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- Southern African Journal of HIV Medicine
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- Volume 3, Issue 2, 2002
Southern African Journal of HIV Medicine - Volume 3, Issue 2, 2002
Volumes & issues
Volume 3, Issue 2, 2002
Source: Southern African Journal of HIV Medicine 3 (2002)More Less
It is two years since the publication of the HIV Clinicians Society's first antiretroviral guidelines. The current issue of the journal is devoted entirely to the issues surrounding antiretroviral therapies. The eagerly awaited revised guidelines have seen changes brought about due to the availability of new drugs and the dramatic price decreases in drugs.
Source: Southern African Journal of HIV Medicine 3, pp 6 –9 (2002)More Less
A greater understanding of the dynamics of HIV-1 infection has resulted from the development and application of molecular biology technologies, in particular the nucleic acid technologies for the detection and quantification of virus in various tissue compartments. This has led to a greater appreciation of the interaction between the virus and the immune system and the immunopathogenesis of the disease. Based on these factors, the development of treatment guidelines has become a more rational process.
Source: Southern African Journal of HIV Medicine 3, pp 10 –11 (2002)More Less
The major receptor that facilitates binding of HIV to human cells is the CD4 differentiation molecule. Table 1 shows the main cell types that bear CD4 or CD4-like molecules and are infected by HIV in vivo. Following HIV infection there is progressive depletion and/or dysfunction of CD4+ T lymphocytes that results in immunodeficiency. A viral surface glycoprotein known as gp120 binds to the CD4 molecule. On binding, a conformational change occurs in the gp120-CD4 complex that allows gp120 to interact with one or more cellular co-receptors. The gp120-co-receptor interaction triggers a further conformational change in gp41, another of the viral surface structures; hydrophobic portions of this molecule merge with the target cell membrane, inducing fusion between virus and cell.
Author W.D. Francois VenterSource: Southern African Journal of HIV Medicine 3, pp 12 –15 (2002)More Less
HIV produces a relentless, progressive and ultimately fatal immunodeficiency syndrome in the vast majority of infected untreated patients.
The immunodeficiency that develops during HIV infection is a continuum, but the disease conveniently falls into several discrete clinical phases. Adding the results of simple blood tests to a clinical assessment allows the treating clinician to make a remarkably accurate assessment of the immediate risk of opportunistic disease, and initiate preventive and antiviral therapy accordingly.
Understanding the natural history of HIV-infected people allows a clinician to delay therapy when the risk of disease is low, and initiate prevention and antiviral therapy when that risk starts to rise.
Despite limited African prospective evidence, it seems that the progression of immunodeficiency is very similar here to developed countries. The range of opportunistic illnesses is significantly different, though, probably reflecting the difference in profiles of diseases in different regions.
Source: Southern African Journal of HIV Medicine 3, pp 16 –17 (2002)More Less
Author Steve AndrewsSource: Southern African Journal of HIV Medicine 3, pp 18 –21 (2002)More Less
The advent of highly active antiretroviral therapies (HAART) in 1995/1996 ushered in a new era in the management of the HIV pandemic, with new drugs, new strategies, new vigour from treating clinicians, and enthusiasm on the part of their patients. Mortality and morbidity figures dropped radically, with associated gains in cost benefits with regard to macro- and microeconomic costs. What soon became evident, however, was the vital importance of patient adherence with prescribed medication in order to garner the benefits that were so rapidly becoming available. As a result, much attention has recently been paid to this aspect of management. Both clinicians and patients are recognising the importance of long-term drug acceptability, availability, and the all-important ability of patients to sustain such challenging regimens.
Source: Southern African Journal of HIV Medicine 3, pp 22 –29 (2002)More Less
The magnitude of HIV infection in southern Africa and the number of impoverished people who desperately need antiretroviral therapy (ART) but will never receive it is overwhelming, and unparalleled in the history of infectious diseases. Lifetime costs associated with antiretroviral therapy and political intransigence remain the most important obstacles to adequate management of HIV infection in many countries, including South Africa, where the availability of finance determines access to therapy. While the Southern African HIV Clinicians Society endorses the right of all HIV-infected adults and children to receive standard of care, it also acknowledges the serious limitations influencing the individual's access to effective therapy.
The Southern African HIV Clinicians Society endorses the right of all HIV-infected adults and children to receive an optimal standard of care and supports all initiatives that improve access to effective therapy.
As knowledge and understanding of the use of antiretroviral therapies is still evolving and new therapeutic agents are becoming available, guidelines are reviewed and updated regularly. The most current version should always be consulted.
Source: Southern African Journal of HIV Medicine 3, pp 30 –31 (2002)More Less
The HIV epidemic more than any other has brought with it the need for health care workers to have counselling skills. The life-changing nature of an HIV diagnosis requires that all persons are fully informed of the consequences of a positive result before they are tested (pretest counselling) and thereafter be told the result and given support if it is positive (post-test counselling). There are a number of other situations in the context of HIV where counselling is required, e.g. bereaved family members, loss of reproductive capability, etc. It is therefore in the best interests of the health care professional not only to know the resources to call upon for more advanced counselling support but also to develop some personal basic counselling skills.
Source: Southern African Journal of HIV Medicine 3, pp 32 –33 (2002)More Less
HIV resistance to antiretroviral agents accounts for a significant proportion of treatment failures. Resistance is the consequence of genetic changes (mutations) that emerge when there is ongoing HIV replication in the face of inadequate concentrations of antiretroviral agents. Factors that contribute to subtherapeutic drug levels include poor penetration of compounds into certain body sites [e.g. brain, testis, retina), inadequate patient adherence, and variable pharmacokinetics (e.g. due to drug-drug interactions, poor absorption, cellular efflux pumps).
A particular clinical problem is that an HIV mutant resistant to one drug frequently exhibits significant cross-resistance to other drugs, including agents that have not been used to treat the patient. Cross-resistance can significantly limit an individual's future treatment options.
Author Gary MaartensSource: Southern African Journal of HIV Medicine 3, pp 34 –36 (2002)More Less
Tuberculosis is the commonest cause of morbidity and mortality in HIV-infected patients in sub-Saharan Africa. With increasing access to antiretroviral therapy in the region, it is inevitable that large numbers of patients will either develop tuberculosis while on antiretroviral therapy or be considered for antiretroviral therapy when tuberculosis develops. There are complex drug interactions and shared toxicity of antiretroviral and tuberculosis therapy that need to be considered. Furthermore, antiretroviral therapy can lead to paradoxical deterioration of tuberculosis. This article reviews these complex interactions and provides recommendations for using antiretroviral and tuberculosis therapy in the southern African context.
Source: Southern African Journal of HIV Medicine 3 (2002)More Less
In most HIV-infected patients commencing highly active antiretroviral therapy, viral load is reduced and with this subsequent immune restoration begins. Studies have shown that CD4+ T cells increase soon after therapy commencement, with the largest increase occurring in the first 3 months and the increase reducing in the 2nd and 3rd years. Immune reconstitution occurs even in those patients in whom severe immune suppression has occurred.
Source: Southern African Journal of HIV Medicine 3, pp 38 –39 (2002)More Less
The development of new molecular techniques has provided clinicians with powerful tools to enable them to manage their patients more effectively. In particular, the development of technologies to measure viral load has assisted clinicians in making decisions regarding initiation of therapy and in monitoring response to therapy, and has facilitated more accurate prognosis in individual patients. The measurement of the viral load is expressed as HIV-1 RNA copies per millilitre of plasma. In previous years CD4 lymphocyte counts were considered to be the best predictors of disease progression and were extensively used as surrogate markers in clinical drug trials. Recent data have shown that viral load estimations are an additional marker of clinical outcome.
Metabolic disturbances associated with antiretroviral therapy and HIV infection : metabolic disturbancesSource: Southern African Journal of HIV Medicine 3, pp 40 –43 (2002)More Less
With the increasing use of antiretroviral (ARV) drugs, some of the long-term effects of the use of these agents are now being recognised. Whereas in the first instance ARVs were blamed for the causation of these abnormalities, it is to be noted that similar abnormalities have been reported in patients who have not used ARVs at all.
Source: Southern African Journal of HIV Medicine 3, pp 44 –48 (2002)More Less
Handbook of HIV Medicine, Douglas Wilson, Sudeshni Naidoo, Linda-Gail Bekker, Mark Cotton, Gary Maartens : book reviewAuthor Ruth CornickSource: Southern African Journal of HIV Medicine 3 (2002)More Less
The Oxford Handbook of HIV Medicine for Developing Countries is a long-overdue addition to the 'Oxford Handbook' series. It is aimed at all those concerned with the health care of people with HIV, including medical students, nurses, newly qualified doctors, primary care practitioners and hospital doctors, and serves as a practical guide to the assessment and management of HIV-related problems.