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- Volume 10, Issue 3, 2009
Southern African Journal of HIV Medicine - Volume 10, Issue 3, 2009
Volumes & issues
Volume 10, Issue 3, 2009
Source: Southern African Journal of HIV Medicine 10, pp 5 –6 (2009)More Less
As this journal's readers are well aware, HIV has complex and wide-ranging impacts on the health of infected individuals. Much of this complexity is due to the nature of host-virus interactions and the pathophysiology of the virus and its sequelae in different organ systems over time. Other aspects are linked to the profound impact an HIV diagnosis has on the life of an infected individual, both through physical morbidity and the psychological and social consequences of a lifelong illness.
Author Francois VenterSource: Southern African Journal of HIV Medicine 10 (2009)More Less
The large International AIDS Society meeting has come and gone from Cape Town. The agenda was dominated by a New Big Idea, an audacious mathematical model by a group of brave World Health Organization modellers showing that giving antiretroviral therapy to everyone with HIV, immediately, could make the epidemic disappear.
Author Rita ThomSource: Southern African Journal of HIV Medicine 10, pp 8 –13 (2009)More Less
The term 'common mental disorders' is an overarching term for conditions that affect a significant number of people in the community. These conditions include depression, anxiety and substance use disorders. In contrast, so-called 'severe mental illnesses' (such as schizophrenia or bipolar mood disorder) are conditions that usually require admission for inpatient treatment and tend both to recur and to be chronically debilitating. Nonetheless, common mental disorders result in a considerable burden to the individual, their families, the community and the economy. Many people with these conditions do not present for treatment, or if they do they usually present to primary care facilities, where these diagnoses are often missed. This is unfortunate, since there is good evidence that these disorders can be effectively treated and that much of this treatment can be provided by primary care clinicians.
The management of trauma and post-traumatic stress disorder in HIV-infected individuals : clinical : PTSDSource: Southern African Journal of HIV Medicine 10, pp 14 –19 (2009)More Less
Women are disproportionately affected by the HIV epidemic and also carry a higher burden of early childhood trauma, other life traumas (e.g. rape and partner violence) and post-traumatic stress disorder (PTSD). Yet PTSD and other common psychiatric disorders (e.g. depression, alcohol abuse) are commonly under-detected in HIV care settings. For many HIV-infected individuals in South Africa, HIV clinical care is the primary point at which mental illness can be identified and an intervention can be administered. When one considers the high prevalence of trauma and PTSD in infected patients, and its potential effects on antiretroviral therapy (ART) adherence, disease progression and quality of life, it is clear that correctly identifying and treating these conditions can significantly contribute to optimal patient care.
Source: Southern African Journal of HIV Medicine 10, pp 20 –27 (2009)More Less
The pathophysiology of psychosis and other forms of severe mental illness in HIV infection is complex, and multifactorial causation is likely in most instances. Severe mental illness has been identified as a risk factor for the acquisition of HIV infection and occurs as both a manifestation of opportunistic infections and a result of the neurotropic effects of the virus. A full psychiatric assessment in people living with HIV / AIDS (PLWHA) presenting with psychosis is important but may prove difficult in many parts of South Africa. This paper presents a variety of algorithms to simplify the assessment and management of an HIV-infected patient with psychosis.
Source: Southern African Journal of HIV Medicine 10, pp 28 –29 (2009)More Less
While HIV invades the brain early in the course of HIV infection, severe mental illness probably only occurs later in the disease. In many instances this may be the first presentation of a psychiatric illness in a younger person. In addition, the clinical syndrome may include manic and / or psychotic features, together with neurocognitive disturbance. These patients are at risk of secondary opportunistic infections or other features of systemic immunocompromise which may cause or confound the clinical picture.
Author Dinesh SinghSource: Southern African Journal of HIV Medicine 10, pp 30 –34 (2009)More Less
Neurocognitive impairment (NCI) occurs in 10 - 60% of people living with HIV / AIDS (PLWHA), depending on the severity of the NCI and the stage of the disease. The clinical features and definitions have evolved over the past two decades. HIV-associated neurocognitive disorder (HAND) is a new term used to describe the spectrum of neurocognitive impairment seen in HIV / AIDS. The earliest to most advanced stages are asymptomatic neurocognitive impairment (ANI), minor neurocognitive disorder (MND) and HIV dementia (HAD), respectively. People with HAND have impairment on multiple cognitive domains, including attention, concentration, memory, executive function, motor functioning and speed of information processing, and sensory perceptual / motor skills deficits. The milder forms of HAND are easily missed. Diagnosis can be made on clinical grounds in the most severe cases; however, milder forms and confirmation of the diagnosis require neuropsychological testing. Screening tests have limited utility, especially in the milder forms of HAND. Individual subtests derived from longer neuropsychological batteries may be complementary in the diagnosis of HAND. Highly active antiretroviral therapy (HAART) has led to a 40% decline in the incidence of HAD. In the post-HAART era, HAD runs a more chronic course, is milder and is reversed in about a third of cases. However, HAART is not universally successful because incident cases occur in people on HAART. Overall HAART has been shown to be of benefit, and screening for HAND should be the standard of care for PLWHA. HAD is an AIDS-defining illness and patients qualify for HAART irrespective of their CD4 count. However, the benefit of starting ARVs for people with ANI and MND is currently inconclusive.
Author Jackie HoareSource: Southern African Journal of HIV Medicine 10, pp 35 –37 (2009)More Less
Advanced HIV disease is strongly associated with an increased occurrence of various neuropsychiatric disorders, and highly active antiretroviral therapy (HAART) is an important aspect of managing these conditions effectively. In addition, there is growing recognition that many HIV-infected individuals will develop neuropsychiatric disorders relatively early in the course of HIV disease, in many cases before CD4 cell counts drop below 500 cells/μl. However, it is not known who in the earlier phases of the disease will go on to develop neurocognitive disorders, or who will respond to treatment. New approaches in neuro-imaging have the potential to detect early HIV-associated damage in the brain. Preliminary evidence suggests that the neurotoxic effects of HIV result in damage to white matter tracts in the brain. Once damage is established and related cognitive disorders ensue, the ability of HAART to reverse existing dysfunction is probably limited. Earlier treatment with HAART in at-risk or minimally symptomatic patients may prevent further decline in cognition and delay the course of HIV disease.
Source: Southern African Journal of HIV Medicine 10, pp 38 –43 (2009)More Less
Objective. Information on the cognitive complications of HIV / AIDS from sub-Saharan Africa, where statistics on HIV are alarming, is sparse because of lack of validated cognitive tools. This study assessed the usefulness and predictive validity of the HIV Dementia Scale (HDS) as a screening tool in HIV-positive Nigerians.
Design. HIV-positive patients were randomly selected over a period of 2 months.
Setting. The HIV / AIDS outpatient clinic at the University of Benin Teaching Hospital, Benin City, Nigeria.
Subjects. Asymptomatic and symptomatic HIV-positive patients were compared with controls matched with regard to age, gender and level of education.
Outcome measures. Cognitive performances on the modified HDS.
Results. Performances on the HDS of 160 HIV-positive subjects (80 asymptomatic and 80 symptomatic) were compared with those of 80 HIV-negative controls. The mean HDS scores (maximum 12) were 10.78 (significant deviation (SD) 1.18) (HIV-negative subjects), 8.85 (SD 1.38) (HIV, asymptomatic) and 5.2 (SD 1.13) (HIV, symptomatic); p<0.01. The HDS was found to have sensitivity of 97.3%, specificity of 80.4%, accuracy of 91.9% anda positive predictive value of 91.4% and a negative predictive value of 93.2%.
Conclusion. The HDS was shown to be a sensitive screening tool for patients with HIV / AIDS in sub-Saharan Africa, but it was insensitive to memory impairment in asymptomatic HIV-positive patients.
Author John ParkerSource: Southern African Journal of HIV Medicine 10, pp 44 –47 (2009)More Less
The use of psychiatric medication in patients with HIV infection is a complex area, but given the high rates of psychiatric disorder in this population - possibly as high as 50% - it deserves further consideration. A number of issues need to be thought about, including the nature of both the psychiatric illness and the HIV infection, the use of antiretroviral therapy (ART), and patient-related factors.
The Virus, Vitamins & Vegetables : The South African HIV / AIDS Mystery, Kerry Cullinan and Anso Thorn (Eds.) : book reviewAuthor Polly ClaydenSource: Southern African Journal of HIV Medicine 10 (2009)More Less
Political power and bad science is never a good combination. The Virus, Vitamins & Vegetables is a collection of essays that takes a look at the baffling government response to the HIV / AIDS epidemic in post-apartheid South Africa and 'the failure of those in powerful positions to acknowledge that a crisis was unfolding ...'.