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- Volume 13, Issue 1, 2012
Southern African Journal of HIV Medicine - Volume 13, Issue 1, 2012
Volumes & issues
Volume 13, Issue 1, 2012
Author Francesca ConradieSource: Southern African Journal of HIV Medicine 13 (2012)More Less
The first Southern African HIV Clinicians Society meeting that I attended was in or around 2002, at the Pharmaceutical Society in Glenhove Road. Professor Gary Maartens spoke on isoniazid preventive therapy, and the room was full (it was the last meeting in that too-small venue). The initial function of the Society was to help a group of private doctors to better manage HIV infections.
Author Landon MyerSource: Southern African Journal of HIV Medicine 13 (2012)More Less
This issue of the Journal continues discussions started in the December 2011 issue. Professor Kuhn responds to the concerns raised by Salojee about the national policy promoting breastfeeding in HIV-exposed infants; she discusses the scientific rationale for the policy revisions, and presents a population perspective rooted in overall child morbidity and mortality. For better or worse, infant feeding is likely to remain an important topic for years to come. Both viewpoints need careful consideration, and subsequent discussions in these pages hopefully can be informed by experiences from implementing the new infant feeding policies in different settings around the country.
Maternal and infant health is protected by antiretroviral drug strategies that preserve breastfeeding by HIV-positive women : opinionAuthor Louise KuhnSource: Southern African Journal of HIV Medicine 13, pp 6 –13 (2012)More Less
The South African Department of Health is justified in withdrawing support for free infant formula. By so doing, it recognises that any intervention that might detract from breast feeding poses a serious threat to infant survival. Since evidence is now strong that antiretroviral drugs used during lactation prevent transmission of infection from a seropositive mother, strategies that promote breastfeeding can now be recommended for enhancing the health of mothers and infants.
Why have socio-economic explanations been favoured over cultural ones in explaining the extensive spread of HIV in South Africa? : opinionSource: Southern African Journal of HIV Medicine 13, pp 14 –16 (2012)More Less
The HIV prevalence in South Africa's various racial / ethnic groups differs by more than an order of magnitude. These differences are determined not by the lifetime number of sexual partners, but by how these partnerships are more likely to be arranged concurrently in African communities. The available evidence demonstrates that neither HIV nor concurrency rates are determined by socio-economic factors. Rather, high concurrency rates are maintained by a culturally sanctioned tolerance of concurrency. Why then do socio-economic explanations trump cultural ones in the South African HIV aetiological literature? In this article, we explore how three factors (a belief in monogamy as a universal norm, HIV's emergence in a time of the construction of non-racialism, and a simplified understanding of HIV epidemiology) have intersected to produce this bias and therefore continue to hinder the country's HIV prevention efforts.
Source: Southern African Journal of HIV Medicine 13, pp 17 –19 (2012)More Less
Editor's note: The previous issue of the SAJHIV (December 2011) carried an Opinion piece by Innes, Cotton and Venter regarding the potential value of low-dose of stavudine (20 mg twice a day). They suggested that reduced dosing of stavudine may lead to levels of viral suppression comparable with those achieved with stavudine 30 mg bd but with a lower risk of toxicity and side-effects, and at a fraction of the cost of tenofovir. The Opinion was related to a larger proposal, led by Venter, to conduct a head-to-head trial comparing low-dose stavudine with tenofovir (both in a regimen including lamivudine and efavirenz) on viral suppression and other treatment outcomes over 24 months. There has been considerable debate regarding the advantages and disadvantages of low-dose stavudine, and in turn the value of any such trial. Here the debate continues with a commentary by Isabelle Andrieux-Meyer et al. and a rebuttal by Venter and colleagues.
Source: Southern African Journal of HIV Medicine 13, pp 20 –21 (2012)More Less
The debate around relooking at stavudine dosing, both in terms of the adult low-dose stavudine study and more broadly, is welcome. The study being proposed to evaluate low-dose stavudine v. tenofovir is a fairly standard placebo-controlled non-inferiority study. The study design is not controversial; however, the choice of study drug has attracted critical attention. We have previously discussed the issue of stavudine use, cost and access, and the significant implications of stavudine in developing countries, in detail in a recent article. We continue to believe that low-dose stavudine clinical trials, in both adults and children, are a priority for developing countries. These studies are being proposed simply because tenofovir is very expensive, and the only available cheaper alternative is stavudine.
Author Leigh F. JohnsonSource: Southern African Journal of HIV Medicine 13, pp 22 –27 (2012)More Less
Background. South Africa's National Strategic Plan (NSP) for 2007 - 2011 aimed to achieve new antiretroviral treatment (ART) enrolment numbers equal to 80% of the number of newly eligible individuals in each year, by 2011.
Objectives. To estimate ART coverage in South Africa and assess whether NSP targets have been met.
Methods. ART data were collected from public and private providers of ART. Estimates of HIV incidence rates were obtained from independent demographic projection models. Adult ART data and incidence estimates were entered into a separate model that estimated rates of progression through CD4 stages, and the model was fitted to South African CD4 data and HIV prevalence data.
Results. By the middle of 2011, the number of patients receiving ART in South Africa had increased to 1.79 million (95% CI 1.65 - 1.93 million). Adult ART coverage, at the previous ART eligibility criterion of CD4 <200/μl, was 79% (95% CI 70 - 85%), but reduced to52% (95% CI 46 - 57%) when assessed according to the new South African ART eligibility criteria (CD4<350/μl). The number of adults starting ART in 2010/11 was 1.56 times (95% CI 1.08 - 1.97) the number of adults who became ART-eligible in 2010/11, well in excess of the 80% target. However, this ratio was substantially higher in women (1.96, 95% CI 1.33 - 2.51) than in men (1.23, 95% CI 0.83 - 1.58) and children (1.13, 95% CI 0.74 - 1.48).
Conclusion. South Africa has exceeded the ART targets in its 2007 - 2011 NSP, but men and children appear to be accessing ART at a lower rate than women.
Source: Southern African Journal of HIV Medicine 13, pp 28 –33 (2012)More Less
The WHO recommends starting lifelong ART for all pregnant women with a CD4 count at or below 350 cells/mm3, which recognises the important component of 'when to start' and the role that timing of initiation plays in reducing mortality and disease progression. The data on 'what to start' are conflicting, and options for resource-limited settings are limited. The choice of an ART regimen for pregnant women is complicated by the need to take into account the health and safety of both the mother and baby. Particularly contentious is whether to use a nevirapine- (NVP) or efavirenz- (EFV) based regimen. This review presents the latest evidence on the safety and efficacy of EFV and NVP in pregnancy and offers recommendations for improving maternal and child health outcomes and avoid mother-to-child transmission as South Africa moves toward turning back the tide on its HIV epidemic.
Chronic genital ulcer disease with subsequent development of methicillin-resistant Staphylococcus aureus (MRSA) urethritis and bacteraemia in an HIV-seropositive person - a case observation : case studySource: Southern African Journal of HIV Medicine 13, pp 34 –35 (2012)More Less
HIV-seropositive persons are at increased risk of methicillin-resistant Staphylococcus aureus (MRSA). Genital ulcerative disease and sexually transmitted infection with subsequent MRSA infection in HIV-seropositive persons have been documented only once. We report a case of a 44-year-old man who presented to the Infectious Diseases Institute, Kampala, Uganda, with chronic genital ulcer disease and who subsequently developed MRSA urethritis and bacteraemia. This case also demonstrates that persistent genital ulcer disease in HIV-seropositive persons may be as a result of concurrent MRSA infection.