Disputas: Balthazar M.R. Nyombi
MPhil Balthazar M.R. Nyombi ved Institutt for allmenn- og samfunnsmedisin vil forsvare sin avhandling for graden ph.d. (philosophiae doctor): Challenges and opportunities in scaling up HIV antiviral treatment in Tanzania
1. opponent: Laboratory Director PhD Mika Salminen, Dept.of Infectious Disease Epidemiology and Control, National Public Health Institute – KTL, Helsinki, Finland
2. opponent: Professor, MD, PhD Eligius Lyamuya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
3. medlem av bedømmelseskomitéen: Professor dr.med. Borghild Roald, Fakultetsdivisjon Ullevål universitetssykehus, Universitetet i Oslo
Leder av disputas: Professor dr.med. Øivind Larsen, Institutt for allmenn- og samfunnsmedisin, Universitetet i Oslo
Veileder: Hovedveileder: Seniorforsker dr.philos. Carol Holm-Hansen, Nasjonalt folkehelseinstitutt, Division of Infectious Disease Control. Biveileder: Professor dr.med. Gunnar Bjune, Institutt for allmenn- og samfunnsmedisin, Seksjon for internasjonal helse, Universitetet i oslo
The aim of this thesis was to investigate the prevalence of HIV-1 among youth using a saliva-based assay, the evolution and genetic diversity of HIV-1, and the presence of mutations among virus strains circulating in Kagera and Kilimanjaro regions in Tanzania.
HIV-1 infection in Tanzania is widespread with considerable variation in prevalence between populations and geographical locations. The prevalence of HIV-1 was significantly higher among students attending urban schools (5.5%) than rural school (1%). A national priority is to describe the epidemiology of the HIV-1 epidemic by generating data using expanded voluntary counseling and testing centers in the country. This approach is of special importance for early detection, and for developing preventive measures and treatment strategies for people living with the virus.
HIV is characterized into groups and subtypes according to genomic mutations that occur during replication. Mutations also result from unfavorable environments such as host immune responses or use of antiretroviral drugs. The diversity of AIDS viruses circulating among the population has implications for control strategies and the quality of care for persons living with HIV/AIDS. Limited information is available concerning the efficacy of current antiretroviral drugs for the treatment of non-B subtype infections that are prevalent in the developing world. Mutations associated with antiretroviral failure are based on investigations of HIV-1 subtype B infections that represent only 10% of the infections worldwide.
HIV-1 subtypes A, C, D and recombinants circulate in Kagera and Kilimanjaro regions, Tanzania. The prevalence of subtype D is declining, subtype A is stable and subtype C as well as recombinants are increasing. Mutations associated with antiretroviral resistance were low among antiretroviral treatment-naïve pregnant women infected with HIV-1 strains circulating in the regions. This may indicate that antiretroviral therapy is effective in Tanzania. The high degree of HIV-1 genetic variability poses challenges for the design of effective vaccines, development of accurate diagnostic tools, monitoring the efficacy of antiretroviral treatment and the success of antiretroviral therapy.
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