Aim. To examine false-positive HIV DNA polymerase chain reaction (PCR) test results in children, and the potential implications for the paediatric HIV epidemic in sub-Saharan Africa.
Methods. A review was done of records over a 6-year period of children less than 18 months old at an HIV treatment site in South Africa, to evaluate those with an initial 'false'-positive HIV DNA PCR result, but later proven to be HIV-uninfected with HIV DNA PCR and / or quantitative HIV RNA PCR tests. We calculated the influence of changing HIV transmission rates on predictive values (PV) of HIV DNA PCR tests in a hypothetical population of all HIV-exposed infants over a 1-year period. (Positive PV: proportion of individuals with a positive test with disease; negative PV: proportion of individuals with negative test and no disease).
Results. Of 718 children, 40 with an initial positive HIV DNA PCR test were subsequently proven to be HIV-uninfected, resulting in a positive PV of 94.4%. Most (75%) uninfected children had PMTCT interventions and were asymptomatic or mildly symptomatic (77.5%). Calculations using a test specificity of 99.4%, as reported previously, show a decrease in positive PV using a single-test strategy from 98.6% at 30% HIV transmission rate, to 94.8% at 10% transmission, to 62.5% at 1% transmission. Reduction in test specificity further decreases positive PV at low transmission rates.
Conclusion. Decreasing mother-to-child HIV transmission rates reduce the positive predictive value of a single HIV DNA PCR test result, necessitating adaptations to diagnostic algorithms to avoid misdiagnosis and inappropriate treatment, especially with early initiation of antiretroviral therapy in asymptomatic infants.
Aim. We aimed to ascertain if there had been any improvement in the number of nurses being immunised against hepatitis B virus (HBV) infection in a large academic hospital in which, 10 years previously, only 30.6% of the nurses were immune to infection with the virus, and to ascertain the incidence of infection with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) in these nurses.
Methods. We studied 170 predominantly black nurses. Their blood was tested for the presence of active or past HBV infection using appropriate immunoassays, HCV infection by chromatographic immunoassays confirmed by polymerase chain reaction assays, and HIV using a rapid test confirmed by enzyme-linked immunosorbent assays.
Results. Serum of 89 (52.4%) nurses was positive for hepatitis B surface antibody (anti-HBs). Of these nurses 18 said that they had not received the vaccine; the serum of 9 of these was positive for anti-hepatitis B core antibody (anti-HBc) as well as anti-HBs, indicating natural infection with the virus. Of the nurses positive for anti-HBs, 89 were tested for anti-HBc; 28.2% tested positive for anti-HBc. Three nurses gave dates of immunisation that fell outside of their nursing careers; 3 (1.8%) were actively infected with the virus; 2 (1.8%) were infected with HCV; 10 nurses (5.9%) were positive for HIV.
Conclusion. Nurses at this academic hospital remain at high risk of work-related HBV infection.
Objective. As sub-Saharan Africa is highly endemic for hepatitis B virus (HBV) and human immunodeficiency virus (HIV) infections, and their co-infection requires special management, we aimed to assess the serological and molecular characteristics of HBV in patients with AIDS.
Design. This was a cross-sectional, case control study, which enrolled 200 patients with AIDS and 200 HIV-negative controls. HBV serology was done in all participants and HCV serology in participants with a hepatitis B core antibody (anti-HBc) only serological pattern. Nested HBV polymerase chain reaction (PCR) and HBV viral load assays were used for HBV molecular detection.
Results. Hepatitis B surface antigen (HBsAg) prevalence was 3-fold higher while the 'anti-HBc only' pattern was 6-fold higher in the AIDS group compared with the controls. Mean HBV viral load was significantly higher in HBsAg-positive patients with CD4+ cell counts <100 cells/μl than in patients with CD4+ cell counts of 100-200 cells/μl (p=0.019). There were markedly reduced hepatitis B surface antibody (anti-HBs) titres in the AIDS group compared with the controls (p=0.002). A significant proportion of AIDS patients with an 'anti-HBc only' pattern had CD4+ cell counts <100 cells/μl (p=0.004). Occult HBV prevalence was 3.5% in the AIDS group compared with 1% in the controls (p=0.092). When occult HBV infection was taken into consideration, the overall HBV prevalence became 10% in the AIDS group and 3% in the control group.
Conclusion. We showed an increased HBV prevalence in patients with AIDS and identified a CD4+ cell count <100 cells/μl as a major risk factor for the 'anti-HBc only' pattern and increased HBV replication. These data have significant public health implications for HBV in developing countries, especially in areas where antiretroviral (ARV) guidelines do not cater for HBV / HIV co-infection.
Insulin-dependent diabetic patients are not educated on safe sharps disposal methods, so leading to unsafe disposal of needles. Appropriate education on the correct disposal of sharps should be an integral part of their diabetic counseling. Doctors, nurses and pharmacists should all take responsibility for educating and reinforcing information about correct sharps disposal methods. Patients should be advised to either discard sharps into puncture-resistant containers placed into their household refuse, or return them in secure containers for disposal by the dispensing institutions. Patients should also be educated regarding health risks associated with used needles. The South African Metabolic and Endocrine (SEMDSA) Guidelines and the South African Standard Treatment Guidelines (STG) should also give clear guidance on the safe disposal of needles.
Chromosome 22q11 aberrations substantially increase the risk for developing schizophrenia. Although micro-deletions in this region have been extensively investigated in different populations across the world, little is known of their prevalence in African subjects with schizophrenia. We screened 110 African Xhosa-speaking participants with schizophrenia for the presence of micro-deletions. As further verification for the presence or absence of 22q11 microdeletions, we screened 238 Xhosa schizophrenia patients and 240 healthy Xhosa individuals from a larger schizophrenia candidate 22q11 gene study using molecular analyses. Data from molecular and cytogenetic analyses confirmed the absence of 22q11 microdeletions in the Xhosa schizophrenia samples. Although the absence of chromosome 22q11 micro-deletions in this group of patients does not exclude the possibility that it may occur in Xhosa schizophrenia patients, we concluded an extremely low prevalence. Our findings suggest that unique susceptibility loci may be present in this group.
Objective. We present the first report from the South African Register of Assisted Reproductive Techniques.
Methods. All assisted reproductive technology (ART) centres in South Africa were invited to join the register. Participant centres voluntarily submitted information from 2009 on the number of ART cycles, embryo transfers, clinical pregnancies, age of female partners or egg donors, and use of fertilisation techniques. Data were anonymised, pooled and analysed.
Results. The 12 participating units conducted a total of 4 512 oocyte aspirations and 3 872 embryo transfers in 2009, resulting in 1 303 clinical pregnancies. The clinical pregnancy rate (CPR) per aspiration and per embryo transfer was 28.9% and 33.6%, respectively. Fertilisation was achieved by intracytoplasmic sperm injection in two-thirds of cycles. In most cycles, 1 - 2 embryos or blastocysts were transferred. Female age was inversely related to pregnancy rate.
Conclusion. The register achieved a high rate of participation. The reported number of ART cycles covers approximately 6% of the estimated ART demand in South Africa. The achieved CPRs compare favourably with those reported for other countries.
Background. Recent progress has been made in the understanding of venous thrombo-embolism (VTE) in children and neonates; however, indications for laboratory investigations and therapeutic interventions are not well defined.
Method. The Southern African Society of Thrombosis and Haemostasis reviewed available literature and comprehensive evidence-based guidelines for paediatric antithrombotic therapy. A draft document was produced and revised by consensus agreement. The guidelines were adjudicated by independent international experts to avoid local bias.
Results and conclusion. We present concise, practical guidelines for the clinical management and laboratory investigation of VTE in children and neonates. Recommendations reflect current best practice which will hopefully lead to improved anticoagulation practice in this age group.
The European Society of Cardiology together with the European Atherosclerosis Society published updated dyslipidaemia guidelines in 2011. SA Heart and the Lipid and Atherosclerosis Society of Southern Africa officially adopt these guidelines. This statement adapts aspects of the guidelines to the South African situation. Using the updated Framingham risk charts, interventional strategies are based according to the cardiovascular risk score and low-density lipoprotein cholesterol (LDL-C) levels. The Framingham risk score refers to the 10-year risk of any cardiovascular event, and includes four categories of risk. Treatment targets are those of the European guidelines. The LDL-C goal is 1.8 mmol/l for the very high-risk group (>30%), 2.5 mmol/l for the high-risk group (15 - 30%), and 3 mmol/l for those below 15% risk. Intensive management of dyslipidaemia in South Africa will significantly reduce the cardiovascular disease health burden.