- Title
- Genetic characteristics of Human Immunodeficiency Virus-1, and deter-minants of late presentation for care and Diabetes mellitus amongst newly diagnosed Human Immunodeficiency Virus positive patients in the Eastern Cape, South Africa.
- Creator
- Sogbanmu, Olufunso Oladipo
- Subject
- HIV infections
- Date
- 2019
- Type
- Thesis
- Type
- Doctoral
- Type
- PhD
- Identifier
- http://hdl.handle.net/${Handle}
- Identifier
- vital:40495
- Description
- Phylogenies may help to characterize transmission pairs, enhance contact tracing and outbreak investigations, track the origin and spread of epidemics over place and time, and to identify patterns of onward Human Immunodeficiency-Virus (HIV) transmission among risk groups. If the pattern and evolution of HIV drug resistance can be mapped, this may influence the development of guidelines in the clinical management of HIV especially with issues relating to prevalence of primary drug resistance and its impact on outcomes of present antiretroviral treatment (ART) regimen in use and the ability to trace and track the development of drug resistant strains. The roll-out of the test and treat Programme for newly diagnosed HIV infected pa-tient, seeks to identify HIV infected individuals early and to prevent morbidity and mortality associated with the late presentation for HIV care. The determination of the magnitude of ‘late presentation’ and or ‘presentation with advanced HIV disease’ can be used in very diverse settings and for many purposes. It provides a unified way to define the problem, thereby targeting appropriate interventions to prevent the detrimental outcomes associated with late presentation to care. The subtle relationship between HIV and diabetes mellitus (DM) may also help in formulating better preventive programs to aid the control of non-communicable diseases such as DM. This cross-sectional study includes a purposive selection of 335 HIV positive patients attending the voluntary counselling and Testing (VCT) and HIV Counselling and Testing (HCT) centres and outpatient departments at Cecilia Makiwane Hospital and the HCT sites at the Buffalo District municipality community health centres, Eastern Cape Province, South Africa. Late or delayed presentation of HIV infection was defined as CD4 cell count beneath 350 cells/μL and/or patients presenting with an AIDS-defining event at the first follow-up regardless of the CD4 cell count. Chapter 1 provides the general introduction had an overview of the introduction to the study, the statement of the research problem, hypothesis, the aim and the objectives. xx Chapter 2 looked in-depth at the HIV, case definition, the latest epidemiology of HIV, the HIV genome, the life cycle of HIV, its diagnosis, the classes of antiretroviral drugs, development of drug resistance. Chapter 3 highlighted the prevalence of Transmitted Drug Resistance (TDR) with focus on the protease gene. RNA was extracted from blood samples of 72 newly diagnosed HIV-1 patients attending some HIV testing and counselling clinics from August 2016 to July 2017. Protease fragments were amplified with specific primers by RT-PCR followed by nested PCR. The amplified products were sequenced using the ABI 360 sequencer, edited with Geneious version 9.1.5 and translated into amino acid with BioEdit software. Drug related resistance mutation (DRMs) analysis was performed on all the protease sequences in accordance with the 2009 WHO list of surveillance drug resistance mutations by submitting the edited sequences to Stanford HIV drug interpretation programme and the international AIDS society-USA guidelines for query of drug resistance associated mutations while phylogenetic analysis was performed using MEGA 6 to allocate all viral sequences into subtypes. In the study, a total of 52/72 (71.1%) reliable HIV-1 protease sequences were obtained in which subtyping and drug resistance mutations were performed. Two (3.8%) major Protease resistance associated mutation (V82A/L and L90M) were observed while another polymorphism like L10F, T74S, Q58E, L10I/V and M46V were also identified. Phylogenetic analyses delineated all the sequences as HIV-1 subtype C. Chapter 4 describes the prevalence and the determinants of late presentation amongst newly diagnosed HIV positive individuals in the Eastern Cape. It indicates the extent of the prevalence of patients presenting to care and at what HIV stage they were assessing health care services since the inception of the ‘test and treat’ strategy. It is a cross-sectional study where a total of 335 newly diagnosed patients were recruited consecutively be-tween August 2016 and July 2017. Late presenter for HIV care was defined in accordance with the European Late Presenter Consensus working group as a patient who reports for care when the CD4 count is below 350 cells/μL and/or when there is an established Aids- xxi defining clinical condition, irrespective of CD4 count. Adjusted and unadjusted logistic regression analysis was used to examine the determinants of late HIV diagnosis. The study showed that 60% of patients were late presenters, with 35% presenting with advanced disease. The major determinants identified were being male and low level of education. This led to recommendations directed at ensuring programmes that targets men in identifying their HIV status and assess care at early stage to prevents the morbidity and mortality associated with delayed presentation. Also, it was recommended that effort should be made to improve access to education and also include HIV related topics into the educational curriculum. Chapter 5 aimed to describe the prevalence and determinants of DM amongst newly diagnosed HIV positive individuals. This is a cross-sectional study which recruited 335 patients between August 2016 and September 2017. Definition for diabetes mellitus was made based on the SEDMSA 2015 guideline of HBA1C of above 6.5%. Adjusted and unadjusted logistic regression analysis was used to examine the determinants of abnormal glycated haemoglobin. Findings showed the prevalence of DM at about 6% amongst newly diagnosed HIV positive individuals. This is similar to findings in other study within the country, but a bit lower than what was obtained in the developed countries. The role of older age (above 40 years) as predisposing factor to development of diabetes in newly diagnosed HIV positive individual was well noted and taken. This ensures that screening for DM should be targeted at elderly HIV positive individuals. The grey area of the appropriate mode of diagnostic test to use to diagnose HIV is still debatable, however, a combination of HBA1c and fasting blood sugar (FBS) may improve the diagnosis of DM in this population group. In chapter 6, the general conclusions, recommendations and future perspectives of the study are reflected.
- Format
- 164 leaves
- Format
- Publisher
- University of Fort Hare
- Publisher
- Faculty of Science and Agriculture
- Language
- English
- Rights
- University of Fort Hare
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UFH Department of Biochemistry & Microbiology
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