Scielo RSS <![CDATA[Southern African Journal of HIV Medicine]]> http://www.scielo.org.za/rss.php?pid=2078-675120140004&lang=pt vol. 15 num. 4 lang. pt <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Message From the Editor</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67512014000400001&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Message From the Executive</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67512014000400002&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Managing the HIV-infected neonate: A rural doctor's perspective</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67512014000400003&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Adult antiretroviral therapy guidelines 2014</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67512014000400004&lng=pt&nrm=iso&tlng=pt These guidelines are intended as an update to those published in the Southern African Journal of HIV Medicine in 2012. Since the release of the previous guidelines, the scale-up of antiretroviral therapy (ART) in southern Africa has continued. Cohort studies from the region show excellent clinical outcomes; however, ART is still being initiated late (in advanced disease) in some patients, resulting in relatively high early mortality rates. New data on antiretroviral drugs have become available. Although currently few, there are patients in the region who are failing protease-inhibitor-based second-line regimens. To address this, guidelines on third-line therapy have been expanded. <![CDATA[<b>Safety of the surgeon: 'Double-gloving' during surgical procedures</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67512014000400005&lng=pt&nrm=iso&tlng=pt BACKGROUND: In the face of increasing HIV/AIDS prevalence in subSaharan Africa, we evaluate the effectiveness of 'double-gloving' during surgery as a means of protecting the surgeon operating on patients with a known or unknown HIV status. METHODS: A prospective study was conducted to determine the rate of glove puncture and intraoperative injury in categories of patients with known positive, known negative or unknown HIV status. RESULTS: The surgeon and the first assistant double-gloved in all the 1 050 procedures performed between 2009 and 2013, and a total of 8 400 surgical gloves were used. Sixty-nine patients (6.6%) were HIV-positive, 29 patients (2.8%) were HIV-negative, and the HIV status was unknown for the remaining 952 patients (90.7%). The overall glove puncture rate in the study was 14.5%. The glove puncture rate was 0%, 31% and 15% for HIV-positive, HIV-negative and HIV status unknown, respectively, and this difference was statistically significant. The mean operating time in the group with glove punctures was 148 min (95% confidence interval (CI) 135 - 161), while mean operating time in the group without glove puncture was 88 min (95% CI 84 - 92). CONCLUSION: Double-gloving offers protection against intraoperative injury. Knowing the HIV status of the patient offers additional protection to the operating surgeon. While we recommend routine double-gloving for surgeons working in HIV-prevalent patient populations, we also advocate for the routine screening for HIV in all surgical patients. <![CDATA[<b>Paediatric ART outcomes in a decentralised model of care in Cape Town, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67512014000400006&lng=pt&nrm=iso&tlng=pt BACKGROUND: Although subSaharan Africa faces the world's largest paediatric HIV epidemic, only 1 in 4 children has access to combination antiretroviral therapy (ART). A decentralised approach to HIV care is advocated, but programmes in resource-limited settings encounter many challenges to community-initiated paediatric ART implementation. METHODS: A retrospective cohort analysis of 613 children receiving ART between 2004 and 2009 was performed in seven physician-run primary healthcare (PHC) clinics in Cape Town. Baseline characteristics, serial CD4+, viral load (VL) levels and status at study closure were collected. RESULTS: Two subgroups were identified: children who were initiated on ART in a PHC clinic (n=343) and children who were down-referred from tertiary hospitals (n=270). The numbers of children initiated on ART in PHC increased sevenfold over the study period. Down-referred children were severely ill at ART initiation, with higher VLs, lower CD4+ counts and higher rates of tuberculosis co-infection (25.3% v. 16.9%; p=0.01). Median time to virological suppression was 29 weeks in PHC-ART initiates and 44 weeks in children down-referred (p<0.0001). Children down-referred to PHC either maintained or gained virological suppression. Longitudinal cohort analysis demonstrated sustained VL suppression &gt;80%, high rates of immune reconstitution and low mortality. CONCLUSIONS: Increasing numbers of children are initiated on ART in PHC settings and achieve comparable immunological, virological and survival outcomes, suggesting successful decentralisation of paediatric HIV care. Down-referral of children with adherence-related virological failure may assist with attainment of virological suppression and sparing use of second-line medications. <![CDATA[<b>Disseminated fatal <i>Talaromyces </i>(<i>Penicillium</i>)<i> marneffei </i>infection in a returning HIV-infected traveller</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67512014000400007&lng=pt&nrm=iso&tlng=pt We report a case of disseminated fatal Talaromyces (Penicillium) marneffei infection in an HIV-infected, antiretroviral treatment-experienced South African woman who had travelled to mainland China. The 37-year-old woman was admitted to a private hospital in fulminant septic shock and died within 12 h of admission. Intracellular yeast-like bodies were observed on the peripheral blood smear. A serum cryptococcal antigen test was negative. Blood cultures flagged positive after 2 days; on direct microscopy, yeast-like bodies were observed and a thermally dimorphic fungus, confirmed as T. marneffei, was cultured after 5 days. The clinical features of HIV-associated disseminated penicilliosis overlap with those of tuberculosis and endemic deep fungal infections. In the southern African context, where systemic opportunistic fungal infections such as cryptococcosis are more common among HIV-infected patients with a CD4+ count of <100 cells/µL, this infection is not likely to be considered in the differential diagnosis unless a travel history is obtained. <![CDATA[<b>'Excelling in Clinical Care': Southern African HIV Clinicians Society Conference</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67512014000400008&lng=pt&nrm=iso&tlng=pt We report a case of disseminated fatal Talaromyces (Penicillium) marneffei infection in an HIV-infected, antiretroviral treatment-experienced South African woman who had travelled to mainland China. The 37-year-old woman was admitted to a private hospital in fulminant septic shock and died within 12 h of admission. Intracellular yeast-like bodies were observed on the peripheral blood smear. A serum cryptococcal antigen test was negative. Blood cultures flagged positive after 2 days; on direct microscopy, yeast-like bodies were observed and a thermally dimorphic fungus, confirmed as T. marneffei, was cultured after 5 days. The clinical features of HIV-associated disseminated penicilliosis overlap with those of tuberculosis and endemic deep fungal infections. In the southern African context, where systemic opportunistic fungal infections such as cryptococcosis are more common among HIV-infected patients with a CD4+ count of <100 cells/µL, this infection is not likely to be considered in the differential diagnosis unless a travel history is obtained.