Scielo RSS <![CDATA[Southern African Journal of HIV Medicine]]> http://www.scielo.org.za/rss.php?pid=2078-675120160001&lang=en vol. 17 num. 1 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Feeding practices and nutritional status of HIV-exposed and HIV-unexposed infants in the Western Cape</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67512016000100001&lng=en&nrm=iso&tlng=en BACKGROUND: Optimal infant- and young child-feeding practices are crucial for nutritional status, growth, development, health and, ultimately, survival. Human breast milk is optimal nutrition for all infants. Complementary food introduced at the correct age is part of optimal feeding practices. In South Africa, widespread access to antiretrovirals and a programme to prevent mother-to-child transmission of HIV have reduced HIV infection in infants and increased the number of HIV-exposed uninfected (HEU) infants. However, little is known about the feeding practices and nutritional status of HEU and HIV-unexposed (HU) infants OBJECTIVE: To assess the feeding practices and nutritional status of HIV-exposed and HIV-unexposed (HU) infants in the Western Cape DESIGN: Prospective substudy on feeding practices nested in a pilot study investigating the innate immune abnormalities in HEU infants compared to HU infants. The main study commenced at week 2 of life with the nutrition component added from 6 months. Information on children's dietary intake was obtained at each visit from the caregiver, mainly the mother. Head circumference, weight and length were recorded at each visit. Data were obtained from 6-, 12- and 18-month visits. World Health Organization feeding practice indicators and nutrition indicators were utilised SETTING: Tygerberg Academic Hospital, Western Cape. Mothers were recruited from the postnatal wards SUBJECTS: Forty-seven mother-infant pairs, 25 HEU and 22 HU infants, participated in this nutritional substudy. Eight (17%) infants, one HU and seven HEU, were lost to follow-up over the next 12 months. The HEU children were mainly Xhosa (76%) and HU were mainly mixedrace (77%) RESULTS: The participants were from poor socio-economic backgrounds. In both groups, adherence to breastfeeding recommendations was low with suboptimal dietary diversity. We noted a high rate of sugar- and salt-containing snacks given from a young age. The HU group had poorer anthropometric and nutritional indicators not explained by nutritional factors alone. However, alcohol and tobacco use was much higher amongst the HU mothers CONCLUSION: Adherence to breastfeeding recommendations was low. Ethnicity and cultural milieu may have influenced feeding choices and growth. Further research is needed to understand possible reasons for the poorer nutritional and anthropometric indicators in the HU group <![CDATA[<b>The profile and frequency of known risk factors or comorbidities for deep vein thrombosis in an urban district hospital in KwaZulu-Natal</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67512016000100002&lng=en&nrm=iso&tlng=en BACKGROUND: Although deep vein thrombosis (DVT) is a preventable disease, it increases the morbidity and mortality in hospitalised, patients, resulting in considerable economic health impact. The identification and primary prevention of risk factors using risk assessment and stratification with subsequent anti-thrombotic prophylaxis in moderate- to severe-risk categories is the most rational means of reducing morbidity and mortality. AIM AND SETTING: The aim of the study was to describe the profile and frequency of known risk factors or comorbidities of hospitalised medical patients with ultrasound-diagnosed DVT in an urban district hospital in KwaZulu-Natal. METHODS: A retrospective review of clinical notes of all medical patients (age > 13 years) admitted to the hospital with ultrasound-diagnosed DVT between July and December 2013. RESULTS: The median age was 40 years (interquartile range 32-60 years) and female preponderance was 72.84%. HIV and tuberculosis emerged as the prevalent risk factors, accounting for 51.85% and 35.80%, respectively. Other risk factors observed were recent hospitalisation (34.57%), smoking (25.93%), previous DVT (19.75%) and congestive cardiac failure (18.52%). CONCLUSION: DVT in our study occurred predominantly in young female patients unlike previous studies where patients were generally older. Furthermore, HIV and tuberculosis were the two most common known risk factors or comorbidities observed. Clinicians should have a heightened awareness of venous thromboembolism in patients with either condition or where both conditions occur together and appropriate thromboprophylaxis should be administered. <![CDATA[<b>Treatment outcomes in a rural HIV clinic in South Africa: Implications for health care</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67512016000100003&lng=en&nrm=iso&tlng=en OBJECTIVE: To assess the treatment outcomes of an HIV clinic in rural Limpopo province, South Africa. METHODS: A retrospective cohort study involving medical records review of HIV-positive patients initiated on antiretroviral treatment (ART) was conducted from December 2007 to November 2008 at Letaba Hospital. Data on socio-demographic characteristics, CD4 counts, viral loads (VLs), opportunistic infections, adverse effects of treatment, hospital admissions, and patient retention at 6, 12, 24, and 36 months on ART were collected. Analysis included descriptive statistics, chi-square and t-tests. RESULTS: Of 124 patient records sampled, the majority of patients were female (69%), single (49%), unemployed (56%), living at least 10 km from the hospital (52.4%), and were on treatment at 36 months (69%). Approximately 84% of patients achieved viral suppression (VLs < 400 copies/mL) by 6 months of ART and the mean CD4 count increased from 128 at baseline to 470 cells/mm³ at 24 months. There was a mean weight gain of 5.9 kg over the 36 months and the proportion of patients with opportunistic infections decreased from 54.8% (n = 68) at baseline to 15.3% (n = 19) at 36 months. Although the largest improvements in CD4, VLs, and weights were recorded in the first 6 months of ART, viral rebound became evident thereafter. Of all variables, only age < 50 years and being pregnant were significantly associated with higher VLs (p= 0.03). CONCLUSION: Good treatment outcomes are achievable in a rural South African ART clinic. However, early viral rebound and higher VLs in pregnancy highlight the need for enhanced treatment adherence support, especially for pregnant women to reduce the risk of mother to child transmission. <![CDATA[<b>The prevalence of HIV in the sudden, unexplained and unexpected death population at the Pretoria Medico-Legal Laboratory</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67512016000100004&lng=en&nrm=iso&tlng=en PURPOSE: To determine the prevalence of HIV in the sudden, unexplained and unexpected (SUU) death population admitted to the Pretoria Medico-Legal Laboratory. METHODS: This study was conducted at the Pretoria Medico-Legal Laboratory. Blood samples were obtained from decedents who died suddenly and/or unexpectedly, during autopsy, by a forensic pathologist. Sample collection continued until 100 valid samples were analysed for HIV antibodies. The data collected included demographic details and case-related information. RESULTS AND CONCLUSION: SUU deaths accounted for 14% of all cases admitted to the Pretoria Medico-Legal Laboratory. The HIV prevalence in the SUU deaths was 43%, which is 17% higher than the general mortuary population in Pretoria (p = 0.0045). The majority of these deaths were due to respiratory disease processes, with 12 cases having HIV/TB co-infection. <![CDATA[<b>Compliance to HIV treatment monitoring guidelines can reduce laboratory costs</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67512016000100005&lng=en&nrm=iso&tlng=en BACKGROUND: Panel tests are a predetermined group of tests commonly requested together to provide a comprehensive and conclusive diagnosis, for example, liver function test (LFT). South African HIV antiretroviral treatment (ART) guidelines recommend individual tests for toxicity monitoring over panel tests. In 2008, the National Health Laboratory Services (NHLS) request form was redesigned to list individual tests instead of panel tests and removed the 'other tests' box option to facilitate efficient ART laboratory monitoring. OBJECTIVES: This study aimed to demonstrate changes in laboratory expenditure, for individual and panel tests, for ART toxicity monitoring. METHOD: NHLS Corporate Data Warehouse (CDW) data were extracted for HIV conditional grant accounts to assess ART toxicity monitoring laboratory expenditure between 2010/2011 and 2014/2015. Data were classified based on the tests requested, as either panel (LFT or urea and electrolytes) or individual (alanine transaminase or creatinine) tests. RESULTS: Expenditure on panel tests reduced from R340 million in 2010/2011 to R140m by 2014/2015 (reduction of R204m) and individual test expenditure increased from R34m to R76m (twofold increase). A significant reduction in LFT panel expenditure was noted, reducing from R322m in 2010/2011 to R130m in 2014/2015 (60% reduction). CONCLUSION: Changes in toxicity monitoring guidelines and the re-engineering of the NHLS request form successfully reduced expenditure on panel tests relative to individual tests. The introduction of order entry systems could further reduce unnecessary laboratory expenditure. <![CDATA[<b>The end of the line? A case of drug resistance to third-line antiretroviral therapy</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67512016000100006&lng=en&nrm=iso&tlng=en HIV drug resistance has been described in all antiretroviral drug classes and threatens the long-term success of HIV treatment. Here, we describe the first reported case of acquired resistance to the integrase strand transfer inhibitors in South Africa. This case illustrates the dilemma of treatment in the context of inadequate adherence and poor psychosocial support and highlights the potential risk of transmission of multidrug-resistant virus. <![CDATA[<b>Hepatitis B co-infection in HIV-infected patients receiving antiretroviral therapy at the TC Newman Anti Retroviral Treatment Clinic in Paarl, Western Cape</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67512016000100007&lng=en&nrm=iso&tlng=en BACKGROUND: Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) co-infection in South Africa is estimated to be between 5% and 23%; however, only limited evidence is available. Co-infection increases the risk of chronification of HBV, liver cirrhosis and death. OBJECTIVE: To assess the HBV and/or HIV co-infection rate amongst the adult antiretroviral treatment cohort at the TC Newman ART Clinic in Paarl, Western Cape. METHODS: In a retrospective, cross-sectional study, the routine hepatitis B surface antigen screening results for all adult HIV patients who were started on antiretroviral treatment over a period of 19 months were collected and analysed for gender, CD4 count and age. RESULTS: Amongst the 498 participants (60% female participants), the Hepatitis B surface Antigen positivity rate was 7.6%. Male gender, age between 50 and 59 years and a low CD4 count were correlated with higher rates. CONCLUSION: Useful insight could be obtained by analysing routine data. The prevalence of almost 8% confirms the need for testing of HIV-positive patients for hepatitis B. <![CDATA[<b>Recommendations for the management of indeterminate HIV PCR results within South Africa's early infant diagnosis programme</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67512016000100008&lng=en&nrm=iso&tlng=en Indeterminate HIV PCR results represent missed diagnostic opportunities within South Africa's early infant diagnosis programme. These results not only delay diagnosis and appropriate management but are also a source of confusion and apprehension amongst clinicians and caregivers. We describe the extent of indeterminate HIV PCR results within South Africa's early infant diagnosis programme and provide recommendations for the management of these cases, both in terms of laboratory practice and the clinical care of the infants. <![CDATA[<b>What is the role of CD4 count in a large public health antiretroviral programme?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67512016000100009&lng=en&nrm=iso&tlng=en Indeterminate HIV PCR results represent missed diagnostic opportunities within South Africa's early infant diagnosis programme. These results not only delay diagnosis and appropriate management but are also a source of confusion and apprehension amongst clinicians and caregivers. We describe the extent of indeterminate HIV PCR results within South Africa's early infant diagnosis programme and provide recommendations for the management of these cases, both in terms of laboratory practice and the clinical care of the infants. <![CDATA[<b>Southern African guidelines on the safe use of pre-exposure prophylaxis in persons at risk of acquiring HIV-1 infection</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67512016000100010&lng=en&nrm=iso&tlng=en The Southern African HIV Clinicians Society published its first set of oral pre-exposure prophylaxis (PrEP) guidelines in June 2012 for men who have sex with men (MSM) who are at risk of HIV infection. With the flurry of data that has been generated in PrEP clinical research since the first guideline, it became evident that there was a need to revise and expand the PrEP guidelines with new evidence of safety and efficacy of PrEP in several populations, including MSM, transgender persons, heterosexual men and women, HIV-serodiscordant couples and people who inject drugs. This need is particularly relevant following the World Health Organization (WHO) Consolidated Treatment Guidelines released in September 2015. These guidelines advise that PrEP is a highly effective, safe, biomedical option for HIV prevention that can be incorporated with other combination prevention strategies in Southern Africa, given the high prevalence of HIV in the region. PrEP should be tailored to populations at highest risk of HIV acquisition, whilst further data from studies in the region accrue to guide optimal deployment to realise the greatest impact regionally. PrEP may be used intermittently during periods of perceived HIV acquisition risk, rather than continually and lifelong, as is the case with antiretroviral treatment. Recognition and accurate measurement of potential risk in individuals and populations also warrants discussion, but are not extensively covered in these guidelines.