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- Volume 11, Issue 2, 2010
Southern African Journal of HIV Medicine - Volume 11, Issue 2, 2010
Volumes & issues
Volume 11, Issue 2, 2010
Author Linda-Gail BekkerSource: Southern African Journal of HIV Medicine 11 (2010)More Less
The wonderful World Cup and a devastating public sector strike are behind us. One generated national pride and reminders that we are the rainbow nation with fabulous potential, and the other national shame that compassion and humanity for the most poor and vulnerable could be sacrificed for material gain. With the enormous responsibility of lifelong antiretroviral treatment for over a million individuals we need a health system that is reliable, responsible and obsessive.
Prevention of mother-to-child transmission outcomes in the private sector in central Durban : original articleSource: Southern African Journal of HIV Medicine 11, pp 6 –7 (2010)More Less
The prevention of mother-to-child transmission (PMTCT) programme in the central region of Ethekweni Metro, KwaZulu-Natal (Durban central area), was investigated. Data for all HIV-exposed infants from eight private paediatric practices seen between January 2004 and June 2005 were reviewed retrospectively. One hundred and one black African infants were born to 100 HIV-positive women of average age 30 years. Median viral loads and CD4 counts were 11 391 copies/ml and 426 cells/µl, respectively. Eighty-six women received HAART and 5 had no prophylaxis. Of the 92 infants tested, 2 were HIV positive, giving a transmission rate of 2.2%. Both their mothers had received suboptimal prophylaxis, and if they are excluded, the transmission rate falls to less than 1%, a rate consistent with those in the developed world.
Prevention is better than cure - the art of avoiding non-adherence to antiretroviral treatment : original articleSource: Southern African Journal of HIV Medicine 11, pp 8 –10 (2010)More Less
The much-used phrase 'prevention is better than cure' is applicable to many circumstances, including human immunodeficiency virus (HIV) infection. In recent years suggestions have been made for a move towards treatment strategies that emphasise prevention of foreseeable adherence problems on a patient-by-patient basis, through focused patient preparation before commencing antiretroviral therapy (ART). This is well elucidated in a statement made in 2004 by Coetzee et al.: 'As it is difficult to ascertain robust predictors of adherence, there has been a move to concentrate on patient preparation before the initiation of ART rather than the use of nonclinical predictors of adherence or selection criteria. A paradigm focused on preparation rather than selection is better suited to the aggressive targets for the scaling up of ART in countries with large epidemics (such as in South Africa), where the view of ART as a very expensive rationed intervention is rapidly changing.'
The role of South African traditional health practitioners in the treatment of HIV/aids : a study of their practices and use of herbal medicines : original articleSource: Southern African Journal of HIV Medicine 11, pp 11 –17 (2010)More Less
Background. A large proportion of HIV-positive South Africans regularly consult traditional health practitioners (THPs) for their health care needs, despite evidence of negative interactions with antiretrovirals (ARVs) and no published peer-reviewed clinical evidence for the efficacy of traditional medicines in the treatment of HIV. We investigated the dominant practices of THPs towards HIV-positive patients and whether these practices have changed following widespread public awareness campaigns covering HIV and its treatment.
Method. The study used a semi-structured interviewer-administered questionnaire in the home language of the interviewee. A total of 52 THPs from four provinces (Gauteng, Limpopo, KwaZulu-Natal and Eastern Cape) were interviewed. Of the respondents 38% were based in the rural areas, and 69% classified themselves as inyangas, the remainder being sangomas.
Findings. All the THPs in the survey offered treatment for HIV, although only 20% claimed to be able to cure the disease; 88% prepared their own medication, mostly from plant material, and sold their products as aqueous extracts in labelled bottles. None of these products had been systematically evaluated, and there was generally no record keeping, either of the patient or of the medicine itself. Quality control practices such as expiry dates, controlled storage conditions and batch records were totally unknown in our sample. Only 38% of the THPs had received training on HIV/AIDS, although 75% believed that they were well informed about the disease. Our own assessment was that only 50% had a working knowledge of HIV; more disturbingly, 37% believed that only traditional medicines should be used for its treatment and a further 50% believed that traditional medicines and ARVs can be taken simultaneously.
Interpretation. Despite ongoing public educational campaigns on HIV, some of which have specifically targeted THPs, the care of HIV-positive patients continues to be compromised by the traditional sector. Although some progress is evident, THP approaches to HIV treatment fail to conform to minimum standards proposed by the World Health Organization and other organisations, and represent a considerable challenge to the integration of THPs with the biomedical sector and the antiretroviral treatment programme in South Africa.
Immune reconsitution inflammatory syndrome among adolescents : a report of cases in a resource-limited setting (Uganda) : original articleSource: Southern African Journal of HIV Medicine 11, pp 18 –19 (2010)More Less
Author Karin Van Den BergSource: Southern African Journal of HIV Medicine 11, pp 19 –20 (2010)More Less
To the Editor: We at the South African National Blood Service (SANBS) are acutely aware of the issues surrounding the exclusion of men who have sex with men (MSM) from donating blood and the negative emotions that surround this policy. I would like to assure readers that SANBS does not make such decisions lightly, and we constantly review policies based on the latest scientific findings. It is perhaps time to review the basis of the current policy and engage in debate on its scientific merit.
Source: Southern African Journal of HIV Medicine 11, pp 24 –29 (2010)More Less
Clinical guidelines from the National Department of Health (DoH), South Africa, for prevention of mother-to-child transmission (PMTCT), revised in 2010, recommend that HIV-positive pregnant women with a CD4 count of 350 cells/µl or less commence lifelong antiretroviral therapy (ART). DoH guidance for women initiating ART in pregnancy in the public sector - on which the overwhelming majority of HIV-positive South Africans rely for their care - recommends they receive nevirapine with tenofovir and lamivudine or emtricitabine at any stage of gestation. In cases where a woman is already receiving ART with an efavirenz-based regimen, it is recommended that this should be substituted for nevirapine if she is still in the first trimester of pregnancy. Efavirenz is therefore contraindicated in pregnant women at any time during pregnancy; for those already receiving the drug, it is only switched in the first trimester. The concern about the use of efavirenz in pregnancy dates back to preclinical studies. It is the only antiretroviral with preclinical primate data and in turn has the strongest US Food and Drug Administration (FDA) category and the most scrutiny during pregnancy. The drug also has the most conflicting recommendations, both from guidelines and product labelling. This article is a summary of what we know (and do not know) about using efavirenz in pregnancy. We argue that reconsideration of the risk and benefits of this evidence, which has informed South African guidance, is warranted.
Tuberculous abdominal abscess in an HIV-infected man : neither infection previously diagnosed : case studySource: Southern African Journal of HIV Medicine 11, pp 30 –34 (2010)More Less
A 38-year-old man had a 1-week history of right lower quadrant abdominal pain; the initial impression was that he had diverticulitis of the ascending colon with an intra-abdominal abscess. Signs of peritonitis mandated an immediate right hemicolectomy. The unusual location of the abscess and the patient's unusual postoperative course suggested that he might also have a systemic disease. Testing for HIV infection was positive. After 2 weeks in hospital, he was treated as an outpatient for both tuberculosis and HIV with a favourable outcome. In Taiwan a pre-operative HIV test is not performed routinely, and the HIV sero-prevalence in surgical patient populations is unknown. Surgeons should keep the possibility of HIV infection in mind in a patient with an unusual clinical course.
Source: Southern African Journal of HIV Medicine 11, pp 32 –34 (2010)More Less
Anaemia is a relatively common finding in HIV-positive patients, with rates (among females) as high as 37%, compared with their HIV-negative counterparts (17%). Anaemia of chronic disease plays a very important role in this population group, and is estimated to occur in 18 - 95% of cases. For this reason, it is imperative to distinguish this condition from other underlying or concurrent causes of anaemia that may warrant treatment. This clinical case illustrates the value of critically evaluating the parameters of a full blood count and haematinic screen, to so determine which patients warrant further workup.
Author A.D. BlackSource: Southern African Journal of HIV Medicine 11 (2010)More Less
The articles in this edition by Kao and Hung and Van de Vyver and Visser both deal with aspects of abdominal mycobacterial infections. Van de Vyver's article highlights the importance of investigating abnormalities that cannot be attributed to HIV infection alone, and demonstrates that abdominal mycobacterial infection may present with a paucity of abdominal symptoms and signs.
Source: Southern African Journal of HIV Medicine 11, pp 35 –36 (2010)More Less
A rare phenomenon of atypical lipodystrophy in a patient on HAART in the absence of a protease inhibitor regimen : case studySource: Southern African Journal of HIV Medicine 11, pp 37 –38 (2010)More Less
Lipodystrophy is a complication of patients on antiretroviral (ARV) medication; however, it is commonest in patients on long-term treatment and those on protease inhibitor (PI) regimens. We present a rare case of atypical lipodystrophy, presenting as multiple subcutaneous lipomas, in a patient who had been on a non-PI ARV regimen for 6 weeks.
Source: Southern African Journal of HIV Medicine 11, pp 39 –40 (2010)More Less
Pneumocystis jirovecii is well known to cause interstitial plasma cell pneumonia in immunocompromised patients. It has been implicated as a rare cause of infections in other anatomical sites. We report a rare case of P. jirovecii infection of the external auditory canal. This was the first manifestation of a previously unknown HIV infection.