Scielo RSS <![CDATA[Southern African Journal of HIV Medicine]]> vol. 22 num. 1 lang. en <![CDATA[SciELO Logo]]> <![CDATA[<b>Skin and mucosal manifestations of an AIDS-related systemic mycosis</b>]]> <![CDATA[<b>A trio of infectious diseases and pulmonary embolism: A developing world's reality</b>]]> INTRODUCTION: Human immunodeficiency virus (HIV), Tuberculosis (TB) and coronavirus disease (COVID-19) infections independently possess the ability to trigger formation of venous thromboembolism (VTE) and pulmonary embolism (PE). To the authors' knowledge, this is the first case report describing the presence of PE in a patient with all three aforementioned infectious co-morbidities. PRESENTATION: A patient living with HIV with virological failure secondary to defaulting antiretroviral therapy (ART) presented with hypoxia, clinical and radiological features suggestive of community-acquired pneumonia (CAP) with raised inflammatory markers and D-dimer levels. MANAGEMENT: She was commenced on prophylactic anticoagulation, supplemental oxygen and empirical antibiotics targeting CAP and pneumocystis jiroveci pneumonia, swabbed for COVID-19 infection and had sputa sent for Gene Xpert® TB testing. A day later, COVID-19 results returned positive and the patient was transferred to isolation and added onto dexamethasone and therapeutic anticoagulation. Sputa returned positive for mycobacterium TB a day later, and anti-tuberculosis therapy was added. She remained persistently hypoxic, with a Well's score of 3 placing her at moderate risk for PE, which prompted for a computed tomography pulmonary angiogram (CTPA) being ordered, which demonstrated left lower lobe subsegmental PE. Warfarin was added to her regimen. She was discharged on day 18 with a therapeutic international normalised ratio (INR) and not requiring oxygen therapy. CONCLUSION: This scenario is relevant in low to middle-income countries. The utilisation of a raised D-Dimer in the setting of all four coexisting conditions in arriving at a definite diagnosis remains uncertain. We noted that despite our index patient being on thrombo-prophylaxis, she developed PE highlighting the need for increased vigilance in all COVID-19 patients, even those on prophylactic anticoagulation. <![CDATA[<b>False-positive rapid diagnostic tests in paediatric and obstetric patients in South Africa</b>]]> INTRODUCTION: Providing easily accessible, quick and accurate human immunodeficiency virus (HIV) testing services (HTS) is central to achieving the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets. Rapid diagnostic tests (RDTs) for HIV are affordable and technically easy to perform. Two positive RDTs from different manufacturers are required to make a diagnosis of HIV in South Africa. Difficulty arises when there are discordant results from the two kits. In this case report, we will discuss four instances of false-positive RDTs PATIENT PRESENTATION: Case 1 is a 10-year-old female, referred for initiation of antiretroviral treatment (ART). She was diagnosed using two of the same brand RDT at her local clinic. Case 2 is a 21-year-old female who presented to obstetric admissions in labour. Case 3 is a 39-year-old female who was screened for HIV during a routine antenatal appointment. Case 4 is a 22-year-old female who was admitted 21 days postpartum with puerperal sepsis. All four cases had discordant RDTs when screened for HIV at our facility MANAGEMENT AND OUTCOME: The results of all the investigations conducted on all four patients confirmed HIV negative status. The reference laboratory verified the results and reran the RDTs, which remained discordant. This confirmed a false-positive result in all four cases with the screening RDT. CONCLUSION: With high numbers tested and a low yield of new cases, each individual case of discordancy may cause unnecessary distress, confusion and treatment, particularly in high-risk scenarios like pregnancy. Trends of false-positive and discordant RDT results should be monitored and inform HTS guidelines <![CDATA[<b>Administering human immunodeficiency virus post-exposure prophylaxis: challenges experienced by mothers in Lusaka, Zambia</b>]]> BACKGROUND: Mothers living with human immunodeficiency virus (HIV) should be guided to practise safe childbirth, provide appropriate infant feeding, return infants for repeat HIV testing and administer for the required period, protective antiretroviral (ARV) medication (post-exposure prophylaxis [PEP]) to their infants. Although several studies have explored challenges related to the prevention of mother-to-child transmission (PMTCT), no studies were found that focused specifically on the mother and PEP. OBJECTIVES: To explore and understand the challenges experienced by mothers in Lusaka, Zambia, whilst providing their children with PEP. METHODS: This study utilised a qualitative methodology and a descriptive design. Fifteen semi-structured individual interviews were conducted with mothers who gave PEP to their infants. Study evaluation made use of Creswell's six steps of data analysis RESULTS: Women experienced numerous challenges. Challenges of an individual and social nature included 'negative' emotions, misconceptions and a lack of understanding of PEP. Post-exposure prophylaxis was sometimes burdensome and partner involvement often limited. Cultural, religious practices and stigma deterred some women from continuing PEP. Healthcare challenges included time-consuming appointments and protracted waiting periods. Clinic organisation was often inefficient and complicated by stock-outs of essential medication such as nevirapine. Healthcare workers were at times stigmatising towards mothers living with HIV and their infants. The counselling support provided by the healthcare workers was felt to be inadequate in the face of the burden of PEP. CONCLUSION: Post-exposure prophylaxis as part of the PMTCT programme is key to eliminating mother-to-child transmission of HIV. Postnatal support for women administering PEP to their children can be enhanced through counselling that is person- and family-centred is culturally sensitive and offers differentiated services that include PEP, integrated mother-and-child healthcare and access to support groups. <![CDATA[<b>Estimating qualification and factors associated with third-line antiretroviral therapy referral in the Western Cape</b>]]> BACKGROUND: South Africa's antiretroviral therapy (ART) programme is the largest globally and the universal test-and-treat policy is expected to increase the numbers on ART. This may have implications for treatment failure rates implying a greater future need for third-line regimens. South Africa initiated a third-line programme in 2013. However, there is little evidence quantifying the third-line need in this setting and the programme itself has not been formally evaluated. OBJECTIVES: The study evaluated the third-line ART referral process in the Western Cape. METHOD: Routinely collected data were analysed to derive an estimate of patients meeting criteria for third-line referral and compared with patients who were referred. Factors associated with referral were identified. RESULTS: In the study period, 947 patients met criteria for third-line referral and 167 patients were referred. Comparison revealed a poor overlap of only 42 patients. In multivariate analysis, factors associated with referral included receiving care at a hospital rather than a primary healthcare facility (adjusted odd ratios [aOR] = 2.15, 95% confidence interval [CI] 1.1-4.2), a higher number of viral load [VLs] ≥ 1000 copies/mL whilst on a protease inhibitor (PI) (aOR = 1.2, 95% CI 1.01-1.42) and a greater number of years on a PI (aOR = 1.25, 95% CI 1.07-1.46). Patients with a 6-month gap in dispensing were less likely to be referred (aOR = 0.37, 95% CI 0.17-0.81. CONCLUSION: This study adds to a limited body of knowledge regarding third-line ART programmes. The findings indicate missed opportunities for and inappropriate referral of patients. Factors associated with referral were largely health system related. Clinician awareness and compliance with referral remain unknown and may be contributory. <![CDATA[<b>Profile of presentation of HIV-positive patients to an emergency department in Johannesburg, South Africa</b>]]> BACKGROUND: Despite improved availability and better access to antiretroviral therapy (ART), approximately 36% of human immunodeficiency virus (HIV)-positive South Africans are still not virally suppressed. OBJECTIVE: The aim of this study was to describe the patterns of presentation of HIV-positive patients to a major central hospital emergency department (ED) METHODS: In this prospectively designed study, consecutive HIV-positive patients presenting to the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) adult ED were enrolled between 07 July 2017 and 18 October 2018. RESULTS: A total of 1224 participants were enrolled. Human immunodeficiency virus was newly diagnosed in 212 (17.3%) patients, 761 (75.2%) were on ART, 245 (32.2%) reported ART non-adherence, 276 (22.5%) had bacterial pneumonia, 244 (19.9%) had tuberculosis (TB), 86 (7.0%) had gastroenteritis, 205 (16.7%) required intensive care unit admission, 381 (31.1%) were admitted for ≥ 7 days and 166 (13.6%) died. With regard to laboratory parameters, CD4 cell count was < 100 cell/mm³ in 527 (47.6%) patients, the viral load (VL) was &gt; 1000 copies/mL in 619 (59.0%), haemoglobin was < 11 g/dL in 636 (56.3%), creatinine was &gt; 120 µmol/L in 294 (29.3%), lactate was &gt; 2 mmol/L in 470 (42.0%) and albumin was < 35 g/L in 633 (60.8% CONCLUSION: Human immunodeficiency virus-positive patients presenting to the CMJAH ED demonstrated a high prevalence of opportunistic infections, required a prolonged hospital stay and had high mortality rates. There is a need to improve the quality of ART services and accessibility to care. <![CDATA[<b>Uptake of the Ithaka mobile application in Johannesburg, South Africa, for human immunodeficiency virus self-testing result reporting</b>]]> BACKGROUND: Human immunodeficiency virus self-testing (HIVST) can reduce facility-based HIV testing barriers; however, no proven applications exist with widespread uptake for self-reporting or linkage to care. Mobile health (mHealth) applications (apps) have shown high usability and feasibility scores, so Ithaka was developed for South Africans to self-report HIVST results outside clinical settings. OBJECTIVES: This study investigated the use of Ithaka as a support tool for HIVST users, specifically the ability to self-report results. METHOD: This cross-sectional study was conducted from November 2018 to June 2019. At existing HIVST distribution sites, individuals were given HIVST kits and then invited to use Ithaka. Participants could test at home and report their results through the app anytime. Ithaka tracked when people logged-on, registered, received counselling and reported results. Post-study surveys on user experience were also conducted. RESULTS: Of 751 participants, 531 (70.7%) logged onto the app, 412 (54.9%) registered, 295 (39.3%) received counselling and 168 (22.4%) self-reported results. Participants strongly agreed that Ithaka was useful and that it was easy to upload results. Forty-one participants completed a post-test survey, and 39/41 (95.1%) completed the app journey. Most participants (36/41;87.8%) had no challenges, although 2/41 (4.9%) cited perceived data costs, 2/41 (4.9%) difficulty uploading results and 1/41 (2.4%) language, as challenges CONCLUSION: Despite the small sample size, this study has shown that HIVST participants under pragmatic conditions were willing and able to self-report results via the app, whilst also identifying areas of improvement for scaling up. <![CDATA[<b>Nevirapine-induced Stevens-Johnson syndrome in children living with HIV in South Africa</b>]]> BACKGROUND: Although adverse drug reactions resulting from the use of nevirapine (NVP) are well described in adults (estimated frequency of 6% - 10%), it has previously been considered less common in children (0.3% - 1.4%). Stock-outs of antiretroviral agents occur frequently in South Africa and result in interruptions in therapy and drug substitutions. OBJECTIVES: To report on a case series of paediatric patients who suffered cutaneous drug reactions to NVP at rates not previously described in children. METHOD: We describe a retrospective observational case series of six children living with HIV who developed Stevens-Johnson Syndrome (SJS) following exposure to NVP because of a prolonged stock-out of efavirenz 200 mg tablets in South Africa RESULTS: Of the 392 paediatric patients receiving antiretroviral therapy at the institution, 172 were affected by the efavirenz stock-out. Of these, 85 children were changed to NVP of which six developed NVP-induced SJS (7.1% incidence rate). The median time between initiating NVP and developing symptoms was 27 days (range 12-35 days). All patients responded well to NVP cessation and symptomatic treatment. One patient was referred for specialist care. Two patients were successfully rechallenged with efavirenz after developing SJS and three continued lopinavir/ritonavir. CONCLUSIONS: This is the second largest case series of NVP-induced SJS in children to date and raises the possibility that the incidence of SJS in children may be higher than previously described. Further research is required to explore the risk factors associated with NVP-induced SJS in children. This case series highlights the negative impact of drug stock-outs on patient health outcomes. <![CDATA[<b>HIV-1/2 differentiation in a South African public laboratory</b>]]> BACKGROUND: The human immunodeficiency virus type-2 (HIV-2) prevalence in South Africa (SA) is unknown, however, sporadic cases have been reported. Human immunodeficiency virus -1 and 2 differentiation is not part of most South African public laboratories' testing algorithm. Human immunodeficiency virus -2 diagnosis using serology assays may be complicated by HIV-1 and HIV-2 antibody cross-reactivity. OBJECTIVES: To determine the proportion of HIV-2 infections in specimens that tested HIV-1/2 positive at a public laboratory in Tshwane. METHOD: A total of 480 specimens that were previously tested with fourth generation ELISA platforms (Modular E170 [Roche, Switzerland] and Architect i2000 [Abbott, Germany]) were randomly selected. Human immunodeficiency virus -1 and 2 antibody differentiation testing was carried out using the Multispot HIV-1/2 rapid assay (Bio-Rad Laboratories, USA). An in-house nested HIV-2 PCR assay targeting the 5′-long terminal repeats (5′-LTR) region was evaluated and used as a confirmatory test RESULTS: The study tested 480 HIV-1/2 seropositive patients and their mean age was 36.7 years (range 3-82 years). Of the 480 patients, 292 (60.8%) were female, 182 (37.9%) were male and 6 (1.3%) were not specified. Human immunodeficiency virus differentiation results were as follows: 466 (97.1%) were positive for only HIV-1 antibodies, 11 (2.3%) [95%CI: (0.98%; 3.74%)] were positive for both HIV-1 and HIV-2 antibodies, 3 (0.6%) were negative for both antibodies and none were positive for only HIV-2 antibodies. Of the 11 specimens with both HIV-1 and HIV-2 antibodies, seven had sufficient volume for confirmatory testing and were all negative on the in-house HIV-2 PCR assay. CONCLUSION: The multispot HIV-1/2 rapid assay demonstrated cross-reactivity between HIV-1 and HIV-2 antibodies. Human immunodeficiency virus -2 infections were not detected. <![CDATA[<b>The clinical and demographic profile of women living with HIV admitted to the acute unit at Stikland Psychiatric Hospital</b>]]> BACKGROUND: There is a paucity of research on the clinical profile of women living with human immunodeficiency virus (HIV) (WLWH) admitted with acute mental health illness. Existing studies are small and did not look at factors that could have an impact on medication adherence. As a first step to inform service delivery for this vulnerable population, a thorough understanding of the composition and needs of these patients should be identified. OBJECTIVES: To describe the socio-demographic and clinical profile that could have an influence on the antiretroviral therapy (ART) adherence of WLWH at an inpatient psychiatric unit. METHODS: In this retrospective audit, the medical records of all WLWH (18-59 years of age), discharged from the acute unit at Stikland Psychiatric Hospital, were reviewed over a 12-month period. RESULTS: Of the 347 female patients discharged, 55 patients were positive for HIV (15.9%). The majority of them were unmarried (78.2%), unemployed (92.7%), had a secondary level of education (Grade 8-10) (58.2%), lived with a family member (83.6%) and had children (61.8%). The most common psychiatric diagnosis on discharge was substance use disorder with 78.2% of patients being categorised as substance users. Interpersonal violence was only reported by 5.5% of patients. Although most patients performed poorly on the Montreal Cognitive Assessment (MoCA) and International HIV Dementia Scale (IHDS), only 12% of patients received a diagnosis of HIV-associated neurocognitive disorder (HAND) upon discharge. Antiretroviral therapy (ART) was initiated in 21.8% of patients. Only eight patients had a viral load of < 200 copies/mL, indicating viral suppression. CONCLUSION: Our findings may inform service planning and emphasise the need for targeted intervention strategies to improve treatment outcomes in this vulnerable group. <![CDATA[<b>World AIDS Day 2020: Reflections on global and South African progress and continuing challenges</b>]]> BACKGROUND: Reflecting on progress and challenges in meeting global human immunodeficiency virus (HIV) targets is often done ahead of World AIDS Day. This article reflects on progress and the continuing challenges in meeting targets in South Africa (SA OBJECTIVE: To review policy and implementation related progress and continuing challenges towards eliminating HIV as a public health threat by 2030. METHOD: Policy analysis and review of modeling data from Thembisa 4.3. RESULTS: South Africa has made significant progress in the adoption of policies with two exceptions. While there are gaps in reaching the 90-90-90 implementation targets, progress has been made in the past decade. CONCLUSION: While progress has been made in the past decade towards the global targets, much work remains to ensure that HIV transmission is curtailed and those that require treatment are initiated on treatment and are virally suppressed. <![CDATA[<b>Ten years of nurse-initiated antiretroviral treatment in South Africa: A narrative review of enablers and barriers</b>]]> BACKGROUND: The roll out of nurse-initiated and managed antiretroviral treatment (NIMART) was implemented in 2010 by the National Department of Health (NDoH) in South Africa in response to the large numbers of persons living with HIV who needed treatment. To enable access to treatment requires shifting the task from doctors to nurses, which had its own challenges, barriers and enablers. OBJECTIVES: The aim of this narrative is to review content on the implementation of NIMART in South Africa over the period 2010-2020, with a focus on enablers and barriers to the implementation. METHOD: A comprehensive search of databases, namely, PubMed, Google Scholar and Cumulative Index to Nursing and Allied Health Literature (CINAHL), yielded qualitative, quantitative and mixed-method studies that addressed various topics on NIMART. Inclusion and exclusion criteria were set and 38 publications met the inclusion criteria for the review. RESULTS: Training, mentorship, tailored tuberculosis (TB) and HIV guidelines, integration of services and monitoring and support have enabled the implementation of NIMART. This resulted in increased knowledge and confidence of nurses to initiate patients on antiretroviral treatment (ART) and decreased time to initiation and loads on referral facilities. Barriers such as non-standardised training, inadequate mentoring, human resource constraints, health system challenges, lack of support and empowerment, and challenges with legislation, policy and guidelines still hinder NIMART implementation. CONCLUSION: Identifying barriers and enablers will assist policymakers in implementing a structured programme for NIMART in South Africa and improve access, as well as the training and mentoring of professional nurses, which will enhance their competence and confidence <![CDATA[<b>Access to HIV services and viral load suppression among children during the 90-90-90 strategy implementation in South Africa: A time series analysis</b>]]> BACKGROUND: During the era of the Millennium Development Goals (MDG), children were shown to have less access to human immunodeficiency virus (HIV) services than their adult counterparts; hence the call to prioritise children in the implementation of the Sustainable Development Goals (SDGs). However, South African (SA) national data in 2019 indicated that almost 3 years into the implementation of the 90-90-90 strategy, only 59% of children living with HIV had been tested for HIV compared to 90% of adults. OBJECTIVES: To evaluate the access of children to HIV services and record the viral load (VL) suppression rates during the implementation of the 90-90-90 strategy in the City of Johannesburg (COJ), South Africa. METHODS: This study applied a quasi-experimental interrupted time-series (ITS) design using the monthly District Health Information System (DHIS) and National Health Laboratory Services (NHLS) databases spanning the period from 2015 to 2020, that is, before and after the implementation and roll-out of the 90-90-90 strategy. Data were extracted from these databases into MS Excel 2010 spreadsheets and analysed with Stata 15 software from Stata Corp using a two-tailed t-test at a 5% level of significance RESULTS: Overall, a significant increase was observed in the number of individuals tested for HIV, n = 757, p = 0.0086, and retained in care n = 2523, p = 0.001 over the whole period of analysis beginning in April 2015. Adult HIV testing, antiretroviral treatment (ART) initiation and retention in care had been decreasing in absolute numbers over a 10-month period before the intervention. An increase in these three data elements was observed following the implementation of the 90-90-90 program. On the other hand, children aged 0-15 years had demonstrated a significant increase in absolute numbers tested for HIV, n = 171, p = 0.001, but an insignificant increase in number of ART initiations, n = 14.33, p = 0.252, before implementation but a decrease after this. The overall VL suppression rates for children were lower than those of adults. CONCLUSION: Although the COJ has recorded progress in adult HIV testing, ART initiation and retention, children living with HIV aged 0-15 years continue to experience less access to HIV services and lower VL suppression than youths and adults of ≥ 15 years. Therefore, to ensure that the 90-90-90 targets are achieved across different age groups, children must be prioritised so that they can equally access these services with adults <![CDATA[<b>Ocular manifestations of people living with HIV in Tunisia</b>]]> BACKGROUND: Ocular involvement is a common complication of human immunodeficiency virus (HIV). Knowledge about this topic in Tunisia is limited. OBJECTIVE: To investigate ophthalmic manifestations in patients living with HIV in Tunisia. METHOD: This was an observational study, performed between January 2007 and December 2016. We included patients with ocular disorders related to HIV. The data were recorded retrospectively from chart review. RESULTS: Amongst 98 people living with HIV (PLWH), 36 participants (55 eyes) had ocular manifestations. The mean age was 32.2 ± 5.6 years. Twenty-four patients were men and 12 were women. The mean value of CD4+ T-cell count was 156.5 ± 4.2 cells/µL. Bilateral lesions were found in 19 eyes. Best corrected visual acuity was better than 6/12 in 36 eyes. The most common ocular finding was dry eye syndrome (22%), cotton-wool spots (20%) and retinal haemorrhage (16%) followed by cytomegalovirus (CMV) retinitis (9%), anterior uveitis (7%), toxoplasmosis (4%) and tuberculosis retinochoroiditis (7%) Herpetic keratitis (5%), Herpes zoster ophthalmicus (2%) and syphilitic chorioretinitis (2%). Papilledema was found in three eyes (5%). Panuveitis was observed in four eyes (7%): three of them were associated with chorioretinal toxoplasmosis, syphilitic chorioretinitis and CMV retinitis. The fourth was attributable to immune recovery uveitis. A CD4+ T-cell count of ≤ 200 cells/µL was found to be an independent risk factor for developing posterior segment manifestations CONCLUSION: Various ophthalmic manifestations were observed in PLWH. The most common lesion was retinopathy. Ocular involvement can be serious leading to poor visual prognosis, which requires close collaboration between the ophthalmologist and infectious disease physician. <![CDATA[<b>Immune activation and arterial stiffness in lean adults with HIV on antiretroviral therapy</b>]]> BACKGROUND: Greater T-cell activation was associated with reduced vascular compliance amongst persons living with HIV (PLWH) especially among overweight and obese individuals. There is a paucity of data regarding immune activation and arterial stiffness amongst PLWH in sub-Saharan Africa (SSA) OBJECTIVE: To determine the association between immune activation and arterial stiffness in lean PLWH in SSA. METHOD: Forty-eight human immunodeficiency virus positive (HIV+) adults on antiretroviral therapy (ART) &gt;5 years and 26 HIV-negative adults, all with BMI < 25 kg/m² and no history of CVD, were enrolled. The relationship of vascular compliance with circulating CD4+ and CD8+ naïve, memory, activated and senescent T cells, and serum 8-isoprostane was assessed by HIV status. RESULTS: Increased immune activation was observed in the CD4+ and CD8+ T cells of PLWH, 16.7% vs. 8.9% and 22.0% vs. 12.4% respectively; p < 0.001 (both). Furthermore, a higher proportion of senescent CD4+ T cells were associated with a lower carotid-femoral pulse wave velocity (cfPWV; p = 0.01), whilst a higher proportion of activated CD8+ T cells were associated with a lower carotid-radial pulse wave velocity (crPWV; p = 0.04), after adjustment for BMI and age. However, PLWH also had a higher median carotid-femoral augmentation index (cfAiX) (21.1% vs. 6.0%; p < 0.05) in comparison to their HIV controls. CONCLUSION: Our population of lean PLWH had increased immune activation and higher cfAiX, a marker of arterial stiffness, compared to HIV-negative persons. The negative association between immune activation and arterial stiffness as measured by crPWV in PLHW on long-term treatment needs further elucidation. <![CDATA[<b>Symptomatic gallstones and HIV in black South African women: Changing trends of gallstone disease?</b>]]> BACKGROUND: The incidence of metabolic disorders in human immunodeficiency virus (HIV) endemic settings is a prevailing burden in developing countries. Cholesterol homeostasis and fat metabolism are altered by HIV and antiretroviral therapy (ART), thereby possibly contributing to complications such as gallstone formation. OBJECTIVES: The aim of this study was to evaluate established risk factors for the formation of cholesterol gallstones in black South African women living with HIV (WLHIV). METHOD: A case series study was conducted of all black South African women undergoing cholecystectomy for gallstone disease over a 1-year period at King Edward VIII Hospital, Durban, South Africa. Age, body mass index (BMI), family history of gallstones, oestrogen exposure and lipograms were compared between WLHIV and uninfected women. Categorical variables were tested using either the Fisher's exact test or Pearson's chi-square test. Means were compared using independent t-tests. For non-normally distributed data, the Mann-Whitney U test was used. Statistical tests were two-sided, and p-values of less than 0.05 were considered statistically significant. RESULTS: A total of 52 patients were assessed, 34 HIV-uninfected and 18 WLHIV. The median age of WLHIV versus the uninfected women was 35 and 50 years, respectively, (p = 0.015). A statistically significant number of uninfected women were in the overweight/obese category (BMI &gt; 25 kg/m²) compared to the normal weight category (BMI < 25 kg/m²) (p < 0.001). The number of obese WLHIV did not reach statistical significance. CONCLUSION: The age of occurrence of gallstone disease amongst black South African WLHIV was significantly lower and fewer women were obese compared with the uninfected women with gallstone disease. These findings differ from known gallstone risk factors in other populations and in uninfected black South African women. This could be attributed to the metabolic alterations caused by HIV infection itself and/or to the long-term use of ART. Larger cohort studies are required to elucidate the role of HIV and ART in cholestatic disease