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- Southern African Journal of HIV Medicine
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- Volume 9, Issue 4, Spring 2008
Southern African Journal of HIV Medicine - Volume 9, Issue 4, Spring 2008
Volumes & issues
Volume 9, Issue 4, Spring 2008
Author Francois VenterSource: Southern African Journal of HIV Medicine 9 (Spring 2008)More Less
The Journal is starting to feel like Men's Health, what with posters, guidelines and now a state-of-the art science update, HIV Treatment Bulletin, falling out of it. Exco is pleased to announce an important and strategic partnership with HIV i-Base, who publish HIV Treatment Bulletin. We are distributing the southern African version of their excellent newsletter, which will exclusively focus on the scientific reports and resources that have local relevance - with a strong focus onpaediatrics and maternal health.
Author Linda-Gail BekkerSource: Southern African Journal of HIV Medicine 9 (Spring 2008)More Less
This Spring edition brings 2008 to a close. And what a year it has been. Not many breakthroughs in HIV or TB, but a lot of activity in terms of understanding early infection better, really getting to grips with early immune responses, and again thinking through our prevention options. In 2008 the concept of antiretrovirals for prevention as well as treatment has come to the fore with second-generation microbicides, pre-exposure prophylaxis and the notion that we may be able to 'treat our way out of the epidemic' becoming possibilities. Gratifyingly, this year also saw a record number of people being tested and accessing ART, and roll-out for both testing and treatment is truly scaling up.
Author Jerome Amir SinghSource: Southern African Journal of HIV Medicine 9, pp 6 –10 (Spring 2008)More Less
International guidelines on HIV testing stipulate that only certified persons should perform HIV testing. Current South African policy does not stipulate who may perform an HIV test and is silent on an HIV tester certification process. Despite contradictions in national guidelines and policies on who may perform HIV testing, draft regulations allow for designated professionals and a 'competent person' to draw blood. While traditional health practitioners may be deemed competent persons, they are forbidden from performing such procedures by their governing statute. Accordingly, while it could be argued that it is ethically permissible for traditional health practitioners to perform HIV testing provided such persons are appropriately trained and certified, the performance of such procedures by such persons may have legal implications.
Author William MaphamSource: Southern African Journal of HIV Medicine 9, pp 11 –16 (Spring 2008)More Less
The use of mobile phones in South Africa has increased rapidly and they have become more affordable and available to an increasingly wider population. Their widespread availability has given them the potential to revolutionise health care communication and improve health services. Even before the phone became truly mobile, Haynes et al. found that communication efforts (e.g. telephone contacts) that kept the patient engaged in health care may be the simplest and most cost-effective strategy for improving adherence to chronic medication. Mobile phones can now be used to provide appointment reminders, create treatment adherence systems, record patient diaries, conduct risk assessments, provide information and even conduct research. This article reviews some of the many benefits and functions associated with mobile phone use and health management.
Author Robin WoodSource: Southern African Journal of HIV Medicine 9, pp 18 –24 (Spring 2008)More Less
South Africa has the fourth highest burden of tuberculosis (TB) worldwide after China, India and Indonesia and has the highest TB notification rate of any country. The World Health Organization (WHO) estimated that in 2006 South Africa had 303 114 incident TB cases; of these patients, 32% were tested for HIV and 53% were found to be HIV infected. HIV testing of TB cases has been encouraged by the WHO and testing has resulted in identification of increasing numbers of HIV-infected individuals in the TB control programme. The success of this policy has been demonstrated in the Cape Town Gugulethu antiretroviral clinic, where referrals directly from the local TB clinics have increased from 15% to 30% within the past 2 years. The national TB control programme has therefore become an increasingly important pathway to HIV care and access to highly active antiretroviral therapy (HAART). An additional 15 - 20% of patients in the Gugulethu programme have a diagnosis of TB made during the HAART screening period, further increasing the number of individuals on TB medication who require HAART. Mortality after referral is very high. The HIV / TB case mortality has been reported to be as high as 16 - 35% prior to the introduction of HAART, with both HIV and TB contributing to this mortality. Optimal timing of HAART is currently unknown and there is an urgent need for development of evidence-based protocols for HAART initiation and immune reconstitution disease (IRD) management.
Author Polly ClaydenSource: Southern African Journal of HIV Medicine 9, pp 25 –32 (Spring 2008)More Less
The most effective way to combat paediatric HIV infection is through good management of maternal health and prevention of mother-to-child transmission (PMTCT). However, by the end of 2007, of an estimated 33.2 million people living with HIV, 2.1 million were children. Of these 90% lived in sub-Saharan Africa and 420 000 were newly infected in that year.
Although in recent years the number of children treated with antiretroviral therapy (ART) has increased from about 75 000 in 2005 to almost 200 000 in 2007, many children living with HIV are not receiving treatment. Without it approximately 35% will die before their first birthday and 53% by the time they reach the age of 2 years. By age 5 years it is estimated that 62 - 89% of children will have died.
Emerging data from sub-Saharan Africa show that most children starting ART are doing so at older ages, usually 5 years or more, that most start at a late stage of the disease, and that mortality in the first few months of treatment remains high.
A recent study shows that starting treatment in early infancy can be lifesaving, and this has informed revisions in World Health Organization (WHO) guidelines (see WHO 'Dear Health Care Provider' letter, Fig. 1). At present the majority of children who could benefit from these recommendations are not being diagnosed or treated.
Guidance for antiretroviral therapy in HIV-infected infants less than 1 year of age : clinical : paediatricsSource: Southern African Journal of HIV Medicine 9, pp 34 –35 (Spring 2008)More Less
Forty per cent of HIV-infected children die before they reach their first year of life, mainly in the first 6 months. Data from the Children with HIV Early Antiretroviral Therapy (CHER) study indicate that even when infants appear well and their CD4 counts are > 25% there is a 75% increased risk of mortality when antiretroviral therapy (ART) is deferred until threshold CD4 depletion occurs or clinical criteria are met. Even after starting ART, young infants have excess mortality within the first year of life. Every effort should therefore be made to identify HIV-infected infants as early as possible so that ART can be initiated without delay.
Changes in body composition and other anthropometric measures of female subjects on highly active antiretroviral therapy (HAART) : a pilot study in Kwazulu-Natal, South Africa : clinical : adultSource: Southern African Journal of HIV Medicine 9, pp 36 –42 (Spring 2008)More Less
Background and objectives. An understanding of the effect of highly active antiretroviral therapy (HAART) on various aspects of health, including nutritional status, is needed to ensure that population-specific guidelines can be developed for South Africa. This study aimed to investigate the changes in body composition and other anthropometric measures that occur in HIV-infected women after the initiation of HAART and to explore the relationship between these measures and CD4 lymphocyte count.
Design and setting. A longitudinal study was carried out at the Umkhumbane Community Health Centre, KwaZulu-Natal.
Subjects. 30 HIV-infected adult women who started HAART between March 2007 and October 2007.
Methods. Anthropometric measurements and bioelectrical impedance analysis were performed at baseline and 24 weeks after commencing HAART. CD4 lymphocyte counts were done at baseline and at the 24-week visit.
Results. There was a statistically significant increase in all anthropometric measures except waist-hip ratio and lean body mass. The mean weight change (± standard deviation) was 3.4±5.8 kg (p = 0.006). Mean body mass index (BMI) (kg/m2) increased from 25.6±5.7 to 27.3±5.6 (p = 0.007). Seventy per cent of subjects gained weight, 18.5% had a stable weight and 11.1% lost weight. Subjects with lower CD4 lymphocyte counts experienced greater increases in weight, BMI, fat mass and body fat percentage. No significant association was found between anthropometric changes and change in CD4 count between baseline and the 24-week visit.
Conclusions. The findings demonstrate the value of including circumference measurements and body composition techniques as part of nutritional status assessment. Research is needed to determine the best methods of bringing about favourable anthropometric changes to enhance the health of patients on HAART.
Source: Southern African Journal of HIV Medicine 9, pp 44 –49 (Spring 2008)More Less
The rise of novel antiretrovirals (ARVs) has introduced a new evolutionary phase in HIV care. In developed countries, the 1980s and early 1990s were characterised by palliative care and opportunistic infection prophylaxis; the late 1990s by an attempt to use a limited and toxic antiretroviral arsenal effectively while cycling through high levels of resistance; and finally, the first half of this decade by working out the easiest-to-take regimens, using the steadily rising number of safer drugs. At present, there are 8 nucleoside analogues (NRTIs), 3 non-nucleoside analogues (NNRTIs), 10 protease inhibitors (PIs), and one each of the fusion, entry and integrase inhibitors to choose from, along with a new drug pipeline that targets both existing and new targets in the viral replicative cycle. The choice may seem quite vast, but the reality is that many of these drugs cannot be used simultaneously or in patients with extensive drug resistance. In addition, some drugs have unacceptable toxicities and are not favoured in current treatment regimens.
Source: Southern African Journal of HIV Medicine 9 (Spring 2008)More Less
International Convention Centre, Durban
31 March - 3 April 2009
Alert! All HIV practitioners, health care workers, community-based organisations and government officials: You have until the end of December to send your abstracts for the South African HIV Conference of the year!!! We are looking for new studies, best practices, novel ideas, and key findings. You can submit on line at www.saids.com.
Source: Southern African Journal of HIV Medicine 9, pp 51 –52 (Spring 2008)More Less
Liver function test abnormalities are prevalent in patients with HIV, and in particular advanced HIV. Opportunistic infections, drug hepatotoxicity and viral hepatitis co-infections are frequently encountered. We present a patient with advanced HIV and abnormal liver function tests in whom the definitive diagnosis of multiple opportunistic infections was made by liver biopsy. This case illustrates the diagnostic value of liver biopsy in our local patient population, where diagnostic uncertainty is common and empiric therapy is often the standard of care.