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- Southern African Journal of HIV Medicine
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- Volume 10, Issue 1, Summer 2009
Southern African Journal of HIV Medicine - Volume 10, Issue 1, Summer 2009
Volumes & issues
Volume 10, Issue 1, Summer 2009
Author Francois VenterSource: Southern African Journal of HIV Medicine 10 (Summer 2009)More Less
You will, I hope, be reading this at or immediately after the Durban AIDS Conference, an extravaganza held every two years and hosted this year by the Journal editor, Professor Linda-Gail Bekker. A huge amount of work goes into these conferences, and we hope this one is a massive success. The Society, funded by a generous grant from MTN, is supporting the skills-building workshops.
Author Linda-Gail BekkerSource: Southern African Journal of HIV Medicine 10 (Summer 2009)More Less
What an exciting time we are having in terms of HIV meetings in South Africa this year! I can't wait to finally get to the 4th SA HIV Conference in Durban, and in July we will be back here in the Fairest Cape at the HIV Pathogenesis Conference - always very worth while in terms of the new findings and new thinking it attracts. Both conferences have had an excellent number of abstracts, so peer reviewed input at both is going to be great.
Author Brian HonermannSource: Southern African Journal of HIV Medicine 10, pp 6 –8 (Summer 2009)More Less
South African Security Forces Union and Others v. Surgeon General and Others. This case challenged the South African National Defence Force's health classification policy, which for years has prevented recruits and soldiers with HIV from recruitment, external deployment or promotion within the SANDF regardless of their actual state of health or the area of work for which they would be responsible. Along with the Union, the individual applicants in the case were a potential recruit who had applied to join the Air Force band as a trumpeter, a soldier who conducts combat readiness preparation for deploying troops, and an administrative personnel clerk. Respectively, these three applicants had been denied recruitment, foreign deployment and promotion in the SANDF solely on the basis of their HIV status.
Source: Southern African Journal of HIV Medicine 10, pp 10 –14 (Summer 2009)More Less
There are an estimated 350 million hepatitis B carriers worldwide. The prevalence of mono-infection with hepatitis B in South Africa has been estimated at approximately 10% for the rural population and 1% in urban areas. The transmission routes of hepatitis B and HIV are similar, but hepatitis B is more efficient. Co-infection with HIV and hepatitis B is therefore not unusual. Recent studies have shown that the prevalence of HIV / HBV co-infection (using HBV surface antigen (HBsAg) as a marker for HBV) in South Africa ranges from 4.8% to 17%, depending on the population studied.
The guidelines for the South African HIV Comprehensive Care, Management and Treatment (CCMT) programme do not include viral hepatitis studies. Hepatitis B serology is usually done only if serum aminotransferases are evaluated in the absence of another known cause (e.g. tuberculosis and concomitant medications). The clinical sequelae of HIV / HBV co-infection are multiple and can cause an increase in morbidity and mortality. Awareness of HBV / HIV co-infection with appropriate diagnosis and management is imperative for improved care of our HIV patients.
Author Polly ClaydenSource: Southern African Journal of HIV Medicine 10, pp 15 –18 (Summer 2009)More Less
Highly active antiretroviral therapy (HAART) of three or more drugs is used extensively in industrialised countries for pregnant women with HIV, both to treat their own infection and to prevent mother-to-child transmission (MTCT). However, experts agree that current practice is based on limited randomised controlled trial data and guidelines are largely informed by observational studies and expert opinion. The British HIV Association (BHIVA) Pregnancy Guidelines note that 'The Cochrane Systematic Review of randomised controlled trials in this area shows how limited the guidelines would be were they to be restricted to such high-level evidence' (see box). Despite this, good results using HAART, showing both reduction in transmission to less than 2% and benefits to maternal health, have been reported from several cohorts and observational studies in industrialised countries.
Research and programmes from resource-limited settings have largely focused on short-course regimens of antiretrovirals in pregnancy, with the objective of reducing MTCT, but data are gradually emerging from cohorts of women from these settings receiving HAART.
Source: Southern African Journal of HIV Medicine 10, pp 20 –23 (Summer 2009)More Less
The Conference on Retroviruses and Opportunistic Infections (affectionately known as 'CROI' by regulars) is held annually in North America. The conference is acknowledged as a showpiece scientific HIV event, keenly observed by commentators for new moves forward in a rapidly evolving field. This year it was held in icy Montreal, with over 4 000 delegates and tons of useful science.
Source: Southern African Journal of HIV Medicine 10, pp 27 –28 (Summer 2009)More Less
Few medical interventions for any illness arrest morbidity and mortality as effectively as antiretroviral therapy (ART) does for HIV. Delays result in rapid progression to illness and death. The guidelines below list the patients who qualify for urgent ART, with timeline expectations. In addition, those who do not qualify for 'urgent' ART must receive as rapid an assessment as is possible.
The role of concurrent sexual relationships in the spread of Sexually Transmitted Infections in young South Africans : original articleSource: Southern African Journal of HIV Medicine 10, pp 29 –36 (Summer 2009)More Less
We still do not know why the HIV prevalence in southern and eastern Africa is an order of magnitude higher than anywhere else in the world. An article in this journal in 2007 argued that a key determinant was not so much the lifetime numbers of sexual partnerships, but rather the high proportion of these partnerships that are arranged concurrently. Concurrency has been associated with elevated rates of sexually transmitted infections (STIs) elsewhere, but this relationship has never been demonstrated in an African setting, where its effect is proposed to be greatest. We conducted a secondary data analysis from a representative survey of 14 - 25-year-olds living in Cape Town to test the hypothesis that concurrency is associated with self-reported symptoms of an STI. On logistic multiple regression analysis we found a modest but statistically significant relationship between self-reported STI symptoms and having had a partner who engaged in concurrency.
The Keiskamma AIDS treatment programme : evaluation of a community-based antiretroviral programme in a rural setting : original articleSource: Southern African Journal of HIV Medicine 10, pp 38 –41 (Summer 2009)More Less
This paper documents the outcomes of the first 174 patients enrolled in a recently established community-based antiretroviral (ARV) treatment programme. Many people are living with HIV / AIDS and are in need of ARVs. Access to ARVs can pose many logistical difficulties for poor and sick persons, particularly in rural areas. This community based treatment programme aimed to overcome these challenges, providing transport and nursing care, as well as actively seeking persons too sick to leave their homes. This led to the inclusion of many persons with advanced HIV in the treatment population. The study used routinely collected CD4 counts, viral loads and patient observation. The results show that the majority of patients responded well to treatment. There was higher mortality among the population with advanced disease, but a considerable proportion responded well. Only 4 patients were lost to follow-up. This study details how community-based ARV programmes can be useful adjuncts to the facility-based system. Effective treatment programmes must address the needs of the communities they serve.
An interesting case of HSV Pneumonia and PCP co-infection ina patient with AIDS : a diagnostic and management challenge : adult case studySource: Southern African Journal of HIV Medicine 10, pp 42 –43 (Summer 2009)More Less
The advent of HIV and AIDS has brought about many diagnostic and management challenges regarding multiple opportunistic infections. Pneumocystis jirovecii pneumonia (PCP) is a common presentation in patients with AIDS who are not on prophylaxis or highly active antiretroviral therapy (HAART). Herpes simplex 1 virus (HSV-1) is a ubiquitous virus that mainly causes benign disease during primary infection. However, it is known to cause severe pneumonia and disseminated disease in the immunocompromised. We present a case of HSV-1 pneumonitis and PCP co-infection in an HIV-positive patient with respiratory failure. To the best of our knowledge, based on Pubmed and Google Scholar searches, this is the first case to be reported in the English language literature.
Cavitation of the Ghon focus in an HIV-infected infant who acquired tuberculosis after the initiation of HAART : paediatric case studySource: Southern African Journal of HIV Medicine 10, pp 44 –48 (Summer 2009)More Less
Tuberculosis immune reconstitution inflammatory syndrome (IRIS) may present as new or worsening cavitation. We present an HIV-infected infant in whom TB infection and subsequent cavitation of the Ghon focus appeared to coincide with immune reconstitution due to highly active antiretroviral therapy (HAART). TB-IRIS in response to infection that occurs after starting HAART has not previously been described.
Author Beth HarleySource: Southern African Journal of HIV Medicine 10 (Summer 2009)More Less
This is a locally produced book covering what primary care health care workers (HCWs) need to know about managing HIV both before and after antiretroviral care is necessary. It is aimed at nurses and doctors, but counsellors and even some lay people will find much of the information useful. At its core is a desire to provide continuing medical education to the many HCWs who do not get the chance to receive teaching on an ongoing basis.