Southern African journal of HIV medicine最新文献

{"title":"Southern African HIV Clinicians Society Guideline for the clinical management of syphilis.","authors":"Remco P H Peters, Jeremy S Nel, Eitzaz Sadiq, Tendesayi Kufa, Derrick P Smit, Gillian Sorour, Nigel Garrett, Katherine Gill, Lehlohonolo Makhakhe, Nomathemba C Chandiwana, Neil F Moran, Karen Cohen, Camilla Wattrus, Mahomed Yunus Moosa","doi":"10.4102/sajhivmed.v25i1.1577","DOIUrl":"10.4102/sajhivmed.v25i1.1577","url":null,"abstract":"<p><p>Syphilis, 'the great imitator', caused by <i>Treponema pallidum</i> infection, remains a complex and multifaceted disease with a rich history of clinical diversity. This guideline aims to be a comprehensive guide for healthcare workers in Southern Africa, offering practical insights into the epidemiology, pathogenesis, clinical manifestations, diagnostic testing, therapeutic principles, and public health responses to syphilis. Although the syphilis burden has declined over the years, recent data indicate a troubling resurgence, particularly among pregnant women and neonates. This guideline highlights the diagnostic challenges posed by syphilis, stemming from the absence of a single high-sensitivity and -specificity test. While treatment with penicillin remains the cornerstone of treatment, alternative regimens may be used for specific scenarios. We highlight the importance of thorough patient follow-up and management of sex partners to ensure optimal care of syphilis cases. In the context of public health, we emphasise the need for concerted efforts to combat the increasing burden of syphilis, especially within high-risk populations, including people living with HIV.</p>","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"25 1","pages":"1577"},"PeriodicalIF":0.0,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11079416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140900783","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":"Virologic outcomes with tenofovir-lamivudine-dolutegravir in adults failing PI-based second-line ART.","authors":"Ying Zhao, Jacqueline Voget, Isaac Singini, Zaayid Omar, Vanessa Mudaly, Andrew Boulle, Gary Maartens, Graeme Meintjes","doi":"10.4102/sajhivmed.v25i1.1567","DOIUrl":"10.4102/sajhivmed.v25i1.1567","url":null,"abstract":"<p><strong>Background: </strong>In South African antiretroviral guidelines, selected patients failing second-line protease inhibitor (PI)-based therapy qualify for genotypic resistance testing - those with PI resistance receive darunavir-based third-line regimens; those without PI resistance continue current regimen with adherence support. The Western Cape province, from September 2020, implemented a strategy of tenofovir-lamivudine-dolutegravir (TLD) for patients, provided there was no tenofovir resistance, irrespective of PI resistance.</p><p><strong>Objectives: </strong>To evaluate virologic outcomes with TLD among adults failing second-line PI regimens with no tenofovir resistance.</p><p><strong>Method: </strong>An observational cohort study comparing outcomes in patients switched to TLD with those continuing the same PI or switched to darunavir-based regimens. Follow-up was until virologic suppression (HIV-1 RNA < 400 copies/mL), or at the point of censoring.</p><p><strong>Results: </strong>One hundred and thirty-three patients switched to TLD, 101 to darunavir-based regimens, and 121 continued with the same PI. By 12 months, among patients with PI resistance, 42/47 (89%) in the TLD group had HIV-1 RNA < 400 copies/mL compared to 91/99 (92%) in the darunavir group (hazard ratio, 1.11; 95% confidence interval, 0.77-1.60). In patients without PI resistance, 66/86 (77%) in the TLD group had HIV-1 RNA < 400 copies/mL compared to 42/120 (35%) in those continuing with the same PI (hazard ratio, 4.03; 95% confidence interval, 2.71-5.98). Two patients receiving TLD developed virologic failure with high-level dolutegravir resistance.</p><p><strong>Conclusion: </strong>Amongst patients failing second-line PI with no PI resistance, switching to TLD was associated with higher virologic suppression, likely due to improved adherence. Virologic outcomes were similar in patients with PI resistance switched to darunavir-based regimens or TLD.</p>","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"25 1","pages":"1567"},"PeriodicalIF":0.0,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11079356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140900784","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":"Trends in body mass index in the pre-dolutegravir period in South Africa","authors":"F. van Ginkel, Roos B Barth, H. Tempelman, Kerstin Klipstein-Grobusch, D. Grobbee, Karine Scheuermaier, Francois W.D. Venter, Alinda G. Vos-Seda","doi":"10.4102/sajhivmed.v25i1.1523","DOIUrl":"https://doi.org/10.4102/sajhivmed.v25i1.1523","url":null,"abstract":"Background: Antiretroviral therapy (ART) is associated with weight gain, but this has been shown to be more marked with dolutegravir and other integrase strand transfer inhibitors.Objectives: We studied weight gain in people living with HIV (PLWH) on ART compared to the general population in the period before dolutegravir was introduced in a rural South African cohort.Method: Longitudinal analysis of the Ndlovu Cohort Study including 36–48 months’ follow-up data. From 2014 to 2019, data were collected annually in Limpopo, rural South Africa. Linear mixed models using HIV status, demographics, ART use and cardiovascular risk factors were used to estimate trends in body mass index (BMI) over time.Results: In total, 1518 adult, non-pregnant participants were included, of whom 518 were PLWH on ART (79.8%), 135 PLWH not yet on ART (20.2%) and 865 HIV-negative. HIV-negative participants had significantly higher BMIs than PLWH on ART at all study visits. There was a significant increase in BMI in all subgroups after 36 months (PLWH on ART, BMI +1.2 kg/m2, P  0.001; PLWH not on ART, BMI +1.8 kg/m2, P  0.001 and HIV-negative, BMI +1.3 kg/m2, P  0.001).Conclusion: The increase in BMI in PLWH and HIV-negative participants is a serious warning signal as obesity results in morbidity and mortality.","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"84 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140670273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of drug-induced liver injury in people with HIV treated for tuberculosis: 2024 update","authors":"Tom Boyles, Rebecca H. Berhanu, Neliswa Gogela, Hannah Gunter, T. Lovelock, Ndiviwe Mphothulo, Arifa Parker, Helena Rabie, Lauren Richards, P. Sinxadi, Camilla Wattrus, M. Moosa","doi":"10.4102/sajhivmed.v25i1.1558","DOIUrl":"https://doi.org/10.4102/sajhivmed.v25i1.1558","url":null,"abstract":"No abstract available.","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"34 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140361581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inflammatory mechanisms contributing to retinal alterations in HIV infection and long-term ART","authors":"Lungile M. Buthelezi, A. Munsamy, Kathutshelo P. Mashige","doi":"10.4102/sajhivmed.v25i1.1548","DOIUrl":"https://doi.org/10.4102/sajhivmed.v25i1.1548","url":null,"abstract":"People living with HIV (PLWH) may face an increased risk of eye complications associated with ageing, chronic inflammation, and the toxicity arising from long-term antiretroviral therapy (ART). This review aims to understand how inflammatory pathways contribute to retinal alterations observed in PLWH on long-term ART. This review was conducted using four electronic database searches, namely Scopus, Hinari, Google Scholar, and PubMed; from 1996 (when ART became available) until January 2022, without language restriction. Sources from clinical trials, meta-analyses, randomised controlled trials, and systematic reviews were used. Dysregulated para-inflammation (chronic inflammation) damages the blood-retina barrier, resulting in the altered retinal immune privilege and leading to the development of retinal and blood vessel changes. There is an interplay between the effects of the disease versus ART. ART causes mitochondrial toxicity, which affects the retinal ganglion cells and retinal pigment epithelium (RPE) due to oxidative stress. Infection by HIV also affects retinal microglia, which contributes to RPE damage. Both of these mechanisms affect the blood vessels. Assessing the integrity of the inner and outer blood-retina barrier is a pivotal point in pinpointing the pathogenesis of inner retinal alterations. Optical coherence tomography is a valuable tool to assess these changes. There is a paucity of research to understand how these structural changes may affect visual function, such as contrast sensitivity and colour vision.","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"111 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140379291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social support experiences of adolescents living with perinatal HIV in rural Limpopo, South Africa","authors":"R. A. Mabasa, L. Skaal, T. Mothiba","doi":"10.4102/sajhivmed.v25i1.1521","DOIUrl":"https://doi.org/10.4102/sajhivmed.v25i1.1521","url":null,"abstract":"","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":" 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140210017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of the COVID-19 pandemic on early infant diagnosis of HIV in Cape Town, South Africa","authors":"Hendrike Van Vollenhoven, E. Kalk, Stuart M. Kroon, Tafadzwa Maseko, F. Phelanyane, J. Euvrard, Lezanne Fourie, Nicolene Le Roux, P. Nongena","doi":"10.4102/sajhivmed.v25i1.1542","DOIUrl":"https://doi.org/10.4102/sajhivmed.v25i1.1542","url":null,"abstract":"Background: In South Africa, infants who are HIV-exposed are tested for HIV at birth and 10 weeks of age. The COVID-19 pandemic lockdown restrictions resulted in reduced access to healthcare services and uncertain impact on early infant HIV testing.Objectives: To describe the effects of the COVID-19 pandemic lockdown restrictions on early infant HIV testing and diagnosis in Cape Town, South Africa.Method: This retrospective cohort study compares HIV-exposed infants born during the first COVID-19 pandemic lockdown (2020) to those born in the same period the year before (2019). Laboratory and other data were abstracted from the Provincial Health Data Centre.Results: A total of 2888 infants were included: 1474 born in 2020 and 1413 in 2019. Compared to 2019, there was an increase in the 10-week HIV polymerase chain reaction (PCR) uptake in 2020 (71% vs. 60%, P 0.001). There was also an increase in the proportion of infants who demised without 10-week testing or were lost to follow-up in 2020 compared to 2019 (8% vs. 5%, P = 0.017). Differences detected in birth HIV PCR positivity rates between the two groups (1.1% vs. 0.5%, P = 0.17) did not reach statistical significance; however, a significant increase in vertical transmission of HIV by 10 weeks old was found in the 2020 cohort (1.2% vs. 0.5%. P = 0.046).Conclusion: Vertical transmission of HIV at 10 weeks increased in the Cape Town Metropolitan during the initial COVID-19 lockdown. There was also an increase in the proportion of deaths without testing by 10 weeks in the 2020 group.","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"269 10‐13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140233527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective review of maternal HIV viral load electronic gatekeeping codes in South Africa.","authors":"Siphesihle K Mahanjana, Tladi Ledibane, Gayle G Sherman, Tanya Y Murray, Ahmad F Haeri Mazanderani","doi":"10.4102/sajhivmed.v25i1.1539","DOIUrl":"10.4102/sajhivmed.v25i1.1539","url":null,"abstract":"<p><strong>Background: </strong>Maternal electronic gatekeeping (eGK) codes for HIV viral load (VL) testing of pregnant and breastfeeding women were developed to permit increased frequency of maternal HIV VL testing without automated gatekeeping cancellation, and to enable virological surveillance.</p><p><strong>Objectives: </strong>This study describes the national uptake of maternal eGK codes and VL suppression (VLS) rates disaggregated by age during antenatal, delivery and postnatal periods in South Africa during 2022.</p><p><strong>Method: </strong>HIV VL tests associated with C#PMTCT (used for antenatal and postnatal testing) and C#DELIVERY (used at delivery) eGK codes between 01 January and 31 December 2022, were extracted from the National Institute for Communicable Diseases Data Warehouse. Uptake of eGK codes was calculated using indicators from the District Health Information System as denominators while HIV VLS rates (< 1000 copies/mL) were calculated as monthly and annual percentages.</p><p><strong>Results: </strong>Overall, national maternal eGK code uptake was 41.8%, 24.5% and 0.12% for the antenatal, delivery and postnatal periods, respectively. The monthly antenatal eGK uptake increased from 27.5% to 58.5% while delivery uptake increased from 17.3% to 30.0%. The overall annual maternal HIV VLS rate was 86.7% antenatally and 87.2% during delivery. The monthly average HIV VLS for adolescent girls and young women (AGYW) was 76.1% antenatally and 79.6% during delivery.</p><p><strong>Conclusion: </strong>Although overall national uptake of maternal HIV VL eGK codes was low, antenatal and delivery uptake improved over time, thereby facilitating use of eGK codes for programmatic monitoring of maternal VLS rates for the first time. Quality of care among pregnant AGYW requires urgent attention.</p>","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"25 1","pages":"1539"},"PeriodicalIF":0.0,"publicationDate":"2024-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10913175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140041248","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":"Very low HIV positivity on paediatric surgical wards in Mozambique: Implications for inpatient provider-initiated testing programmes","authors":"Henriques Viola, Angela Bi, Dalva Khosa, Zacarias Mateus, Massada da Rocha, V. Amado, Atanásio Taela, Daniel A. DeUgarte, Andreas Schindele, W. Chris Buck","doi":"10.4102/sajhivmed.v25i1.1544","DOIUrl":"https://doi.org/10.4102/sajhivmed.v25i1.1544","url":null,"abstract":"","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139380057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Country ownership and sustainable programming of the HIV response in South Africa: A scoping review.","authors":"Refilwe N Phaswana-Mafuya, Edith Phalane, Haley Sisel, Lifutso Motsieloa, Katherine Journeay, Vuyiseka Dubula, Jabulile Sibeko, Pholokgolo Ramothwala","doi":"10.4102/sajhivmed.v24i1.1511","DOIUrl":"10.4102/sajhivmed.v24i1.1511","url":null,"abstract":"<p><strong>Background: </strong>Concerns have arisen regarding the extent to which South Africa's HIV response can be country-owned and sustainable given substantial foreign investment and technical support.</p><p><strong>Objectives: </strong>To assess the extent to which South Africa's national HIV response is country-owned.</p><p><strong>Method: </strong>We conducted a scoping review of South African literature using the Global Health Initiative Framework for country ownership.</p><p><strong>Results: </strong>South Africa has clear aspirations for what should be accomplished and strategies are aligned with national and international priorities. Although South Africa has leveraged community-based strategies to reach key populations (KPs), most are supported by international donors, which poses a sustainability challenge. Despite robust capacity strengthening and training programmes, South Africa continues to face healthcare worker shortages. While it is commendable that South Africa funds nearly 70% of the national HIV response, the funds mainly support HIV treatment. This may create dependency on international partners.</p><p><strong>Conclusion: </strong>South Africa appears to be progressing well along the spectrum of country ownership, but sustained efforts are required to combat HIV. Greater ownership over KP programming and prevention services are especially needed to achieve greater impact.</p>","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"24 1","pages":"1511"},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10696614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138500622","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}