- A-Z Publications
- Southern African Journal of HIV Medicine
- Previous Issues
- Volume 12, Issue 1, 2011
Southern African Journal of HIV Medicine - Volume 12, Issue 1, 2011
Volumes & issues
Volume 12, Issue 1, 2011
Author Francois VenterSource: Southern African Journal of HIV Medicine 12 (2011)More Less
Several things are coming to completion in this important year for the Society. A new board of interim directors has been elected to construct our new constitution, or 'Memorandum of Association', legalese from the new Companies Act that is about to come into force. It will be presented to the old executive for discussion, and then circulated for comment, in the next few months. I welcome Tim Tucker, one of South Africa's unsung heroes from the vaccine enterprise, and Eric Hefer, who is known by reputation to many of you and is a longtime Exco member, to the interim board. They'll also be advising on our new structure, and how we take the organisation towards new elections in November.
Author Linda-Gail BekkerSource: Southern African Journal of HIV Medicine 12 (2011)More Less
A recently released report by United Nations Secretary General Ban Ki-moon, titled Uniting for Universal Access: Towards Zero New HIV infections, Zero Discrimination am Zero AIDS-related Deaths, highlights the fact that the global rate of new HIV infections is declining, treatment access is expanding, and the world has made significant strides in reducing transmission from mother to child.
Author Laura Mary CampbellSource: Southern African Journal of HIV Medicine 12, pp 6 –7 (2011)More Less
A clinical assessment of antiretroviral-treated patients referred from the private sector to the South African Government Antiretroviral (ARV) Programme : a retrospective analysis : original articleAuthor Rianna GoundenSource: Southern African Journal of HIV Medicine 12, pp 8 –14 (2011)More Less
Objectives. A comparison of the effects of highly active antiretroviral therapy (HAART) on the immunological, virological and clinical status of two groups of patients in the South African government antiretroviral (ARV) programme in KwaZulu-Natal, viz. patients previously treated with ARVs in the private sector and then entering the government programme (private group), and ARV-naïve patients entering the programme directly (government group).
Methods. A retrospective, cohort study was performed by reviewing records of 58 former private sector patients and 98 patients initiated on ARV treatment in the government sector. Treatment regimens, CD4 cell counts, viral loads and regimen modifications were analysed.
Results. The study found that use of various classes of ARV drugs varied between the private sector and the government sector. Median distribution of CD4 cell count increased from 158.5 to 419 cells/µl for the private group (42 patients (72.4%)) and from 101 to 358 cells/µl for the government group (95 patients (96.9%)), over an average time span ranging from 29 to 30 months. Median viral load decreased in the private group (29 patients (50%)) and the government group (66 patients (67.3%)) to approximately 3.22 log copies/ml (25 copies/ml) over an average time span ranging from 27 to 29 months. The rate of change of CD4 cell count (p=0.47) and viral load (p=0.097) between the two groups was not significantly different.
Conclusion. This study showed that even for patients with prior experience with ARVs, virological and immunological success is still achievable with the use of standardised HAART regimens in the government programme.
Expanding access to HIV counselling and testing at schools - the Manguzi experience : original articleSource: Southern African Journal of HIV Medicine 12, pp 16 –18 (2011)More Less
South Africa's HIV epidemic disproportionately affects the youth. The importance of knowing one's status via voluntary counselling and testing (VCT) is recognised as a key strategy in fighting the epidemic and is reflected in the National Strategic Plan (NSP), which has set targets of 70% of all adults knowing their status by 2011 and 25% of all adults having been tested in the past 12 months. The Human Sciences Research Council survey in 20081 showed that 50.8% of all South Africans 15 years and older have had an HIV test, pointing to wider acceptance of VCT. As a further response to reaching the NSP target, the national HIV counselling and testing campaign was launched in April 2010 with a focus on mobilising all South Africans to be tested for HIV and ensuring that every South African knows their HIV status. Both the NSP and the national HIV testing campaign recognise the importance of community mobilisation and community-based models of VCT to achieve these targets. The NSP in particular has a goal to expand successful strategies of testing outside health care facilities to cover 70% of all districts by 2011.
Young people are reluctant to use health care facilities, and several 'youth friendly' strategies have been tried to target adolescents. This case study serves to document the successes of one such community-based VCT strategy, aimed at young people in northern KwaZulu-Natal, South Africa.
Provincial differences in infant deaths in South Africa - an effect of antiretroviral interventions? : original articleSource: Southern African Journal of HIV Medicine 12, pp 20 –23 (2011)More Less
Objective. It has previously been demonstrated that a peak in registered infant deaths, at 2 - 3 months of age at death, developed between 1997 and 2002 in South Africa, alongside the evolving HIV epidemic. The objective of this analysis was to explore the age distribution of post-neonatal infant deaths in South Africa by province, and relate the observed distributions to HIV and intervention characteristics.
Design. Ecological study based on registered infant deaths and published HIV and intervention characteristics.
Methods. Numbers of registered infant deaths beyond 1 month of age at death were plotted by year of death, province of South Africa and age at death in months, for the years 1997 - 2007.
Results. The total number of registered deaths in infants aged 1 - 11 months increased from 15 404 in 1997 to 34 479 in 2006. Eight of the 9 provinces experienced an annual peak in registered infant deaths at 2 - 3 months of age between 1997 and 2007. This peak in mortality was not observed in the Western Cape. In 7 of 9 provinces registered post-neonatal infant deaths did not rise markedly in 2007 compared with 2005.
Conclusions. We identified a single province out of 9 South African provinces in which a peak in early infant deaths at age 2 - 3 months did not occur during the period 1997 - 2007. This was the province with the earliest and highest coverage of antiretroviral interventions from 1999 onwards. It is possible that these interventions have averted the greater increase in early infant deaths seen in the rest of South Africa over this period.
HIV and serum protein electrophoresis patterns in KwaZulu-Natal : a retrospective study : original articleSource: Southern African Journal of HIV Medicine 12, pp 24 –26 (2011)More Less
Objective. To describe the effect of HIV serostatus on serum proteins, serum protein electrophoresis (SPEP) patterns and monoclonal bands.
Setting. Inkosi Albert Luthuli Central Hospital, Durban.
Design. Retrospective, anonymous analysis of routine laboratory results.
Results. Monoclonal bands were not increased in HIV-positive patients, who were younger and had increased polyclonal and oligoclonal bands and total proteins when compared with HIV-negative patients.
Source: Southern African Journal of HIV Medicine 12, pp 27 –33 (2011)More Less
HIV-hepatitis B virus (HBV) co-infected patients are at risk of increased morbidity and mortality. Early recognition of dual infection is a critical factor in directing appropriate therapy, and HBV screening should therefore be undertaken at the time of HIV diagnosis. Vaccination against HBV should be considered for all HIV patients who are not yet infected with HBV. Antiretroviral therapy containing two antiretrovirals active against HBV should be started if the patient either has symptomatic liver disease or is asymptomatic with a CD4 count of <350 cells/µl.
Nonspecific radiographic manifestations of cytomegalovirus infection in 4 HIV-positive adults - diagnosis through transbronchial biopsy : case studies - HIV and lung diseaseSource: Southern African Journal of HIV Medicine 12, pp 34 –36 (2011)More Less
We report on 4 HIV-positive adult patients who presented (over a 2-year period) with clinically significant cytomegalovirus (CMV) pneumonia requiring transbronchial biopsy for diagnosis. The patients were not on antiretroviral therapy. Clinical findings were nonspecific, sputum samples were negative, blood test results were non-contributory, and empirical treatment had failed. Radiological findings were extensive but nonspecific. Three of the 4 patients were co-infected with Pneumocystis jirovecii (PJP) pneumonia, further confounding the radiological diagnosis.
Source: Southern African Journal of HIV Medicine 12, pp 37 –38 (2011)More Less
The mechanisms behind accelerated emphysema in adults with HIV infection and the HIV-infected smoking population are both multifactorial and unclear. However, the association of HIV and emphysematous lung disease is recognised. We describe a patient with HIV infection and accelerated emphysema, highlighting the facts that no other background disease predisposed him to these lung changes, and that smoking in conjunction with HIV infection acted synergistically to produce the changes.
Bilateral lower motor neuron facial nerve palsy due to HIV seroconversion : case study - HIV and the neuronsSource: Southern African Journal of HIV Medicine 12, pp 39 –40 (2011)More Less
A 34-year-old-woman presented with acute onset of headache and bilateral facial nerve paralysis. On examination bilateral lower motor neuron 7th cranial nerve palsy in keeping with bilateral Bell's palsy was apparent. Investigations showed aseptic meningitis, with a low CD4 count of 352 cells/µl and an elevated viral load (5 300 counts/ml, log = 3.72), in keeping with acute HIV infection. Bell's palsy is a known complication of seroconversion - 13 cases have been reported worldwide. To our knowledge this is the first reported case in South Africa.
Effects of dual renin-angiotensin system blockade on proteinuria in a hypertensive black African HIV-infected patient : case study - HIV and the kidneysSource: Southern African Journal of HIV Medicine 12, pp 41 –42 (2011)More Less
The risks of concurrent treatment with tenofovir and aminoglycosides in patients with HIV-associated tuberculosis : case study - HIV and the kidneysSource: Southern African Journal of HIV Medicine 12, pp 43 –45 (2011)More Less
The South African public sector antiretroviral treatment (ART) guidelines have recently been changed to include tenofovir in the first-line regimen. Injectable drugs from the aminoglycoside class are part of the intensive phase of regimen 2 tuberculosis (TB) treatment and the multidrug-resistant (MDR) TB treatment regimen in the South African TB programme. We wish to draw the attention of clinicians managing patients with HIV-associated TB to the potential dangers of concurrent administration of these drugs. We present two illustrative cases.
Feasibility and acceptability of sexual abstinence for interruption of HIV transmission among individuals with acute HIV infection - formative data from CHAVI 011 : letterSource: Southern African Journal of HIV Medicine 12 (2011)More Less
To the Editor: We refer to the article by Parkhurst and Whiteside in the April 2010 issue of the Southern African Journal of HIV Medicine. The authors suggest that a limited period of population-wide sexual abstinence might be an effective and low-cost method of interrupting the transmission of HIV, particularly among individuals with acute HIV infection (AHI).
Source: Southern African Journal of HIV Medicine 12, pp 47 –48 (2011)More Less
Imagine a small gathering. Gradually, word spreads and the intimate affair turns into a fulcrum of activity. From a handful of friends, hundreds of people join, bringing strobe lights, powerful loudspeakers and copious amounts of food. The party, one of the most successful ever held, lasts through the night. Then the lights are turned on, the cops arrive and the party grinds to a halt. No more parties are allowed, ever again.