Southern African Journal of Hiv Medicine最新文献

{"title":"An unusual case of abdominal mycobacterial infection: Case report and literature review","authors":"P. Ekermans, Rene de Gama, C. Kock, E. Hoosien, T. Slavik, T. Marshall, Craig Corcoran, J. van Ingen","doi":"10.4102/sajhivmed.v20i1.993","DOIUrl":"https://doi.org/10.4102/sajhivmed.v20i1.993","url":null,"abstract":"This article presents a case of an HIV-infected paediatric patient with an unusual Mycobacterium genavense infection with predominantly abdominal organ involvement.","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2019-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44922247","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":"Disclosure of human immunodeficiency virus status to children in South Africa: A comprehensive analysis","authors":"S. V. van Elsland, R. Peters, C. Grobbelaar, Patiswa Ketelo, M. Kok, M. Cotton, A. M. V. van Furth","doi":"10.4102/sajhivmed.v20i1.884","DOIUrl":"https://doi.org/10.4102/sajhivmed.v20i1.884","url":null,"abstract":"Background The extent of disclosure of HIV status to children and adolescents and the context facilitating their disclosure process have received little attention. Objectives To assess disclosure and provide a comprehensive analysis of characteristics associated with disclosure to children (3–14 years) receiving antiretroviral treatment in a South African semi-urban clinic. Methods This cross-sectional study used structured interview administered questionnaires which were supplemented with medical record data. Predictors included child, caregiver, clinical and socio-economic characteristics, viral suppression, immune response, adherence, health-related quality of life and family functioning. Results We included 190 children of whom 45 (23.7%) received disclosure about their HIV status, of whom 28 (14.7%) were partially disclosed and 17 (8.9%) were fully disclosed. Older age of the child and higher education of the caregiver were strongly associated with disclosure. Female caregivers, detectable viral load, syrup formulation, protease inhibitor (PI) regimens with stavudine and didanosine, and self-reported non-adherence were strongly associated with non-disclosure. Conclusion When children do well on treatment, caregivers feel less stringent need to disclose. Well-functioning families, higher educated caregivers and better socio-economic status enabled and promoted disclosure. Non-disclosure can indicate a sub-optimal social structure which could negatively affect adherence and viral suppression. There is an urgent need to address disclosure thoughtfully and proactively in the long-term disease management. For the disclosure process to be beneficial, an enabling supportive context is important, which will provide a great opportunity for future interventions.","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2019-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48218987","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":"Measles in adults: A comparison of hospitalised HIV-infected and HIV-uninfected patients.","authors":"Nina E Diana, Charles Feldman","doi":"10.4102/sajhivmed.v20i1.877","DOIUrl":"10.4102/sajhivmed.v20i1.877","url":null,"abstract":"<p><strong>Background: </strong>Although measles is traditionally a childhood illness, there are an increasing number of adult cases. Despite both measles and HIV infection being endemic in sub-Saharan Africa, there are little data regarding outcomes in co-infected patients.</p><p><strong>Objectives: </strong>Compare demographic, clinical, laboratory and radiographic features, as well as outcome (length of hospital stay, complications and mortality) between HIV-infected and HIV-uninfected adult patients admitted with confirmed measles.</p><p><strong>Methods: </strong>We conducted a retrospective record review of adult patients with confirmed measles who were admitted to the Infectious Diseases Unit at the Charlotte Maxeke Johannesburg Academic Hospital during the peak of the 2009 and 2010 South African measles outbreak. The data collected included demographic, clinical and laboratory parameters, as well as outcomes.</p><p><strong>Results: </strong>Of the 33 confirmed measles cases admitted, 24 patients were tested for HIV infection and 18 tested seropositive. There were no significant differences in the demographics, clinical findings or laboratory data when comparing the HIV-positive and HIV-negative cases. Serious clinical manifestations were seen more frequently in HIV-positive patients (odds ratio [OR] 5, 95% confidence interval [CI] 0.48-51.8, <i>p</i> = 0.34). One of the six patients testing HIV-negative developed pneumonia, while six of the 18 HIV-positive patients had a course complicated by pneumonia. Five of these HIV-positive patients required admission to the intensive care unit, three developing respiratory failure necessitating mechanical ventilation. HIV-positive patients had several other manifestations, including acute kidney injury, purulent conjunctivitis, pancreatitis and encephalitis. HIV-positive patients had a significantly longer hospital stay (<i>p</i> = 0.03). There were three deaths in the HIV-positive group, but none in the HIV-negative group (OR 2.9, 95% CI 0.13-65.3, <i>p</i> = 0.55).</p><p><strong>Conclusion: </strong>Our study provides data on the largest series of hospitalised adults infected with HIV and co-infected with measles. More severe consequences seemed to occur in hospitalised HIV-positive patients.</p>","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":"1 1","pages":"877"},"PeriodicalIF":1.6,"publicationDate":"2019-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11466014/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70338918","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":"Adherence to combination antiretroviral therapy among orphaned children in Dar es Salaam, Tanzania","authors":"S. Mugusi, Nassoro Mopei, O. Minzi","doi":"10.4102/sajhivmed.v20i1.954","DOIUrl":"https://doi.org/10.4102/sajhivmed.v20i1.954","url":null,"abstract":"Background Adherence to combination antiretroviral therapy (cART) among HIV-infected children is often complicated by various factors including medication formulation, dosing frequency, drug toxicities, age and developmental stage, psychosocial and behavioural characteristics of both children and caregivers and can additionally be complicated by being an orphan. Objectives This study was aimed at determining the factors and the extent of their influence on cART adherence among HIV-infected orphaned children attending Care and Treatment Centres (CTCs) in Dar es Salaam, Tanzania. Methods A cross-sectional study was performed, which assessed adherence in HIV-positive orphaned children aged 2–14 years receiving nevirapine (NVP) based cART for at least 6 months. Data was collected using questionnaires administered to primary caregivers of HIV-infected orphaned children, the review of medical files, and the laboratory measurement of NVP plasma concentrations and CD4 counts. Adherence to cART was determined based on caregivers’ self-report, consistency of clinic attendance and NVP plasma concentrations. Results Among the 216 enrolled orphaned children, adherence to cART was found to be 79.6%, 82.9% and 72.2% respectively based on caregivers’ self-report, clinic attendance and NVP plasma levels. Significant reductions in NVP concentrations (< 3 µg/mL) were seen among children with poor immunological outcomes, poor clinic attendance (p < 0.05) and were suggested by caregivers’ self-reported adherence (p = 0.06). Adherence challenges identified by caregivers included financial constraints (87.5%), lengthy waiting times at clinics (75.5% spent > 2 h at the clinic) and low HIV knowledge among caregivers. Conclusion Significant numbers of HIV-infected orphans have poor adherence to cART ranging between 17% and 28% based on different assessment methods. Inadequate caregiver knowledge of HIV/AIDS, long clinic waiting times and forgetfulness were identified as barriers to cART adherence in these orphans.","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2019-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47001016","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":"A descriptive analysis of the role of a WhatsApp clinical discussion group as a forum for continuing medical education in the management of complicated HIV and TB clinical cases in a group of doctors in the Eastern Cape, South Africa","authors":"Joana Woods, Michelle A. Moorhouse, Lucia Knight","doi":"10.4102/sajhivmed.v20i1.982","DOIUrl":"https://doi.org/10.4102/sajhivmed.v20i1.982","url":null,"abstract":"Background As South Africa’s (SA) HIV programme increases in size, HIV/TB cases occur that are often beyond the clinical scope of primary healthcare clinicians. In SA’s Eastern Cape (EC) province, health facilities are geographically widespread, with a discrepancy in specialist availability outside of academic institutions. The aim of this study is to describe WhatsApp and its use as an alternative learning tool to improve clinicians’ access to specialised management of complicated HIV/TB cases. Objectives To analyse clinicians’ use of the WhatsApp chat group as a learning tool; to assess clinicians’ confidence in managing complicated HIV and TB patients after participating in the WhatsApp case discussion group; to describe the perceived usefulness of the chat group as a learning tool; to understand clinicians’ knowledge and use of informed consent when sharing patient case details on a public platform such as WhatsApp. Method An observational, cross-sectional study was conducted among a group of clinicians from the EC that formed part of a WhatsApp HIV/TB clinical discussion group. Data were collected using a structured anonymous Internet questionnaire and analysed with Epi Info, using descriptive and analytic statistics. Results The analysis found the majority of participants had gained new clinical confidence from group participation. This was associated with the increased group engagement in group follow-up (odds ratio [OR] 48.13 [95% confidence interval [CI] 4.99–464.49]); in posting questions (OR 3.81 [95% CI 1.02–18.48]); in reports of ‘new’ clinical insights (OR 23.75 [95% CI 3.95–142.88]); in referencing old case material (OR 21.42 [95% CI 4.39–104.84]) and in the use of peer guidance to manage cases (OR 48.13 [95% CI 4.99–464.49]). However, there was a discrepancy in participants’ knowledge and actual use of informed consent when posting patient details on social media. Conclusions Our study findings support the use of WhatsApp in a medical setting as an effective means of communication, long distance learning and support between peers and specialists.","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42258420","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":"Rapid emergence of resistance to antiretroviral treatment after undisclosed prior exposure: A case report","authors":"T. Rossouw, G. van Dyk, G. V. van Zyl","doi":"10.4102/sajhivmed.v20i1.965","DOIUrl":"https://doi.org/10.4102/sajhivmed.v20i1.965","url":null,"abstract":"Introduction Patients who disengaged from care may present as therapy naïve for antiretroviral treatment (ART) initiation at a different site, without being recognised as being at an increased risk of rapid treatment failure and HIV drug resistance. Patient presentation A 43-year-old woman, who gave no prior history of ART, was initiated on a standard first-line regimen of TDF, FTC and EFV. She had a poor response to treatment with evidence of treatment failure at 12 months. Management and outcome HIV-1 drug resistance tests showed no pre-treatment HIVDR mutations, but revealed high-level drug resistance to all component drugs at 12 months. On investigation, viral load (VL) was recorded in 2012 and 2013, providing evidence of prior ART use. Conclusion Linkage of patient therapy and laboratory information to unique patient identifiers may allow health-care workers to identify patients who previously received ART and disengaged from care. This will enable differentiated care when these patients reinitiate ART, which should involve expedited VL testing and more rapid transition to definitive second-line ART.","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2019-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46145083","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":"Baseline CD4 and mortality trends in the South African human immunodeficiency virus programme: Analysis of routine data","authors":"R. Lilian, K. Rees, M. Mabitsi, J. McIntyre, H. Struthers, R. Peters","doi":"10.4102/sajhivmed.v20i1.963","DOIUrl":"https://doi.org/10.4102/sajhivmed.v20i1.963","url":null,"abstract":"Background Despite widespread availability of antiretroviral therapy (ART) in South Africa, there remains a considerable burden of human immunodeficiency virus (HIV)-related morbidity and mortality. Objectives To describe ART initiation and outcome trends over time, with a focus on clients presenting with advanced HIV-infection, so as to identify interventions to reduce morbidity and mortality. Methods Routine TIER.Net data from HIV-infected adults who had a documented baseline CD4 count and were newly initiating ART in Johannesburg or Mopani districts from 2004 to 2017 were analysed. Trends in baseline CD4 count and 5-year mortality were investigated and the population initiating ART with CD4 < 200 cells/mm3 was described. Results The Johannesburg and Mopani data sets comprised 203 131 and 101 814 records, respectively. Although median CD4 count increased over time, the proportion of initiations at CD4 < 200 cells/mm3 in 2017 remained high (Johannesburg 39%, Mopani 35%). Mortality was significantly increased among clients with CD4 < 200 compared to those with higher baseline counts (p < 0.001). Even though mortality among clients with low CD4 declined over time, likely because of improved drug regimens, in 2016–2017 mortality was still significantly increased among these clients (p < 0.001). Delivery of cotrimoxazole prophylaxis to clients with low CD4 declined over time to < 30% in 2017 and was associated with clinical stage. Presentation with CD4 < 200 cells/mm3 was associated with older age, male gender and hospitalisation. Conclusion A concerningly large proportion of South Africans still initiate ART at low CD4 counts. This is associated with increased mortality and requires targeted interventions to improve delivery of prophylactic regimens and early engagement in care.","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2019-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43391611","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":"Outcomes of Stevens–Johnson syndrome and toxic epidermal necrolysis in HIV-infected patients when using systemic steroids and/or intravenous immunoglobulins in Pietermaritzburg, South Africa","authors":"A. Chateau, N. Dlova, H. Dawood, C. Aldous","doi":"10.4102/sajhivmed.v20i1.944","DOIUrl":"https://doi.org/10.4102/sajhivmed.v20i1.944","url":null,"abstract":"Background Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe life-threatening mucocutaneous reactions. There is an ongoing controversy regarding the use of systemic corticosteroids and intravenous immunoglobulin (IVIG) in SJS/TEN and their utility in HIV-infected patients. Objectives The objective was to assess the outcome of a combination of intensive supportive care with oral corticosteroids in SJS and a combination of systemic steroids and IVIG for 3 consecutive days in HIV-infected patients with TEN. In addition, we assessed management in a general dermatology ward without implementing wound debridement. Methods This was a retrospective cohort study of 36 HIV-infected adults with SJS/TEN admitted to a tertiary dermatology unit between 1st January 2010 and 31st July 2011. Standard-of-care protocols included identification and elimination of the possible causative drug, meticulous wound care without debridement, initiation of oral prednisone (1 mg/kg/day) on admission for 3 consecutive days, and the addition of IVIG (1 g/kg/day) for 3 consecutive days to those with TEN. Results Of the 36 patients in the study, 32 were female. Nevirapine was the commonest drug implicated. A diagnosis of tuberculosis did not increase the case fatality rate. Complications included infections, anaemia, drug-induced hepatitis, ocular involvement, renal impairment, deep vein thrombosis, respiratory distress, Leucopenia, gastritis and hypernatremia. The overall survival rate was 97%. Conclusion HIV-infected SJS and TEN patients were treated in a tertiary dermatology ward with a treatment plan of skin care, and a combination of systemic corticosteroids and IVIG respectively had a survival rate of 97%.","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2019-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4102/sajhivmed.v20i1.944","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47316571","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":"Factors influencing the confidence and knowledge of nurses prescribing antiretroviral treatment in a rural and urban district in the Western Cape province","authors":"Deborah J. Solomons, A. S. van der Merwe, T. Esterhuizen, Talitha Crowley","doi":"10.4102/sajhivmed.v20i1.923","DOIUrl":"https://doi.org/10.4102/sajhivmed.v20i1.923","url":null,"abstract":"Background Since the introduction of nurse-initiated and managed antiretroviral treatment (NIMART) in South Africa in 2010, initiation of antiretroviral therapy (ART) in primary care has become the responsibility of nurses. The continued success of this approach is dependent on factors such as adequate training and effective support systems. Objectives This study aimed to investigate factors influencing the knowledge and confidence of professional nurses in managing patients living with human immunodeficiency virus (HIV) in primary healthcare settings in a rural and urban district in the Western Cape. Methods A cross-sectional survey was conducted amongst 77 NIMART-trained nurses from 29 healthcare facilities to measure demographic details, influencing factors, HIV management confidence and HIV management knowledge. Results The majority of participants had adequate HIV management knowledge and reported being very confident or expert in the HIV management skills or competencies. Participants trained recently on local guidelines (Practical Approach to Care Kit) (3 years ago or less) had significantly higher knowledge scores. Regular feedback about clinic and personal performance was associated with higher HIV management knowledge. Participants who received NIMART mentoring over a period of 2 weeks had a higher mean confidence score compared to other periods of mentoring. A higher caseload of patients living with HIV was also associated with higher knowledge and confidence. Conclusion Training, mentorship and clinical practice experience are associated with knowledge and confidence. Recommendations include the strengthening of current training and mentoring and ensuring that NIMART-trained nurses are provided with regular updates and sufficient opportunities for clinical practice.","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2019-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45913933","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":"A case report of untreatable HIV infection in Harare, Zimbabwe","authors":"C. Chimbetete, Linda Chirimuta, M. Pascoe, O. Keiser","doi":"10.4102/sajhivmed.v20i1.885","DOIUrl":"https://doi.org/10.4102/sajhivmed.v20i1.885","url":null,"abstract":"Introduction Zimbabwe, like other resource limited countries, manages HIV infection using the public health approach with standard antiretroviral therapy (ART) regimens for first, second and third-line treatment. Third-line ART is the last available treatment option and is based on dolutegravir and darunavir use after HIV drug resistance testing. Patient Presentation We report here a 17-year-old patient on dolutegravir (DTG) and Darunavir based third-line antiretroviral therapy (ART) previously exposed to raltegravir who develops multidrug resistance HIV to the four ART classes available in Zimbabwe. Management and Outcome A trophism assay revealed that patient has CXCR4 trophic virus and hence will not benefit from Maraviroc. Patient is currently stable and receiving a holding regimen of abacavir, lamivudine and lamivudine. Conclusion This is the first documented case of multiclass resistance to the four available ART classes in Zimbabwe. The development and transmission of multiclass HIV drug resistance in resource limited settings has potential to undo the gains of national ART programs. There is need to ensure optimum adherence to ART even in the era of DTG.","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2019-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4102/sajhivmed.v20i1.885","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43342859","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}