In The Veterans Aging Cohort Study: A Secondary Data Analysis, Natalie Lynn Wilson
Examining Hiv-Associated Symptom Burden And Microbial Translocation In The Veterans Aging Cohort Study: A Secondary Data Analysis, Natalie Lynn Wilson
All ETDs from UAB
The pathophysiological effects of HIV infection, including inflammation, contribute to symptom burden and poor clinical outcomes. Within the gut associated lymph tissue, immune activation leads to dysfunction of the gastrointestinal epithelial barrier and subsequent movement of microbial products from the gut into the blood. The translocation of microbial products from the gut into the blood circulation has been identified as a key contributor to HIV disease progression and chronic inflammation. Chronic inflammation has been associated with various symptoms including symptoms commonly reported in HIV disease. However, it is unknown if these symptoms are associated with inflammation related to microbial translocation. …
Patient And System Level Factors As Predictors Of Adherence To Antiretroviral Therapy Appointment Schedules In Cambodia, Gary T. Daigle
Patient And System Level Factors As Predictors Of Adherence To Antiretroviral Therapy Appointment Schedules In Cambodia, Gary T. Daigle
All ETDs from UAB
PATIENT AND SYSTEM LEVEL FACTORS AS PREDICTORS OF ADHERENCE TO ANTIRETROVIRAL THERAPY APPOINTMENT SCHEDULES IN CAMBODIA GARY T. DAIGLE EPIDEMIOLOGY / INTERNATIONAL HEALTH ABSTRACT On-time attendance at clinical appointments by patients on antiretroviral therapy (ART) is essential to the prevention of medication interruptions, viral rebound, drug resistance, and long term mortality. An observational study conducted in 2010, Enablers and Adherence to Antiretroviral Therapy in Cambodia, sought to identify factors that predict on-time clinical appointment attendance by patients on ART. These factors were classified as either ART patient level factors (e.g. demographic, clinical) or patient care and support system level factors …
Host Genetic Factors Associated With Cervical Human Papillomavirus Clearance, Staci Lynn Sudenga
Host Genetic Factors Associated With Cervical Human Papillomavirus Clearance, Staci Lynn Sudenga
All ETDs from UAB
This dissertation research focuses on how variants in various host genes are associated with clearance of HPV in three longitudinal cohorts from the United States. I first examined the definition of the intermediate phenotype to cervical cancer, HPV persistence and then I incorporated this phenotype in all my three aims by examining variations in xenobiotic metabolism genes in HIV-1 negative and immune-related genes in HIV-1 positive females and how these contribute to HPV infection outcomes. Several significant variants were associated with HPV clearance for the three aims. For the first aim, in ALTS assessing functional variants within xenobiotic metabolism genes …
Tuberculosis Screening And Treatment Outcomes In Zambia, Jennifer Harris
Tuberculosis Screening And Treatment Outcomes In Zambia, Jennifer Harris
All ETDs from UAB
Zambia is a country in Southern Africa with dual HIV and tuberculosis (TB) epidemics. The annual TB incidence is 444/100,000 and 64% of TB patients are co-infected with HIV. Accurate screening and diagnosis for TB is challenging since it often presents with non-specific signs and symptoms and the available diagnostics are neither sensitive nor specific. Papers one and two of this dissertation focus on the derivation of TB screening rules to more accurately identify high-risk persons in two Zambian populations: inmates and HIV clinic patients. Among inmates, being HIV positive and having a body mass index < 18.5 most strongly predicted HIV disease. Chest pain was also strongly associated, but this may have been a chance finding. For HIV clinic patients, we developed four rules with increasing complexity of clinical tools used for screening. Sensitivity was very high with all rules; the addition of vital signs and pulmonary exam findings to symptom-based screening rules greatly increased the rules' specificity. Furthermore, a rule incorporating pulmonary exam findings performed similarly to a rule with chest radiography suggesting pulmonary exam may be an inexpensive alternative to x-ray. The final paper looks at TB incidence, mortality and intermediate clinical outcomes in a cohort of HIV clinic patients with and without TB during their first 12 months of HIV care. TB incidence was very high during this time period, despite thorough screening at baseline. Mortality was elevated in both culture-confirmed and clinically-diagnosed TB patients, with much of the elevated risk concentrated in TB patients who had culture-confirmed but clinically-unapparent disease. Looking at intermediate outcomes among patients who started anti-retroviral therapy, the change in CD4 cell count was similar for patients with and without TB. TB patients started off with lower mean body weights and hemoglobin concentrations but also showed greater increases over 12 months, thus `catching up' with the TB-negative patients. If these findings are replicable in other cohorts they could have substantial impact on TB screening and diagnostic procedures in resource limited, high burden countries like Zambia.
The Effects Of Markers For Hiv Disease Progression, Social Network, Barriers To Care, Depression, And Substance Abuse On Medical Appointment Adherence Of Hiv-Infected Adults, Yeow Chye Ng
All ETDs from UAB
The study was designed to test a causal model of theoretical relationships among markers for HIV disease progression, social network, barriers to care, depression, substance abuse, and medical appointment adherence among HIV-infected adults. The proposed causal model was derived and developed from Lazarus and Folkman's theory of stress, appraisal, and coping. The knowledge gained from this study may yield critical information with respect to determining how a health care provider or researcher can develop specific behavioral interventions for the improvement of medical appointment adherence among HIV-infected adults living in the Southeastern United States. The correlational study was a secondary analysis …
Social Support, Social Stigma, Health, Coping, And Quality Of Life In Older Gay Men With Hiv, Larry Zuendel Slater
Social Support, Social Stigma, Health, Coping, And Quality Of Life In Older Gay Men With Hiv, Larry Zuendel Slater
All ETDs from UAB
With the advent of antiretroviral therapy, people with HIV/AIDS are living longer and managing their HIV infection as would an individual with any other chronic disease. As life expectancy increases, quality of life has progressed as an emerging issue for older adults with HIV/AIDS. A majority of people living with HIV in the U.S. are still gay men, who thus comprise a large portion of those who are growing older with the disease. The aims of the descriptive, correlational study were to: (1) explore the relationships among age, race, socioeconomic status, health, social support, social stigma, coping, perceived health, and …
Limited Transplantation Of Antigen-Expressing Hematopoietic Stem Cells Induces Long-Lasting Cytotoxic T Cell Responses And Effect Of Altered Suppressive Myeloid Population On Hiv-Disease Progression, Warren L. Denning
All ETDs from UAB
While each type of cancer and chronic viral infection has its own specific pathology, they share two common mechanisms of immune evasion. The first mechanism is the exhaustion or deletion of antigen-specific T cells. The second mechanism is the formation of an immunosuppressive environment responsible for the block of T cell function. Elicitation of antigen-specific T cells be accomplished by immunotherapy in place of conventional treatments such as HAART and chemotherapy. In addition, immunotherapy can alleviate the side-effects associated with long-term use of conventional therapies while reducing the total cost. The results presented here provide an alternative to conventional methods …
Killer Immunoglobulin-Like Receptors And Human Leukocyte Polymorphisms In Hiv-1 Pathogenesis, Aimee Marie Merino
Killer Immunoglobulin-Like Receptors And Human Leukocyte Polymorphisms In Hiv-1 Pathogenesis, Aimee Marie Merino
All ETDs from UAB
Human leukocyte antigen (HLA) molecules influence the adaptive and innate immune responses through interactions with cytotoxic T lymphocytes and natural killer cells (NK). HLA influence the activation state of NK through direct binding to killer immunoglobulin-like receptors (KIR) and presentation of HLA-derived peptides to NKG2 receptors. Activated NK can kill HIV-infected cells through direct cytolysis and release cytokines that influence other aspects of the immune system. Variations in KIR gene content and allelic variants have been associated with autoimmunity, transplantation success, and infectious diseases such as hepatitis C and HIV/AIDS. We investigated the impact of KIR genes and potential KIR-HLA …
Conceptualization Of Cervical Cancer And Screening Experiences Among Zambian Women Attending A Cervical Screening Program, Heather Leah White
Conceptualization Of Cervical Cancer And Screening Experiences Among Zambian Women Attending A Cervical Screening Program, Heather Leah White
All ETDs from UAB
Invasive cervical cancer (ICC) is the second most commonly diagnosed malignancy worldwide, and approximately 85% of the disease burden occurs in underdeveloped countries. In 2006, the Zambian government launched a cervical screening program within primary health clinics using visual inspection with acetic acid (VIA) coupled with immediate treatment via cryotherapy. The objective of this dissertation was to determine whether the VIA screening program is responsive to the needs and concerns of Zambian women in an effort to improve screening uptake, and for human immunodeficiency virus (HIV) positive women who are potentially subject to increased ICC screening and treatment, increase long-term …
Oral Lesions As Clinical Markers For Antiretroviral Therapy Failure In Hiv Patients, Irene M. Tamí-Maury
Oral Lesions As Clinical Markers For Antiretroviral Therapy Failure In Hiv Patients, Irene M. Tamí-Maury
All ETDs from UAB
The true nature of the association of oral lesions (OL) and gold standards of HIV progression, CD4+ T cell counts (CD4) and HIV-1 RNA viral load (VL), is not completely clear, especially when patients are on antiretroviral therapy (ART). Our aim was to assess the association between OL and virologic failure among HIV/AIDS patients on ART. We conducted a retrospective study of 744 HIV patients who entered care between 2000 and 2006 at the UAB 1917 Clinic. Data was collected for 2 years after enrollment. Prevalence of OL was 35.8%. Oropharyngeal candidiasis (OPC) was the most prevalent OL (74.9%). Among …
The Role Of Socs Proteins In Hiv Immune Evasion, Lisa Nowoslawski Akhtar
The Role Of Socs Proteins In Hiv Immune Evasion, Lisa Nowoslawski Akhtar
All ETDs from UAB
Upon human immunodeficiency virus (HIV) infection the host mounts a robust and multifaceted immune response. To achieve successful replication, HIV must possess a powerful arsenal of immune evasion weapons. While a complex strategy for HIV immune evasion has been described in the periphery, little is known about the mechanism allowing HIV to overcome the simple interferon (IFN)-ß-mediated innate immune defenses of the central nervous system (CNS). In light of the devastating cognitive dysfunction that is caused by HIV replication within the CNS, a better understanding of this mechanism is critical. Recent studies have shown that viral pathogens can induce the …
Determinants Of Self-Efficacy To Seek Care For Tuberculosis And Complete Tuberculosis Treatment Among Hiv-Positive Patients Attending Government Hiv/Aids Clincis In Honduras, Mayra Silvana Arias
Determinants Of Self-Efficacy To Seek Care For Tuberculosis And Complete Tuberculosis Treatment Among Hiv-Positive Patients Attending Government Hiv/Aids Clincis In Honduras, Mayra Silvana Arias
All ETDs from UAB
HIV-positive persons bear an elevated risk of developing, relapsing, and dying from tuberculosis (TB), and have greater risk of TB treatment default. Yet little is known about the factors that influence TB care-seeking among this population. This study evaluated sociodemographic, cognitive, and psychosocial characteristics of PLHA without a history of TB receiving care in specialized HIV/AIDS clinics in Honduras, and the influence of several variables on self-efficacy to seek care, including: (1) seeking care for prolonged cough despite external constraints and potential HIV stigmatization, and (2) completing TB treatment once diagnosed. The majority of participants were women (55%). Seventy-two percent …