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- Volume 14, Issue 3, 2013
Southern African Journal of HIV Medicine - Volume 14, Issue 3, 2013
Volumes & issues
Volume 14, Issue 3, 2013
Call for submissions : a decade of antiretroviral therapy in the public sector : message from the editorAuthor Landon MyerSource: Southern African Journal of HIV Medicine 14 (2013)More Less
For the last 13 years, the Southern African Journal of HIV Medicine (SAJHIVMED) has provided state-of-the art updates and in-depth local insights into both the population-level impact of the HIV epidemic and the management of HIV-infected and at-risk individuals across Southern Africa. The history of the Journal is intertwined with the expansion of access to antiretroviral therapy (ART) across South Africa and the region. As 2014 marks the 10-year anniversary of the public sector roll-out of ART services in South Africa, SAJHIVMED is planning a special edition to reflect on the lessons and celebrate the achievements during this time.
Author Francesca ConradieSource: Southern African Journal of HIV Medicine 14 (2013)More Less
Fellow HIV Clinicians, by now I am sure that most of you know that the World Health Organization (WHO) issued new guidelines. One of the most important differences is that these guidelines suggest initiating HIV-positive individuals on antiretroviral therapy (ART) at a CD4+ count of 500 cells/µl. This has caused much debate. With fixed-dose combination (FDC) treatment (one pill once daily) and medications with low side-effect profiles now available, many of the arguments for delayed therapy have fallen away. However, there is no clear clinical evidence of a benefit to starting ART earlier.
Source: Southern African Journal of HIV Medicine 14, pp 105 –106 (2013)More Less
Source: Southern African Journal of HIV Medicine 14, pp 108 –110 (2013)More Less
Legal debates regarding child participation in HIV research have tended to focus on issues of informed consent. However, much less attention has been given to privacy; accordingly, we classify this as a 'Cinderella issue' that has been excluded from 'the ball' (academic debate). Here we argue that privacy issues are as important as consent issues in HIV-prevention research. We describe a child's right to privacy regarding certain health interventions in South African law, and identify four key norms that flow from the law and that could be applied to HIV-prevention research: (i) children cannot have an expectation of privacy regarding research participation if they have not given independent consent to the study; (ii) children may have an expectation of privacy regarding certain components of the study, such as HIV testing, if they consent independently to such services; (iii) children's rights to privacy in health research are limited by mandatory reporting obligations; (iv) children's rights to privacy in HIV-prevention research may be justifiably limited by the concept of the best interests of the child. We conclude with guidelines for researchers on how to implement these principles in HIV-related research studies.
Consensus statement : management of drug-induced liver injury in HIV-positive patients treated for TB : guidelineSource: Southern African Journal of HIV Medicine 14, pp 113 –119 (2013)More Less
Drug-induced liver injury (DILI) in HIV/tuberculosis (TB) co-infected patients is a common problem in the South African setting, and re-introduction of anti-TB drugs can be challenging for the healthcare worker. Although international guidelines on the re-introduction of TB treatment are available, the definition of DILI is not uniform, management of antiretroviral therapy (ART) in HIV co-infection is not mentioned, and the guidance on management is not uniform and lacks a practical approach. In this consensus statement, we summarise important aspects of DILI and provide practical guidance for healthcare workers for different patient groups and healthcare settings on the re-introduction of anti-TB drugs and ART in HIV/TB co-infected individuals presenting with DILI.
Analysis of HIV-related mortality data in a tertiary South African neurology unit, 2006 - 2012 : original articleAuthor C-M. SchutteSource: Southern African Journal of HIV Medicine 14, pp 121 –124 (2013)More Less
Background. South Africa (SA) has a high prevalence of HIV infection with almost 11% of the population aged >2 years living with HIV. At the Steve Biko Academic Hospital, Pretoria, the Neurology Department has seen a steady increase in HIV-related neurology patients.
Objective. To evaluate the mortality data of this unit as it relates to HIV infection.
Methods. The study was a retrospective analysis of records. Patient mortality statistics for 2006, 2008, 2010 and 2012 were analysed regarding cause of death, sex, age and HIV status.
Results. During 2006, 85 patients died: 33% were HIV-positive, 13% were HIV-negative and 54% had not tested for HIV. By 2010, these figures were 50%, 22% and 28%, respectively, changing little in 2012 (48%, 28% and 24%, respectively). Causes of death in the HIV-positive group were meningitis in 58% - with tuberculous meningitis the most common aetiology - followed by strokes (14%), space-occupying lesions (8%) and status epilepticus (7%). Among HIV-positive patients aged 20 - 30 years, a larger proportion of young women died than men. In the combined untested and HIV-negative group, strokes accounted for the vast majority of deaths.
Conclusion. Neurological complications of HIV remain common in SA and contribute significantly to the overall mortality in our tertiary neurology unit, with TB posing a serious threat. A strong corps of clinical neurologists with training in infective neurology is needed urgently in the coming years to care for this growing number of patients.
HIV risk behaviour among public primary healthcare patients with tuberculosis in South Africa : original articleSource: Southern African Journal of HIV Medicine 14, pp 125 –130 (2013)More Less
Objective. To identify factors associated with HIV in tuberculosis (TB) patients in a public primary healthcare (PHC) setting in South Africa (SA).
Method. Among 4 900 consecutively selected TB patients (54.5% men; women 45.5%) from 42 public PHC clinics in 3 districts in SA, a cross-sectional survey was performed to assess new TB and new TB retreatment patients within one month of anti-TB treatment.
Results. The sample comprised 76.6% new TB patients and 23.4% TB retreatment patients. Of those who had tested for HIV, 59.9% were HIV-positive; 9.6% had never tested for HIV. In multivariate analysis, older age (odds ratio (OR) 5.86; confidence interval (CI) 4.07 - 8.44), female gender (OR 0.47; CI 0.37 - 0.59), residing in an informal settlement (OR 1.55; CI 1.13 - 2.12), being a TB retreatment patient (OR 0.55; CI 0.42 - 0.72), occasions of sexual intercourse with condom use (OR 1.07; CI 1.02 - 1.13) and having a sexual partner receiving antiretroviral treatment (ART) (OR 7.09, CI 4.35 - 11.57) were associated with an HIV-positive status in TB patients.
Conclusion. This study revealed high HIV risk behaviour (e.g. unprotected last sexual intercourse and alcohol and drug use in the context of sexual intercourse) among TB patients in SA. Various factors were associated with HIV risk behaviour. Condom use and substance use risk reduction need to be considered as HIV-prevention measures when planning such strategies for TB patients.
'Feedback : where data finally get thrilling' - tools for facility managers to use data for improved health outcomes in the prevention of mother-to-child transmission of HIV and antiretroviral therapy : conference reportSource: Southern African Journal of HIV Medicine 14, pp 131 –134 (2013)More Less
Data use and data quality continue to be a challenge for government sector health facilities and districts across South Africa. Led by the National Department of Health, key stakeholders, such as the Anova Health Institute and district health management teams, are aligning efforts to address these gaps. Coverage and correct implementation of existing tools - including TIER.net, routine data collection forms and the South African District Health Information System - must be ensured. This conference report provides an overview of such tools and summarises suggestions for quality improvement, data use and systematic evaluation of data-related interventions.
Source: Southern African Journal of HIV Medicine 14, pp 135 –137 (2013)More Less
We describe a case of HIV/tuberculosis (TB) co-infection from KwaZulu-Natal, South Africa, characterised by drug resistance in both pathogens. The development of drug resistance was linked temporally to two periods of incarceration. This highlights the urgent need for improved integration of HIV/TB control strategies within prison health systems and within the broader public health framework.
Source: Southern African Journal of HIV Medicine 14, pp 138 –140 (2013)More Less
Candida endocarditis is rare, but associated with a high mortality. The most common species implicated is Candida albicans. The epidemiology of invasive Candida infections is changing, with a predominance of non-albicans species causing invasive disease. We describe a case of Candida parapsilosis endocarditis in an HIV-positive patient with pre-existing mitral valve disease and renal failure on haemodialysis. The patient presented with fever and malaise. Clinical examination revealed pulmonary oedema and severe mitral regurgitation. Blood cultures were positive for C. parapsilosis. β-D-glucan assay levels were elevated. An echocardiogram showed large, friable vegetations on the mitral valve. C. parapsilosis was cultured from the haemodialysis tip and the vegetations. The patient responded well to mitral valve replacement and antifungal therapy. A high index of suspicion and aggressive diagnostic modalities and therapy are essential in patients with candidaemia, to decrease mortality due to this condition.
Source: Southern African Journal of HIV Medicine 14, pp 141 –143 (2013)More Less
Chylothorax is a rare cause of pleural effusion, seen in approximately 2% of cases. In HIV-positive patients with Kaposi's sarcoma (KS), the development of chylothorax presents as a diagnostic challenge with an aggressive course and poor, often lethal outcome. In this clinical scenario, the aetiology of chylothorax may include infections and malignancy, while pleural fluid examination and computed tomography of the mediastinum may fail to establish a cause. We present a case of KS-associated non-traumatic chylothorax resulting in death, and a review of available literature on this condition.
Source: Southern African Journal of HIV Medicine 14, pp 144 –146 (2013)More Less
Intravenous amphotericin B is a key component of the antifungal therapy for cryptococcal meningitis recommended in South African and international guidelines. Unfortunately, its use is associated with significant toxicity including deterioration in renal function, electrolyte disturbance, anaemia and infusion reactions. Chemical phlebitis is common following administration via peripheral cannulae. This can be complicated by bacterial infection, resulting in localised cellulitis or bacterial sepsis. Here we describe two patients with cryptococcal meningitis who developed methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia during, or shortly after treatment with amphotericin B. These cases illustrate the dangers of line-related sepsis in hospitalised individuals and some of the difficulties encountered during treatment of this condition.
Author S. BelardSource: Southern African Journal of HIV Medicine 14 (2013)More Less
The emergence of high quality, yet affordable portable ultrasound devices during the past decade has brought the ultrasound examination out of imaging services to the patients' bedside. Point-of-care (POC) ultrasound is increasingly practised throughout various medical disciplines. Simplified and targeted ultrasound protocols, applied by the attending clinician or medical staff, allow instantaneous assessment of clinically relevant questions. Time to diagnosis can be shortened, referrals can be avoided, and resources can be saved. POC ultrasound requires little training and is a safe and effective tool, with particular value for resource-limited settings where imaging modalities are often restricted.