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Message from the Editor
This June edition of SAJHIVMED is being released to coincide with the 6th South African AIDS Conference, held in Durban. The conference programme is filled with renowned speakers from a range of backgrounds, and the focus of the meeting – integration of policies and systems in response to HIV – is particularly critical at this stage of our response to the epidemic.
Paralleling the broad focus of this meeting, the diversity of articles in this issue of the Journal emphasises the range of clinical, psychosocial and health systems challenges raised by the HIV epidemic and our responses to it. On the topic of the prevention of mother-to-child transmission (PMTCT) of HIV, Mnyani and McIntyre1 document the challenges to providing high quality services in Soweto; while their research was conducted around previous PMTCT guidelines, the results showing the difficulties in delivering PMTCT interventions in primary care are especially noteworthy in light of recently revised national policies. In the area of mental health, Govender and Schlebusch2 present a potentially useful screening tool for identifying patients at risk of suicidality following HIV diagnosis – a critically important but widely neglected concern. Rebe and colleagues3 discuss the health service needs of men who have sex with men and suggest a range of approaches to the design and delivery of services. On the topic of the social impact of the epidemic, Jury and Nattrass4 present unique insights into how the household circumstances of patients initiating ART may change over time, suggesting decreased reliance on family members for individuals stable on treatment. Meanwhile, there has been great interest in innovative strategies for managing large numbers of stable, relatively healthy ART patients in primary care. Wilkinson5 reports on the development of ‘adherence clubs’ in Cape Town, which have the potential to reduce the patient load within clinical services – an approach that certainly warrants greater consideration.
This issue also features a rich array of interesting clinical case reports. Haeri Mazanderani and Ebrahim6 discuss a case of HIV/HTLV-1 co-infection, and the seemingly paradoxical finding of progressive HIV disease with lymphocyte proliferation. There is widespread concern around the incidence of new HIV infections in pregnant women, and Kalk and colleagues7 present two cases of mother-to-child HIV transmission that show the risks associated with acute HIV infection in pregnant and breastfeeding women. Meanwhile, Barnardt8 presents an unusual case of Kaposi’s sarcoma in pregnancy, with complexities in managing concomitant infection, malignancy and pregnancy.
Complementing these traditional case reports, we present here a new feature of the Journal, a critical case review that incorporates perspectives from local and international clinicians. This first instalment from Venter and colleagues9 presents a common picture of acute liver failure with multiple potential causes; a special thanks to our discussants, Sarah Fidler and Sarah Stacey, for outlining their clinical thinking. Ideas for future cases to approach in this format will be most welcome – please send in your suggestions.
Happy reading.
Landon Myer
Associate Professor
School of Public Health & Family Medicine
University of Cape Town
landon.myer@uct.ac.za
1. Mnyani CN, McIntyre JA. Challenges to delivering quality care in a prevention of mother-to-child transmission of HIV programme in Soweto. Southern African Journal of HIV Medicine 2013;14(2):64-69. [http://dx.doi.org/10.7196/SAJHIVMED.902]
2. Govender RD, Schlebusch L. A suicide risk screening scale for HIV-infected persons in the immediate post-diagnosis period. Southern African Journal of HIV Medicine 2013;14(2):58-63. [http://dx.doi.org/10.7196/SAJHIVMED.899]
3. Rebe KB, De Swardt G, Struthers H, McIntyre JA. Towards ‘men who have sex with men-appropriate' health services in South Africa. Southern African Journal of HIV Medicine 2013;14(2):52-57. [http://dx.doi.org/10.7196/SAJHIVMED.841]
4. Jury C, Nattrass N. Parental presence within households and the impact of antiretroviral therapy in Khayelitsha, Cape Town. Southern African Journal of HIV Medicine 2013;14(2):70-74. [http://dx.doi.org/10.7196/SAJHIVMED.921]
5. Wilkinson LS. ART adherence clubs: A long-term retention strategy for clinically stable patients receiving antiretroviral therapy. Southern African Journal of HIV Medicine 2013;14(2):48-50. [http://dx.doi.org/10.7196/SAJHIVMED.924]
6. Haeri Mazanderani AF, Ebrahim O. Progressive HIV infection in the presence of a raised CD4+ count: HIV/HTLV-1 co-infection. Southern African Journal of HIV Medicine 2013;14(2):92-94. [http://dx.doi.org/10.7196/SAJHIVMED.904]
7. Kalk E, Slogrove A, Speert DP, Bettinger JA, Cotton MF, Esser M. HIV sero-conversion during late pregnancy – when to retest. Southern African Journal of HIV Medicine 2013;14(2):90-92. [http://dx.doi.org/10.7196/SAJHIVMED.903]
8. Barnardt P. Managing AIDS-related Kaposi’s sarcoma and pregnancy. Southern African Journal of HIV Medicine 2013;14(2):87-88. [http://dx.doi.org/10.7196/SAJHIVMED.851]
9. Venter F, Masingi N, Stacey S, Fidler S. Clinical challenge: Deteriorating liver function in TB and HIV co-treatment. Southern African Journal of HIV Medicine 2013;14(2):95-97. [http://dx.doi.org/10.7196/SAJHIVMED.927]