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- Volume 2006, Issue 23, 2006
Southern African Journal of HIV Medicine - Volume 2006, Issue 23, 2006
Volumes & issues
Volume 2006, Issue 23, 2006
Author Francois VenterSource: Southern African Journal of HIV Medicine 2006 (2006)More Less
Extracted from text ... 3THE SOUTHERN AFRICAN JOURNAL OF HIV MEDICINE march 2006 The Society executive is very excited to report that we have secured funding to significantly expand our support to HIV care programmes in Southern Africa. We will be looking at improving existing treatment and other guidelines. We will also be looking at new guidelines in areas that have been raised by clinicians on the ground, as well as establish several 'think tanks' to give people space to start throwing around new ideas in the field of HIV prevention and treatment. We will be expanding access to the Journal and Transcript ..
Author Des MartinSource: Southern African Journal of HIV Medicine 2006 (2006)More Less
Extracted from text ... The article by Professor Robin Wood in this issue highlights the dilemma surrounding antiretroviral first-line regimens. We do have an effective, cheap, first-line therapy: however it contains d4T, which has toxicities. These have been noted and vary in prevalence in South Africa. The efficacy and cost of the current first-line therapy has to be balanced against the decreased toxicity and increased expense of a first-line therapy containing tenofovir (expected to be registered in South Africa in about 12 months). The increased costs of a tenofovircontaining regimen will include the higher cost of monitoring, this time for renal toxicities. On ..
The role of stavudine in the South African public sector antiretroviral programme : should the perfect be the enemy of the good? : public healthAuthor Robin WoodSource: Southern African Journal of HIV Medicine 2006, pp 5 –8 (2006)More Less
Stavudine (d4T) was one of the first nucleoside analogues developed as an HIV antiretroviral (ARV). An early monotherapy trial demonstrated similar antiviral activity to zidovudine (AZT), and a comparative study of d4T and AZT in combination with lamivudine (3TC) and a protease inhibitor(PI) reported similar therapeutic outcome in each randomised treatment arm. <BR>Since registration in 1993 by the US Federal Drug Agency, d4T has been used extensively in combination therapy and was one of the first ARVs to become available in South Africa as a generic formulation. There is recently published evidence that its use is associated with higher CD4 cell count responses than other nucleoside analogues. The generic formulation with 3TC and nevirapine (NVP) is currently the cheapest ARV combination therapy available worldwide. With the development of a necessary public health approach to expanded access to ARVs in resource-poor settings the World Health Organization (WHO) included d4T in its recommended first-line ARV regimens. Following widespread use of d4T, adverse events including lipodystrophy, neuropathy and lactic acidosis associated with long-term therapy have been increasingly recognised. Despite the proven utility of d4T in more than a decade of use and its very low cost there has been an increasing swing of medical opinion against use of d4T and a search for alternatives.
Author Gary MaartensSource: Southern African Journal of HIV Medicine 2006, pp 10 –12 (2006)More Less
Antiretroviral therapeutic drug monitoring (TDM) is an additional monitoring tool to assist in the management of HIV-infected patients. Antiretroviral TDM is frequently undertaken in Europe, but less often in the USA. This overview will assess the principles, current evidence for, and limitations of TDM. Lastly, the potential role of TDM in southern Africa will be discussed.
Source: Southern African Journal of HIV Medicine 2006, pp 13 –17 (2006)More Less
More individuals were newly infected with HIV in 2005 than any other year. Sub-Saharan Africa and especially southern Africa bears the brunt of this pandemic. Although the picture in sub-Saharan Africa is largely one of a 'stable' epidemic where AIDS-related mortality is matched by the incidence of new infections, some countries in the Southern regions have continued to see increasing HIV prevalence.1 In this light, there is an urgent need for new approaches to HIV prevention. Here we review the current state of HIV prevention technologies, with particular emphasis on new approaches to HIV prevention that have particular promise in southern Africa. The focus here is on interventions that address sexually transmitted HIV, since the vast majority of new HIV infections in Africa are through heterosexual contact, and other important HIV prevention interventions (such as blood safety interventions and the prevention of mother-to-child transmission) are not included.
Source: Southern African Journal of HIV Medicine 2006, pp 18 –24 (2006)More Less
Richard Cooke and Lynne Wilkinson sought out a deep rural hospital in the old Transkei area of the Eastern Cape to attempt to set up a holistic HIV programme including access to antiretrovirals (ARVs). They looked for a hospital difficult to access by road, where the majority of the people were unemployed and where HIV-positive people currently have minimal health and social support. <BR>They identified Madwaleni hospital, a 220-bed district hospital built as a missionary hospital in the early fifties. It is approximately 30 km south-east of a small town called Elliotdale (approximately 80 km south-east of Mthatha). District statistics indicate that the hospital serves a population of approximately 256 000. <BR>Madwaleni is approximately 110 km (including 30 km of dirt road) from its referral centre, Nelson Mandela Hospital Complex (NMH) in Mthatha. Madwaleni has a small operating theatre, an X-ray facility and a laboratory, and patients are referred to NMH for all specialist consultations, and for surgery other than minor operations and caesarean sections. By car or ambulance this route takes approximately 1 1/2 hours, but for patients who are referred and need to use public transport, it takes closer to 2 1/2 hours. <BR>Madwaleni has a total of 5 doctors (including HIV / ARV programme doctors) and 117 nurses (including 46 professional nurses) at the time of writing in 2006. It has a small nursing college on site. <BR>At the beginning of 2005 Madwaleni's HIV programme, as at many rural government hospitals, was run by a single nurse and included HIV voluntary counselling and testing (VCT) for people coming to the hospital and specifically requesting to be tested, a small HIV support group started the previous year, prophylactic treatment (when available) for those patients requesting assistance, prevention of mother-to-child transmission (PMTCT) counselling and provision of nevirapine to some of the HIV-positive women accessing the hospital's services, and provision of formula feed (when available) for mothers who chose to formula feed upon receiving PMTCT counselling.
Source: Southern African Journal of HIV Medicine 2006, pp 25 –28 (2006)More Less
Extracted from text ... 25 An increasingly encountered phenomenon in research and clinical management of HIV is HIV discordance, the situation where one member of a sexual partnership is HIV infected, while the other is uninfected. This situation has wide clinical and research implications. In particular, seronegative partners within discordant relationships are a particularly high-risk group for HIV acquisition; a high proportion of new HIV infections in mature generalised epidemics is likely to occur within discordant couples.1 In this overview we will examine some of the biological and socio-behavioural correlates of discordance. As identification of the joint serostatus of a couple poses particular ..
Author Nicoli NattrassSource: Southern African Journal of HIV Medicine 2006, pp 29 –31 (2006)More Less
South African AIDS policy has long been characterised by suspicion on the part of President Mbeki and his Health Ministers towards antiretroviral therapy. The Minister of Health, Manto Tshabalala-Msimang, resisted the introduction of antiretrovirals for mother-to-child transmission prevention (MTCTP) until forced to do by a Constitutional Court ruling - and she resisted the introduction of highly active antiretroviral therapy (HAART) for AIDS-sick people until a cabinet revolt in late 2003 forced her to back down on this too. Since then, the public sector rollout of HAART has gained momentum, but it has been uneven across the provinces and continues to be constrained by a marked absence of political will at high levels.
Author Fatima HassanSource: Southern African Journal of HIV Medicine 2006, pp 32 –34 (2006)More Less
On 8 August 2003, the government of South Africa (SA) made a commitment to provide antiretroviral (ARV) treatment in the public health sector. On 19 November 2003, it published the Operational Plan on Comprehensive HIV and AIDS Care, Management and Treatment for South Africa (the Operational Plan). Some 2 1/2 years later, let us take stock of what is happening.
Author E. VariavaSource: Southern African Journal of HIV Medicine 2006, pp 35 –37 (2006)More Less
North West Province (NWP) has one of the highest HIV prevalences in South Africa. It is further challenged by severe poverty, a huge surface area housing a scattered community, and limited human resources. Despite this, it is one of the provinces that have successfully initiated large-scale ARV access in South Africa. This article describes the challenges and solutions that the province has grappled with to improve access to care for people with HIV.
HIV and hepatitis B coinfection in southern Africa : a review for general practitioners : HIV / HB coinfectionSource: Southern African Journal of HIV Medicine 2006, pp 38 –44 (2006)More Less
Sub-Saharan Africa is facing serious HIV and hepatitis B epidemics, with coinfection becoming a major public health problem. In addition, the prevention and treatment of concurrent illnesses such as hepatitis B in HIV-infected people is becoming increasingly important as their life expectancy lengthens due to treatment with highly active antiretroviral therapy (HAART). Despite the important epidemiological burden and clinical consequences of coinfection, there is a paucity of research to inform practice that derives from studies conducted in highly endemic regions. This article reviews the current status and limitations of knowledge on coinfection with the hepatitis B virus (HBV) and HIV. It will examine the basic epidemiology of coinfection; the implications for disease progression of each condition; the therapeutic implications including drug toxicities; and current evidence and guidelines for the use of vaccine-based prevention strategies. In addition the article highlights critical areas for future research on coinfection in sub-Saharan Africa.
Source: Southern African Journal of HIV Medicine 2006, pp 45 –46 (2006)More Less
Extracted from text ... 45 A 34-year-old woman tested HIV-positive in December 2005, and was referred to a specialist HIV unit in mid-January 2006. She had presented to her general practitioner with oesophageal candidiasis and a history of a cough and occasional loose stools since November 2005, with an 8 kg weight loss over the past 6 months. She had no history of other opportunistic infections or HIV-related conditions. On examination her temperature was 38.5?C and she had sinus tachycardia. Wasting, pallor and severe oral thrush were noted. There was no lymphadenopathy, hepatomegaly or splenomegaly, and the findings on respiratory examination were normal. The ..
Author Dave SpencerSource: Southern African Journal of HIV Medicine 2006, pp 47 –52 (2006)More Less
<I> 'Who among us shall dwell with the devouring fire? Who among us shall dwell with everlasting burnings?' He who walks righteously and speaks uprightly. He who despises the gain of oppression, who gestures with his hands refusing bribes. Who stops his ears from hearing of bloodshed and shuts his eyes from seeing evil.'</I> <BR>Politics has been defined as the 'art and science of government' and ethics as 'moral principles, the science of morals in human conduct, rules of conduct'. The reader would know politics by its public face - its leaders, their words, their actions: 'levelling the playing fields', 'quiet diplomacy', 'kill the farmer, kill the boer', 'shifting the goal posts', 'redressing the imbalances', 'playing the race card.' Ethical issues in health are familiar too: triaging survivors, prioritising limited budgets, maintaining confidentiality, obtaining informed consent, deciding upon ventilator/dialysis access, euthanasia and embryo research. Making choices has never been easy. <BR>Writing from prison in 1945, Bonhoeffer commented upon ethics: 'Rarely has any generation shown so little interest in any kind of theoretical or systematic ethics. Our period of history is oppressed by an abundance of ethical problems. Today, there are once more villains and saints. These emerge from the primeval depths to open the infernal or divine abyss and allow us to see briefly into mysteries of which we had never dreamed. What is worse than doing evil is being evil. It is worse for a liar to tell the truth than for a lover of the truth to lie. A falling away is of infinitely greater weight than a falling down. One is distressed by the failure of <I>reasonable</I> people to perceive the depths of evil or the depths of the holy. With the best of intentions they believe that a little reason will clamp together the parting timbers of their house...'