Browsing by Author "Moosa, Mahomed Yunus Suleman."
Item Clinical and mycological predictors of cryptococcosis-associated immune reconstitution inflammatory syndrome.(Wolters Kluwer Health., 2013) Chang, Christina C.; Dorasamy, Afton A.; Gosnell, Bernadett I.; Elliott, Julian H.; Spelman, Tim.; Omarjee, Saleha.; Naranbhai, Vivek.; Ndung'u, Peter Thumbi.; Moosa, Mahomed Yunus Suleman.; Lewin, Sharon R.; French, Martyn A.; Coovadia, Yacoob Mahomed.Abstract available in PDF file.Item Compartmentalisation of innate immune responses in the central nervous system during cryptococcal meningitis/HIV co-infection.(Wolters Kluwer Health., 2014) Naranbhai, Vivek.; Chang, Christina C.; Durgiah, Raveshni.; Omarjee, Saleha.; Lim, Andrew.; Moosa, Mahomed Yunus Suleman.; Elliott, Julian H.; Ndung'u, Peter Thumbi.; Lewin, Sharon R.; French, Martyn A.; Carr, William Henry.Abstract available in PDF file.Item Effect of HIV status and suppression on SARS-CoV-2 disease severity, vaccine response, and evolution=Umthelela wesifo sesandulela-ngculazi nokucindezelwa kwaso yi-SARS-CoV-2 ubunzima besifo, ukusebenza kwekhambi kanye nokuthuthuka.(2023) Karim, Farina.; Sigal, Alexander.; Moosa, Mahomed Yunus Suleman.Abstract SARS-CoV-2 is a global pandemic that has infected 672,115,430 people globally (https://coronavirus.jhu.edu/map.html, accessed 08.02.2023). SARS-CoV-2 is continuously evolving, and new variants pose a continuous threat to curbing this pandemic. Simultaneously, South Africa still struggles to control and manage an enduring HIV pandemic. The synergistic interplay between these two pandemics has necessitated an understanding of how these two viruses interact with each other to tailor an intervention. This thesis investigated the effect of SARS-CoV-2 infection on disease dynamics, differential disease outcomes, vaccine response, as well as SARSCoV- 2 evolution in people living with HIV (PLWH) with different levels of HIV suppression and differing HIV suppression history. The first study investigated the difference in disease severity amongst PLWH in the first and second infection waves in South Africa. COVID-19. Thereafter, we explored persistent SARS-CoV-2 infection in immunocompromised individuals and intra-host evolution in a case study of a participant with advanced HIV infection. Here, we illustrated that advanced HIV disease may lead to prolonged SARS-CoV-2 infection and shedding of infectious virus and results in intra-host evolution of variant mutations, making intra-host evolution in advanced HIV individuals a particular concern within the South African context. Finally, we observed that effectively controlling HIV through ART facilitates SARS-CoV-2 clearance. The last study widened the observations to five participants with advanced HIV disease and showed that vaccination does induce a potent neutralizing antibody response in this group, but only if HIV viremia is first effectively suppressed with antiretroviral therapy. These findings highlight the importance of suppressing HIV infection in eliciting an effective immune response against, and preventing evolution of SARS-CoV-2. Iqoqa I-SARS-CoV-2 yisifo esesigulise umhlaba wonke sase sigulisa inani elingama 672,115,430 abantu emhlabeni jikelele (https://coronavirus.jhu.edu/map.html, accessed 08.02.2023). I-SARS-CoV-2 isaqhubeka nokusabalala kanti izinhlobo zayo ezinye zisaqhubeka nokuba yingozi ukuba isifo singanqandeka. Khona-manjalo, iNingizimu Afrikha isathwele kanzima ukulawula isifo sesandulela-ngculazi. Ukuthelelana nokuxhumana phakathi kwalezi zifo kwenze kwanesidingo sokuqonda ukuthi zidlelana kanjani ukwenzela ukuphuma nekhambi. Lolu cwaningo lucwaninge umthelela we SARS-CoV-2 nezinkinga ezikhona ngenxa yazo, imiphumela ehlukene yesifo, ukusebenza kwekhambi, kanjalo nokukhula kwe SARS-CoV-2 ebantwini abaphila naso lesi sifo bebe benesandulela-ngculazi benezinga lesandulela-ngculazi elehlukile kanye nomlando owehlukile. Ucwaningo lokuqala lucubungule umehluko wesankahlu sesifo ezifweni ze-PLWH esiwombeni sokuqala nesesibili salesi sifo eNingizimu Afrikha. Ngakho-ke iye yahlolwa kwalendela umthelela we-SARS-CoV-2 kubantu abanamasosha aphansi omzimba kanye nalokhu esikubiza nge-intra-host evolution ocwaningweni lwesimo kubabambi-qhaza abanesandulela-ngculazi esisezingeni eliphezulu. Lapha kutholakale ukuthi isandulela-ngculazi esisezingeni eliphezulu singaholela ekuguleni isikhathi eside uma unesifo seSARS-CoV-2 kanye nokuthola ezinye izifo ezithelelanayo kanti imiphumela ye-intra-host evolution of variant mutations, okwenza ukukhula kwe-intra-host kulabo abanesandulela-ngculazi ephezulu kusabise isimo saseNingizimu Afrikha. Isiphetho, kutholakale ukuthi ukulawula isandulela-ngculazi nge-ART kwenza iSARS-CoV-2 idambe. Ucwaningo lokugcina luveze ngokubanzi obekubukelwe kubabambiqhaza abanesandulela-ngculazi esiphezulu ngokuthi kuvele ukuthi ikhambi lenza kudambe ukugula kuleli qoqo, kodwa kuphela uma isandulela-ngculazi siqale sacindezelwa nge-antiretroviral therapy. Lemiphumela iveza ukubaluleka kokucindezelwa kwesandulela-ngculazi ukulwa kanye nokucindezela isifo seSARS-CoV-2.Item Profile and management of AIDS related lymphoma.(2022) Rapiti, Nadine.; Moosa, Mahomed Yunus Suleman.Worldwide, HIV-associated lymphoma (HAL) is a common HIV-related malignancy. Most are aggressive, high-grade B cell malignancies and are classified as AIDS Related Lymphomas (ARL). ARL include Diffuse large B cell lymphoma (DLBCL), Burkitt lymphoma (BL), and less commonly, plasmablastic lymphoma (PBL), primary effusion lymphomas (PEL) and primary central nervous system lymphoma (PCNSL). Prior to antiretroviral therapy (ART), the incidence of lymphoma was 60-200 fold higher than that seen in HIV-negative subjects, but this has decreased to 11-25 fold with the widespread use of ART. The prevalence of HIV in South Africa (SA) is estimated at 13.5% (8 million people), with the province of KwaZulu-Natal (KZN) leading other provinces at a seroprevalence rate of 18%. Most patients in SA access medical care through government health facilities. King Edward Vlll Hospital (KEH) is a government-funded, tertiary health care centre affiliated with the academic hospital of the Nelson R. Mandela School of Medicine of the University of KwaZulu located in Durban, KZN. Most ARL in the indigent population, other than BL, are treated at KEH. The aim of this original research was to describe the profile, outcome and prognostic variables of ARL treated in a government hospital at the epicentre of the HIV/AIDS pandemic in KZN, and compare this to data described elsewhere in South Africa and internationally. There is limited data from South Africa on ARL, and no data from KZN. Globally, conventional chemotherapy for ARL has been supplemented by rituximab, which is a monoclonal antibody targeting CD20. A shift in treatment midway through this study period, to include the use of rituximab locally for CD20-positive ARL, provided an opportunity to compare outcomes with and without rituximab. Plasmablastic lymphoma is a challenging ARL, in terms of diagnosis and management. As this is an unusual lymphoma, with a prevalence of 0.004% of all lymphomas, there viii are no large, prospective trials. We describe our experience with the profile and outcome of this cohort of ARL patients, treated with combination chemotherapy. Outcome in lymphoma is guided by prognostic scoring systems, the international prognostic index (IPI) or the age-adjusted IPI (aaIPI). As these prognostic scoring systems have not been validated in the local population in KZN, the utility of these scoring systems was assessed in this research.Item Stavudine induced lactic acidosis, risk factors and predictive laboratory markers : a nested case-control study in South Africa.(2012) Luke, Christopher Alan.; Moosa, Mahomed Yunus Suleman.Introduction The incidence of antiretroviral therapy induced lactic acidosis and its associated mortality may be reduced by appropriate dosing, risk stratification and early detection. This study describes the epidemiology, risk factors and predictive laboratory markers for lactic acidosis in subjects commenced on stavudine containing antiretroviral therapy between 2004 and 2007 at a hospital in KwaZulu- Natal. Persons with body weight above 60kg received 40mg twice daily and those below 30mg. Methods A nested case-control study design was used. Risk factor analysis was adjusted for the established risk factors of weight and gender. Results Lactic acidosis occurred in 79 (17 per 1000 person years) of 1 762 persons. Significant baseline risk factors were female gender (Adjusted Odds Ratio (AOR) =5.4) and increased body weight (AOR, compared to persons <60 kg, was 6.6 for persons 60 to 69 kg, 6.9 for persons 71 to 80 kg, and 95.7 for persons >80 kg). Predictors six months into therapy were an alanine transaminase >50 IU /L (AOR=11.1) and triglyceride between 1-1.5 mmol/l (AOR=11.2 compared to persons with triglyceride <0.5 mmol/l). No associations were found with regard to age, CD4 counts, viral loads or creatinine and albumin levels. Conclusion Obese females are at greatest risk for lactic acidosis with exponential increased in risk at weights above 80kg. The 30mg dose may be preferable, given that a sharp increase in risk occurred at 60kg, and that that the 30mg dose has been shown to have adequate virologic suppression. Additional risk factors for LA include an increase in alanine transaminase and triglyceride at 6 months of treatment.Item Urine lipoarabinomannan to monitor antituberculosis therapy response and predict mortality in an HIV-endemic region: a prospective cohort study.(BMJ., 2015) Drain, Paul K.; Gounder, Lilishia.; Grobler, Anna Christina.; Sahid, Faieza.; Bassett, Ingrid V.; Moosa, Mahomed Yunus Suleman.Abstract available in pdf.