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- Volume 13, Issue 3, 2012
Southern African Journal of HIV Medicine - Volume 13, Issue 3, 2012
Volumes & issues
Volume 13, Issue 3, 2012
Author Francesca ConradieSource: Southern African Journal of HIV Medicine 13, pp 106 –108 (2012)More Less
I am not sure if I am the only one who feels this way, but sometimes I feel we are fighting a losing battle. It seems that the numbers and the challenges are overwhelming. But, something happened in the last few weeks that reminded me never to give up in fighting for the healthcare rights of all South Africans. Michelle Moorehouse, a member of our board, was incensed by an advertisement for Pre-Sex gel. This clearly unregistered product was being manufactured and sold by a doctor in Port Elizabeth. Michelle did not want anyone to buy this gel and to think that they were protected from HIV. She drafted a passionate letter that was sent off to a number of key stakeholders, including the Registrar of Medicine. The Medicines Control Council (MCC) visited the doctor's rooms, withdrew the product and stopped all sales. Who knows how many lives have been saved as a consequence? Well done to Michelle. We need to fight each battle that comes our way with the same dedication.
Author Landon MyerSource: Southern African Journal of HIV Medicine 13 (2012)More Less
The 20th International AIDS Conference was recently held in July in Washington, DC, USA. South Africa, generally, and the Southern African HIV Clinicians Society, specifically, were well represented, with prominent presentations by senior academics and policy makers. Indeed, following the conference, I have heard several colleagues from around the country comment that 'South Africans were presenting everywhere' at the meeting. The conference theme, 'Turning the Tide Together', reflected a sense of renewed hope in the fight against the HIV epidemic. Research towards a cure for HIV disease received a great deal of attention, while discussions of antiretroviral-based prevention strategies shifted from trials for determining efficacy towards grappling with the practical issues of implementation. Although most of us could not attend the meeting, luckily much of the conference content is downloadable from the website: http://www.aids2012.org.
Source: Southern African Journal of HIV Medicine 13, pp 110 –112 (2012)More Less
This edition of the Southern African Journal of HIV Medicine includes a new Antiretroviral Drug Dosing Chart for Children and Adolescents (2012). The chart was updated by the Southern African HIV Clinicians Society's ARV Dosing Committee, a sub-group of the Society's Child and Adolescent Committee, and the National Department of Health (DoH). The purpose of the chart is to provide an accurate and reliable antiretroviral therapy (ART) dosing guide for South African practitioners initiating and managing ART in children and adolescents. The chart is intended for doctors, nurses and pharmacists working in the South African public sector.
Source: Southern African Journal of HIV Medicine 13, pp 114 –133 (2012)More Less
These guidelines are intended as an update to those published in the Southern African Journal of HIV Medicine in January 2008. Since the release of the previous guidelines, the scale-up of antiretroviral therapy (ART) in Southern Africa has continued to grow. Cohort studies from the region show excellent clinical outcomes; however, ART is still being started late (in advanced disease), resulting in relatively high early mortality rates. New data on antiretroviral (ARV) tolerability in the region and several new ARV drugs have become available. Although currently few in number, some patients in the region are failing protease inhibitor (PI)-based second-line regimens. To address this, guidelines on third-line (or 'salvage') therapy have been expanded.
Estimated use of abacavir among adults and children enrolled in public sector antiretroviral therapy programmes in Gauteng Province, South AfricaSource: Southern African Journal of HIV Medicine 13, pp 134 –137 (2012)More Less
In South Africa, abacavir (ABC) is currently recommended as part of first- and second-line antiretroviral therapy (ART) for HIV-positive paediatric patients. Concerns about overprescribing of the drug, particularly to adults, led to an analysis of ABC use in public sector ART programmes. We investigated current prescription of the drug to adults and children accessing ART in 4 public sector programmes across Gauteng Province, South Africa. ABC was almost exclusively prescribed to children initiating ART and adults requiring regimen changes due to drug toxicities. Patterns of ABC use among HIV-positive paediatric patients followed national ART treatment guidelines on the application of the drug. Although ABC is commonly used in the private sector for adults, the current national ART treatment guidelines for adults and adolescents should include ABC as an alternative to standard first- or second-line ART.
TB/HIV integration at primary care level : a quantitative assessment at 3 clinics in Johannesburg, South AfricaSource: Southern African Journal of HIV Medicine 13, pp 138 –143 (2012)More Less
Background. In 2004 the World Health Organization (WHO) released the Interim Policy on Collaborative TB/HIV activities. According to the policy, for people living with HIV (PLWH), activities include intensified case finding, isoniazid preventive therapy (IPT) and infection control. For TB patients, activities included HIV counselling and testing (HCT), prevention messages, and cotrimoxazole preventive therapy (CPT), care and support, and antiretroviral therapy (ART) for those with HIV-associated TB. While important progress has been made in implementation, targets of the WHO Global Plan to Stop TB have not been reached.
Objective. To quantify TB/HIV integration at 3 primary healthcare clinics in Johannesburg, South Africa.
Methods. Routinely collected TB and HIV data from the HCT register, TB 'suspect' register, TB treatment register, clinic files and HIV electronic database, collected over a 3-month period, were reviewed.
Results. Of 1 104 people receiving HCT: 306 (28%) were HIV-positive; a CD4 count was documented for 57%; and few received TB screening or IPT. In clinic encounters among PLWH, 921 (15%) had documented TB symptoms; only 10% were assessed by smear microscopy, and few asymptomatic PLWH were offered IPT. Infection control was poorly documented and implemented. HIV status was documented for 155 (75%) of the 208 TB patients; 90% were HIV-positive and 88% had a documented CD4 count. Provision of CPT and ART was poorly documented.
Conclusion. The coverage of most TB/HIV collaborative activities was below Global Plan targets. The lack of standardised recording tools and incomplete documentation impeded assessment at facility level and limited the accuracy of compiled data.
Source: Southern African Journal of HIV Medicine 13, pp 144 –149 (2012)More Less
Aim. To determine changes in adherence to antiretroviral therapy (ART) in HIV-positive patients with depression, following treatment with an antidepressant or psychotherapy.
Methods. The study was prospective, randomised and controlled. Consenting volunteers aged ≥18 years and stable on ART for ≥6 months were included in the study. Sociodemographic data were obtained, and a clinical diagnostic evaluation and the Hamilton Depression rating scale (HAMD) were performed on all subjects at entry to and at the end of the study. Participants found to be depressed were randomly assigned antidepressant treatment (20 mg citalopram) or interpersonal psychotherapy (IPT) (5 sessions). Medication was dispensed at each visit and patients were asked to return all unused medication to determine ART adherence. The study was approved by the University of the Witwatersrand.
Results. Sixty-two HIV-positive persons receiving ART participated; 30 were not depressed (control group) and 32 were depressed (patient group). No significant differences in demographic characteristics existed between the control and patient groups. Mean ART adherence at the start of the study was 99.5% (standard error (SE) ±0.46) and 92.1% (SE ±1.69) in the control and patients groups, respectively. Mean ART adherence at the end of the study changed marginally in the control group (99.7%; SE ±0.46) and increased significantly in the patient group (99.5%; SE ±0.13) (p>0.05). The mean ART adherence rate of patients who received pharmacotherapy increased from 92.8% to 99.5%, and of those who received psychotherapy increased from 91.1% to 99.6% (p>0.05). There was no significant association between the increased adherence in the patient group and baseline demographic and clinical characteristics, irrespective of antidepressant therapy or IPT (p>0.05).
Conclusion. Successful treatment of depression with an antidepressant or psychotherapy was associated with improved ART adherence, independent of the type of treatment and sociodemographic factors. It is necessary to identify HIV-positive patients at risk of depression, to initiate antidepressant treatment which may prevent ART non-adherence, and subsequent disease progression and increased morbidity.
Persistent dizziness and recurrent syncope due to HIV-associated Addison's disease : case report from a resource-limited settingSource: Southern African Journal of HIV Medicine 13, pp 150 –151 (2012)More Less
Addison's disease or primary adrenal insufficiency is a well-recognised fatal endocrine condition among HIV-infected patients. HIV infection is associated with adrenal gland destruction and profound disruption of the hypothalamicpituitary adrenal axis. We describe a case of HIV-associated Addison's disease in a 58-year-old newly diagnosed HIV-seropositive male patient, highlighting its occurrence in this era of the HIV/AIDS pandemic.
Control and non-progression of HIV-1 infection in sub-Saharan Africa : a case and review : case reportSource: Southern African Journal of HIV Medicine 13, pp 152 –155 (2012)More Less
Elite and viraemic controllers represent unique subsets of HIV-infected patients who may also be long-term non-progressors (LTNPs). LNTPs constitute an estimated 1 - 15% of the total HIV-positive population in the USA and Europe, but less is known about their epidemiology in sub-Saharan Africa. Though the exact mechanisms for long-term non-progression appear to be numerous and are still under investigation, research on elite controllers may hold the key to new therapeutics and vaccine development. The clinical management of such patients can be challenging, as there are no standard guidelines for treatment, particularly in resource-limited settings. We describe the case of an HIV-infected Botswanan man who is likely an elite or viraemic controller.