Publications

PURPOSE OF REVIEW

The purpose of this review is to highlight recent advances in our understanding of host genetic determinants of HIV pathogenesis and to provide a theoretical framework for interpreting these studies in the context of our evolving understanding of HIV immunopathogenesis.

RECENT FINDINGS

The first genome-wide association analysis of host determinants of HIV pathogenesis and other recent studies evaluating the interaction between killer cell immunoglobulin-like receptors and human leukocyte antigen alleles have implicated both adaptive and innate immune responses in the control of HIV replication. Furthermore, genetic variation associated with the expression of CCR5 and its ligand have been strongly associated with both decreased susceptibility to HIV infection and delayed clinical progression, independent of their effects on viral replication, suggesting a potential role for CCR5 inhibitors as immune-based therapies in HIV disease.

SUMMARY

Host factors associated with the control of HIV replication may help identify important targets for vaccine design, while those associated with delayed clinical progression provide targets for future immune-based therapies against HIV infection.

BACKGROUND

Self-care has been shown to be an effective strategy to decrease heart failure (HF) costs and improve patient outcomes. However, high symptom burden, overall poor health, and economic and financial concerns in socioeconomically disadvantaged populations such as those of low socioeconomic status and those who are indigent or uninsured may have difficulty performing self-care behaviors. Currently, little is known about this group and their self-care behaviors. Therefore, the purpose of this study was to describe the demographic and clinical characteristics of indigent HF patients and their performance of self-care behaviors and explore the challenges and barriers they face in managing their HF.

SUBJECT AND METHODS

This was a descriptive, cross-sectional study using one-time structured interviews. Participants with HF were recruited from 3 cardiology clinics and 1 hospital. The patients were asked to answer questions regarding demographics and clinical risk factors, the Self-care of Heart Failure Index, and 3 open-ended questions regarding the challenges and barriers of managing their HF.

RESULTS

The sample (N = 65) was composed of 55% women, with a mean (SD) age of 59 (14), 35% were nonwhite, 86% were unemployed, and 52% were indigent. Major concerns included increasing symptoms, fear of death, lack of information, and financial challenges. Self-care was low.

CONCLUSION

Patients with low socioeconomic status and indigent HF patients face unique challenges that contribute to poor self-care. Future research is needed to explore ways to improve self-care behaviors in this population.