Southern African journal of HIV medicine最新文献

{"title":"Causes of death in adults living with HIV in South Africa: A single-centre postmortem study.","authors":"Tanvier Omar, Nadia Sabet, Alistair Calver, Gajendra Chita, Lucas E Hermans, Willem D F Venter, Adriaan Basson, Monique Nijhuis, Annemarie Wensing, Neil Martinson, Maria Papathanasopoulos, Ebrahim Variava","doi":"10.4102/sajhivmed.v26i1.1673","DOIUrl":"10.4102/sajhivmed.v26i1.1673","url":null,"abstract":"<p><strong>Background: </strong>Mortality among people living with HIV (PLWH) in developing settings remains elevated, despite high coverage with antiretroviral therapy (ART), with 70% - 80% being virally suppressed (VS).</p><p><strong>Objectives: </strong>This study aimed to determine cause-specific mortality in PLWH in South Africa.</p><p><strong>Method: </strong>An autopsy study with detailed medical record review was undertaken in PLWH dying in hospital. Minimally invasive autopsies were performed on 38 VS and 21 unsuppressed PLWH (≥ 18 years) dying in hospital between May 2018 and April 2022. We assessed clinical and histological findings to determine underlying, contributing, and immediate causes of death (CODs).</p><p><strong>Results: </strong>Median CD4 counts were 180 and 42 cells/mm³ in patients with and without VS respectively. Leading immediate CODs in both VS and unsuppressed PLWH were respiratory failure, sepsis, and septic shock; leading contributing CODs in decreasing order of frequency in both groups were acute kidney injury (AKI), bacterial pneumonia, immunological failure, gastroenteritis and current tuberculosis. Leading underlying CODs in both groups were hypertension, current tuberculosis, malignancies, and chronic obstructive pulmonary disease. VS was associated with lower risk of septic shock and AKI.</p><p><strong>Conclusion: </strong>VS on ART appeared to reduce risk of death from specific pathologies. However, infections, multi-organ failure, non-AIDS-defining malignancies, and metabolic diseases remain important CODs. Incomplete immune reconstitution appears to be a key contributor to premature death.</p>","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"26 1","pages":"1673"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HIV viral suppression after enhanced adherence counselling in children on dolutegravir-based regimens in Malawi.","authors":"Lucky Makonokaya, Maggie Khumbanyiwa, Louiser U Kalitera, Rachel Chamanga, Shalom Dunga, Lilian Jiah, Elton Masina, Nilesh B Bhatt, Thulani Maphosa","doi":"10.4102/sajhivmed.v26i1.1692","DOIUrl":"10.4102/sajhivmed.v26i1.1692","url":null,"abstract":"<p><strong>Background: </strong>Viral suppression (VS) rates in children on antiretroviral therapy (ART) are lower than in adults. We described the effect of enhanced adherence counselling (EAC) on VS among children with high HIV viral load accessing dolutegravir (DTG)-based ART in a programme setting in Malawi.</p><p><strong>Objectives: </strong>This study evaluated the proportion of children with high viral load on DTG-based ART who re-suppressed following EAC and factors associated with VS post-EAC.</p><p><strong>Method: </strong>We included all patients aged < 15 years with a high viral load result (> 1000 copies/mL) after taking DTG-based ART for at least 6 months between January 2022 and March 2023, covering 104 healthcare facilities in Malawi. Descriptive statistics summarised the distribution of demographic and clinical characteristics. Multivariable logistic regression determined the factors associated with VS following EAC.</p><p><strong>Results: </strong>Overall, 1475 participants were enrolled; 884 (59.9%) were aged 10-14 years. A total of 1448 (98.2%) were enrolled in EAC, of whom 787 (54.3%), 308 (21.3%), and 353 (24.4%) completed three, two, and one session(s), respectively. Follow-up HIV viral load results were available for 1091 (74%) participants enrolled in EAC, and 782 (71.7%) achieved VS. Patients from urban areas were less likely to achieve VS post-EAC than those from rural areas (adjusted odds ratio [aOR]: 0.58, 95% confidence interval [CI]: 0.42-0.80).</p><p><strong>Conclusion: </strong>Nearly three-quarters of children with high viral load on DTG-based regimens achieved VS following EAC. Further research on the other contributors of virologic failure among children in Malawi is required.</p>","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"26 1","pages":"1692"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longer-term virologic outcomes on tenofovir-lamivudine-dolutegravir in second-line ART.","authors":"Jennifer K van Heerden, Ying Zhao, Claire M Keene, Rulan Griesel, Zaayid Omar, René Goliath, Kayla Delaney, Gert van Zyl, Gary Maartens, Graeme Meintjes","doi":"10.4102/sajhivmed.v26i1.1677","DOIUrl":"https://doi.org/10.4102/sajhivmed.v26i1.1677","url":null,"abstract":"<p><strong>Background: </strong>Dolutegravir in second-line antiretroviral therapy (ART) is more effective with recycled tenofovir than switching to zidovudine. However, dolutegravir resistance is more frequent in second-line compared to first-line ART.</p><p><strong>Objectives: </strong>We report long-term virologic outcomes from a clinical trial.</p><p><strong>Method: </strong>AntiRetroviral Therapy In Second-line: investigating Tenofovir-lamivudine-dolutegravir (ARTIST) was a randomised, double-blind, phase II clinical trial. Eligible participants had two consecutive HIV-1 RNA ≥ 1000 copies/mL on first-line ART, mostly tenofovir-emtricitabine-efavirenz. Participants were switched to tenofovir-lamivudine-dolutegravir (TLD) with lead-in 50 mg dolutegravir twice daily in stage one (<i>n</i> = 62), and randomised to TLD with additional lead-in 50 mg dolutegravir or placebo for the first 14 days in stage two (<i>n</i> = 130). We present results up to 158 weeks, combining stages one and two.</p><p><strong>Results: </strong>We enrolled 192 participants: 127/176 (72%) had resistance (Stanford score ≥ 15) to both tenofovir and lamivudine. At week 48, 151/186 (81%; 95% confidence interval [CI] 75%, 87%) had HIV-1 RNA < 50 copies/mL. Of 127 participants with follow-up through week 158, 78% (95% CI 70%, 85%) maintained HIV-1 RNA < 50 copies/mL, 11% had HIV-1 RNA 50-999 copies/mL, and 11% had HIV-1 RNA ≥ 1000 copies/mL. Twenty-nine participants met criteria for resistance testing: one developed intermediate-level dolutegravir resistance (G118R mutation) at week 96, and one had high-level dolutegravir resistance (E138K, G118R, G163R, T66A mutations) detected at week 146.</p><p><strong>Conclusion: </strong>Among adults switching to TLD with detectable HIV-1 RNA and substantial tenofovir and lamivudine resistance, a high proportion maintained virologic suppression up to 158 weeks. Emergent dolutegravir resistance occurred in ~1% of participants after 2-3 years on second-line TLD.</p>","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"26 1","pages":"1677"},"PeriodicalIF":0.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-reported HIV testing and treatment among migrants from northeast South Africa: A cross-sectional, population-based analysis.","authors":"Rachel R Yorlets, F Xavier Goméz-Olivé, Carren Ginsburg, Sadson Harawa, Kathleen Kahn, Stephen Tollman, Mark Collinson, Mark Lurie","doi":"10.4102/sajhivmed.v26i1.1666","DOIUrl":"https://doi.org/10.4102/sajhivmed.v26i1.1666","url":null,"abstract":"","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"26 1","pages":"1666"},"PeriodicalIF":0.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and facilitators of HIV treatment services among men who have sex with men during COVID-19 lockdown.","authors":"Betty Sebati, Edith Phalane, Amukelani Bilankulu, Refilwe N Phaswana-Mafuya","doi":"10.4102/sajhivmed.v26i1.1670","DOIUrl":"https://doi.org/10.4102/sajhivmed.v26i1.1670","url":null,"abstract":"<p><strong>Background: </strong>The provision of HIV treatment services was severely impacted by the COVID-19 pandemic and the subsequent lockdown measures, particularly among men who have sex with men (MSM), a population disproportionately affected by HIV.</p><p><strong>Objectives: </strong>To explore the service providers' perspectives on the barriers and facilitators of the HIV treatment services during the COVID-19 lockdown in Capricorn District, Limpopo province.</p><p><strong>Method: </strong>The study followed an exploratory design and was conducted in Capricorn District in Limpopo province. A purposive sample of 10 HIV treatment service providers were included in the study. An interview guide was developed using the Consolidated Framework for Implementation Research (CFIR) domains and associated constructs. The transcribed qualitative data were captured and analysed on Atlas.ti version 24.</p><p><strong>Results: </strong>The barriers included fear of COVID-19 transmission, movement restrictions during the initial phase of the lockdown period, target-driven performance pressure, lack of mobile clinics, and understaffing. The facilitators included teamwork among the various stakeholders in the programme, tailoring strategies to reach more MSM, partnerships and connections with the Department of Health and other relevant organisations.</p><p><strong>Conclusion: </strong>The study revealed that the tailoring of the MSM programme facilitated access to HIV treatment services during COVID-19.</p>","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"26 1","pages":"1670"},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tracking viral control in adolescents on antiretroviral therapy in Lusaka, Zambia: A retrospective cohort analysis.","authors":"Kaala Moomba, Talitha Crowley, Brian van Wyk","doi":"10.4102/sajhivmed.v26i1.1665","DOIUrl":"https://doi.org/10.4102/sajhivmed.v26i1.1665","url":null,"abstract":"<p><strong>Background: </strong>In 2023, an estimated 39.9 million people globally were living with HIV, of which 1.55 million were adolescents aged 10-19 years. The 2021 Zambia HIV Impact Assessment revealed lower viral suppression rates in adolescents (15-24 years old) compared to adults on antiretroviral therapy (ART). Lusaka District, Zambia, has the highest number of adolescents on ART, with a 15.1% HIV prevalence in 2018.</p><p><strong>Objectives: </strong>To determine the prevalence and factors associated with viral suppression among adolescents living with HIV (10-19 years) on ART in Lusaka District, Zambia.</p><p><strong>Method: </strong>A retrospective cohort analysis was done of 3409 adolescents on ART at public health facilities in Lusaka from January 2023 to December 2023, and who had viral loads recorded. Socio-demographic, clinical, treatment and behavioural data were extracted from electronic health records and analysed using SPSS version 29.</p><p><strong>Results: </strong>The adolescent cohort in Lusaka achieved 91.8% viral suppression rate (< 1000 copies/mL), with 79% fully suppressed (< 50 copies/mL). In multivariate analysis, older adolescents (15-19 years) had lower odds of suppression compared to younger adolescents (10-14 years) (adjusted odds ratio [AOR] = 1.79; confidence interval [CI] : 1.32-2.43). Higher odds of viral suppression were linked to first-line dolutegravir regimen (AOR = 5.12; CI: 3.23-8.11) and optimal adherence (AOR = 1.89; CI: 1.03-3.47), while regimen switches reduced the odds of viral suppression (AOR = 0.60; CI: 0.45-0.80).</p><p><strong>Conclusion: </strong>Zambia reached the previous UNAIDS 90-90-90 targets with a viral suppression rate of 91.8%. However, to reach the revised 95% target by 2030, tailored interventions should be implemented to improve adherence and retention in care, particularly for older adolescents.</p>","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"26 1","pages":"1665"},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reflexed cryptococcal antigenaemia detection rates in the Western Cape, South Africa.","authors":"Naseem Cassim, Manuel P da Silva, Lindi-Marie Coetzee","doi":"10.4102/sajhivmed.v26i1.1676","DOIUrl":"https://doi.org/10.4102/sajhivmed.v26i1.1676","url":null,"abstract":"<p><strong>Background: </strong>Reflexed cryptococcal antigenaemia (CrAg) testing has been offered on remnant CD4 specimens with a count < 100 cells/µL from 2017 in South Africa. The Western Cape is the only province to introduce CrAg testing for counts of 100 cells/µL to 200 cells/µL.</p><p><strong>Objectives: </strong>The objective of this study was to assess the reflexed CrAg detection rate in the Western Cape.</p><p><strong>Method: </strong>The retrospective analysis of laboratory data for reflexed CrAg testing was conducted between September 2022 and May 2024. The CrAg detection rate was reported for the following CD4 categories at the provincial, district, and sub-district levels: (1) < 100 cells/µL, (2) ≥ 100 cells/µL - ≤ 200 cells/µL, and (3) ≤ 200 cells/µL.</p><p><strong>Results: </strong>Data are reported for 80 809 specimens, with a CrAg detection rate of 4.0% for a CD4 ≤ 200 cells/µL compared to 6.2% for a count < 100 cells/µL. For a count of ≥ 100 cells/µL - ≤ 200 cells/µL, a CrAg detection rate of 2.1% was reported. The district CrAg detection rate for counts ≤ 200 cells/µL ranged from 1.4% (Central Karoo) to 5.9% (Cape Winelands). Excluding subdistricts without CrAg-positive specimens, the detection rate ranged from 1.3% (Beaufort West) to 8.3% (Swartland).</p><p><strong>Conclusion: </strong>The study findings of a CrAg detection rate of 4.0% in the Western Cape province justifies their decision to extend reflexed screening to a threshold of 200 cells/µL. However, most CrAg-positive specimens were identified for a count < 100 cells/µL. Intensified approaches to find CrAg-positive patients with a count ≤ 200 cells/µL are required.</p>","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"26 1","pages":"1676"},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid emergence of dolutegravir resistance on second-line dolutegravir-based ART.","authors":"Kirusha Naidoo, Richard J Lessells, Jienchi Dorward, Mahomed Y S Moosa, Yukteshwar Sookrajh, Pravi Moodley, Paul K Drain, Nigel Garrett","doi":"10.4102/sajhivmed.v26i1.1701","DOIUrl":"https://doi.org/10.4102/sajhivmed.v26i1.1701","url":null,"abstract":"<p><p>The integrase strand transfer inhibitor, dolutegravir (DTG), is widely used in first- and second-line antiretroviral therapy (ART) regimens in South Africa. We describe an adult with virological failure on second-line tenofovir/lamivudine/dolutegravir (TLD2) and rapid emergence of DTG resistance within 3 months, while receiving rifapentine-based tuberculosis preventive therapy.</p>","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"26 1","pages":"1701"},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delivery models of HIV pre-exposure prophylaxis and their influence on uptake in South Africa: An integrative review.","authors":"Junior M Ntimani, Andile G Mokoena-de Beer, Deliwe R Phetlhu","doi":"10.4102/sajhivmed.v26i1.1684","DOIUrl":"https://doi.org/10.4102/sajhivmed.v26i1.1684","url":null,"abstract":"<p><strong>Background: </strong>Maximising the use of HIV pre-exposure prophylaxis (PrEP) is crucial to eliminate new HIV transmissions, especially in high-prevalence areas such as South Africa. Strengthening access and acceptability of PrEP is essential for effective HIV prevention and to ensure sufficient uptake among those at risk.</p><p><strong>Objectives: </strong>This review aims to explore the existing PrEP delivery models in the South African public health settings and their influence on its uptake.</p><p><strong>Method: </strong>An integrative review approach was followed and electronic databases, namely PubMed, Medline, EBSCOhost, and Google Scholar, were searched. We selected qualitative and quantitative studies that focused on South Africa, written in English, and were published in peer-reviewed journals between 2016 and 2024.</p><p><strong>Results: </strong>Two distinct models were identified, namely the health facility-based model and the community-based model which is inclusive of the use of pharmacies. Both models have constraints and facilitators that impact on access and acceptability, thus influencing uptake.</p><p><strong>Conclusion: </strong>Decentralisation as a means to ensure access, and awareness to facilitate acceptability, are critical drivers of the PrEP service's success. Therefore, it is critical to develop intervention strategies that focus on access and acceptability among the target population, driven by the need to overcome barriers and ensure sustainability.</p>","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"26 1","pages":"1684"},"PeriodicalIF":0.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Southern African HIV Clinicians Society guideline on pre-exposure prophylaxis to prevent HIV.","authors":"Pippa Macdonald, Gonasagrie Nair, Camilla Wattrus, Saiqa Mullick, Melanie Pleaner, Elzette Rousseau, Hasina Subedar, Dvora Joseph-Davey, Johan Hugo, Sinead Delany-Moretlwe, Linda-Gail Bekker","doi":"10.4102/sajhivmed.v26i1.1713","DOIUrl":"https://doi.org/10.4102/sajhivmed.v26i1.1713","url":null,"abstract":"","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"26 1","pages":"1713"},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}