Southern African journal of HIV medicine最新文献

{"title":"No increased in utero and peripartum HIV acquisition risk in HIV-exposed preterm infants.","authors":"Gbolahan Ajibola, Charlotte Mdluli, Kara Bennett, Maureen Sakoi, Oganne Batlang, Joseph Makhema, Shahin Lockman, Roger Shapiro, Landon Myer, Kathleen Powis","doi":"10.4102/sajhivmed.v24i1.1509","DOIUrl":"10.4102/sajhivmed.v24i1.1509","url":null,"abstract":"<p><strong>Background: </strong>Limited data exist on the differential risk of HIV acquisition between infants born preterm versus those born at term to women living with HIV (WLHIV). With a reported increase in preterm delivery among pregnant WLHIV, understanding the risk of vertical transmission of HIV in preterm infants can inform strategies to optimise the timing of diagnostic testing, antiretroviral prophylaxis, and infant feeding.</p><p><strong>Objectives: </strong>To describe the prevalence and timing of HIV acquisition, in utero versus perinatal, among infants with perinatal HIV exposure born prior to 37 weeks completed gestation age compared to those born at term in the Botswana-based Mpepu study and explore predictors of infant HIV acquisition.</p><p><strong>Method: </strong>Using data extracted from the Mpepu study, we describe the prevalence, timing and risk factors for HIV acquisition in infants born preterm versus those born at term. Fisher exact testing was used to test for differences in prevalence and timing of HIV and a multivariable logistic regression model was used to assess risk factors for infant HIV acquisition.</p><p><strong>Results: </strong>2866 infants born to WLHIV were included in this secondary analysis. 532 (19%) were born preterm. There was no observed difference in the prevalence of HIV acquisition among infants born preterm versus at term overall (0.8% vs 0.6%, <i>P</i> = 0.54), at birth (0.2% vs 0.3%, <i>P</i> = 1.00) or between 14 and 34 days post-delivery (0.6% vs 0.3%, <i>P</i> = 0.41). The absence of maternal antiretroviral use during pregnancy significantly predicted infant HIV acquisition, with the risk of HIV acquisition reduced by 96% among infants whose mothers were taking antiretroviral treatment (ART) during pregnancy (adjusted odds ratio: 0.003, confidence interval: 0.01-0.02, <i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>There was no observed increase of in utero and peripartum HIV acquisition among infants born preterm following foetal exposure to HIV compared to those born at term.</p>","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"24 1","pages":"1509"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10623649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71490682","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":"2023 Southern African HIV Clinicians Society Adult Antiretroviral Therapy Guidelines: What's new?","authors":"Jeremy Nel, Camilla Wattrus, Regina Osih, Graeme Meintjes","doi":"10.4102/sajhivmed.v24i1.1528","DOIUrl":"10.4102/sajhivmed.v24i1.1528","url":null,"abstract":"","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"24 1","pages":"1528"},"PeriodicalIF":0.0,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10546902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41151672","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":"Doxycycline post-exposure prophylaxis for sexually transmitted infections in South Africa.","authors":"Remco P H Peters, James A McIntyre, Nigel Garrett, Adrian J Brink, Connie L Celum, Linda-Gail Bekker","doi":"10.4102/sajhivmed.v24i1.1510","DOIUrl":"10.4102/sajhivmed.v24i1.1510","url":null,"abstract":"<p><p>South Africa has a large burden of bacterial sexually transmitted infections (STIs) with high rates among men who have sex with men (MSM). Randomised controlled trials have recently demonstrated high effectiveness of doxycycline post-exposure prophylaxis (PEP) for prevention of bacterial STIs in MSM, with 70% - 85% reductions in <i>Chlamydia trachomatis</i> infection and syphilis, and approximately 50% reduction in <i>Neisseria gonorrhoeae</i> infection. Doxycycline PEP was not demonstrated to be effective in reducing <i>C. trachomatis</i> and <i>N. gonorrhoeae</i> infection among Kenyan cisgender women. Although no worrisome trends in antimicrobial resistance (AMR) were observed in the trials, important concerns remain about doxycycline PEP and AMR development in STIs, other pathogens, commensals, and the microbiome. Tetracycline resistance in <i>N. gonorrhoeae</i> is already widespread in South Africa, but emergence of AMR in other STIs would be concerning. Larger sample sizes of doxycycline PEP users with longer follow-up time are needed to understand the impact that doxycycline PEP may have on AMR at individual and population level. In this opinion article, we weigh the benefits of doxycycline PEP for prevention of bacterial STIs against the existing AMR concerns and data gaps in the South African context. Based on the current evidence, we conclude that it would be reasonable to offer doxycycline PEP to high-risk MSM on a case-by-case basis, provided that it is offered by experienced sexual health clinicians in settings that have access to diagnostic STI testing and ongoing AMR surveillance.</p>","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"24 1","pages":"1510"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10546896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41168363","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 2023 Guideline for post-exposure prophylaxis: Updated recommendations.","authors":"Jaco Horak, Willem D F Venter, Camilla Wattrus, Nectarios Papavarnavas, Pauline Howell, Gillian Sorour, Carole Wallis, Katherine Gill, Francesca Conradie, Linda-Gail Bekker","doi":"10.4102/sajhivmed.v24i1.1522","DOIUrl":"10.4102/sajhivmed.v24i1.1522","url":null,"abstract":"","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"24 1","pages":"1522"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10546897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41173681","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":"Diminished health and social outcomes among men who have sex with men who use drugs in Zimbabwe.","authors":"Munyaradzi Mapingure,&nbsp;Innocent Chingombe,&nbsp;Tafadzwa Dzinamarira,&nbsp;Chesterfield Samba,&nbsp;Brian Moyo,&nbsp;Owen Mugurungi,&nbsp;Godfrey Musuka","doi":"10.4102/sajhivmed.v24i1.1513","DOIUrl":"10.4102/sajhivmed.v24i1.1513","url":null,"abstract":"of","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"24 1","pages":"1513"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10546898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41180816","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":"The prevalence of multimorbidity in virally suppressed HIV-positive patients in Limpopo.","authors":"Limakatso Lebina,&nbsp;Tumiso Malatji,&nbsp;Firdaus Nabeemeeah,&nbsp;Kegaugetswe Motsomi,&nbsp;Tsundzukani Siwelana,&nbsp;Khuthadzo Hlongwane,&nbsp;Neil Martinson","doi":"10.4102/sajhivmed.v24i1.1495","DOIUrl":"10.4102/sajhivmed.v24i1.1495","url":null,"abstract":"<p><strong>Background: </strong>Non-communicable diseases (NCDs) are an emerging global public health problem.</p><p><strong>Objectives: </strong>To assess the prevalence of NCDs and their risk factors among adults on antiretroviral therapy (ART).</p><p><strong>Method: </strong>This was a cross-sectional study (July 2019 - January 2020) in Limpopo, South Africa. Patients were enrolled if they were ≥ 40 years, HIV-positive, and virologically suppressed on ART. Data were analysed descriptively, and a binomial regression model was used to identify risk factors for NCDs.</p><p><strong>Results: </strong>The majority of participants (65%; 319/488) were women. Most (83%; 405/488) were aged 40-59 years; 60% (285/472) were overweight or obese. Based on self-report, 22% (107/488) were currently smokers. Almost half (44%) 213/488) reported daily consumption of vegetables and 65% (319/488) exercised regularly and 39% (190/488) reported treatment for another chronic disease. The leading comorbid conditions were hypertension (32%; 158/488) and diabetes mellitus (5%; 24/488). Risk factors for hypertension included age 60 years and older (relative risk [RR]: 1.72; 95% confidence interval [CI]: 1.29-2.30) diabetes (RR: 1.42; 95% CI: 1.08-1.87), overweight (RR: 1.32; 95% CI: 1.03-1.69) and obesity (RR: 1.69; 95% CI: 1.32-2.17).</p><p><strong>Conclusion: </strong>There is a high prevalence, both of risk factors for NCDs and multimorbidity (> 1 chronic disease) in patients who are ≥ 40 years and virologically suppressed on ART.</p>","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"24 1","pages":"1495"},"PeriodicalIF":0.0,"publicationDate":"2023-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10546900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41176107","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":"Assessing very advanced HIV disease in adolescent girls and young women.","authors":"Naseem Cassim, Lindi-Marie Coetzee, Manuel P da Silva, Deborah K Glencross, Wendy S Stevens","doi":"10.4102/sajhivmed.v24i1.1501","DOIUrl":"https://doi.org/10.4102/sajhivmed.v24i1.1501","url":null,"abstract":"<p><strong>Background: </strong>South Africa has the largest HIV epidemic globally, with ~7.5 million people living with HIV in 2021. Adolescent girls (AG) and young women (YW), aged 15-19 years and 20-24 years, are twice as likely to be living with HIV as their male counterparts. The national HIV prevalence for young women was 9.1% (2021), with limited data on disease severity.</p><p><strong>Objectives: </strong>This study assessed very advanced HIV disease (CD4 < 100 cells/μL) in adolescent girls and young women (AGYW) in South Africa.</p><p><strong>Method: </strong>A retrospective descriptive study analysed data collated from the National Health Laboratory Service database for 2017 to 2021 calendar years for AGYW. National and provincial specimen volumes, the percentage of tests with a CD4 < 100 cells/μL and ≥ 100 cells/μL, and the median and interquartile ranges, were calculated. Logistic regression determined the odds ratio for a CD4 < 100 cells/μL, controlling for age category.</p><p><strong>Results: </strong>Data for 1 199 010 CD4 specimens indicated a significant decrease in volumes of 34% from 287 410 (2017) to 189 533 (2021). The percentage of samples with a count < 100 cells/μL ranged from 4.9% to 5.2% for YW versus 5.6% to 6.1% for AG. Provincial data for a CD4 count < 100 cells/μL ranged between 4.5% and 8.3% in AG and 3.6% to 6.3% for YW. Logistic regression indicated a 24% higher likelihood for AG having a CD4 count < 100 cells/μL.</p><p><strong>Conclusion: </strong>The study reported a higher proportion of very advanced HIV disease for AG versus YW nationally, with provincial disparity needing further analysis.</p>","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"24 1","pages":"1501"},"PeriodicalIF":0.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10713486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138811884","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":"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}