Scielo RSS <![CDATA[Southern African Journal of HIV Medicine]]> http://www.scielo.org.za/rss.php?pid=2078-675120220001&lang=pt vol. 23 num. 1 lang. pt <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Multiple opportunistic infections (pulmonary tuberculosis, <i>Mycobacterium avium</i> complex and parvovirus B19) in a single patient</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67512022000100001&lng=pt&nrm=iso&tlng=pt INTRODUCTION: HIV infection is a common disease in the South African population. The virus can lead to the development of many opportunistic infections. This case study examines co-infection with three opportunistic infections and the need for clinical suspicion of infections in our HIV population. PATIENT PRESENTATION: A 36-year-old unemployed female residing in Soweto, Johannesburg, presented at Chris Hani Baragwanath Hospital (CHBAH). She was HIV positive, defaulting treatment, with no other comorbidities. She presented to CHBAH with general body weakness, diarrhoea, cough and constitutional symptoms; clinically she appeared pale and chronically ill. A differential diagnosis was made of multiple infections co-inhabiting the patient. Management and outcome: The patient had blood, sputum, radiological and invasive bone marrow aspiration, and trephine biopsies completed. The investigations revealed that she was co-infected with Mycobacterium tuberculosis (MTB), Mycobacterium avium complex (MAC) and parvovirus B19. The TB and disseminated MAC infection were managed with rifampicin, isoniazid, ethambutol, pyrazinamide and azithromycin, and reinitiation of antiretroviral (ARV) treatment was planned on further follow-up of the ARV drug resistance test. The parvovirus B19 infection was managed with immunoglobulins (Polygam) and steroids (prednisone). She was discharged successfully for further follow-up. CONCLUSION: A thorough history, clinical examination and subsequent targeted investigations are vital to arriving at the correct diagnosis or diagnoses. The case presented above serves to illustrate how three life-threatening opportunistic infections (OIs), all with differing treatments, may present in a single patient. Clinicians caring for immunosuppressed patients need to remain vigilant for the presence of multiple OIs occurring simultaneously. <![CDATA[<b>Factors influencing the high rejection rates of HIV 1/2 serology samples at Charlotte Maxeke Johannesburg Academic Hospital and the cost implications</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67512022000100002&lng=pt&nrm=iso&tlng=pt BACKGROUND: HIV enzyme-linked immunosorbent assay (ELISA) is one of the most requested test sets within Virology and forms an essential part of patient management. Assessment of the rejection criteria is a key quality indicator, crucial for improving laboratory services and efficiency to ensure accurate and reliable results OBJECTIVES: The aim of this study was to identify the factors that influence the HIV 1/2 serology rejection rates (RR) at Charlotte Maxeke Johannesburg Academic Hospital and to evaluate the associated costs METHODS: A retrospective study was conducted (June to December 2019) to identify the RR and rejection criteria of HIV serology samples throughout the total testing process. Descriptive analysis using percentages and frequencies was used to analyse the RR by phase, health establishment, ward and healthcare professional. A cost analysis incorporating minor and major costs was modelled in each phase of testing, and the total cost of rejections was calculated RESULTS: A total of 6678 tests were received, and 738 were rejected (RR = 11.1%). The pre-analytical phase contributed significantly to the overall RR, with the requirement of a separate sample (57.44%) the most common reason for rejection. The total cost per rejected test was $2.47, which amounted to a total rejection cost of $197.55, of which $158.18 was caused by the pre-analytical rejection criteria CONCLUSION: High RR of HIV tests were noted, resulting in significant cost wastage. Identification and analysis of rejections must be implemented across all laboratories to improve the efficiency of testing, provide a cost-saving benefit and maintain high laboratory standards <![CDATA[<b>Predictors of low antiretroviral adherence at an urban South African clinic: A mixed-methods study</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67512022000100003&lng=pt&nrm=iso&tlng=pt BACKGROUND: Low adherence to antiretroviral treatment (ART) in people living with HIV (PLHIV) remains a critical issue, especially in vulnerable populations. Although ART is responsible for greatly reducing the mortality and morbidity associated with HIV, low treatment adherence continues to impact the effectiveness of ART. Considering that a high level of adherence to ART is required for the excellent clinical outcomes with which ART is often associated, understanding the complex contextual and personal factors that limit high levels of treatment adherence remains paramount. Poor adherence remains an issue in many South African communities many years after the introduction of ART OBJECTIVES: Our study sought to understand the specific factors and the interactions among them that contribute to non-adherence in this patient population in order to devise successful and contextually appropriate interventions to support ART adherence in PLHIV METHODS: This mixed-methods study employed a study-specific questionnaire (N = 103) and semi-structured interviews (N = 8) to investigate the factors linked to non-adherence at the Heideveld Community Day Centre in Cape Town, South Africa RESULTS: Over half (57.3%) of participants were ART non-adherent. Non-adherence was correlated with younger age, negative self-image and a low belief in the necessity of ART (P < 0.05). In patient interviews, alcohol use, treatment fatigue and stigmatisation emerged as contributors to suboptimal adherence CONCLUSION: The results suggest that there remains a need for context-sensitive interventions to support PLHIV in South African communities. Future research needs to ensure that these targeted interventions take these factors into consideration <![CDATA[<b>The influence of smoking and HIV infection on pulmonary function</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67512022000100004&lng=pt&nrm=iso&tlng=pt BACKGROUND: Prevalence of HIV, smoking, and pulmonary infections in South Africa are high. OBJECTIVES: We investigated the role of smoking and HIV status on lung function. METHODS: This is a secondary analysis of a cross-sectional study conducted in South Africa. Data included demographics, pulmonary risk factors and a spirometry test to obtain the forced expiratory volume in one second (FEV1) and the ratio of FEV1/forced vital capacity (FVC). In the initial multivariable regression analysis, the effect of smoking on pulmonary function in HIV-positive adults was assessed. The analysis was repeated, assessing the influence of HIV status on lung function in both HIV-negative and HIV-positive smokers. The models were adjusted for age, sex, body mass index (BMI), time since HIV diagnosis, antiretroviral treatment (ART) use, occupational hazards, history of tuberculosis or pneumonia, indoor smoking and the presence of an indoor fireplace during childhood. RESULTS: This study included 524 people living with HIV (PLWH, 66.7% female, mean age 40.9 years [s.d.; 9.4]) and 79 HIV-negative smokers (77.2% male, mean age 34.4 years [s.d.: 12.1]). Of the PLWH, 118 (22.5%) were past or current smokers and 406 (77.5%) were non-smokers. Smoking was not associated with changes in the FEV1 or FEV1/FVC ratio in multivariable regression analysis. In the second analysis, HIV status was also not associated with reduced pulmonary function following adjustment for confounders. CONCLUSION: Neither smoking nor being HIV-positive was associated with decreased pulmonary function in this relatively young population. These findings should be confirmed in a longitudinal study, including an older population. <![CDATA[<b>Age-related differences in the vascular function and structure of South Africans living with HIV</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67512022000100005&lng=pt&nrm=iso&tlng=pt BACKGROUND: As the life expectancy of people living with the HIV increases because of antiretroviral treatment (ART), their risk for vascular co-morbidities and early vascular ageing (EVA) also increases.OBJECTIVE: We aimed to investigate whether HIV infection relates to vascular structure and function in black South African adults and whether this relationship is age dependent.METHOD: This cross-sectional study carried out in urban and rural areas of North West province, South Africa, included 572 age- and sex-matched people living with HIV (PLWH) and without HIV. Participants from the EndoAfrica study and PURE study were stratified according to tertiles of age. Measures of vascular structure (carotid intima-media thickness) and function (carotid-femoral pulse wave velocity, central systolic blood pressure, central pulse pressure and pulse pressure amplification) were determined.RESULTS: Blood pressure measures were lower in PLWH compared with their controls (all P ≤ 0.001), especially in the younger and middle-aged groups (all P ≤ 0.031), whilst vascular measures did not differ (all P ≥ 0.611). In multivariate linear regression analyses, vascular measures were not associated with a HIV- positive status in either the total or any of the age groups.CONCLUSION: Black South Africans living with HIV have a less adverse blood pressure profile than their counterparts without HIV. The HIV-positive status was not associated with measures of vascular structure or function in any age group. The results suggest that HIV does not contribute to EVA in this population; however, further longitudinal investigation is warranted. <![CDATA[<b>Cytomegalovirus retinitis and antiretroviral treatment: A fifteen year experience</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67512022000100006&lng=pt&nrm=iso&tlng=pt BACKGROUND: South Africa's public antiretroviral treatment (ART) programme has undergone progressive changes since its introduction in 2004. The effect of this on the burden of the AIDS-defining opportunistic infection, cytomegalovirus retinitis (CMVR), in SA, has not been fully appreciated. OBJECTIVES: To determine the effect of ART availability in the public sector of SA on the trend in the number of cases of newly diagnosed CMVR over time. METHODS: This is a retrospective study from 01 November 2002 to 31 August 2017 that took place at a tertiary hospital in the KwaZulu-Natal (KZN) province. RESULTS: A total of 383 participants were included in the study, with 60.1% being female and 94% of black African origin. The mean age of patients was 34.08 years (SD ± 7.24). A linear trend model suggested an overall linear decrease in the number of new cases of CMVR per year (R² of 0.67). The average number of new cases of CMVR per year prior to ART being available to all persons living with HIV (PLWH) with a CD4+ ≤ 350 cells/μL and after was 34 and 13, respectively, and the difference (61.76%) between these values was statistically significant, P = 0.001. The median CD4+ count at diagnosis of CMVR was 22 (interquartile range: 9-51.25) cells/μL. An overall 51% of patients in this study were on ART at diagnosis of CMVR. There was a higher proportion of patients on ART ≤ 6 months (63.3%), compared with those on ART &gt; 6 months (36.7%), and the difference was statistically significant, P < 0.01. CONCLUSION: ART has resulted in a decrease in the burden of CMVR on ophthalmic services for many in KZN, particularly following the introduction of ART for all PLWH with a CD4 ≤ 350 cells/μL. <![CDATA[<b>Evaluation of the modified Wells score in predicting venous thromboembolic disease in patients with tuberculosis or HIV in a South African setting</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67512022000100007&lng=pt&nrm=iso&tlng=pt BACKGROUND: There is paucity of data on the modified Wells score (MWS) utility on patients with venous thromboembolism (VTE) in a South African setting where there is a high burden of HIV and tuberculosis (TB). This study analyses the performance of this score in HIV/TB-infected patients compared with non-infected patients OBJECTIVES: To assess the performance of the MWS as an additional risk factor for VTE in hospitalised patients with a high burden of HIV/TB infections METHOD: This study was a retrospective cross-sectional cohort analysis of the utility of the MWS in 156 HIV/TB-infected and non-infected adult patients diagnosed with VTE on compression ultrasonography (CUS) or computed tomography pulmonary angiography (CTPA) in a medical inpatient setting over six months. Patients with HIV and/or TB were assessed as having an additional risk factor (1 point for each), and this was compared with the MWS. A McNeymar's paired sample chi-squared test was used to compare the sensitivity of this score against the MWS RESULTS: Of the 156 patients with VTE who were enrolled, HIV was the commonest risk factor (42.31%) with TB accounting for 10.90% of cases. When the MWS adjusted for HIV/TB was used, the sensitivity increased from 25% to 100% for the HIV-/TB+ category, it increased from 77.36% to 98.11% in the HIV+/TB- category and it increased from 84.62% to 92.95% in the HIV+/TB+ category. These differences were statistically significant at P < 0.05 in all categories CONCLUSION: The MWS performs better when the infectivity of HIV/TB is included as an additional risk factor in the score <![CDATA[<b>Association between socio-economic factors and HIV self-testing knowledge amongst South African women</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67512022000100008&lng=pt&nrm=iso&tlng=pt BACKGROUND: Self-testing for HIV is an effective and alternative method of increasing HIV testing rates and a strategy for reaching populations that are underserved by HIV testing services. Nonetheless, many resource-constrained settings are yet to adopt HIV self-testing (HIVST) into their national HIV programmes OBJECTIVES: This study aimed to examine the association between socio-economic factors and HIVST knowledge amongst South African women METHOD: We used nationally representative data from the 2016 South African Demographic and Health Survey. A sample of 8182 women of reproductive age was analysed. The outcome variable was HIVST knowledge. This was measured dichotomously; know versus do not know about HIVST. The multivariable logistic model was used to examine the measures of association, with the level of significance set at P < 0.05 RESULTS: The prevalence rate of HIVST knowledge was found to be approximately 24.5% (95% confidence interval [CI]: 22.9-26.1) amongst South African women. Women with tertiary education were 3.93 times more likely to have HIVST knowledge, when compared with those with no formal education (odds ratio [OR]: 3.93; 95% CI: 1.37-11.26). Rural residents had a 33% reduction in HIVST knowledge when compared with those residing in urban areas (OR: 0.67; 95% CI: 0.51-0.89). The odds of interaction between the richer and richest women who have good knowledge of HIV infection were 1.88 and 2.24 times more likely to have HIVST knowledge, respectively, when compared with those from the poorest wealth household who have good knowledge of HIV infection CONCLUSION: Based on the low level of HIVST knowledge, the findings emphasise the importance of developing effective HIVST educational campaigns. Moreover, programmes should be designed to address the unique needs of the socio-economically disadvantaged women <![CDATA[<b>SAHCS 2021 Conference Summary</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67512022000100009&lng=pt&nrm=iso&tlng=pt BACKGROUND: Self-testing for HIV is an effective and alternative method of increasing HIV testing rates and a strategy for reaching populations that are underserved by HIV testing services. Nonetheless, many resource-constrained settings are yet to adopt HIV self-testing (HIVST) into their national HIV programmes OBJECTIVES: This study aimed to examine the association between socio-economic factors and HIVST knowledge amongst South African women METHOD: We used nationally representative data from the 2016 South African Demographic and Health Survey. A sample of 8182 women of reproductive age was analysed. The outcome variable was HIVST knowledge. This was measured dichotomously; know versus do not know about HIVST. The multivariable logistic model was used to examine the measures of association, with the level of significance set at P < 0.05 RESULTS: The prevalence rate of HIVST knowledge was found to be approximately 24.5% (95% confidence interval [CI]: 22.9-26.1) amongst South African women. Women with tertiary education were 3.93 times more likely to have HIVST knowledge, when compared with those with no formal education (odds ratio [OR]: 3.93; 95% CI: 1.37-11.26). Rural residents had a 33% reduction in HIVST knowledge when compared with those residing in urban areas (OR: 0.67; 95% CI: 0.51-0.89). The odds of interaction between the richer and richest women who have good knowledge of HIV infection were 1.88 and 2.24 times more likely to have HIVST knowledge, respectively, when compared with those from the poorest wealth household who have good knowledge of HIV infection CONCLUSION: Based on the low level of HIVST knowledge, the findings emphasise the importance of developing effective HIVST educational campaigns. Moreover, programmes should be designed to address the unique needs of the socio-economically disadvantaged women <![CDATA[<b>Alere Determine-tuberculosis lipoarabinomannan positivity in disseminated non-tuberculous mycobacteria: An illustrative case series</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67512022000100010&lng=pt&nrm=iso&tlng=pt INTRODUCTION: In outpatients, the World Health Organization recommends that the urine Alere Determine-tuberculosis lipoarabinomannan (AlereLAM) should be used to support the diagnosis of tuberculosis (TB) in people living with HIV (PLHIV) with CD4 counts ≤ 100 cells/µL or with signs of being 'seriously ill'. There is a risk of a false-positive AlereLAM in disseminated non-tuberculous mycobacterial (NTM) infections and it may be difficult to differentiate a single infection (either Mycobacterium tuberculosis or NTM) from dual infection PATIENT PRESENTATION: We report three patients, enrolled in an operational study assessing AlereLAM use in an outpatient setting, who had advanced HIV (all CD4 < 20 cells/µL) and strongly positive (grade 4+) AlereLAM results in whom Mycobacterium avium or kansasii were later cultured from blood or urine and sputum. MANAGEMENT AND OUTCOME: Based on positive AlereLAM results, all three were initiated on TB treatment. One died before NTM infection was detected. Two were managed for dual infection (TB and NTM) but died within two years. CONCLUSION: Tuberculosis remains a leading cause of death and a disproportionate number of these deaths occur in PLHIV. Tuberculous treatment should be initiated based on a positive AlereLAM result, and this should be followed by additional testing to confirm the diagnosis of TB and to obtain drug susceptibility results. In those not responding to TB treatment where the only positive result was an AlereLAM, an alternative or additional diagnosis of NTM infection should be considered, particularly in patients with a very low CD4 count. <![CDATA[<b>Utilisation of cervical cancer screening among women living with HIV at Kenya's national referral hospital</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67512022000100011&lng=pt&nrm=iso&tlng=pt BACKGROUND: In 2009, Kenyatta National Hospital (KNH) integrated cervical cancer screening within HIV care using visual inspection with acetic acid (VIA) and Pap smear cytology. OBJECTIVES: We evaluated utilisation of cervical cancer screening and human papillomavirus (HPV) vaccination among women living with HIV (WLHIV) receiving HIV care at KNH. METHOD: From November 2019 to February 2020, WLHIV aged ≥ 14 years were invited to participate in a survey following receipt of routine HIV services. We assessed awareness of cervical cancer, uptake of cervical cancer screening, uptake of the HPV vaccine, and barriers to utilisation of these services. In a subset of survey participants, focus group discussions (FGDs) were also conducted to identify screening barriers. RESULTS: Overall, 305 WLHIV participated in the survey. Median age was 36 years (interquartile range [IQR]: 28-43), 41% were married, and 38% completed secondary education. Most (90%) had HIV RNA < 1000 copies/mL. Awareness of cervical cancer was high (84%), although only 45% of WLHIV had screened for cervical cancer at the referral hospital and only 13% knew how to prevent high-risk HPV. No participants had received an HPV vaccination. Older age, higher education, and knowledge of the HPV vaccine were associated with higher likelihood of cervical cancer screening (P < 0.05). In FGDs, barriers to utilising the services included user fees, fear of the procedure impacting fertility, age and gender of the provider, and long waiting times. CONCLUSION: Despite integration with HIV services, the utilisation of cervical cancer screening was low among WLHIV and implementation barriers contributed to low utilisation <![CDATA[<b>Where are the children? Case finding in 5–14-year-olds living with HIV in Johannesburg</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67512022000100012&lng=pt&nrm=iso&tlng=pt BACKGROUND: In 2009, Kenyatta National Hospital (KNH) integrated cervical cancer screening within HIV care using visual inspection with acetic acid (VIA) and Pap smear cytology. OBJECTIVES: We evaluated utilisation of cervical cancer screening and human papillomavirus (HPV) vaccination among women living with HIV (WLHIV) receiving HIV care at KNH. METHOD: From November 2019 to February 2020, WLHIV aged ≥ 14 years were invited to participate in a survey following receipt of routine HIV services. We assessed awareness of cervical cancer, uptake of cervical cancer screening, uptake of the HPV vaccine, and barriers to utilisation of these services. In a subset of survey participants, focus group discussions (FGDs) were also conducted to identify screening barriers. RESULTS: Overall, 305 WLHIV participated in the survey. Median age was 36 years (interquartile range [IQR]: 28-43), 41% were married, and 38% completed secondary education. Most (90%) had HIV RNA < 1000 copies/mL. Awareness of cervical cancer was high (84%), although only 45% of WLHIV had screened for cervical cancer at the referral hospital and only 13% knew how to prevent high-risk HPV. No participants had received an HPV vaccination. Older age, higher education, and knowledge of the HPV vaccine were associated with higher likelihood of cervical cancer screening (P < 0.05). In FGDs, barriers to utilising the services included user fees, fear of the procedure impacting fertility, age and gender of the provider, and long waiting times. CONCLUSION: Despite integration with HIV services, the utilisation of cervical cancer screening was low among WLHIV and implementation barriers contributed to low utilisation <![CDATA[<b>Psychosocial support for adolescents and youth living with HIV during COVID-19: A differentiated approach is needed</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67512022000100013&lng=pt&nrm=iso&tlng=pt BACKGROUND: In 2009, Kenyatta National Hospital (KNH) integrated cervical cancer screening within HIV care using visual inspection with acetic acid (VIA) and Pap smear cytology. OBJECTIVES: We evaluated utilisation of cervical cancer screening and human papillomavirus (HPV) vaccination among women living with HIV (WLHIV) receiving HIV care at KNH. METHOD: From November 2019 to February 2020, WLHIV aged ≥ 14 years were invited to participate in a survey following receipt of routine HIV services. We assessed awareness of cervical cancer, uptake of cervical cancer screening, uptake of the HPV vaccine, and barriers to utilisation of these services. In a subset of survey participants, focus group discussions (FGDs) were also conducted to identify screening barriers. RESULTS: Overall, 305 WLHIV participated in the survey. Median age was 36 years (interquartile range [IQR]: 28-43), 41% were married, and 38% completed secondary education. Most (90%) had HIV RNA < 1000 copies/mL. Awareness of cervical cancer was high (84%), although only 45% of WLHIV had screened for cervical cancer at the referral hospital and only 13% knew how to prevent high-risk HPV. No participants had received an HPV vaccination. Older age, higher education, and knowledge of the HPV vaccine were associated with higher likelihood of cervical cancer screening (P < 0.05). In FGDs, barriers to utilising the services included user fees, fear of the procedure impacting fertility, age and gender of the provider, and long waiting times. CONCLUSION: Despite integration with HIV services, the utilisation of cervical cancer screening was low among WLHIV and implementation barriers contributed to low utilisation <![CDATA[<b>Understanding patients reinitiating antiretroviral therapy in two South African districts</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67512022000100014&lng=pt&nrm=iso&tlng=pt BACKGROUND: In 2009, Kenyatta National Hospital (KNH) integrated cervical cancer screening within HIV care using visual inspection with acetic acid (VIA) and Pap smear cytology. OBJECTIVES: We evaluated utilisation of cervical cancer screening and human papillomavirus (HPV) vaccination among women living with HIV (WLHIV) receiving HIV care at KNH. METHOD: From November 2019 to February 2020, WLHIV aged ≥ 14 years were invited to participate in a survey following receipt of routine HIV services. We assessed awareness of cervical cancer, uptake of cervical cancer screening, uptake of the HPV vaccine, and barriers to utilisation of these services. In a subset of survey participants, focus group discussions (FGDs) were also conducted to identify screening barriers. RESULTS: Overall, 305 WLHIV participated in the survey. Median age was 36 years (interquartile range [IQR]: 28-43), 41% were married, and 38% completed secondary education. Most (90%) had HIV RNA < 1000 copies/mL. Awareness of cervical cancer was high (84%), although only 45% of WLHIV had screened for cervical cancer at the referral hospital and only 13% knew how to prevent high-risk HPV. No participants had received an HPV vaccination. Older age, higher education, and knowledge of the HPV vaccine were associated with higher likelihood of cervical cancer screening (P < 0.05). In FGDs, barriers to utilising the services included user fees, fear of the procedure impacting fertility, age and gender of the provider, and long waiting times. CONCLUSION: Despite integration with HIV services, the utilisation of cervical cancer screening was low among WLHIV and implementation barriers contributed to low utilisation