Southern African Journal of Hiv Medicine最新文献

{"title":"COVID-19 severity and in-hospital mortality in an area with high HIV prevalence.","authors":"Michael T Boswell,&nbsp;Tshegofatso Maimela,&nbsp;Dan Hameiri-Bowen,&nbsp;George Riley,&nbsp;Albertus Malan,&nbsp;Nickietta Steyn,&nbsp;Nomonde Nolutshungu,&nbsp;Talita R de Villiers,&nbsp;Zelda de Beer,&nbsp;John Mathabathe,&nbsp;Khanyisile Tshabalala,&nbsp;Fareed Abdullah,&nbsp;Rajiev Ramlall,&nbsp;Marthinus Heystek,&nbsp;Debashis Basu,&nbsp;Paul Rheeder,&nbsp;Veronica Ueckermann,&nbsp;Wesley van Hougenhouck-Tulleken","doi":"10.4102/sajhivmed.v24i1.1412","DOIUrl":"https://doi.org/10.4102/sajhivmed.v24i1.1412","url":null,"abstract":"<p><strong>Background: </strong>HIV infection causes immune dysregulation affecting T-cell and monocyte function, which may alter coronavirus disease 2019 (COVID-19) pathophysiology.</p><p><strong>Objectives: </strong>We investigated the associations among clinical phenotypes, laboratory biomarkers, and hospitalisation outcomes in a cohort of people hospitalised with COVID-19 in a high HIV prevalence area.</p><p><strong>Method: </strong>We conducted a prospective observational cohort study in Tshwane, South Africa. Respiratory disease severity was quantified using the respiratory oxygenation score. Analysed biomarkers included inflammatory and coagulation biomarkers, CD4 T-cell counts, and HIV-1 viral loads (HIVVL).</p><p><strong>Results: </strong>The analysis included 558 patients, of whom 21.7% died during admission. The mean age was 54 years. A total of 82 participants were HIV-positive. People living with HIV (PLWH) were younger (mean age 46 years) than HIV-negative people; most were on antiretroviral treatment with a suppressed HIVVL (72%) and the median CD4 count was 159 (interquartile range: 66-397) cells/µL. After adjusting for age, HIV was not associated with increased risk of mortality during hospitalisation (age-adjusted hazard ratio = 1.1, 95% confidence interval: 0.6-2.0). Inflammatory biomarker levels were similar in PLWH and HIV-negative patients. Detectable HIVVL was associated with less severe respiratory disease. In PLWH, mortality was associated with higher levels of inflammatory biomarkers. Opportunistic infections, and other risk factors for severe COVID-19, were common in PLWH who died.</p><p><strong>Conclusion: </strong>PLWH were not at increased risk of mortality and those with detectable HIVVL had less severe respiratory disease than those with suppressed HIVVL.</p><p><strong>What this study adds: </strong>This study advances our understanding of severe COVID-19 in PLWH.</p>","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":"24 1","pages":"1412"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9900246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10666282","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":"Late-onset efavirenz toxicity: A descriptive study from Pretoria, South Africa.","authors":"Lyneshree Munsami,&nbsp;Clara M Schutte,&nbsp;Maryke de Villiers,&nbsp;Juliane Hiesgen","doi":"10.4102/sajhivmed.v24i1.1439","DOIUrl":"https://doi.org/10.4102/sajhivmed.v24i1.1439","url":null,"abstract":"<p><strong>Background: </strong>The neuropsychiatric side effects of efavirenz occur mainly early during treatment and are usually mild. A lesser-known and serious complication is late-onset efavirenz toxicity causing ataxia and encephalopathy. Data regarding this condition are limited.</p><p><strong>Objectives: </strong>We describe the clinical picture of late-onset efavirenz toxicity, investigate co-morbidities and report outcomes.</p><p><strong>Method: </strong>This descriptive study of all patients with late-onset efavirenz toxicity was conducted over three years at Kalafong Provincial Tertiary Hospital, Pretoria, South Africa.</p><p><strong>Results: </strong>Forty consecutive patients were identified. Mean age was 42.1 years, three patients (7.5%) were male and the mean efavirenz level was 49.0 μg/mL (standard deviation [s.d.]: 24.8). Cerebellar ataxia (82.5%) and encephalopathy (47.5%) were the most common presenting features (40.0% had both); four patients presented with psychosis. Presence of encephalopathy and/or cerebellar ataxia was associated with higher efavirenz levels compared with psychosis (52.1 μg/mL, s.d.: 24.1 vs 25.0 μg/mL, s.d.: 17.1). In most patients, symptoms resolved, but four patients (10.0%) died, and one patient remained ataxic.</p><p><strong>Conclusion: </strong>Late-onset efavirenz toxicity typically presented with ataxia and encephalopathy, but psychosis can be the presenting feature. The outcome after withdrawal was good, but the mortality of 10.0% is concerning. Recent changes in guidelines favour dolutegravir, but many patients remain on efavirenz, and awareness of the condition is vital.</p><p><strong>What this study adds: </strong>This large, single-centre study contributes to the limited data of HIV-positive patients with late-onset efavirenz toxicity and emphasises its ongoing relevance in clinical practice.</p>","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":"24 1","pages":"1439"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9900310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10672220","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":"Effect of obesity on dolutegravir exposure in Black Southern African adults living with HIV.","authors":"Enkosi Mondleki, Clifford G Banda, Nomathemba C Chandiwana, Simiso Sokhela, Lubbe Wiesner, Francois Venter, Gary Maartens, Phumla Z Sinxadi","doi":"10.4102/sajhivmed.v23i1.1452","DOIUrl":"10.4102/sajhivmed.v23i1.1452","url":null,"abstract":"<p><strong>Background: </strong>Dolutegravir, a component of the preferred first-line antiretroviral therapy regimen, has been associated with increased weight gain. South Africa has a high prevalence of obesity, especially among women. Understanding dolutegravir exposure in patients with obesity is important for dose optimisation.</p><p><strong>Objectives: </strong>We compared the pharmacokinetic parameters of dolutegravir in Southern African adults living with HIV with and without obesity.</p><p><strong>Method: </strong>Blood samples were collected at various time points over a 24 h-period for dolutegravir assays. Non-compartmental analysis was conducted and geometric mean ratios (GMRs), with 90% confidence intervals (CIs), were generated to compare dolutegravir pharmacokinetic parameters between the groups. Regression analyses to assess predictors of dolutegravir exposure were done.</p><p><strong>Results: </strong>Forty participants were enrolled, 26 were women and 10 had obesity. Dolutegravir area under the concentration-time curve to 24-h and the maximum concentrations were not statistically significantly lower in participants with obesity: GMR 0.91 (90% CI: 0.71-1.16) and GMR 0.86 (90% CI: 0.68-1.07), respectively. In a multivariate linear regression analysis adjusting for age, gender, body mass index, creatinine clearance and randomisation arm (tenofovir alafenamide or tenofovir disoproxil fumarate), a unit increase in body mass index was associated with 1.2% lower dolutegravir area under the concentration-time curve to 24-h (<i>P</i> = 0.035).</p><p><strong>Conclusion: </strong>Dolutegravir exposure was marginally lower in participants with obesity, but this is not clinically significant. Our findings suggest that there is no need to dose adjust dolutegravir in people with obesity.</p>","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":"23 1","pages":"1452"},"PeriodicalIF":1.6,"publicationDate":"2022-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9772744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10733074","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":"Experiences in receiving financial incentives to access HIV care in Johannesburg, South Africa.","authors":"Sara Rachel Schlehr, Leanne Singh, Athini Nyatela, Sizwe Nqakala, Samanta T Lalla-Edward","doi":"10.4102/sajhivmed.v23i1.1426","DOIUrl":"10.4102/sajhivmed.v23i1.1426","url":null,"abstract":"<p><strong>Background: </strong>Financial incentivisation has been used to improve all steps of the HIV cascade with varying results. Most studies conducted on the matter are of a quantitative nature, not giving enough space for in-depth understanding as to why financial incentives work or do not work.</p><p><strong>Objectives: </strong>To describe experiences with, and opinions on, the use of financial incentives to promote linkage to and retention in care from the perspective of people living with HIV.</p><p><strong>Method: </strong>We performed a qualitative cross-sectional study. In-depth interviews were conducted with adult men and women with HIV accessing health services or research study visits. After codebook development, NVivo 12 software was used to code and analyse the data.</p><p><strong>Results: </strong>Through the provision of financial incentives, participants were able to cover basic needs. However, some deemed financial incentives as a form of income rather than a nudge to spark interest in changing their health behaviour. Participants communicated that a need for some type of incentive exists and recommended food vouchers as the best possible solution.</p><p><strong>Conclusion: </strong>Financial incentivisation can facilitate engagement in the HIV care continuum through providing support to people living with HIV.</p><p><strong>What this study adds: </strong>This study complements the body of research that explores the feasibility of using incentives and which of them may be most beneficial in encouraging patients with HIV to enter into and sustain HIV care.</p>","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":"23 1","pages":"1426"},"PeriodicalIF":1.6,"publicationDate":"2022-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9724036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10722540","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":"Delays in third-line antiretroviral therapy and outcomes in North West province.","authors":"Babalwa Majova, Ebrahim Variava, Neil Martinson","doi":"10.4102/sajhivmed.v23i1.1394","DOIUrl":"10.4102/sajhivmed.v23i1.1394","url":null,"abstract":"<p><strong>Background: </strong>Rapid switching from second-line to third-line antiretroviral therapy (TLART) is crucial for achieving viral suppression and reducing illness related to ART failure.</p><p><strong>Objectives: </strong>This retrospective cohort study quantified the waiting periods for TLART initiation after virological failure on second-line therapy was detected, assessed factors associated with delays and assessed the outcomes of patients started on TLART.</p><p><strong>Method: </strong>Data were abstracted from records of individuals eligible for TLART, and the time to TLART initiation was calculated. Reasons for delays were categorised according to patient, clinician and administrative processes.</p><p><strong>Results: </strong>Fifty-four patients were eligible for TLART. The median delay from the date of first viral load > 1000 copies/mL on second-line therapy to the start of TLART was 640 days (interquartile range [IQR]: 451-983 days). Of the patients that failed second-line and had an application for TLART, 41 (75.6%) were eventually initiated on TLART, and 11 (20.4%) died while waiting. Delays were primarily due to non-response to the first unsuppressed viral load while on second-line ART: 467 days (IQR: 232-803 days).</p><p><strong>Conclusion: </strong>This study showed a prolonged waiting period for TLART initiation mainly between detected high viral load to requesting of resistance tests; many factors could have contributed, including clinicians' delayed responses to elevated viral loads. Mortality was high before TLART could be initiated. The process of TLART initiation needs to be made more efficient. Healthcare services should be strengthened to (1) recognise and manage virological failure early and identify those eligible for resistance testing, (2) ensure access to resistance testing and appropriately skilled clinicians, and (3) streamline approvals and delivery of TLART.</p>","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":"23 1","pages":"1394"},"PeriodicalIF":1.6,"publicationDate":"2022-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9634953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10433290","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":"Determinants of health-related quality of life in young adults living with perinatally acquired HIV infection in Botswana","authors":"G. Karugaba, G. Thupayagale-Tshweneagae, M. Moleki, Onkabetse V Mabikwa, M. Matshaba","doi":"10.4102/sajhivmed.v23i1.1362","DOIUrl":"https://doi.org/10.4102/sajhivmed.v23i1.1362","url":null,"abstract":"Background Due to the successful antiretroviral therapy (ART) programme in Botswana, large numbers of perinatally HIV-infected adolescents are emerging into young adulthood. Young adulthood is a critical period of human development. However, there is lack of information on the factors affecting the health-related quality of life (HRQOL) of young adults living with perinatally acquired HIV (YALPH) in Botswana. Objectives The objective of this study was to assess the HRQOL and its determinants among YALPH who were enrolled on ART at Botswana-Baylor Children’s Clinical Centre of Excellence in Gaborone, Botswana. Method A cross-sectional study assessed the HRQOL of 509 YALPH aged 18–30 years using the WHOQOL-HIV BREF. Data about other variables of interest were abstracted from medical records. Bivariate analyses were performed using t and Chi-square tests to determine the associations between demographic and clinical variables and general HRQOL. The variables that were associated with the general HRQOL at P-value < 0.1 were included in the multivariable analysis using the logistic regression approach. Results The majority of participants had good general HRQOL (78.4%). The highest mean HRQOL score was in the Physical domain (5.4 [± 2.9]) and the lowest in the Environment domain (13.8 [± 2.7]). The factors that were significantly associated with the general HRQOL included: level of education attained (P = 0.012), employment status (P = 0.069), viral load suppression (P = 0.073) and self-reported illness (P = 0.001). Conclusion Interventions that effectively increase educational attainment, employment opportunities, ART adherence, and prevention or management of illness are needed to promote good HRQOL among YALPH in Botswana.","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2022-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49640743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Where are the children? Case finding in 5–14-year-olds living with HIV in Johannesburg","authors":"J. Dunlop, C. Tait, M. Mabitsi, K. Rees","doi":"10.4102/sajhivmed.v23i1.1378","DOIUrl":"https://doi.org/10.4102/sajhivmed.v23i1.1378","url":null,"abstract":"No abstract available.","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2022-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42128581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding patients reinitiating antiretroviral therapy in two South African districts","authors":"K. Rees., Melanie A Bisnauth, Cara O'Connor, Tshifhiwa Ramvhulela, Nomzamo Vali","doi":"10.4102/sajhivmed.v23i1.1380","DOIUrl":"https://doi.org/10.4102/sajhivmed.v23i1.1380","url":null,"abstract":"No abstract available.","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2022-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49347609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychosocial support for adolescents and youth living with HIV during COVID-19: A differentiated approach is needed","authors":"C. Tait, Njabulo Mbanda, Rudairo Tumba, M. Vujovic, Kate Rees","doi":"10.4102/sajhivmed.v23i1.1379","DOIUrl":"https://doi.org/10.4102/sajhivmed.v23i1.1379","url":null,"abstract":"No abstract available.","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":"23 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2022-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70338763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alere Determine-tuberculosis lipoarabinomannan positivity in disseminated non-tuberculous mycobacteria: An illustrative case series","authors":"R. Greyling, G. Meintjes, B. Sossen","doi":"10.4102/sajhivmed.v23i1.1369","DOIUrl":"https://doi.org/10.4102/sajhivmed.v23i1.1369","url":null,"abstract":"Introduction In outpatients, the World Health Organization recommends that the urine Alere Determine-tuberculosis lipoarabinomannan (AlereLAM) should be used to support the diagnosis of tuberculosis (TB) in people living with HIV (PLHIV) with CD4 counts ≤ 100 cells/µL or with signs of being ‘seriously ill’. There is a risk of a false-positive AlereLAM in disseminated non-tuberculous mycobacterial (NTM) infections and it may be difficult to differentiate a single infection (either Mycobacterium tuberculosis or NTM) from dual infection. Patient presentation We report three patients, enrolled in an operational study assessing AlereLAM use in an outpatient setting, who had advanced HIV (all CD4 < 20 cells/µL) and strongly positive (grade 4+) AlereLAM results in whom Mycobacterium avium or kansasii were later cultured from blood or urine and sputum. Management and outcome Based on positive AlereLAM results, all three were initiated on TB treatment. One died before NTM infection was detected. Two were managed for dual infection (TB and NTM) but died within two years. Conclusion Tuberculosis remains a leading cause of death and a disproportionate number of these deaths occur in PLHIV. Tuberculous treatment should be initiated based on a positive AlereLAM result, and this should be followed by additional testing to confirm the diagnosis of TB and to obtain drug susceptibility results. In those not responding to TB treatment where the only positive result was an AlereLAM, an alternative or additional diagnosis of NTM infection should be considered, particularly in patients with a very low CD4 count.","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2022-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41754046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}