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- Volume 13, Issue 4, 2012
Southern African Journal of HIV Medicine - Volume 13, Issue 4, 2012
Volumes & issues
Volume 13, Issue 4, 2012
Author Landon MyerSource: Southern African Journal of HIV Medicine 13 (2012)More Less
This edition of the Southern African Journal of HIV Medicine is coming out slightly earlier than scheduled, timed to coincide with the first Southern African HIV Clinicians Society Conference in Cape Town. The conference features an exciting line-up of leading local researchers, as well as international experts. During 2013, the Journal will carry some of the reports and papers from the meeting; therefore, if you can't attend the conference, you will still be able to keep up to date on the latest trends and developments in HIV medicine and clinical care.
Author F. ConradieSource: Southern African Journal of HIV Medicine 13 (2012)More Less
'The times they are a-changing.' The South African National AIDS Council (SANAC) reconvened at an impressive inaugural meeting in Pietermaritzburg on 4 October 2012, attended by the Minister of Health, Dr Aaron Motsaeledi, and Deputy President Kgalema Motlanthe. SANAC announced that the incidence of mother-to-child transmission of HIV was down and life expectancy was up - all very good news.
Source: Southern African Journal of HIV Medicine 13, pp 162 –167 (2012)More Less
Following the rapid scale-up of the programme for universal access to antiretroviral therapy (ART) in southern Africa, resistance to antiretroviral medications will occur. A detectable viral load must be treated as an emergency and should trigger intensive patient tracking and adherence counselling. In contrast to the developed world, the incidence of transmitted resistance is still low in most areas in the region. Therefore, in this consensus statement we do not recommend resistance testing in HIV-infected adults upon diagnosis or ART initiation. However, baseline resistance testing is recommended for children who have been exposed to ART for prevention of mother-to-child-transmission therapy and subsequently become HIV-infected. Resistance testing is also recommended after virological failure of first- and second-line ART regimens.
Risk factors for discordant immune response among HIV-infected patients initiating antiretroviral therapy : a retrospective cohort study : original articleSource: Southern African Journal of HIV Medicine 13, pp 168 –172 (2012)More Less
Background. The therapeutic goal of antiretroviral therapy (ART) is sustained immune recovery and viral suppression. However, some patients experience poor CD4 cell count responses despite achieving viral suppression. Such discordant immune responses have been associated with poor clinical outcomes.
Objective. We aimed to determine the prevalence of discordant immune response and explore associated factors in a retrospective cohort of patients attending 2 large public sector clinics, during the 6 months following ART initiation.
Methods. Data were analysed from 810 HIV-infected adults initiated on first-line HAART at 2 clinics in Johannesburg, between 1 November 2008 and 31 December 2009. Multivariate logistic regression models were used to estimate adjusted odds ratios (AORs) to determine associations between discordant immune response and clinical and demographic factors.
Results. At ART initiation, 65% (n=592) of participants were female, with a mean age of 38.5 years. Median baseline CD4 cell count was 155 cells/mm3, 70% (n=645) of patients had a haemoglobin level >11 g/dl and 88% (n=803) were initiated on stavudine-lamivudine-efavirenz/nevirapine (D4T-3TC-EFV/NVP). Six months after ART initiation, 24% (n=220) of patients had a discordant immune response and 7% (n=67) a discordant virological response. On multivariate analysis, baseline CD cell count ≥200 cells/mm3 (AOR 3.02; 95% confidence interval (CI) 2.08 - 4.38; p<0.001) and moderate anaemia (8.0 - 9.4 g/dl) at baseline (AOR 2.30; 95% CI 1.25 - 4.59; p=0.007) were independently associated with the development of discordant immune response, after adjustment for education level, World Health Organization (WHO) clinical stage and ART regimen.
Conclusions. Discordant immune response following ART initiation was common and associated with baseline anaemia and CD4 cell count in our cohort. Intensive monitoring of at-risk individuals may improve clinical outcomes.
Source: Southern African Journal of HIV Medicine 13, pp 174 –177 (2012)More Less
Background. There are few data on HIV prevalence and risk factors among inner-city homeless and marginally housed individuals in South Africa.
Methods. We recruited 136 adults from a Johannesburg inner-city homeless clinic; mean age was 32.4 years, 129 (95%) were male, and 90 (66%) were of South African nationality. Participants were tested for HIV and answered a short demographic survey. Descriptive statistics and uni- and multivariate regression analyses were used for data analysis.
Results. The HIV prevalence in the cohort was 23.5%. Transactional sex, relationship status, number of concurrent sexual partners, condom usage and history of previously treated sexually transmitted infections (STIs), living on the street, the use of alcohol or drugs, and previous exposure to voluntary counselling and testing (VCT), were not significant risk factors for HIV-positivity. Statistically significant HIV risk factors on multivariate analysis included the presence of an STI (odds ratio (OR) 5.6; p<0.01) and unemployment (OR 6.7; p<0.01). South African nationality was a significant risk factor on univariate analysis (OR 2.99; p<0.05), but not on multivariate analysis (OR 2.2; p=0.17).
Conclusion. The HIV prevalence in the sample did not differ appreciably from HIV prevalence estimates in other at-risk populations in similar settings, suggesting that homelessness in a South African city alone may not be a significant risk factor for HIV infection. HIV prevention efforts cannot be restricted to behaviour change programmes, but must be more holistic, recognising the protective role that employment has on HIV incidence.
The case for Option B and Optional B+ : ensuring that South Africa's commitment to eliminating mother-to-child transmission of HIV becomes a reality : forumSource: Southern African Journal of HIV Medicine 13, pp 178 –181 (2012)More Less
In a previous issue of the Southern African Journal of HIV Medicine, Pillay and Black summarised the trade-offs of the safety of efavirenz use in pregnancy (Pillay P, Black V. Safety, strength and simplicity of efavirenz in pregnancy. Southern African Journal of HIV Medicine 2012;13(1):28-33.). Highlighting the benefits of the World Health Organizationâ??s proposed options for the prevention of mother-to-child transmission (PMTCT) of HIV, the authors argued that the South African government should adopt Option B as national PMTCT policy and pilot projects implementing Option B+ as a means of assessing the individual- and population-level effect of the intervention. We echo this call and further propose that the option to remain on lifelong antiretroviral therapy, effectively adopting PMTCT Option B+, be offered to pregnant women following the cessation of breastfeeding, for their own health, following the provision of counselling on associated benefits and risks. Here we highlight the benefits of Options B and B+.
Source: Southern African Journal of HIV Medicine 13, pp 182 –184 (2012)More Less
The high burden of HIV and tuberculosis (TB) among pregnant women in South Africa contributes to a high maternal mortality rate. Isoniazid preventive therapy (IPT) is recommended for the prevention of active TB in HIV-infected individuals, including pregnant women. However, there are few data regarding IPT use in the latter, with concern regarding the concurrent use of IPT with nevirapine in pregnancy, as both treatments are hepatotoxic. The benefit and safety of IPT in HIV-infected pregnant women has not been established. We recommend a simplification of HIV and TB interventions by providing triple antiretroviral therapy to all HIV-infected pregnant women.
Source: Southern African Journal of HIV Medicine 13, pp 186 –187 (2012)More Less
In a South African context, we consider the implications of the United States Food and Drug Administration's recent approval of the OraQuick HIV self-testing kit. We argue that current law and policy inhibit the roll-out of accurate and well-regulated self-testing kits, and create a loophole for sale in supermarkets, but not pharmacies.
Source: Southern African Journal of HIV Medicine 13, pp 188 –194 (2012)More Less
Psychiatric disorders frequently co-occur with HIV, as preceding conditions or consequent to HIV infection. This potentially compromises HIV diagnosis and antiretroviral (ARV) treatment adherence. We provide a brief guide to the diagnosis and treatment of common mental disorders in people living with HIV/AIDS, including: prescribing psychotropics in HIV; neuropsychiatric side-effects of ARVs and other medications commonly prescribed in HIV; and the diagnosis and treatment of depression, anxiety, psychosis, agitation, sleep disturbance, pain, and mania. Psychotropic treatments recommended were drawn primarily from those available in the public sector of South Africa.
Source: Southern African Journal of HIV Medicine 13, pp 196 –197 (2012)More Less
We report 2 cases illustrating that it is too simplistic to link nevirapine (NVP) toxicity exclusively to individuals with immune preservation. Not enough is known about the mechanism of hepatotoxicity or cutaneous eruption to predict these events. This type of hypersensitivity reaction occurs rarely among HIV-exposed infants taking NVP prophylaxis or antiretroviral therapy (ART)-experienced adults with complete plasma viral load suppression. Conversely, HIV-uninfected adults and ART-naive pregnant women appear to be disproportionately affected by the adverse effects of NVP.
Source: Southern African Journal of HIV Medicine 13, pp 198 –200 (2012)More Less
Varicella zoster virus infection causing urinary retention in a child with HIV infection : case reportSource: Southern African Journal of HIV Medicine 13, pp 202 –203 (2012)More Less
An 11-year-old boy receiving antiretroviral therapy for HIV infection and antibacterial therapy for pulmonary tuberculosis presented with urinary retention due to varicella zoster virus infection involving the sacral nerves, confirmed on serological testing. The perineum over dermatomes S2 - S4 on the left was involved with a vesicular and superficially erosive rash. A transurethral catheter was inserted and the patient was treated with acyclovir (300 mg 6-hourly for 5 days). At follow-up 4 weeks later, the perineal skin lesions had healed, the catheter was removed and the patient was able to pass urine.