Southern African HIV Clinicians Society guidelines for antiretroviral therapy in adults: 2020 update

Nel, Jeremy; Dlamini, Sipho; Meintjes, Graeme; Burton, Rosie; Black, John; Davies, Nick; Hefer, Eric; Maartens, Gary; Mangena, Phetho; Mathe, Moeketsi; Moosa, Mahomed-Yunus S.; Mulaudzi, Muhangwi B.; Moorhouse, Michelle; Nash, Jennifer; T, Nkonyane; Preiser, Wolfgang; Rassool, Mohammed; Stead, David; Plas, Helen van der; Vuuren, C.V. van; Venter, François; Woods, Joana

doi:10.4102/sajhivmed.v21i1.1115

Cited by 48 publications

(62 citation statements)

References 102 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, this visceral adipose tissue results in accelerated lipolysis and is what contributes to the high prevalence of non-alcoholic fatty liver disease reported in up to 30%-35% of mono-infected patients, that is, PLWH without hepatitis B or C. 34 In the longest follow-up of body composition following ART, it was found that continued fat gain after 96 weeks of treatment was associated with the greatest risk of metabolic disorders. 35 Southern African HIV Clinicians Society guidelines for antiretroviral therapy in adults: 2020 update, 36 now recommend InSTI (Dolutegravir [DTG])-based therapies as the preferred first-line ART therapy. InSTIs have been touted as not affecting cholesterol metabolism which may have a big impact on preventing CVD and GD in these subsets of patients.…”

Section: Discussionmentioning

confidence: 99%

Symptomatic gallstones and HIV in black South African women: Changing trends of gallstone disease?

Kinoo

Nagiah

Chuturgoon

et al. 2021

Southern African Journal of HIV Medicine

View full text Add to dashboard Cite

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 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.

show abstract

Section: Discussionmentioning

confidence: 99%

Symptomatic gallstones and HIV in black South African women: Changing trends of gallstone disease?

Kinoo

Nagiah

Chuturgoon

et al. 2021

Southern African Journal of HIV Medicine

View full text Add to dashboard Cite

show abstract

“…32 Only four of the patients had a viral load of < 50, which indicates viral suppression based on the most recent guidelines. 33 All eight patients who were virally suppressed were on first-line therapy. Of the 17 patients who were not virally suppressed, 9 were on FDC (a fixed-dose combination tablet containing tenofovir [TDF] + emtricitabine [FTC] + efavirenz [EFV]); 4 were on first-line treatment, but not FDC; and 3 were on second-line treatment.…”

Section: Resultsmentioning

confidence: 99%

“…50 It is therefore important to diagnose cognitive impairment in PLWH to ensure optimal treatment outcomes and to simplify treatment regimens if possible. Hopefully, the replacement of efavirenz with dolutegravir in the fixed drug combination 33 will lead to more patients with psychiatric disorders initiated on this regimen. Although 32 patients scored lower than 26 on the MoCA, only 4 of these patients were diagnosed with HAND.…”

Section: Discussionmentioning

confidence: 99%

The clinical and demographic profile of women living with HIV admitted to the acute unit at Stikland Psychiatric Hospital

Roux

Groenewald

Moxley

et al. 2021

Southern African Journal of HIV Medicine

View full text Add to dashboard Cite

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.

show abstract

“…In South Africa an established IPT protocol exists for HIV positive patients only [ 26 ]. A 12-month duration of IPT is recommended in all non-pregnant HIV positive patients who screened negative for active TB based on symptoms, irrespective of their latent TB status.…”

Section: Methodsmentioning

confidence: 99%

Incident tuberculosis disease in patients receiving biologic therapies in the Western Cape, South Africa from 2007 to 2018

et al. 2020

View full text Add to dashboard Cite

Background South Africa has one of the highest tuberculosis incidence rates. Biologic disease-modifying anti-rheumatic drugs are associated with an increased risk of tuberculosis. The objective of this study was to describe the tuberculosis disease incidence rate among public sector patients receiving biologic therapies in the Western Cape Province. Methods A retrospective, descriptive analysis was undertaken using routine health data collated by the Provincial Health Data Centre from January 2007 (first use of biologic therapy in the Western Cape) to September 2018. Results We identified 609 patients treated with tumour necrosis factor-alpha (TNF-α) or non-TNF-α biologic therapies. Thirty-seven (37) patients developed tuberculosis after biologic therapy exposure, of whom the majority (78%) had an immune mediated inflammatory disease and the remainder (22%) a haematologic malignancy. The incidence rate of tuberculosis per 100,000 person-years was 2227 overall [95% confidence interval (CI): 1591, 3037]. Patients treated with TNF-α inhibitors and non-TNF-α inhibitors had estimated incidence rates of 2819 [95% CI: 1669, 4480] and 1825 [95% CI: 1131, 2797], respectively (p = 0.10). Conclusion Patients exposed to both TNF-α and non-TNF-α biologic therapies may have a higher incidence of tuberculosis disease compared to the background risk of 681 cases per 100,000 per year in the Western Cape.

show abstract

Southern African HIV Clinicians Society guidelines for antiretroviral therapy in adults: 2020 update

Cited by 48 publications

References 102 publications

Symptomatic gallstones and HIV in black South African women: Changing trends of gallstone disease?

Symptomatic gallstones and HIV in black South African women: Changing trends of gallstone disease?

The clinical and demographic profile of women living with HIV admitted to the acute unit at Stikland Psychiatric Hospital

Incident tuberculosis disease in patients receiving biologic therapies in the Western Cape, South Africa from 2007 to 2018

Contact Info

Product

Resources

About