Southern African journal of HIV medicine最新文献

{"title":"Paediatric antiretroviral update.","authors":"Gillian Sorour, Nosisa Sipambo, Moherndran Archary","doi":"10.4102/sajhivmed.v24i1.1506","DOIUrl":"https://doi.org/10.4102/sajhivmed.v24i1.1506","url":null,"abstract":"","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"24 1","pages":"1506"},"PeriodicalIF":0.0,"publicationDate":"2023-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10713480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138811898","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":"Evaluation of a health system intervention to improve virological management in an antiretroviral programme at a municipal clinic in central Durban.","authors":"Christie M Cloete,&nbsp;Jane Hampton,&nbsp;Terusha Chetty,&nbsp;Thando Ngomane,&nbsp;Elizabeth Spooner,&nbsp;Linda M G Zako,&nbsp;Shabashini Reddy,&nbsp;Tarylee Reddy,&nbsp;Nozipho Luthuli,&nbsp;Hope Ngobese,&nbsp;Gita Ramjee,&nbsp;Anna Coutsoudis,&nbsp;Photini Kiepiela","doi":"10.4102/sajhivmed.v20i1.985","DOIUrl":"https://doi.org/10.4102/sajhivmed.v20i1.985","url":null,"abstract":"<p><strong>Background: </strong>With the largest antiretroviral therapy (ART) programme globally, demand for effective HIV management is increasing in South Africa. While viral load (VL) testing is conducted, VL follow-up and management are sub-optimal.</p><p><strong>Objectives: </strong>The objective of this study was to address gaps in the VL cascade to improve VL testing and management.</p><p><strong>Methods: </strong>Antiretroviral therapy records were sampled for an in-depth review. The study team then reviewed individual records, focusing on ART management, virological suppression and retention. Multifaceted interventions focused on virological control, including a clinical summary chart for ART care; streamlining laboratory results receipt and management; monitoring VL suppression, flagging virological failure and missed visits for follow-up; down-referral of stable patients eligible for the chronic club system; and training of personnel and patients.</p><p><strong>Results: </strong>Pre-intervention, 78% (94/120) of eligible patients had VL tests, versus 92% (145/158) post-intervention (<i>p</i> = 0.0009). Pre-intervention, 59% (71/120) of patients accessed their VL results, versus 86% (136/158) post-intervention (<i>p</i> < 0.0001). Post-intervention, 73% (19/26) of patients eligible for ART change were appropriately managed, versus 11% (4/36) pre-intervention (<i>p</i> < 0.0001). Only 27% had no regimen changes (7/26) post-intervention, versus 81% (29/36) pre-intervention (<i>p</i> < 0.0001).</p><p><strong>Conclusion: </strong>Service delivery was streamlined to facilitate HIV services by focusing on VL test monitoring, protocol training and accessibility of results, thereby improving clinical management.</p>","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"20 1","pages":"985"},"PeriodicalIF":0.0,"publicationDate":"2019-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6779997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41224422","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":"Associations of visceral fat thickness and anthropometric measurements with non-alcoholic fatty liver disease development in male patients mono-infected with human immunodeficiency virus.","authors":"Miloš Vujanović,&nbsp;Nina Brkić-Jovanović,&nbsp;Dalibor Ilić,&nbsp;Zorka Drvendžija,&nbsp;Biljana Srdić-Galić,&nbsp;Vesna Turkulov,&nbsp;Snežana Brkić,&nbsp;Daniela Marić","doi":"10.4102/sajhivmed.v20i1.968","DOIUrl":"https://doi.org/10.4102/sajhivmed.v20i1.968","url":null,"abstract":"<p><strong>Background: </strong>Non-alcoholic fatty liver disease (NAFLD) represents the most common form of chronic liver disease in mono-infected (without concomitant hepatitis B and/or C virus infection) people living with human immunodeficiency virus (HIV). The proper and on time identification of at-risk HIV-positive individuals would be relevant in order to reduce the rate of progression from NAFLD into non-alcoholic steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma.</p><p><strong>Objectives: </strong>The aim of this study was to explore visceral fat thickness (VFT) and anthropometric measurements associated with the development of NAFLD in patients mono-infected with HIV and on long-standing combination antiretroviral therapy (cART).</p><p><strong>Method: </strong>Eighty-eight (<i>n</i> = 88) HIV-positive male patients, average age 39.94 ± 9.91 years, and stable on cART, were included in this prospective study. VFT was measured using ultrasonography. Anthropometric measurements included body mass index (BMI), waist-to-hip ratio (W/H), waist-to-height ratio (WHtR), waist and hip circumference (WC, HC). Differences between variables were determined using the chi-square test. The receiver operating characteristic (ROC) curve and the Youden index were used to determine optimal cut-off values of VFT and hepatic steatosis. The area under the curve (AUC), 95% confidence intervals, sensitivity and specificity are reported for the complete sample. Significance was set at <i>p</i> < 0.05.</p><p><strong>Results: </strong>Patients with steatosis had significantly higher values of BMI, HC, WC, W/H and WHtR. The VFT was higher in patients with steatosis (<i>p</i> < 0.001). Specifically, VFT values above 31.98 mm and age > 38.5 years correlated with steatosis in HIV-positive patients, namely sensitivity 89%, specificity 72%, AUC 0.84 (95% CI, 0.76-0.93, <i>p</i> < 0.001), with the highest Youden index = 0.61. The sensitivity of the age determinant above this cut-off point was 84%, specificity 73% and AUC 0.83 (95% CI, 0.75-0.92, <i>p</i> < 0.001), with the highest Youden index of 0.57.</p><p><strong>Conclusion: </strong>In the absence of more advanced radiographic and histological tools, simple anthropometric measurements and VFT could assist in the early identification of persons at risk of hepatic steatosis in low- and middle-income regions.</p>","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"20 1","pages":"968"},"PeriodicalIF":0.0,"publicationDate":"2019-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6739542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41224421","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":"Switching at Low HIV-1 RNA into Fixed Dose Combinations: TDF/FTC/RPV is non-inferior to TDF/FTC/EFV in first-line suppressed patients living with HIV.","authors":"Paula Munderi,&nbsp;Edwin Were,&nbsp;Anchalee Avihingsanon,&nbsp;Pascale A M Mbida,&nbsp;Lerato Mohapi,&nbsp;Samba B Moussa,&nbsp;Marjolein Jansen,&nbsp;Ceyhun Bicer,&nbsp;Perry Mohammed,&nbsp;Yvon van Delft","doi":"10.4102/sajhivmed.v20i1.949","DOIUrl":"https://doi.org/10.4102/sajhivmed.v20i1.949","url":null,"abstract":"<p><strong>Background: </strong>In low- and middle-income countries (LMICs), a substantial unmet need for affordable single-tablet regimen (STR) options remains. Rilpivirine (RPV, TMC278) is formulated in a low-cost STR with tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC).</p><p><strong>Objectives: </strong>Switching at Low HIV-1 RNA into Fixed Dose Combinations (SALIF) compared RPV with efavirenz (EFV), both as STRs with TDF and FTC, in maintaining virologic suppression.</p><p><strong>Methods: </strong>SALIF was a phase 3b, randomised, open-label, non-inferiority study in virologically suppressed adults (HIV-1 RNA < 50 copies/mL) on non-nucleoside reverse transcriptase inhibitor (NNRTI)-based first-line antiretroviral therapy (ART) in Cameroon, Kenya, Senegal, South Africa, Uganda and Thailand. Patients (<i>N</i> = 426), stratified by NNRTI use, were randomised 1:1 to receive TDF/FTC/RPV (300/200/25 mg qd) or TDF/FTC/EFV (300/200/600 mg qd). Primary endpoint was proportion of patients with virologic suppression (HIV-1 RNA < 400 copies/mL) at week 48 (intent-to-treat, modified Food and Drug Administration Snapshot, 10% non-inferiority margin).</p><p><strong>Results: </strong>Patients received TDF/FTC/RPV (<i>n</i> = 213) or TDF/FTC/EFV (<i>n</i> = 211). At week 48, virologic suppression was maintained in 200/213 (93.9%) patients in the RPV arm and 203/211 (96.2%) in the EFV arm (difference -2.3%; 95% confidence interval: -6.4, +1.8), demonstrating non-inferiority of TDF/FTC/RPV. One patient in each arm experienced virologic failure without treatment-emergent resistance. Twenty-seven patients discontinued prematurely (8.0% RPV vs. 4.7% EFV), the most frequent reasons being adverse events (3.3% vs. 0.5%, respectively), site closure (1.9% vs. 0.5%), loss to follow-up (0.9% vs. 1.4%) and consent withdrawal (0.9% vs. 1.4%).</p><p><strong>Conclusion: </strong>In adults with suppressed viral load on first-line NNRTI-based ART in LMICs, switching to an STR of TDF/FTC/RPV was non-inferior to TDF/FTC/EFV in maintaining high rates of viral suppression with a comparable tolerability profile.</p>","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"20 1","pages":"949"},"PeriodicalIF":0.0,"publicationDate":"2019-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41224423","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}