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  1. Chronicity and the care team in Britain’s New Jerusalem : Managing diabetes, managing medicine;
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  7. The ChronoCity Project.

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Chronicity of Epstein-Barr Virus Infection

Returning user. Predictors of posttraumatic stress disorder and symptoms in adults: A meta-analysis. Emily J. Ozer , Suzanne R. Best , Tami L. Lipsey , Daniel Steven Weiss. Posttraumatic stress disorder: a model of the longitudinal course and the role of risk factors. Peritraumatic distress and the course of posttraumatic stress disorder symptoms: a meta-analysis. Saumier , Anne Brunet. Cognitive vulnerabilities to the development of PTSD: a review of four vulnerabilities and the proposal of an integrative vulnerability model. Lisa S. This orientation drew attention to the need for long-term engagement in responding to the HIV epidemic.

It also indicated an intergenerational problem because: a one outcome of the disease was increased orphaning as parents had children and then died prematurely, leaving those children to possible insufficient socialization, thus breaking the bond between generations; b inadequately socialized children were more likely to adopt risky sexual behaviours, thus replenishing the disease susceptible population age cohort [ 3 ].

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Finally, this conceptualization of HIV as a long-wave event cautioned that most standard public health interventions for communicable diseases would be problematic given the ill-fit with funding streams and sheer magnitude of the problem. Free public access to life-saving ART became available in parts of Africa in the mid's, in contrast to many resource-rich countries where ART had been available from Indeed, the clinical, immunologic and virologic effects of ART for people living with HIV in resource-poor countries are well-documented [ 6 — 8 ].

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  • Most people who can access and adhere to treatment can expect improvements in CD4 count and viral load, fewer opportunistic infections and overall reductions in HIV-related morbidity and mortality. HIV in high-prevalence, resource-poor countries is on the path toward becoming a chronic illness [ 9 , 10 ]. First, the advent of widespread ART means that the HIV curve will be higher and will last longer since people continue to become HIV-infected but are also living longer on treatment [ 11 ].

    As a result, progression to AIDS on an individual level is far less predictable, although estimates can be made of treatment failure at a population level. The advent of better drugs at lower prices, especially second-line regimens, could further change the shape of the curve.


    If patterns in sub-Saharan Africa mirror experiences in high-income countries, people on ART will live far longer lives but with new experiences of disability [ 12 — 18 ]. Disability, broadly defined, can result from HIV, its related conditions, and from side effects of the medications [ 19 ].

    This shifting experience has stimulated innovative responses from rehabilitation, health and social sectors in many resource-rich countries [ 20 — 25 ]. However, it is likely that HIV-related disabilities in resource-poor settings will be more acutely disabling given the limited availability of rehabilitation, chronic health care services and social support grants.

    Individual experiences of disability will vary greatly. At a population level, we anticipate that disability will become a common part of living with HIV, and may now be understood as a new version of the second curve. Many of these individuals may eventually transition to AIDS as well, but after a potentially long life that includes fluctuating experiences of illness, wellness and disability over time.


    The ICF has been widely used in both resource-rich and resource-constrained settings for considering the disability dimensions of many health conditions [ 28 , 29 ]. Applied to HIV, impairments, activity limitations and participation restrictions can result from a diverse range of HIV-associated conditions affecting all body systems, including neurological and neurocognitive conditions resulting in brain or spinal cord problems, cardiovascular system changes resulting in strokes or heart attacks, musculoskeletal problems related to osteoarthritis and accelerated osteoporosis, and problems with vision or hearing.

    The strength of the ICF is its concern not only with these diagnoses, but with how these conditions affect people's lives and livelihoods. Disability resulting from HIV-related mental health conditions and neurocognitive changes [ 30 ] is also becoming better understood among people living with HIV in Africa, especially as it is pertains to elevated rates of depression [ 31 ].

    Other mental health conditions with higher prevalence among people living with HIV in some African settings include bipolar disorder, schizophrenia, anxiety, post-traumatic stress disorder and sleep disorders [ 32 ]. Considerable disability can also result from the side effects of ART such as peripheral neuropathies linked to some medications, which can create pain and altered sensation in people's legs impairment , potentially limiting their mobility activity limitation , thus compromising their engagement in work or managing a household participation restriction.

    In , Myezwa and colleagues used the ICF as the basis for a cross-sectional study that demonstrated a high level of disablement among 80 HIV-positive hospital inpatients [ 35 ] and among 45 HIV-positive outpatients in South Africa [ 36 ]. Even more recently, Myezwa et al.

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    People on ART identified body image as a major problem. Other groups reported pain as a problem, and those with limited access to treatment also reported mobility problems. Cardiopulmonary functions were affected in all groups. Gaidhane et al. This early evidence points to the spectrum of disability that we locate as the new second curve in the long-wave event of HIV. The advent of ART in resource-poor settings has marked a dramatic shift in the epidemic giving rise to the potential onset of vastly elevated levels of HIV-related disability.

    Indeed, clinicians working in HIV may be familiar with patients whose clinical markers e. The reverse can also be true. This disconnect points to the importance of considering not only biomedical concerns e. This shift also occurred in resource-rich countries in the 's upon the advent of treatment in those settings.