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- Volume 15, Issue 4, 2014
Southern African Journal of HIV Medicine - Volume 15, Issue 4, 2014
Volumes & issues
Volume 15, Issue 4, 2014
Author Landon MyerSource: Southern African Journal of HIV Medicine 15 (2014)More Less
December is a useful time to pause and reflect on another year's passage, with milestones reached, hurdles overcome and lessons learned. This year has witnessed several notable editions of the Southern African Journal of HIV Medicine (SAJHIVMED). The March edition focused on the 10-year anniversary of public sector antiretroviral therapy (ART) provision in South Africa - an anniversary worth celebrating. The June and September editions continued the Journal's tradition of publishing some of the best research from across the region, including some particularly insightful pieces from local clinicians on the ground, and discussing the shortcomings of existing management strategies or the challenges of providing care under difficult circumstances. The contributions from local clinicians - particularly those working outside tertiary academic medicine - are often the most widely read contributions to the Journal, and we look forward to seeing more submissions in this category.
Author Francesca ConradieSource: Southern African Journal of HIV Medicine 15 (2014)More Less
This is our final issue before the end of the year, and what a year it has been. There is no doubt that the high point for the Society was our second biennial conference in September. We had an even better turn-out than our first conference in 2012, with over 900 delegates from across South Africa and the world. Of course I am biased, but I thought that a really good time was had by all. The conference opened on a public holiday (Heritage Day) and I thought no one would turn up - to my surprise over 600 people attended the opening session. The plenaries were of an international standard and featured national and global experts.
Source: Southern African Journal of HIV Medicine 15 (2014)More Less
Continued improvements for prevention of mother-to-child transmission (PMTCT) of HIV have dramatically reduced the number of vertical infections. However, a number of risk factors for transmission are still seen. There is an increasing awareness that more should and could be done to prevent transmission in these cases, and that targeted early diagnosis (soon after delivery) adds significant value in some infants to prevent prolonged nevirapine exposure leading to resistance, allows for rapid initiation of antiretroviral therapy as per the current guideline, and retains the infant and mother in care.
Source: Southern African Journal of HIV Medicine 15, pp 121 –143 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJHIVMED.1130More Less
These guidelines are intended as an update to those published in the Southern African Journal of HIV Medicine in 2012. Since the release of the previous guidelines, the scale-up of antiretroviral therapy (ART) in southern Africa has continued. Cohort studies from the region show excellent clinical outcomes; however, ART is still being initiated late (in advanced disease) in some patients, resulting in relatively high early mortality rates. New data on antiretroviral drugs have become available. Although currently few, there are patients in the region who are failing protease-inhibitor-based second-line regimens. To address this, guidelines on third-line therapy have been expanded.
Source: Southern African Journal of HIV Medicine 15, pp 144 –147 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJHIVMED.1050More Less
Background. In the face of increasing HIV/AIDS prevalence in sub-Saharan Africa, we evaluate the effectiveness of 'double-gloving' during surgery as a means of protecting the surgeon operating on patients with a known or unknown HIV status.
Methods. A prospective study was conducted to determine the rate of glove puncture and intraoperative injury in categories of patients with known positive, known negative or unknown HIV status.
Results. The surgeon and the first assistant double-gloved in all the 1 050 procedures performed between 2009 and 2013, and a total of 8 400 surgical gloves were used. Sixty-nine patients (6.6%) were HIV-positive, 29 patients (2.8%) were HIV-negative, and the HIV status was unknown for the remaining 952 patients (90.7%). The overall glove puncture rate in the study was 14.5%. The glove puncture rate was 0%, 31% and 15% for HIV-positive, HIV-negative and HIV status unknown, respectively, and this difference was statistically significant. The mean operating time in the group with glove punctures was 148 min (95% confidence interval (CI) 135 - 161), while mean operating time in the group without glove puncture was 88 min (95% CI 84 - 92).
Conclusion. Double-gloving offers protection against intraoperative injury. Knowing the HIV status of the patient offers additional protection to the operating surgeon. While we recommend routine double-gloving for surgeons working in HIV-prevalent patient populations, we also advocate for the routine screening for HIV in all surgical patients.
Paediatric ART outcomes in a decentralised model of care in Cape Town, South Africa : original articleSource: Southern African Journal of HIV Medicine 15, pp 148 –153 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJHIVMED.1084More Less
Background. Although sub-Saharan Africa faces the world's largest paediatric HIV epidemic, only 1 in 4 children has access to combination antiretroviral therapy (ART). A decentralised approach to HIV care is advocated, but programmes in resource-limited settings encounter many challenges to community-initiated paediatric ART implementation.
Methods. A retrospective cohort analysis of 613 children receiving ART between 2004 and 2009 was performed in seven physician-run primary healthcare (PHC) clinics in Cape Town. Baseline characteristics, serial CD4+, viral load (VL) levels and status at study closure were collected.
Results. Two subgroups were identified: children who were initiated on ART in a PHC clinic (n=343) and children who were down-referred from tertiary hospitals (n=270). The numbers of children initiated on ART in PHC increased sevenfold over the study period. Down-referred children were severely ill at ART initiation, with higher VLs, lower CD4+ counts and higher rates of tuberculosis co-infection (25.3% v. 16.9%; p=0.01). Median time to virological suppression was 29 weeks in PHC-ART initiates and 44 weeks in children down-referred (p<0.0001). Children down-referred to PHC either maintained or gained virological suppression. Longitudinal cohort analysis demonstrated sustained VL suppression >80%, high rates of immune reconstitution and low mortality.
Conclusions. Increasing numbers of children are initiated on ART in PHC settings and achieve comparable immunological, virological and survival outcomes, suggesting successful decentralisation of paediatric HIV care. Down-referral of children with adherence-related virological failure may assist with attainment of virological suppression and sparing use of second-line medications.
Disseminated fatal Talaromyces (Penicillium) marneffei infection in a returning HIV-infected traveller : case reportSource: Southern African Journal of HIV Medicine 15, pp 154 –155 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJHIVMED.1087More Less
We report a case of disseminated fatal Talaromyces (Penicillium) marneffei infection in an HIV-infected, antiretroviral treatment-experienced South African woman who had travelled to mainland China. The 37-year-old woman was admitted to a private hospital in fulminant septic shock and died within 12 h of admission. Intracellular yeast-like bodies were observed on the peripheral blood smear. A serum cryptococcal antigen test was negative. Blood cultures flagged positive after 2 days; on direct microscopy, yeast-like bodies were observed and a thermally dimorphic fungus, confirmed as T. marneffei, was cultured after 5 days. The clinical features of HIV-associated disseminated penicilliosis overlap with those of tuberculosis and endemic deep fungal infections. In the southern African context, where systemic opportunistic fungal infections such as cryptococcosis are more common among HIV-infected patients with a CD4+ count of <100 cells/µL, this infection is not likely to be considered in the differential diagnosis unless a travel history is obtained.
'Excelling in Clinical Care' : Southern African HIV Clinicians Society Conference
Cape Town, 24 - 27 September 2014 : abstractsSource: Southern African Journal of HIV Medicine 15, pp 156 –159 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJHIVMED.1124More Less