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- Volume 1, Issue 2, 2000
Southern African Journal of HIV Medicine - Volume 1, Issue 2, 2000
Volumes & issues
Volume 1, Issue 2, 2000
Source: Southern African Journal of HIV Medicine 1 (2000)More Less
In July 2000, seventeen years after the discovery of the human immunodeficiency virus (HIV), thousands of individuals from around the world gathered in Durban, South Africa, to attend the XIIIth International AIDS Conference. Approximately 34 million people worldwide are estimated to be living with HIV or AIDS, 24 million of them in sub-Saharan Africa.' Last year alone, 2.6 million people worldwide died of AIDS, the highest yearly death rate since the start of the epidemic. If current trends continue then southern and South-East Asia, South America and regions of the former Soviet Union will bear a very heavy burden in the next two decades.
Author Shaun ConwaySource: Southern African Journal of HIV Medicine 1 (2000)More Less
While neighbouring Botswana and other SADC countries and states have been solicited with offers of free or highly reduced-price antiretroviral treatments that will bring the cost of HAART to around US$ 1 000 for a year of therapy per patient, South Africa continues to face tough marketeering by the same drug manufacturers, who see the country as a lucrative market with virtually unlimited need for their products.
Author Des MartinSource: Southern African Journal of HIV Medicine 1 (2000)More Less
Antiretroviral (ARV) therapies are again featured in this issue of the Journal. The Guidelines for the use of ARV therapy in paediatric practice, formulated by the paediatric subcommittee under the leadership of Dr Leon Levin, are highlighted. These guidelines are different from those that have appeared elsewhere and are unique to our setting. The Guidelines were circulated to a panel of international reviewers and their views were incorporated into the document. These Guidelines are a companion to the Adult Guidelines that appeared in the July launch issue of the Journal. It may be argued that in both instances there has been a focus on options that are not available to the vast majority of the HIV infected people in our country. This may be so, but we would argue that it is important for our clinicians to be well informed with regard to the difficulties and complexities inherent in the use of these drugs. We are witnessing an increasing use of these therapies in the private sector as more health care funders are providing benefits to HIV-infected individuals, so it behoves all of us to keep abreast of developments in this dynamic field of medicine.
A tapestry of women's experiences : XIII International AIDS Conference presents vital information on women and HIV/AIDS : conference reportAuthor Carmen RetzlaffSource: Southern African Journal of HIV Medicine 1, pp 8 –14 (2000)More Less
The XIII International AIDS Conference, held July 9-14, 2000, in Durban, South Africa, was praised by participants for its focus on inclusion of delegates from resource-limited countries, of community representatives, and of women. The presence, voices, and experiences of African women in particular, set the Durban conference apart.
Clinicians as public health advocates : the need for health professionals to be more vocal in campaigns to extend access to effective HIV/AIDS treatment : care accessAuthor M.J. HeywoodSource: Southern African Journal of HIV Medicine 1, pp 15 –17 (2000)More Less
HIV/AIDS presents a health and development emergency of unprecedented proportions. In the words of epidemiologist Kevin de Cock, it 'threatens to do more to undermine development in Africa in the 21st century, than slavery did in the nineteenth' (comments made at the UNAIDS/WHO Consultation on HIV Reporting and Disclosure, October 1999). Faced with this threat an extraordinary duty falls on health professionals.
Source: Southern African Journal of HIV Medicine 1, pp 19 –30 (2000)More Less
As a result of the present high cost antiretroviral therapy (ART) will be denied to the majority of HIV-infected children in sub-Saharan Africa. Access to ART is now a clear discriminator between the 'haves' and 'have nots'. While this situation is unacceptable, ART is becoming an increasing option in paediatric practice. Promoting affordable ART for children is a priority for clinicians, health administrators and the pharmaceutical industry. The use of ART in children is a highly specialised field. Initial and ongoing management of HIV-infected children by a paediatrician experienced in this field is strongly recommended. If this is impossible, we recommend consultation with such a paediatrician before initiation of ART so that the child may benefit from the most optimal regimen. Certainly, when a clinician decides to change therapy, consultation with an experienced treater should occur in order to ensure maximum efficacy of the new regimen. ART in children follows the same principles as in adults, but generally lags behind in terms of its application in paediatric HIV medicine. The reasons for this are complex and include a reluctance to use new medication in children before efficacy and safety have been confirmed in adults, the need to develop liquid formulations, and because dosage adjustments are necessary. As a result, there are fewer therapeutic options available for children.
Author Leon LevinSource: Southern African Journal of HIV Medicine 1 (2000)More Less
The truth of the above quotation has not dated in 800 years. Nowhere in clinical medicine today is it more relevant than in the treatment of HIV patients using antiretroviral (ARV) therapy. In the South African setting, the cost issue is clearly important and very often limits the treatment that can be prescribed. Therefore, when drawing up the Paediatric HIV Treatment Guidelines for the Southern African HIV Clinicians Society, consideration was given to the fact that treatment options might vary from state-of-the-art combinations to cheaper options suitable for use in a resource-limited setting.
Source: Southern African Journal of HIV Medicine 1, pp 32 –35 (2000)More Less
Nearly two-thirds of South Africa's population has at some time been infected with Mycobacterium tuberculosis. Mast people do not develop symptoms and become clinically ill as they have a robust immune response sufficient to contain the organism's replication. Of the 30% of affected people who develop infections, about 5% develop clinical or active disease, located principally in the lung. Well-known South Africans such as Archbishop Desmond Tutu and the former President Nelson Mandela were once afflicted with tuberculosis (TB). South Africa, like the rest of southern Africa, is experiencing concurrent explosive epidemics of HIV and TB. Indeed, TB is the most frequent opportunistic infection, leading to a number of deaths among HIV-infected patients in sub-Saharan Africa.
Author Koleka P. MlisanaSource: Southern African Journal of HIV Medicine 1, pp 36 –37 (2000)More Less
There is no doubt that the laboratory plays a critical and integral role in the management of HIV-positive patients on antiretroviral therapy (ART). Apart from routine confirmation of the initial diagnosis, viral load measurement and CD4+ lymphocyte count measurements are now available which are essential for deciding when to initiate the therapy as well as for ART monitoring. CD4+ counts have enabled clinicians to ascertain the cumulative damage done to the immune system by HIV infection and the restoration of immunity in patients on effective therapy. Viral load measurements have in turn made it possible to predict time to progression to AIDS as well as how effective the ART is according to undetectable levels. The recently published 'Guidelines for antiretroviral therapy in adults' by the Southern African HIV/AIDS Clinicians Society clearly outline when to undertake viral load, and CD4+ cell count measurements.
Author Claire BorkertSource: Southern African Journal of HIV Medicine 1 (2000)More Less
I read the launch issue of the Southern African Journal of HIV Medicine from cover to cover on the plane returning to the USA after attending the International AIDS Conference in Durban. It was wonderful. The review of preventing mother-to-child transmission by Drs McIntyre and Gray was excellent. The guidelines for ART were quite comprehensive - a great pullout section for clinicians - and the shaded area of 'compromises' was very thoughtfully done. Overall, it was highly readable. I am enclosing my application for the IAPAC and the Southern African HIV Clinician's Society, and I look forward to the next issue.
Source: Southern African Journal of HIV Medicine 1 (2000)More Less
Debate surrounding access to antiretroviral therapy (ART) in South Africa has appropriately focused largely on preventing mother-to-child transmission. As the HIV epidemic grows, increasingly large numbers of patients are discovering that their medical insurance cover is not adequate to fund therapy. The response of the medical insurance industry to the epidemic has been variable, and seems to have been only partially dictated by cost constraints. Some funders have chosen to provide ART within a managed care framework. Medical aid schemes attached to the Aid for AIDS programme, for example, provide dual and triple therapy to their members, achieving an undetectable viral load in 26% of cases; importantly, they have also demonstrated significant cost savings in the medium term (unpublished data presented at the XIII International AIDS Conference, Durban, 9 - 14 July 2000).
Author Shoshana SafferSource: Southern African Journal of HIV Medicine 1, pp 39 –45 (2000)More Less
HIV infection engenders enormous social stigmatisation and fear, and late-stage illness brings devastating neuromedical consequences. Physicians who develop an understanding of the medical aspects of HIV infection as well as the neuropsychiatry of AIDS are in a position to help those with HIV infection achieve the best possible quality of life.
Author Michelle Rotchford GallowaySource: Southern African Journal of HIV Medicine 1 (2000)More Less