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- Volume 2007, Issue 28, 2007
Southern African Journal of HIV Medicine - Volume 2007, Issue 28, 2007
Volumes & issues
Volume 2007, Issue 28, 2007
Author Linda-Gail BekkerSource: Southern African Journal of HIV Medicine 2007 (2007)More Less
Well, spring has sprung and this bumper Spring edition is the final for 2007. What a year it has been! Important circumcision trial results push us to ask about the implementation logistics, and equally important negative results in HIV vaccine, microbicide and diaphragm research make us realise that the road to efficacious prevention modalities will be a long one.
Author Dennis SifrisSource: Southern African Journal of HIV Medicine 2007 (2007)More Less
It was in 1983 that I received a call from a man named Ruben Sher at my rooms in Jeppe Street in Johannesburg. We had spoken once previously when he was doing research on hepatitis B prevalence among gay men, and he was now contacting me about the mysterious 'gay plague' that was hitting gay men in America.
Source: Southern African Journal of HIV Medicine 2007, pp 8 –16 (2007)More Less
HIV-associated opportunistic fungal infections : a guide to using the clinical microbiology laboratory : fungal infections - laboratoryAuthor Nelesh GovenderSource: Southern African Journal of HIV Medicine 2007, pp 18 –23 (2007)More Less
This review aims to provide a guide for clinicians to using the clinical microbiology laboratory for management of common HIV-associated opportunistic fungal infections, e.g. mucosal candidiasis, cryptococcosis, Pneumocystis jirovecii pneumonia (PCP), histoplasmosis, etc. Laboratory tests provide valuable guidance at various stages of management of HIV-infected patients with fungal infections : (i) establishing a diagnosis, (ii) guiding appropriate antifungal therapy in selected circumstances, (iii) providing laboratory prognostic markers, (iv) monitoring response to therapy; and (v) detecting relapses. However, the laboratory is not always able to provide reliable answers to clinically relevant questions, and these limitations must be considered in the interpretation of test results.
Guidelines for the prevention, diagnosis and management of cryptococcal meningitis and disseminated cryptococcosis in HIV-infected patients : guidelineSource: Southern African Journal of HIV Medicine 2007, pp 25 –35 (2007)More Less
While the developed world has seen a substantial decline in incidence rates of CC after the advent of highly active antiretroviral treatment (HAART), the enormity of the burden of AIDS on the African sub-continent and the anticipated delays in achieving full coverage of antiretroviral therapy (ART) programmes imply that CC will continue to cause mortality among our population for years to come. The prognosis of patients with cryptococcal meningitis was very poor prior to the availability of ART, but present survival rates in the context of ART co-administration are much improved. Consequently it has become essential to improve the initial acute management of CC in order to maximise the patient's chances of initial survival and subsequent entry into the ART treatment programme.
Existing international guidelines for the management of cryptococcosis are written for different geographical and clinical contexts and may be impracticable for implementation in sub-Saharan Africa given limited availability of drugs and other resources.
Treatment of HIV-associated cryptococcal meningitis in South Africa : the case for amphotericin B over conventional dose fluconazole for initial therapy : fungal infections - clinicalSource: Southern African Journal of HIV Medicine 2007, pp 36 –39 (2007)More Less
Cryptococcal meningitis is a major cause of morbidity and mortality in African AIDS patients, accounting for between 13% and 17% of deaths in Ugandan HIV-infected individuals and 44% of deaths in a cohort of HIV-seropositive South African miners. This burden of disease is a result of high incidence, especially in southern and East Africa, and high acute mortality. In much of Africa, fluconazole rather than amphotericin B was, and still is, widely used as initial therapy, for a variety of reasons. These include the availability of fluconazole through free access programmes and in generic form, and the attractiveness of an easy to use, safe oral regimen over a difficult to administer intravenous drug with significant side-effects, requiring inpatient admission and close laboratory monitoring. In addition, in the absence of antiretroviral therapy, treatment of cryptococcal meningitis has in the recent past been palliative rather than curative, reducing the rationale for more aggressive therapy, if this is associated with increased side-effects. However, what data there are suggest that outcomes with fluconazole at conventional dosage (up to 400 mg/d) as initial therapy are poor. In addition, the cost of amphotericin B, previously considerable in South Africa, has been reduced. More importantly, increasing access to antiretroviral therapy (ART) now means that the long-term prognosis of patients with cryptococcal meningitis is good, provided they survive the acute infection. We summarise the evidence that a factor contributing to high acute mortality in cryptococcal meningitis is the inadequacy of fluconazole at up to 400 mg/d as an induction regimen, and present the case for initial treatment with amphotericin B in South Africa, where feasible.
Positive prevention : HIV transmission risk reduction interventions for people living with HIV / AIDS : conference plenaryAuthor Seth C. KalichmanSource: Southern African Journal of HIV Medicine 2007, pp 40 –45 (2007)More Less
HIV prevention programmes require scaling up in southern Africa, and interventions that target people living with HIV / AIDS (positive prevention) should be included in all comprehensive HIV prevention plans. Positive prevention interventions have been tested in the USA and have been demonstrated effective in reducing HIV transmission risks. Lessons learned from US trials can be used in selecting and adapting positive prevention interventions for use in southern Africa. Efforts to implement positive prevention will be enhanced by reducing institutionalised AIDS stigmas and culturally held AIDS denialism and by increasing access to HIV / AIDS care services including antiretroviral therapies and sexually transmitted infection detection and treatment. Positive prevention should not replace, but rather should augment, generalised HIV prevention interventions targeting high-risk populations.
Source: Southern African Journal of HIV Medicine 2007, pp 46 –56 (2007)More Less
The HIV / AIDS epidemic is the biggest natural event in the history of our species for the last 500 years. Professor Roy Anderson, who has modelled the likely path of the epidemic, estimates that HIV / AIDS is a 130-year event. This, we contend, is an underestimate. HIV / AIDS has already put an indelible mark on the most affected societies, and that effect will certainly be felt for generations. In addition, Anderson's model - like all such mathematical exercises - measures what can be measured, leaving other factors as hypothetical zeros. The HIV / AIDS epidemic is a complex systemic change in human ecology. It is unleashing secondary impacts that have demographic and epidemiological consequences, which in turn create feedback loops into the dynamics of the epidemic itself.
HIV / AIDS is certainly an historic event. It may also be a 'Darwinian event'. We argue that historians have two particular responsibilities with regard to this epidemic. Firstly history should provide us with ideas, paradigms and methodologies for understanding and responding to the disease. Secondly there is an awful predictability about HIV / AIDS and what it has the potential to do. Historians have the experience of seeing an event of unparalleled significance unfold before their eyes. To some extent this history can be written in advance as a wake-up call as to what might happen. Certainly there must be lessons from the past that we can apply to this epidemic.
Source: Southern African Journal of HIV Medicine 2007, pp 57 –60 (2007)More Less
The immune reconstitution inflammatory syndrome (IRIS) is a frequent early complication of antiretroviral therapy (ART), particularly in patients who commence ART with low CD4 counts and established opportunistic infections. IRIS results from a pathological inflammatory response to pre-existing infective, host or other antigens, alive or dead, causing clinical deterioration in HIV-infected patients after initiating ART. A case definition for IRIS is shown in Table I. The most common forms of IRIS described occur in association with mycobacterial and herpesvirus infections. We describe here a patient who presented with IRIS in association with tuberculosis (TB), then cryptococcosis, and later varicella zoster virus (VZV).