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- Volume 12, Issue 4, 2011
Southern African Journal of HIV Medicine - Volume 12, Issue 4, 2011
Volumes & issues
Volume 12, Issue 4, 2011
Author Landon MyerSource: Southern African Journal of HIV Medicine 12 (2011)More Less
The most appropriate strategies for feeding HIV-exposed infants have been a source of great debate in South Africa for years. During this time policy makers, healthcare providers and (most importantly) mothers living with HIV infection have been concerned and sometimes confused about what is best for the HIV-exposed but uninfected infant.
Source: Southern African Journal of HIV Medicine 12, pp 6 –10 (2011)More Less
The recent decision by the South African Department of Health to withdraw the provision of free replacement (formula) feeds to HIV-exposed infants has hardly evoked any response from clinicians, health professionals or civil society groups. This paper argues that the decision is short-sighted, lacks an adequate evidence base, and is retrogressive and unconstitutional. Nine supporting arguments are presented and an alternative policy proposed.
Source: Southern African Journal of HIV Medicine 12, pp 11 –13 (2011)More Less
In 2009, there were an estimated 5.6 million people living with HIV in South Africa. Based on a threshold of CD4 <350 cells/μl, it is estimated that around 46% of patients are not yet eligible for antiretroviral therapy (ART). The Department of Health guidelines from 20103 have limited recommendations for the care of patients not eligible for ART.
Source: Southern African Journal of HIV Medicine 12, pp 14 –15 (2011)More Less
Current recommendations advise that stavudine be phased out of use. The logistics and cost of switching are significant, and the World Health Organization has forecast that 1.55 million people will still be on stavudine-based antiretroviral therapy by the end of 2012. Stavudine is co-formulated in many countries, is very cheap and effective, and is well tolerated in initial therapy. However, the 40 mg BD dose was associated with considerable long-term toxicity. Several studies suggest that half the original recommended dose has excellent antiviral efficacy with significantly reduced metabolic side-effects. Despite generic tenofovir now being cheaper than zidovudine, tenofovir consumes the majority of adult antiretroviral programme medication budgets in programmes in Africa, where it is used in first-line therapy. Abacavir is far more expensive than zidovudine or tenofovir, and is a major cost driver in paediatric programmes with access to abacavir-based first-line treatment. Low-dose stavudine may offer the only cheaper (and possibly as effective and safe) alternative to programmes grappling with limited financial resources.
Identifying missed opportunities for early intervention among HIV-infected paediatric admissions at Chris Hani Baragwanath Hospital, Soweto, South Africa : original articleSource: Southern African Journal of HIV Medicine 12, pp 16 –23 (2011)More Less
Background and design. HIV is a major contributor to childhood morbidity and mortality in South Africa. We describe HIV prevalence, disease profile, outcome and missed opportunities for early intervention in a cohort of HIV-infected children admitted to Chris Hani Baragwanath Hospital's general paediatric wards between 1 October 2007 and 31 December 2007.
Results. Of 1 510 admissions, 446 (29.5%) were HIV infected. Many children (238, 54.1%) were newly diagnosed in hospital and most had advanced HIV disease (405, 92%). The principal admission diagnoses were pneumonia (165, 37.5%), gastro-enteritis (97, 22%), sepsis (86, 19.5%) and tuberculosis (92, 21%). Of children identified as HIV infected before admission, 128/202 (63.4%) were not accessing antiretroviral treatment (ART), although 121/128 (94.5%) met ART eligibility criteria. Of 364 ART-naïve eligible children, only 15 (4.1%) were commenced on ART as inpatients. Problems with PMTCT implementation in infants under 6 months (N=166) included lack of maternal antenatal HIV testing (51, 30.7%); poor uptake of maternal/infant nevirapine prophylaxis (60, 36.2%); limited use of co-trimoxazole (CTX) prophylaxis (44/147, 29.9%); and delayed infant HIV polymerase chain reaction testing (98/147, 87.5%). Of infants known to be HIV infected prior to hospitalisation, 37/51 (73%) had not initiated ART. The in-hospital case fatality rate (CFR) among HIV-infected children was triple that of the combined HIV-uninfected, exposed and unknown group (12% v. 3.6%). Infants <12 months of age accounted for 73.6% of all HIV-related deaths (CFR 17.1%).
Conclusions. HIV remains highly prevalent and contributes to significant in-hospital mortality. Missed opportunities for PMTCT, HIV diagnosis and ART initiation are frequent. Interventions to optimise paediatric HIV outcomes should target maternal HIV diagnosis, early infant diagnosis, uptake of CTX prophylaxis and prompt initiation of ART, especially among infants. Hospitalised ART-eligible children should be prioritised for inpatient initiation of ART.
Prevalence of postnatal depression and associated factors among HIV-positive women in primary care in Nkangala district, South Africa : original articleSource: Southern African Journal of HIV Medicine 12, pp 24 –28 (2011)More Less
Background. The prevalence of postpartum depression in South Africa is high, but there is lack of prevalence data on postnatal depression among HIV-infected women.
Aim. The aim of this study was to determine the prevalence of depressed mood and associated factors in postnatal HIV-positive women in primary care facilities in Nkangala district, Mpumalanga, South Africa.
Methods. This cross-sectional study was carried out on 607 HIV-positive postnatal women in 48 primary health care clinics and community health centres in Nkangala district. Postnatal women were recruited by systematic sampling (every consecutive patient over a period of 2 months). Demographic and other data were obtained from all the women who responded to a questionnaire in the local language on male involvement, HIV test disclosure, delivery and infant profile, infant HIV diagnosis, stigma, discrimination, postnatal depression, attendance of support groups and social support.
Results. Overall, 45.1% of women reported a depressed mood in the postnatal period. Depressed mood in a multivariable analysis was significantly associated with internalised stigma (odds ratio (OR) 1.12, 95% confidence interval (CI) 1.05 - 1.19; p=0.000), discrimination experiences (OR 1.22, CI 1.03 - 1.46; p=0.023), lack of social support (OR 0.86, CI 0.74 - 0.99; p=0.037) and having had an STI in the past 12 months (OR 2.22, CI 1.21 - 4.04; p=0.010). There were no statistically significant correlations between the Edinburgh Postnatal Depression Scale (EPDS) scores of the women and age, marital status, level of education, employment status and number of own children.
Conclusion. Depressed mood is common among HIV-positive postpartum women. This is significantly associated with lack of social support, stigma and discrimination. Routine screening to identify those currently depressed or at risk of depression should be integrated into postnatal care settings to target those most needing intervention.
Successful treatment of bilateral visual loss caused by idiopathic optic neuritis in an HIV-infected patient : case reportSource: Southern African Journal of HIV Medicine 12, pp 29 –32 (2011)More Less
Optic neuritis is not an uncommon diagnosis in HIV-infected patients, but it is rarely idiopathic. We report a case of a young HIV-infected woman who developed optic neuritis as her presenting manifestation of HIV infection. She had initially experienced sudden-onset right-sided painful visual loss; the left eye had become involved within days. Bilateral swollen discs were apparent on fundoscopy. Investigations were performed for meningitis (including bacterial, cryptococcal, tuberculous and syphilitic types), auto-immune diseases, toxoplasma, rubella, cytomegalovirus, viral hepatitis, HTLV-1/2, HIV-1/2 and syphilis. The only positive result was a reactive HIV enzymelinked immunosorbent assay. The CD4 count was 85 cells/μl. A post-contrast magnetic resonance imaging scan of the brain illustrated enhancement of the optic nerves. Treatment was 3 days of intravenous methylprednisolone 1 g daily, followed by 11 days of oral prednisone 60 mg daily. Highly active antiretroviral therapy was initiated after 2 weeks. Vision improved from day 6 after commencement of steroid therapy, with ongoing recovery at 5 months.
Source: Southern African Journal of HIV Medicine 12, pp 33 –38 (2011)More Less
Tuberculosis (TB) and HIV care in Khayelitsha, and in South Africa as a whole, has overcome numerous obstacles in the past three decades. This article highlights what has been achieved in Khayelitsha, describes the key clinical programme and policy changes that have supported universal coverage for HIV and TB care over the last 10 years, and outlines the challenges for the next decade.
Author G. MutintaSource: Southern African Journal of HIV Medicine 12, pp 39 –40 (2011)More Less