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- Volume 2005, Issue 21, 2005
Southern African Journal of HIV Medicine - Volume 2005, Issue 21, 2005
Volumes & issues
Volume 2005, Issue 21, 2005
Author Leon LevinSource: Southern African Journal of HIV Medicine 2005 (2005)More Less
Extracted from text ... THE SOUTHERN AFRICAN JOURNAL OF HIV MEDICINE november 2005 5 At the outset, I would like to thank Professor Des Martin, outgoing President of the Southern African HIV Clinicians Society, for all he has done for our Society and in particular for the trust he has placed in the Paediatric Subcommittee. We wish him success in all his endeavours for the future. This edition sees the publication of the 3rd version of the SAHIVS Paediatric Antiretroviral Therapy Guidelines (p. 18). Since the first version was published in November 2000, major changes have taken place in the arena of paediatric ..
Author Linda-Gail BekkerSource: Southern African Journal of HIV Medicine 2005 (2005)More Less
Extracted from text ... H O R I Z O N S Can we involve adolescents in HIV vaccine trials - can we afford not to? More than half of the world's population is under 25 years of age - the largest population of young people the world has ever seen. In South Africa, 54% of the population is under 24 years of age. All are at risk for HIV infection. UNAIDS reports that in 2004 there were 14 000 new infections daily. Almost 100% of these were in the developing world, 1 200 were in 14 - 25-year-olds, and half of these ..
Source: Southern African Journal of HIV Medicine 2005, pp 8 –14 (2005)More Less
Half of the ARV agents available worldwide have paediatric approval, but many are without ideal paediatric formulations. Pharmacokinetic differences in paediatric populations require careful attention to dosing and concomitant therapies. Importantly, ARV therapy can be limited by short-term and long-term toxicity and drug interactions. <br>Low-cost, sustained and consistent access to ARV therapy is necessary to combat the HIV epidemic. For optimal response > 90 - 95% adherence to ARVs is required. This requires that extensive education and support resources be provided in addition to the ARV medications themselves. Paediatric patients receiving ARV therapy require ongoing monitoring to ensure tolerability, dose adjustments with advancing age, acceptability and therapeutic success.
Author Mark F. CottonSource: Southern African Journal of HIV Medicine 2005, pp 14 –17 (2005)More Less
HIV infection is a multisystem disease characterised by progressive immunodeficiency and increasing susceptibility to common and opportunistic pathogens. Progressive disease is characterised by reversible and then permanent end-organ dysfunction due to HIV itself or co-pathogens, and also an increased risk of malignancy. <br>The hallmark of immunodeficiency is CD4+ lymphocyte depletion, although other elements of the immune system are also deranged. Children with HIV are classified according to clinical and immunological criteria. Both systems are useful for individual patient management, and together are more useful than either parameter individually. <br>Classification into mutually exclusive categories allows standardisation of this complex multisystem disease process, facilitating case management and informing the clinician of both the extent of clinical progression and prognosis. Because of the varied prevalence of pathogens in different geographical areas, disease manifestations may differ. Some pathogens, such as <I>Pneumocystis jiroveci</I> and cytomegalovirus (CMV), will cause the same disease manifestations in any location. Others, such as <I>Mycobacterium tuberculosis</I>, are more prevalent in sub-Saharan Africa than elsewhere. A classification system should take cognisance of this variability. <br>Decisions to initiate antiretroviral therapy (ART) or to change therapy because of regimen failure are based on an understanding of disease progression. Lastly, the classification system allows for surveillance, facilitating planning by ministries of health for adequate resources and equitable access to care.
Source: Southern African Journal of HIV Medicine 2005, pp 18 –31 (2005)More Less
The Paediatric Sub-committee of the Southern African HIV Clinicians Society comprises paediatricians from the private and public sectors. These guidelines are the result of reviewing all the available paediatric treatment guidelines, consulting with international experts and drawing from their clinical experience. They differ from those of the National Department of Health (DOH), the World Health Organization (WHO) and other international guidelines (PENTA, etc). We encourage all treaters to consult the other guidelines, and make an informed decision for treating children. Websites of other guidelines can be found below under 'Recommended reading'. For the benefit of those working in the State Sector, a summary of the DOH Guidelines can be found in this journal on page 33.
Guidelines for the management of HIV-infected children (National Department of Health, South Africa 2005)Source: Southern African Journal of HIV Medicine 2005, pp 33 –37 (2005)More Less
Extracted from text ... THE SOUTHERN AFRICAN JOURNAL OF HIV MEDICINE november 2005 33 G U I D E L I N E S GUIDELINES FOR THE MANAGEMENT OF HIV-INFECTED CHILDREN (NATIONAL DEPARTMENT OF HEALTH, SOUTH AFRICA 2005) A summary of antiretroviral treatment guidelines Tammy Meyers, FCPaed (SA) Harriet Shezi Children's Clinic, Chris Hani Baragwanath Hospital, Johannesburg Brian Eley, FCPaed (SA) Red Cross Children's Hospital, Cape Town National guidelines for the management of HIV-infected children in South Africa have been developed as a consensus document by practising HIV clinicians around the country. Guidelines for antiretroviral (ARV) management of children appear in a booklet ..
Author Leon J. LevinSource: Southern African Journal of HIV Medicine 2005, pp 38 –42 (2005)More Less
An important principle in treating patients with HIV is that the first regimen is your best chance for success. So get it right the first time. Historically children have always lagged behind adults in their (virological) response to antiretrovirals (ARVs). However, with improvements in knowledge about pharmacokinetics, adherence and newer more potent and tolerable drugs in children, response to therapy in children is now approximating that in adults. Nevertheless, it is inevitable that over time, for a variety of reasons, a significant number of patients will need to move to a second-line regimen. For this reason, it is important that we have an approach to changing therapy.
Can measuring immunity to HIV during antiretroviral therapy (ART) in children provide a clue to markers of ART effectiveness?Author Clive GraySource: Southern African Journal of HIV Medicine 2005, pp 42 –45 (2005)More Less
The vexing issue of whether the immune system can be reconstituted during HIV infection by supplying antiretroviral therapy (ART) has been a question asked about HIV-infected adults and children receiving therapy. Knowing that the immune system is sufficiently plastic in adults to show restoration of specific and general immunity after receiving ART is promising when translated to paediatric treatment. There is evidence in children of immune reconstitution after receiving various therapeutic regimens. This review will examine some of the aspects of immune restoration in general, and specifically in children, and pose the question whether knowledge of changes in immunity in tandem with viral suppression can provide clues as to how to measure immune efficacy of ART.
Source: Southern African Journal of HIV Medicine 2005, pp 46 –48 (2005)More Less
With the widespread use of highly active antiretroviral therapy (HAART), the epidemic of paediatric HIV has evolved into a chronic disease of childhood. The difference between this disease and most other chronic diseases of childhood, however, is that it is not only a life-threatening diagnosis but also an extremely stigmatising one, resulting in highly emotionally charged responses to disclosure of such a diagnosis to the patient. The disclosure process is made much more difficult when the person being disclosed to is a child. One of the major difficulties is that one is dealing with many layers of disclosure: disclosure of HIV status to the child; the concomitant disclosure of HIV status of the parent/s and other siblings or other family members; and having to anticipate the child's own disclosure to his/her friends, extended family and community. Approaches to disclosing the diagnosis may vary between parents and between health care providers, but one thing that has been established in many studies world-wide is that the child needs to be informed, many suggesting sooner rather than later during the course of the illness. It has been suggested that disclosure of the diagnosis to the child is an integral part of providing comprehensive medical care to a child infected by HIV and may impact positively on adherence to medication. During adolescence, disclosure of the diagnosis may also aid in preventing high-risk behaviour, thereby curbing spread of the disease. Disclosure of HIV to a child should be seen as an ongoing process that may last several years depending on the cognitive development of the child. Health care providers who deal with HIV infection in children need to develop a plan that will enable them to support parents in disclosure.
Author R. WoodSource: Southern African Journal of HIV Medicine 2005, pp 49 –51 (2005)More Less
Highly active antiretroviral therapy (HAART) has to date been based on use of a triple combination of drugs chosen from three classes of antiretrovirals (ARVs), nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs). These ARV classes target two of the three virally encoded enzymes necessary for viral replication after entry of HIV into the host cell. A greater understanding of the viral-host interactions necessary for new infection of CD4 cells has led to the development of compounds able to inhibit viral entry. The novel fusion inhibitor T-20 has entered clinical use and has a particular role in salvage therapy of patients with HIV strains resistant to present classes of ARVs. Co-receptor inhibitors have shown <I>in vivo</I> antiviral activity and are now entering phase III development. Integrase (IN), the third viral enzyme encoded by the <I>pol</I> gene, has remained an elusive target. Compounds with low toxicity and able to inhibit (IN) are now entering phase II clinical development. These new HIV treatment modalities represent a significant advance in and addition to our anti-HIV armamentarium. This review will outline the mechanisms of action of entry inhibitors and IN inhibitors and discuss the lead compounds within each class.