Southern African Journal of Hiv Medicine最新文献

{"title":"Nevirapine-induced Stevens-Johnson syndrome in children living with HIV in South Africa.","authors":"Jacques D du Toit,&nbsp;Koot Kotze,&nbsp;Helene-Mari van der Westhuizen,&nbsp;Taryn L Gaunt","doi":"10.4102/sajhivmed.v22i1.1182","DOIUrl":"https://doi.org/10.4102/sajhivmed.v22i1.1182","url":null,"abstract":"<p><strong>Background: </strong>Although adverse drug reactions resulting from the use of nevirapine (NVP) are well described in adults (estimated frequency of 6% - 10%), it has previously been considered less common in children (0.3% - 1.4%). Stock-outs of antiretroviral agents occur frequently in South Africa and result in interruptions in therapy and drug substitutions.</p><p><strong>Objectives: </strong>To report on a case series of paediatric patients who suffered cutaneous drug reactions to NVP at rates not previously described in children.</p><p><strong>Method: </strong>We describe a retrospective observational case series of six children living with HIV who developed Stevens-Johnson Syndrome (SJS) following exposure to NVP because of a prolonged stock-out of efavirenz 200 mg tablets in South Africa.</p><p><strong>Results: </strong>Of the 392 paediatric patients receiving antiretroviral therapy at the institution, 172 were affected by the efavirenz stock-out. Of these, 85 children were changed to NVP of which six developed NVP-induced SJS (7.1% incidence rate). The median time between initiating NVP and developing symptoms was 27 days (range 12-35 days). All patients responded well to NVP cessation and symptomatic treatment. One patient was referred for specialist care. Two patients were successfully rechallenged with efavirenz after developing SJS and three continued lopinavir/ritonavir.</p><p><strong>Conclusions: </strong>This is the second largest case series of NVP-induced SJS in children to date and raises the possibility that the incidence of SJS in children may be higher than previously described. Further research is required to explore the risk factors associated with NVP-induced SJS in children. This case series highlights the negative impact of drug stock-outs on patient health outcomes.</p>","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":"1182"},"PeriodicalIF":1.7,"publicationDate":"2021-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8008046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25582056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uptake of the Ithaka mobile application in Johannesburg, South Africa, for human immunodeficiency virus self-testing result reporting.","authors":"Alex E Fischer,&nbsp;Mothepane Phatsoane,&nbsp;Mohammed Majam,&nbsp;Luke Shankland,&nbsp;Musaed Abrahams,&nbsp;Naleni Rhagnath,&nbsp;Samanta T Lalla-Edward","doi":"10.4102/sajhivmed.v22i1.1197","DOIUrl":"https://doi.org/10.4102/sajhivmed.v22i1.1197","url":null,"abstract":"<p><strong>Background: </strong>Human immunodeficiency virus self-testing (HIVST) can reduce facility-based HIV testing barriers; however, no proven applications exist with widespread uptake for self-reporting or linkage to care. Mobile health (mHealth) applications (apps) have shown high usability and feasibility scores, so Ithaka was developed for South Africans to self-report HIVST results outside clinical settings.</p><p><strong>Objectives: </strong>This study investigated the use of Ithaka as a support tool for HIVST users, specifically the ability to self-report results.</p><p><strong>Method: </strong>This cross-sectional study was conducted from November 2018 to June 2019. At existing HIVST distribution sites, individuals were given HIVST kits and then invited to use Ithaka. Participants could test at home and report their results through the app anytime. Ithaka tracked when people logged-on, registered, received counselling and reported results. Post-study surveys on user experience were also conducted.</p><p><strong>Results: </strong>Of 751 participants, 531 (70.7%) logged onto the app, 412 (54.9%) registered, 295 (39.3%) received counselling and 168 (22.4%) self-reported results. Participants strongly agreed that Ithaka was useful and that it was easy to upload results. Forty-one participants completed a post-test survey, and 39/41 (95.1%) completed the app journey. Most participants (36/41;87.8%) had no challenges, although 2/41 (4.9%) cited perceived data costs, 2/41 (4.9%) difficulty uploading results and 1/41 (2.4%) language, as challenges.</p><p><strong>Conclusion: </strong>Despite the small sample size, this study has shown that HIVST participants under pragmatic conditions were willing and able to self-report results via the app, whilst also identifying areas of improvement for scaling up.</p>","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":"1197"},"PeriodicalIF":1.7,"publicationDate":"2021-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8008042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25582063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"False-positive rapid diagnostic tests in paediatric and obstetric patients in South Africa.","authors":"Josephine Keal,&nbsp;Ahmad H Mazanderani,&nbsp;Nicola van Dongen,&nbsp;Gillian Sorour,&nbsp;Karl-Gunter Technau","doi":"10.4102/sajhivmed.v22i1.1186","DOIUrl":"https://doi.org/10.4102/sajhivmed.v22i1.1186","url":null,"abstract":"<p><strong>Introduction: </strong>Providing easily accessible, quick and accurate human immunodeficiency virus (HIV) testing services (HTS) is central to achieving the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets. Rapid diagnostic tests (RDTs) for HIV are affordable and technically easy to perform. Two positive RDTs from different manufacturers are required to make a diagnosis of HIV in South Africa. Difficulty arises when there are discordant results from the two kits. In this case report, we will discuss four instances of false-positive RDTs.</p><p><strong>Patient presentation: </strong>Case 1 is a 10-year-old female, referred for initiation of antiretroviral treatment (ART). She was diagnosed using two of the same brand RDT at her local clinic. Case 2 is a 21-year-old female who presented to obstetric admissions in labour. Case 3 is a 39-year-old female who was screened for HIV during a routine antenatal appointment. Case 4 is a 22-year-old female who was admitted 21 days postpartum with puerperal sepsis. All four cases had discordant RDTs when screened for HIV at our facility.</p><p><strong>Management and outcome: </strong>The results of all the investigations conducted on all four patients confirmed HIV negative status. The reference laboratory verified the results and reran the RDTs, which remained discordant. This confirmed a false-positive result in all four cases with the screening RDT.</p><p><strong>Conclusion: </strong>With high numbers tested and a low yield of new cases, each individual case of discordancy may cause unnecessary distress, confusion and treatment, particularly in high-risk scenarios like pregnancy. Trends of false-positive and discordant RDT results should be monitored and inform HTS guidelines.</p>","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":"1186"},"PeriodicalIF":1.7,"publicationDate":"2021-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7876992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25383422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Profile of presentation of HIV-positive patients to an emergency department in Johannesburg, South Africa.","authors":"Abdullah E Laher,&nbsp;Willem D F Venter,&nbsp;Guy A Richards,&nbsp;Fathima Paruk","doi":"10.4102/sajhivmed.v22i1.1177","DOIUrl":"https://doi.org/10.4102/sajhivmed.v22i1.1177","url":null,"abstract":"<p><strong>Background: </strong>Despite improved availability and better access to antiretroviral therapy (ART), approximately 36% of human immunodeficiency virus (HIV)-positive South Africans are still not virally suppressed.</p><p><strong>Objective: </strong>The aim of this study was to describe the patterns of presentation of HIV-positive patients to a major central hospital emergency department (ED).</p><p><strong>Methods: </strong>In this prospectively designed study, consecutive HIV-positive patients presenting to the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) adult ED were enrolled between 07 July 2017 and 18 October 2018.</p><p><strong>Results: </strong>A total of 1224 participants were enrolled. Human immunodeficiency virus was newly diagnosed in 212 (17.3%) patients, 761 (75.2%) were on ART, 245 (32.2%) reported ART non-adherence, 276 (22.5%) had bacterial pneumonia, 244 (19.9%) had tuberculosis (TB), 86 (7.0%) had gastroenteritis, 205 (16.7%) required intensive care unit admission, 381 (31.1%) were admitted for ≥ 7 days and 166 (13.6%) died. With regard to laboratory parameters, CD₄ cell count was < 100 cell/mm³ in 527 (47.6%) patients, the viral load (VL) was > 1000 copies/mL in 619 (59.0%), haemoglobin was < 11 g/dL in 636 (56.3%), creatinine was > 120 µmol/L in 294 (29.3%), lactate was > 2 mmol/L in 470 (42.0%) and albumin was < 35 g/L in 633 (60.8%).</p><p><strong>Conclusion: </strong>Human immunodeficiency virus-positive patients presenting to the CMJAH ED demonstrated a high prevalence of opportunistic infections, required a prolonged hospital stay and had high mortality rates. There is a need to improve the quality of ART services and accessibility to care.</p>","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":"1177"},"PeriodicalIF":1.7,"publicationDate":"2021-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7876985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25383420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A trio of infectious diseases and pulmonary embolism: A developing world's reality.","authors":"Somasundram Pillay,&nbsp;Nombulelo Magula","doi":"10.4102/sajhivmed.v22i1.1192","DOIUrl":"https://doi.org/10.4102/sajhivmed.v22i1.1192","url":null,"abstract":"<p><strong>Introduction: </strong>Human immunodeficiency virus (HIV), Tuberculosis (TB) and coronavirus disease (COVID-19) infections independently possess the ability to trigger formation of venous thromboembolism (VTE) and pulmonary embolism (PE). To the authors' knowledge, this is the first case report describing the presence of PE in a patient with all three aforementioned infectious co-morbidities.</p><p><strong>Presentation: </strong>A patient living with HIV with virological failure secondary to defaulting antiretroviral therapy (ART) presented with hypoxia, clinical and radiological features suggestive of community-acquired pneumonia (CAP) with raised inflammatory markers and D-dimer levels.</p><p><strong>Management: </strong>She was commenced on prophylactic anticoagulation, supplemental oxygen and empirical antibiotics targeting CAP and pneumocystis jiroveci pneumonia, swabbed for COVID-19 infection and had sputa sent for Gene Xpert® TB testing. A day later, COVID-19 results returned positive and the patient was transferred to isolation and added onto dexamethasone and therapeutic anticoagulation. Sputa returned positive for mycobacterium TB a day later, and anti-tuberculosis therapy was added. She remained persistently hypoxic, with a Well's score of 3 placing her at moderate risk for PE, which prompted for a computed tomography pulmonary angiogram (CTPA) being ordered, which demonstrated left lower lobe subsegmental PE. Warfarin was added to her regimen. She was discharged on day 18 with a therapeutic international normalised ratio (INR) and not requiring oxygen therapy.</p><p><strong>Conclusion: </strong>This scenario is relevant in low to middle-income countries. The utilisation of a raised D-Dimer in the setting of all four coexisting conditions in arriving at a definite diagnosis remains uncertain. We noted that despite our index patient being on thrombo-prophylaxis, she developed PE highlighting the need for increased vigilance in all COVID-19 patients, even those on prophylactic anticoagulation.</p>","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":"1192"},"PeriodicalIF":1.7,"publicationDate":"2021-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7877195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25383423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Skin and mucosal manifestations of an AIDS-related systemic mycosis.","authors":"Michael T Boswell,&nbsp;Liam Robinson,&nbsp;Nelesh Govender","doi":"10.4102/sajhivmed.v22i1.1198","DOIUrl":"https://doi.org/10.4102/sajhivmed.v22i1.1198","url":null,"abstract":"","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":"1198"},"PeriodicalIF":1.7,"publicationDate":"2021-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7876957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25383424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating qualification and factors associated with third-line antiretroviral therapy referral in the Western Cape.","authors":"Sadiyya Sheik,&nbsp;Bart Willems","doi":"10.4102/sajhivmed.v22i1.1184","DOIUrl":"https://doi.org/10.4102/sajhivmed.v22i1.1184","url":null,"abstract":"<p><strong>Background: </strong>South Africa's antiretroviral therapy (ART) programme is the largest globally and the universal test-and-treat policy is expected to increase the numbers on ART. This may have implications for treatment failure rates implying a greater future need for third-line regimens. South Africa initiated a third-line programme in 2013. However, there is little evidence quantifying the third-line need in this setting and the programme itself has not been formally evaluated.</p><p><strong>Objectives: </strong>The study evaluated the third-line ART referral process in the Western Cape.</p><p><strong>Method: </strong>Routinely collected data were analysed to derive an estimate of patients meeting criteria for third-line referral and compared with patients who were referred. Factors associated with referral were identified.</p><p><strong>Results: </strong>In the study period, 947 patients met criteria for third-line referral and 167 patients were referred. Comparison revealed a poor overlap of only 42 patients. In multivariate analysis, factors associated with referral included receiving care at a hospital rather than a primary healthcare facility (adjusted odd ratios [aOR] = 2.15, 95% confidence interval [CI] 1.1-4.2), a higher number of viral load [VLs] ≥ 1000 copies/mL whilst on a protease inhibitor (PI) (aOR = 1.2, 95% CI 1.01-1.42) and a greater number of years on a PI (aOR = 1.25, 95% CI 1.07-1.46). Patients with a 6-month gap in dispensing were less likely to be referred (aOR = 0.37, 95% CI 0.17-0.81).</p><p><strong>Conclusion: </strong>This study adds to a limited body of knowledge regarding third-line ART programmes. The findings indicate missed opportunities for and inappropriate referral of patients. Factors associated with referral were largely health system related. Clinician awareness and compliance with referral remain unknown and may be contributory.</p>","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":"1184"},"PeriodicalIF":1.7,"publicationDate":"2021-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8008132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25582057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Administering human immunodeficiency virus post-exposure prophylaxis: challenges experienced by mothers in Lusaka, Zambia.","authors":"Mildred Lusaka,&nbsp;Talitha Crowley","doi":"10.4102/sajhivmed.v22i1.1183","DOIUrl":"https://doi.org/10.4102/sajhivmed.v22i1.1183","url":null,"abstract":"<p><strong>Background: </strong>Mothers living with human immunodeficiency virus (HIV) should be guided to practise safe childbirth, provide appropriate infant feeding, return infants for repeat HIV testing and administer for the required period, protective antiretroviral (ARV) medication (post-exposure prophylaxis [PEP]) to their infants. Although several studies have explored challenges related to the prevention of mother-to-child transmission (PMTCT), no studies were found that focused specifically on the mother and PEP.</p><p><strong>Objectives: </strong>To explore and understand the challenges experienced by mothers in Lusaka, Zambia, whilst providing their children with PEP.</p><p><strong>Methods: </strong>This study utilised a qualitative methodology and a descriptive design. Fifteen semi-structured individual interviews were conducted with mothers who gave PEP to their infants. Study evaluation made use of Creswell's six steps of data analysis.</p><p><strong>Results: </strong>Women experienced numerous challenges. Challenges of an individual and social nature included 'negative' emotions, misconceptions and a lack of understanding of PEP. Post-exposure prophylaxis was sometimes burdensome and partner involvement often limited. Cultural, religious practices and stigma deterred some women from continuing PEP. Healthcare challenges included time-consuming appointments and protracted waiting periods. Clinic organisation was often inefficient and complicated by stock-outs of essential medication such as nevirapine. Healthcare workers were at times stigmatising towards mothers living with HIV and their infants. The counselling support provided by the healthcare workers was felt to be inadequate in the face of the burden of PEP.</p><p><strong>Conclusion: </strong>Post-exposure prophylaxis as part of the PMTCT programme is key to eliminating mother-to-child transmission of HIV. Postnatal support for women administering PEP to their children can be enhanced through counselling that is person- and family-centred is culturally sensitive and offers differentiated services that include PEP, integrated mother-and-child healthcare and access to support groups.</p>","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":"1183"},"PeriodicalIF":1.7,"publicationDate":"2021-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7876968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25383421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The influence of haemodialysis on CD4+ T-cell counts in people living with human immunodeficiency virus with end-stage kidney disease.","authors":"Melanie Pretorius,&nbsp;Estee Benade,&nbsp;June Fabian,&nbsp;Denise Lawrie,&nbsp;Elizabeth S Mayne","doi":"10.4102/sajhivmed.v21i1.1125","DOIUrl":"https://doi.org/10.4102/sajhivmed.v21i1.1125","url":null,"abstract":"<p><strong>Background: </strong>In South Africa it is estimated that 7.9 million people are living with human immunodeficiency virus (HIV). HIV is associated with an increased risk of kidney disease. For people living with HIV (PLWH) who develop end-stage kidney disease (ESKD), access to renal replacement therapy can be difficult. Kidney transplantation is a cost-effective option, with improved overall survival and better quality of life. In Johannesburg, the eligibility criteria for kidney transplantation include a sustained CD4+ T-cell count of > 200 cells/μL and suppressed HIV replication.</p><p><strong>Objective: </strong>To investigate the influence of haemodialysis on the lymphocyte subsets in PLWH with ESKD. In addition, all available %CD4+ T-cell counts, absolute CD4+ T-cell counts and viral load measurements were collected to assess the longitudinal trends of these measurements in PLWH with ESKD.</p><p><strong>Methods: </strong>This was a cross-sectional study comparing two groups. The HIV-infected study participants (<i>n</i> = 17) and HIV-uninfected controls (<i>n</i> = 17) were recruited from renal dialysis centres in Johannesburg from 2017 to 2018. Demographic data and social data were collected from all the study participants (<i>n</i> = 17). Blood samples were collected from all the study participants (before and after a haemodialysis session), and the lymphocyte subsets were then measured. The available longitudinal data for the serial CD4+ T-cell counts and HIV viral loads were collected (<i>n</i> = 14).</p><p><strong>Results: </strong>Our cohort showed a statistically significant increase in the post-dialysis percentage of CD4+ T cells (5%, <i>p</i> < 0.001) and the absolute CD4+ T-cell counts (21 cells/µL, <i>p</i> < 0.03). The longitudinal trend analysis for the percentage of CD4+ T cells revealed a significant increase in five participants (36%), and a single patient (7%) had a significant decrease in the longitudinal trend analysis for the absolute CD4+ T-cell counts. The longitudinal trend analysis for HIV viral load revealed the majority of our participants were not virologically suppressed.</p><p><strong>Conclusion: </strong>This study showed that haemodialysis does not have an immediate negative impact on CD4+ T-cell count, suggesting that immunologic recovery is not impeded by treatment of the underlying ESKD.</p>","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":"1125"},"PeriodicalIF":1.7,"publicationDate":"2020-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7756925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38777070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracranial pressure management in patients with human immunodeficiency virus-associated cryptococcal meningitis in a resource-constrained setting.","authors":"Philasande Mkoko,&nbsp;Jessica Du Preez,&nbsp;Senlika Naidoo","doi":"10.4102/sajhivmed.v21i1.1171","DOIUrl":"https://doi.org/10.4102/sajhivmed.v21i1.1171","url":null,"abstract":"<p><strong>Background: </strong>Cryptococcal meningitis (CCM) is the leading cause of meningitis in people living with HIV (PLWH) in sub-Saharan Africa (SSA). The mortality and morbidity associated with CCM remain high. Combination of antifungal therapy, diligent management of intracranial pressure (IP) and the correct timing of the introduction of antiretroviral therapy (ART) minimise the risk of mortality and morbidity. The absence of spinal manometers in many healthcare centres in SSA challenges the accurate measurement of cerebrospinal fluid (CSF) pressure and its control.</p><p><strong>Objectives: </strong>We hypothesised that four lumbar punctures (LPs) in the first week of the diagnosis and treatment of CCM would reduce IP such that in-hospital mortality and morbidity of HIV-associated CCM (HIV/CCM) would be significantly reduced.</p><p><strong>Methods: </strong>We conducted a retrospective study to assess whether receipt of four or more LPs in the first week of the diagnosis and treatment with combination antifungal therapy of HIV/CCM would be associated with the reduction of in-hospital mortality in adult PLWH.</p><p><strong>Results: </strong>From 01 January 2016 to 31 December 2016, 116 adult patients were admitted to the Dora Nginza District Hospital in Zwide, Port Elizabeth, South Africa. After exclusion of 11 (two were younger than 18 years, two had missing hospital records and seven demised or left the hospital before 7 days of hospitalisation), 105 patients were included in the analysis. The mean age was 39.4 (standard deviation [s.d.] ± 9.7) years, 64.8% were male. All were PLWH. A total of 52.4% had defaulted ART and 25.7% were ART naïve. Forty-three patients received four or more LPs (mean = 4.58 [± 0.96]) in the first week of hospitalisation with an associated in-hospital mortality of 11.6% (<i>n</i> = 5/43) compared with 62 patients who received less than four LPs (mean = 2.18 [± 0.80]) with an in-hospital mortality of 29% (<i>n</i> = 18/62) and a relative risk of 0.80 (95% CI, 0.66-0.97), <i>p</i> = 0.034.</p><p><strong>Conclusion: </strong>In the current study of adult PLWH presenting to hospital with HIV/CCM, four or more LPs in the first 7 days following admission and the initiation of treatment were associated with a 17.4% reduction in absolute risk of in-hospital mortality and a 20% reduction in relative risk of in-hospital mortality. This mortality difference was noted in patients who survived and were in hospital at the time of the 7-day study census and persisted until the time of hospital discharge.</p>","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":"1171"},"PeriodicalIF":1.7,"publicationDate":"2020-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7756785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38777076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}