- A-Z Publications
- Southern African Journal of HIV Medicine
- Previous Issues
- Volume 9, Issue 2, Autumn 2008
Southern African Journal of HIV Medicine - Volume 9, Issue 2, Autumn 2008
Volumes & issues
Volume 9, Issue 2, Autumn 2008
Author Francois VenterSource: Southern African Journal of HIV Medicine 9 (Autumn 2008)More Less
It has been a tough few months for government doctors. The disgraceful public attacks on doctors Colin Pfaff and Mark Blaylock by various KwaZulu-Natal politicians and bureaucrats have been met with unprecedented public and media anger (see http://www.sahivsoc.org/). Happily this has resulted, at least at the time of writing, in wiser political heads stepping in to stop unrestrained public statements by leaders responsible for the health care of almost a quarter of all South Africans.
Author Linda-Gail BekkerSource: Southern African Journal of HIV Medicine 9 (Autumn 2008)More Less
It has been an incredible three months. As a Zimbabwean who came to this country and nailed my colours to the South African mast many years ago, I am as confused as many South Africans and most Africans at the events that have recently unfolded in this country. Why is it that human beings are so often intolerant? The HIV infected have also been been subjected to discrimination in the form of the 'New Apartheid', as Archbishop Tutu has called their alienation.
Source: Southern African Journal of HIV Medicine 9, pp 6 –10 (Autumn 2008)More Less
Criminal law, constitutional rights and medical ethics (not forgetting common sense) can at times contradict each other, putting medical professionals on the spot. This article is based on a case study discussed on the HIV Policy & Ethics Discussion Forum : http://groups.google.com/group/policy-ethics.
HIV / AIDS in South Africa
The Moral Economy of Aids in South Africa
Learning from HIV and AIDS : booksSource: Southern African Journal of HIV Medicine 9, pp 10 –42 (Autumn 2008)More Less
HIV/AIDS in South Africa : This definitive textbook covers all aspects of HIV / AIDS in southern Africa, from basic science to medicine, sociology, economics and politics. It has been written by a highly-respected team of southern African HIV experts and provides a thoroughly researched account of the epidemic in the region.
The Moral Economy of Aids in South Africa : Relatively few people have access to antiretroviral treatment in South Africa. The Government justifies this on grounds of affordability. Nicoli Nattrass argues that the government's view insulates AIDS policy from social discussion and efforts to fund large-scale intervention.
Learning from HIV and AIDS : Different professional and academic disciplines have addressed the HIV and AIDS pandemic from a variety of perspectives, using different analytical approaches. By bringing these together in one volume, Learning from HIV and AIDS provides a more complete picture of this multi-faceted disease, from the biological and social factors that facilitate HIV transmission to the powerful cultural and political forces that fuel the pandemic.
In defence of rational Aids activism : how the irrationality of Act Up-Paris and others is risking the health of people with HIV or at risk of HIV infection : opinionSource: Southern African Journal of HIV Medicine 9, pp 12 –17 (Autumn 2008)More Less
This article describes the irrational actions of Act Up-Paris and some other organisations in recent years. We have written it because their activities are threatening the development of new treatment and prevention technologies for people with HIV. They are also undermining scientific research programmes in developing countries.
The groups we discuss here couch their anti-science agenda in progressive rhetoric. They therefore persuade some well-intentioned people and organisations unfamiliar with HIV science to support their causes. But there is nothing progressive about hindering life-saving medical research. Act Up-Paris and the other organisations discussed here are endangering the lives of people with HIV; they have to be exposed.
Guidelines for the prevention and treatment of HIV in arrested, detained and sentenced persons : guidelinesSource: Southern African Journal of HIV Medicine 9, pp 21 –33 (Autumn 2008)More Less
Source: Southern African Journal of HIV Medicine 9, pp 34 –42 (Autumn 2008)More Less
HIV infection is common in southern Africa and presents our society with numerous challenges. HIV can cause chronic kidney disease (CKD) and can contribute significantly to the burden of patients requiring renal replacement therapy (RRT). HIV-associated nephropathy (HIVAN) was the third commonest cause of end-stage renal failure (ESRF) in black patients in the USA after hypertension and diabetes, and since the availability of antiretroviral therapy (ART) is now in 7th place. Furthermore HIV infection may coexist with ESRF of any other cause, and we have even experienced instances of seroconversion to HIV positive of patients already on dialysis.
The utility of pharmacy dispensing data for ART programme evaluation and early identification of patient loss to follow-up : case studySource: Southern African Journal of HIV Medicine 9, pp 44 –48 (Autumn 2008)More Less
The rapid scale-up of antiretroviral treatment (ART) programmes in sub-Saharan Africa has challenged the capacities of ART services to monitor and retain large numbers of patients within programmes effectively. Many ART clinics in sub-Saharan Africa now have to cope with patient complements of several thousands, all of whom require monitoring and tracking. Initially, programme emphasis was placed on the maintenance of high levels of adherence to therapy, particularly because of the concerns of widespread viral resistance that could develop as a result of expanded access to ART in low- and middle-income countries (LMICs).
Short-term effectiveness and safety of HAART in the form of a generic fixed-dose combination of stavudine, lamivudine and nevirapine (Triviro) in HIV-1-infected adults in Zimbabwe : clinicalSource: Southern African Journal of HIV Medicine 9, pp 51 –56 (Autumn 2008)More Less
Objectives. To assess the effectiveness and safety of a twice-daily regimen of a generic fixed-dose combination (FDC) of stavudine, lamivudine and nevirapine (Triviro) in a cohort of Zimbabwean HIV-1-positive adults.
Design. A prospective, open-label, one-arm study of antiretroviral-naïve adults with CD4 counts < 200 cells / µl. Fifty-three intention-to-treat (ITT) patients were enrolled and monitored for 4 months.
Setting. Three primary health care facilities in Zimbabwe.
Outcome measures. Efficacy criteria included plasma HIV-1 RNA load, CD4 counts, patient weight and Karnofsky performance scores. Toxicity was assessed by clinical evaluation and laboratory tests.
Results. There was a significant 3.0 log10 decrease in viral load at weeks 8 and 16 for both groups. Viral loads ≤ 400 copies / ml were achieved in 96% of per protocol (PP) and 85% of ITT patients at 8 and 16 weeks. At 4 months 85% of the PP group and 76% of the ITT group achieved undetectable viral loads. There was a significant increase in median CD4 counts of 101 cells / µl for PP and 86 cells / µl for the ITT analysis. The number of PP patients with Karnofsky scores of 100 improved from 10 (21%) to 38 (81%) and BMI increased by an average of 1.15 kg/m2. Of the 134 adverse events recorded, 4 (3%) were severe. Of 16 adverse drug reactions in 10 patients, 13 were ascribed to nevirapine. One adverse reaction resulted in withdrawal from the study.
Conclusion. The effectiveness and safety of Triviro was comparable to that seen with other formulations, and our results support the use of this FDC in Zimbabwe and elsewhere.
Development and implementation of an HIV / AIDS trials management system : a geographical information systems approach : case studySource: Southern African Journal of HIV Medicine 9, pp 58 –62 (Autumn 2008)More Less
Introduction. Researchers, practitioners and policymakers make decisions at all levels - from local to international. Accessible, integrated and up-to-date evidence is essential for successful and responsive decision-making. A current trials register of randomised and clinically controlled trials of HIV / AIDS interventions can provide invaluable information to decision-making processes. Using the newly emerging geographical information systems (GIS) technology, we have developed a tool which assists such decisions.
Objective. To demonstrate how the tool provides consistent, quantitative information in an accessible format, making it a key tool in evidence-based decision-making.
Methods. We identified all HIV / AIDS trials in relation to publications for the period 1980 - 2007, using both electronic and manual search methods. To facilitate searching the trials register, studies were coded by using a comprehensive but user-friendly coding sheet. We captured the geographical co-ordinates for each trial and used the ArcGIS 9 mapping software to design and develop a geodatabase of trials.
Results. The geodatabase delivered the complete requirements for a data-driven information system, featuring the following functions: (i) a clear display of the spatial distribution of HIV / AIDS trials around the world; (ii) identification of and access to information about any particular trial on a map; and (iii) a global resource of potential information on the safety and efficacy of prevention and treatment measures.
Conclusions. The building of a functioning HIV / AIDS trials management system can provide policymakers, researchers and practitioners with accessible, integrated and up-to-date evidence that is essential to successful and dynamic decision-making.