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- Volume 2006, Issue 24, 2006
Southern African Journal of HIV Medicine - Volume 2006, Issue 24, 2006
Volumes & issues
Volume 2006, Issue 24, 2006
Author Gita RamjeeSource: Southern African Journal of HIV Medicine 2006, pp 7 –11 (2006)More Less
Sub-Saharan Africa is the region worst affected by the HIV pandemic, hosting over 64% of global infections. Women are disproportionately affected, with reports of almost 60% of infections among women between the ages of 15 and 49 years in sub-Saharan Africa. In South Africa, 1 in 4 women are infected by the age of 25 years. Biological, socio-economic and cultural factors contribute to the vulnerability of women to HIV. The only effective method of HIV prevention, the male condom, is not in the control of women. It has therefore become increasingly clear that female-initiated methods or technologies need to be developed to allow women to have control over their sexual health, and HIV prevention in particular. <BR>Microbicides are one of the female-initiated technologies for prevention of HIV among women. The products could be formulated as gels, creams or suppositories. The concept is based on application of the product in the vagina prior to sexual intercourse to prevent HIV infection. There are several products in the pipeline, their development ranging from early stages to large-scale efficacy trials. <BR>The field of microbicides research is increasingly gaining momentum in South Africa and elsewhere. South Africa is host to five phase III clinical trials; four microbicide trials and one trial of vaginal diaphragms for HIV prevention. The majority of microbicides being tested are compounds called fusion inhibitors which act by preventing the binding of HIV to target cells in the vagina.
Author Graeme MeintjesSource: Southern African Journal of HIV Medicine 2006, pp 12 –15 (2006)More Less
The 13th Conference on Retroviruses and Opportunistic Infections (CROI) was held in Denver, Colorado, on 5 - 8 February 2006. Several papers were presented on the topic of structured treatment interruptions (STIs) of antiretroviral therapy in adults, and this was probably the most controversial antiretroviral treatment issue discussed at the conference. This article summarises these papers.
Author Mark HeywoodSource: Southern African Journal of HIV Medicine 2006, pp 16 –22 (2006)More Less
Boosting protease inhibitors with low-dose ritonavir - unravelling the mystery : boosting protease inhibitorsAuthor S.L. ModiSource: Southern African Journal of HIV Medicine 2006, pp 23 –26 (2006)More Less
The advent of highly active antiretroviral treatment (HAART) has had the dramatic effect of changing HIV infection from a relentlessly progressive disease with inevitable death to a disease that is chronic and manageable. The goal of HAART is to suppress HIV replication maximally, and thereby restore immunological function, reduce HIV-related morbidity and mortality, and improve quality of life. HIV-infected persons who qualify for treatment can be treated with a HAART regimen consisting of two nucleoside reverse transcriptase inhibitors (NRTIs) combined with a non-nucleoside reverse transcriptase inhibitor (NNRTI) or a protease inhibitor (PI).
Author Dave SpencerSource: Southern African Journal of HIV Medicine 2006, pp 28 –32 (2006)More Less
The HIV / AIDS epidemic affects large numbers of people in sub-Saharan Africa. Most are unaware of their HIV status. Despite two decades of scientific advance, the education of communities and the provision of antiretroviral medication to some, many still succumb to the virus. Can this situation be changed? Antiretroviral (ARV) drugs have been shown to be effective in both poor and rich communities. But for the majority, these agents remain unaffordable and difficult to access. After 2 years, the public-sector ARV rollout programme in South Africa remains under-subscribed and under-utilised. Diets, vitamins, micronutrients and herbal concoctions have been advocated. But none has provided the survival benefit, freedom from opportunistic disease, and completeness of recovery, of antiretroviral therapy. <BR>In recent years, research in developing countries has suggested that the daily use of the sulfonamide combination antibiotic, co-trimoxazole (CTX, trimethoprim-sulfamethoxazole, TMP / SMX), enhances the survival of infected adults and children. Co-trimoxazole (CTX) use in patients with advanced HIV infection became widespread in the 1980s when efficacy against <I>Pneumocystis jiroveci</I> pneumonia (PJP) was demonstrated. In this context, prophylactic CTX was commenced at CD4 levels of 200 cells / µl or less or following an AIDS-defining condition including PJP itself, prolonged and unexplained fever and weight loss. It was discontinued once the CD4 count rose to and remained above 200 cells / µl for at least 6 months. <BR>But the landscape for prophylactic CTX use in Africa appears to be changing. Recent World Health Organization (WHO) Guidelines have recommended expanding CTX use to all HIV-infected persons - where CD4 levels are unknown - with symptomatic WHO stage 2, 3 or 4 disease and where CD4 counts are available, to all with counts below 350 cells / µl. All HIV-infected persons with TB - pulmonary and non-pulmonary - are to be placed on CTX prophylaxis irrespective of their CD4 cell count. A 'universal option' of 'CTX to all' is offered to those who live in regions of high HIV prevalence and inadequate health care support. When is CTX prophylaxis stopped? 'The general view is to continue CTX prophylaxis in adults - in resource-poor settings - indefinitely.'
Author Liesl GerntholtzSource: Southern African Journal of HIV Medicine 2006, pp 34 –35 (2006)More Less
In May 2006, Judge Edwin Cameron, probably the most high-profile South African living openly with HIV, delivered a lecture at the University of KwaZulu-Natal in honour of Professor Ronald Louw. Professor Louw, a lecturer in the Faculty of Law at the university, a member of the Treatment Action Campaign and a human rights activist, had died a few weeks earlier of an AIDS-related illness. Despite his access to information about HIV, and to adequate resources to manage his illness, Professor Louw had not tested for HIV, and by the time his HIV status was discovered he was too ill to benefit from treatment.
Source: Southern African Journal of HIV Medicine 2006, pp 38 –43 (2006)More Less
Home-based care has emerged as a service delivery model to cope with the devastation caused by the HIV / AIDS epidemic in sub-Saharan Africa, where medical and traditional care infrastructures have been overwhelmed. In these communities homebased care workers provide critical services, which include physical, psychosocial, and palliative care activities. A quantitative and qualitative study of home-based care workers in South Africa was conducted in 2005 to better understand the needs, fears and motivations of front-line care workers at Thembalethu Home Based Care (THBC), located within the Nkomazi region of South Africa's Mpumalanga province. The objectives of this study were to:<ul> <li>Describe the socio-demographic background of home-based care workers to better understand worker demographics, workers' finances and job characteristics</li> <li>Assess THBC care workers' willingness to undergo voluntary counselling and testing (VCT) to determine their HIV status</LI> <li>Explore the emotional impacts of care work for THBC frontline care workers to determine what mechanisms could be put in place in order to support and expand the current care work infrastructure.</li></ul> Findings suggest that THBC care workers value the emotional support from weekly group meetings and use this time to process the emotional impacts of their care work. Although rates of testing are low, 83% of participants would consider undergoing VCT to learn their HIV status. Specific strategies to ensure that care workers receive appropriate medical care and supportive services are discussed.
Source: Southern African Journal of HIV Medicine 2006, pp 45 –47 (2006)More Less
The objective of antiretroviral therapy (ART) is to suppress viral replication so that immune restoration can occur. Failure of immune restoration is usually associated with poor virological suppression. In children a good immunological and clinical response to ART is often achieved despite incomplete viral suppression. However, we have recently managed a number of children in whom immune restoration did not occur despite excellent virological suppression. We present a case, discuss possible causes and speculate on the appropriate course of action.