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- Southern African Journal of HIV Medicine
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- Volume 12, Issue 2, 2011
Southern African Journal of HIV Medicine - Volume 12, Issue 2, 2011
Volumes & issues
Volume 12, Issue 2, 2011
Author Francois VenterSource: Southern African Journal of HIV Medicine 12 (2011)More Less
I hope you are reading this at the Durban AIDS Conference! The meeting is a major event on the conference circuit, and is jam-packed with exciting events, talks and seminars, as well as debates about everything from behaviour change to the responsibilities of donors. I'll be particularly interested in the sessions on the revamping of primary care in South Africa and on nurse-initiated ART (NiMART). We've made big gains in treatment, but we need to get more people into care and earlier, and for that to happen, we need all our primary care sites to be firing effectively.
Source: Southern African Journal of HIV Medicine 12, pp 6 –11 (2011)More Less
South Africa has the highest number of people living with HIV in the world. Despite this, many South Africans do not know their HIV status and uptake of voluntary counselling and testing (VCT) has been suboptimal. In clinical settings there are many missed opportunities for HIV diagnosis as most patients are not routinely offered HIV counselling and testing (HCT). Provider-initiated counselling and testing (PICT) has been introduced to ensure that HCT becomes the standard of care in all consultations with health providers. PICT promotes universal access to prevention, care and treatment services for all clients by increasing the utilisation and acceptance of HCT services.
This article outlines the rationale for PICT as well as providing an overview of the implementation protocol that will equip health care providers with the knowledge required to integrate HCT into routine medical care.
Source: Southern African Journal of HIV Medicine 12, pp 12 –17 (2011)More Less
Provision of antiretroviral therapy (ART) is not an end in itself but a means to achieving improved wellness for people living with HIV. Rehabilitation, broadly defined, is another key contributor to wellness within this context. Understanding the potential for rehabilitation requires that one is able to consider HIV not only within a biomedical model that focuses on body systems, diagnoses and symptoms, but also within a rehabilitation framework that focuses on how these diagnoses and symptoms affect people's lives more broadly. Furthermore, rehabilitation is a human rights imperative, which deserves the energetic attention enjoyed by other aspects of HIV treatment and care. In particular, the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) is shining a long-overdue spotlight on the human rights imperatives associated with disability. For South Africa and other countries, proactively and meaningfully engaging rehabilitation in the HIV response will require major shifts on several fronts, including practice, education, policy and research. We argue that in settings where ART delivery is now widespread, HIV should be understood not only as a medical issue, but as a rehabilitation and disability concern. Whereas medicine adds years to life, it is rehabilitation that aims to add life to years.
Author Sonia MenonSource: Southern African Journal of HIV Medicine 12, pp 18 –20 (2011)More Less
Despite being a preventable disease, cervical cancer is still the second most common cancer in women worldwide. HIV infection is associated with a higher incidence, more rapid progression, and increased recurrence rates of human papillomavirus (HPV)-associated cervical intra-epithelial neoplasia and invasive cancer. The disease burden in developing countries is the result of inadequate national health care infrastructures that cannot establish or sustain comprehensive screening programmes, together with a high prevalence of HIV infection, particularly in southern Africa. In this article, clinically relevant issues for primary prevention of cervical lesions by a quadrivalent HPV vaccine and the 'screen-and-treat' protocol in settings of high HIV prevalence will be explored.
Bacterial vaginosis, alterations in vaginal flora and HIV genital shedding among HIV-1-infected women in Mozambique : original articleSource: Southern African Journal of HIV Medicine 12, pp 22 –24 (2011)More Less
Objectives. We investigated whether abnormal vaginal flora, including bacterial vaginosis (BV), are associated with detection of cervical HIV-1 RNA among HIV-infected women in Mozambique.
Methods. We obtained clinical data and vaginal specimens from HIV-infected women registering for their first visit at one of two HIV care clinics in Mozambique. We compared women with detectable cervical HIV viral load (≥40 copies / ml) with women with undetectable cervical HIV.
Results. We enrolled 106 women. Women with abnormal vaginal flora (intermediate Nugent scores, 4 - 6) were more likely to have detectable cervical HIV RNA than women with normal vaginal flora (adjusted odds ratio 7.2 (95% confidence interval 1.8 - 29.1), adjusted for CD4 count). Women with BV had a non-significantly higher likelihood of detectable cervical HIV than women with normal flora.
Conclusions. Abnormal vaginal flora were significantly associated with cervical HIV expression. Further research is needed to confirm this relationship.
Pattern of pericardial diseases in HIV-positive patients at University College Hospital, Ibadan, Nigeria : original articleSource: Southern African Journal of HIV Medicine 12, pp 25 –26 (2011)More Less
Rationale. Pericarditis has been reported as the most common cardiac complication of HIV disease, followed by pericardial effusion.
Methods. A retrospective review was conducted of all 68 patients treated for pericardial diseases between August 2003 and July 2008 at University College Hospital, Ibadan, Nigeria. HIV-positive patients (N=42) were compared with those who were HIV negative (N=26).
Results. More male than female patients presented with pericardial disease, and the HIV-positive patients were younger than those who were HIV negative. Pericardial effusion was the commonest mode of presentation, accounting for 20 HIV-positive patients (47.7%) and 13 HIV-negative patients (50%). Pericardiostomy was the commonest surgical intervention performed in HIV-positive patients (N=15), while the majority of HIV-negative patients had pericardiocentesis.
Conclusion. Pericardial effusion was the commonest cardiac presentation in HIV-positive patients in our setting. We recommend that patients with pericardial effusion be investigated for HIV infection.
Author Mark F. CottonSource: Southern African Journal of HIV Medicine 12, pp 27 –30 (2011)More Less
HIV-infected children have a high risk of acquiring tuberculosis. The World Health Organization (WHO) has released isoniazid preventive therapy (IPT) recommendations for adults and children living with HIV, based on efficacy studies, mainly in adults. Data from children appear conflicting. IPT guidelines for children were developed in response to WHO guidelines at a local meeting, followed by discussions.
IPT should be given to all HIV-infected children after exposure to a source case if treatment for active disease is not required. For children whose mothers' HIV status was known antentally, when tuberculosis has been actively excluded in mothers and at infant follow-up, and when infants have commenced antiretroviral therapy in the first 3 months of life, IPT is not required. Otherwise, all infants and children should be given IPT for 6 months once active tuberculosis has been excluded.
Source: Southern African Journal of HIV Medicine 12, pp 31 –44 (2011)More Less
Ninety years ago the isolation of insulin transformed the lives of people with type 1 diabetes. Now, models based on empirical data estimate that a 25-year-old person with HIV, when appropriately treated with antiretroviral therapy, can expect to enjoy a median survival of 35 years, remarkably similar to that for someone of the same age with type 1 diabetes. It is high time we normalised the lives of people living positively with HIV. This includes the basic human right to conceive and raise children. HIV-positive individuals may be in serodiscordant relationships or in seroconcordant relationships. As health care providers, it is our responsibility to ensure we understand the opportunities and risks of natural conception in these scenarios, so that we can help our patients to make informed decisions about their own lives. Most of all, it is our duty to make family planning in the setting of positive prevention as safe as we can. This includes informed decisions on contraception, adoption, fostering, conception and prevention of mother-to-child transmission.
Some months ago a dedicated group of individuals, invited and sponsored by the Southern African HIV Clinicians Society, came together in Cape Town to devise guidance in this area, recognising that there are ideal strategies that may be outside the realm of the resource constraints of the public sector or health programmes in southern Africa. This guideline therefore attempts to provide a range of strategies for various resource settings. It is up to us, the providers, to familiarise ourselves with the merits / benefits and risks of each, and to then engage patients in meaningful discussions. All the above, however, is based on the premise and prerequisite that the subject of family planning is actively raised and frequently discussed in our patient encounters.
Unusual presentation of extrapulmonary tuberculosis : a case report on mammary tuberculosis : case studySource: Southern African Journal of HIV Medicine 12, pp 45 –46 (2011)More Less
This case study highlights an unusual manifestation of extrapulmonary tuberculosis (TB) in a person living with HIV, namely mammary TB. Clinicians practising in settings where HIV and TB are endemic need to be aware of the clinical presentation, diagnosis and management of mammary TB.
Source: Southern African Journal of HIV Medicine 12, pp 47 –48 (2011)More Less
A 49-year-old man was diagnosed as HIV infected, with a CD4 count of 60 cells/μl. He was started on an antiretroviral treatment regimen comprising zidovudine, lamivudine and efavirenz. Following treatment, his CD4 count improved and the viral load was undetectable. He was subsequently found to have a moderately differentiated adenocarcinoma of the lower oesophagus.