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- Volume 1, Issue 1, 2000
Southern African Journal of HIV Medicine - Volume 1, Issue 1, 2000
Volumes & issues
Volume 1, Issue 1, 2000
Author Des MartinSource: Southern African Journal of HIV Medicine 1 (2000)More Less
The 13th International Aids Conference takes place in Durban, South Africa, from 9 to 14 July 2000. This is noteworthy for a number of reasons : In the first instance, it is the first time that the conference is being held on the African continent, and notably, it is also the first time it is being held in a developing country. The host country is witnessing the fastest growing HIV epidemic in the world - it is estimated that 1 in 10 South Africans is infected with the virus. The scientific community, and indeed the population at large, has recently witnessed the re-emergence of the debate surrounding the link between HIV and AIDS. The sensationalism surrounding this has only served to deviate and diffuse the focus away from the prevention and management of the problem. The Southern African HIV Clinicians Society has played an active part during recent times in reassuring both the public and clinicians about the way forward in dealing with the epidemic.
Author Shaun ConwaySource: Southern African Journal of HIV Medicine 1 (2000)More Less
The Southern African HIV Clinicians Society has an imperative to enable greater access to quality HIV care. It represents medical professionals who are involved in HIV/AIDS care within the region and serves as the Specialist Interest Group for HIV/AIDS to the South African Medical Association.
Source: Southern African Journal of HIV Medicine 1, pp 9 –11 (2000)More Less
The Joint United Nations Programme on HIV/ AIDS (UNAIDS) and the World Health Organisation (WHO) have estimated that at the end of 1999 there were 33.4 million people (32.4 million adults and 1.2 million children) infected with HIV. Approximately 96% of people with HIV/ AIDS live in the developing world and recent estimates suggest that of all people infected with HIV worldwide, 70% (6 out of every 10 men, 8 of every 10 women, and 9 of every 10 children) live in sub-Saharan Africa. It is estimated that more than 40 million people globally will be HIV-positive by the end of this year, and still no cure has been found. The impact of the epidemic is already being felt in most developing countries, including South Africa. Life expectancy has been significantly reduced as many people in the 15 - 49-year age group are now dying of AIDS.
Author Andrew ClarkSource: Southern African Journal of HIV Medicine 1, pp 12 –13 (2000)More Less
Where antiretroviral therapy (ART) is available, it continues to impact significantly on disease progression and mortality among HIV-infected individuals. Highly active ART (HAART) is generally accepted as constituting optimal therapy, providing 60 - 70% of patients with durable viral suppression below the level of detection. Patients who fail to achieve or maintain viral suppression have emerged as one of the greatest challenges in ART.
Source: Southern African Journal of HIV Medicine 1, pp 14 –17 (2000)More Less
Source: Southern African Journal of HIV Medicine 1, pp 22 –27 (2000)More Less
The magnitude of HIV infection in Southern Africa and the number of impoverished people who desperately need antiretroviral therapy (ART), but who will never receive this, is overwhelming, and unparalleled in the history of infectious diseases. High costs associated with antiretroviral therapy remain the most prohibitive factor influencing the way that HIV is managed in countries such as South Africa, where the availability of finance determines access to therapy. While the Southern African HIV Clinicians Society endorses the right of all HIV-infected adults and children to receive an optimal standard of care, it also acknowledges the serious limitations influencing individual access to effective therapy. As a result of the constraints within the Southern African context, treatment cannot always be optimal and this has resulted in serious contemplation of acceptable, yet not always optimal, therapeutic alternatives that may currently be more affordable and realistic. Certain recommendations in this document are therefore presented as unavoidable compromises that might not meet internationally established standards of care, and where these occur, they have been indicated by a grey shaded background. As knowledge and understanding of the use of antiretroviral therapies is still evolving and new therapeutic agents become available, these guidelines will be reviewed and updated regularly. The most current version should always be consulted.
Preventing mother-to-child transmission of HIV : African solutions for an African crisis : preventionSource: Southern African Journal of HIV Medicine 1, pp 30 –31 (2000)More Less
The issue of mother-to-child transmission (MTCT) of HIV has become increasingly politicised in South Africa, with accusations and counter-accusations from all sides. Clinicians and activists, unable to comprehend the government's decisions not to provide inexpensive treatment to prevent MTCT, accuse it of child murder, while the President and Minister of Health claim concern about the safety of the drugs and make sweeping statements about mothers being killed. Amid all the political noise, scientific findings seem to be forgotten. The South African President has called for a 'search for specific and targeted responses to the specifically African incidence of HIV-AIDS', but it appears that some of the evidence already collected by African scientists and their collaborators, with the participation of African women and children, has been ignored. HIV seroprevalence in pregnant women in South Africa averages 23%, rising to 33% in the worst-hit provinces. Some South African studies' have reported MTCT rates of over 35% in the absence of any intervention and where breast-feeding is practised. With a conservative estimate of 800 000 births per year in South Africa, this suggests 70000 infants are affected annually. The head of the Medical Research Council, Professor Malegapuru Makgoba, wrote in a recent Science editorial that the decision not to use antiretrovirals for the prevention of MTCT 'poses serious moral and ethical dilemmas in a nation where maternal-fetal transmission of HIV accounts annually for 10% of the total HIV disease burden'. The need for an effective and affordable strategy to reduce MTCT of HIV is a matter of urgency.
Clinical insights into the interaction of childhood tuberculosis and HIV in the Western Cape : tuberculosisSource: Southern African Journal of HIV Medicine 1, pp 33 –35 (2000)More Less
The mutually deleterious interaction of HIV infection and tuberculosis (TB) was recognised in adults soon after the scope of the HIV epidemic became evident. It is now clear that in populations with a high incidence of infection due to Mycobacterium tuberculosis, clinical TB disease is one of the first signs of declining immunity in HIV-infected adults.
Author David BrittainSource: Southern African Journal of HIV Medicine 1, pp 37 –38 (2000)More Less
HIV has become the major health problem in southern Africa. The manifestations of this disease affect every aspect of clinical practice, and the protean symptomatology of HIV infection and AIDS makes a sound approach to the diagnosis of common problems essential. The environment of cost containment within which medical practitioners are required to care for their patients necessitates a thorough understanding of the pathology of these clinical problems in order to facilitate accurate and appropriate diagnosis and therapy. Haematological problems manifest in almost every AIDS patient. The most serious complications are the cytopenias, immune deregulation and haematological malignancies.
Author Michelle Rotchford GallowaySource: Southern African Journal of HIV Medicine 1, pp 39 –41 (2000)More Less
The South African AIDS Vaccine Initiative (SAAVI) was established in 1999 to co-ordinate the quest for ab locally relevant HIV/AIDS vaccine far the region. The overall goal of the initiative is to develop a safe, effective, affordable and accessible vaccine for the South African population by the year 2005. SAAVI is a national project sanctioned by the South African government and has the status of a lead project within the Medical Research Council (MRC). The initiative is a public-private partnership with funding from both government and non-governmental sources: direct funding comes from the Department of Health; the Department of Arts, Culture, Science and Technology; and Eskom (the national electricity supplier); and indirect funding, from the US National Institutes of Health (NIH) and the International AIDS Vaccine Initiative (IAVI). Further private sector funding will be sought, particularly from other international agencies and biotechnology companies. SAAVI is governed by a Steering Committee with representation from the Department of Health, funders, the MRC and other stakeholders. A Scientific Advisory Committee, consisting of high-profile local and international scientists, and an Ethics Committee, make scientific decisions. The research and development process is multicentred and multidisciplinary in its approach, focusing on vaccine development, vaccine trials and testing, advocacy and education, and ethics. There is also an important emphasis on capacity development - investing in skills and infrastructure to encourage the growth and expansion of vaccinology and the development of the country's scientists and scientific process. The ultimate hope is for a locally produced vaccine that is affordable to the greater population.
Source: Southern African Journal of HIV Medicine 1 (2000)More Less
The HIV epidemic, perhaps as no other, is challenging the foundations of modern medical ethics, economic principles of information protection and trade. The epidemic exposes many of society's inadequacies such as in education of moral standards, sexism, racism and classism. The challenges to medical society to prevent and alleviate pain and suffering are enormous. The pressure to find a cure for HIV infection is hastened by the unabated progress of the epidemic. As researchers and clinicians working in the field of HIV/AIDS we are exposed more than society in general to the enormity and severity of the problems posed by the HIV epidemic. In an attempt to progress rapidly with the necessary scientific research for society's gain, we may run the risk of exposing research participants to unethical research. Furthermore, by ignoring patent protection and research-proven good clinical practice, Or by importing generic equivalent medication, we pose the risk of treatment failure and the generation of potentially resistant virus mutations.
Author Eftyhia VardasSource: Southern African Journal of HIV Medicine 1 (2000)More Less
But there is no single problem that is more pressing than our fast deteriorating relations with the microbial world.
These words capture the prevailing sentiment towards infectious diseases in the light of the emergence of infections caused by recently identified viruses such as human herpesvirus 8 (HHV8), Sin Nombre virus and H5N1 influenza. But the virus that has challenged humanity at every level, with an estimated 30 - 40 million people having been infected worldwide, is the human immune deficiency virus (HIV). Yet, in the midst of these virological crises, there is little interest in clinical virology as an area of postgraduate study among South African medical graduates.