Thirty years since the emergence of HIV/Aids, it is more important to deal with the costs of medicines and how to sustain access to them, rather than the initiation of treatment, according to an HIV specialist.

Addressing the first Southern African HIV Clinicians Society conference, Professor Brian Guzzard, an expert adviser to the UK government on HIV and head of one of Europe’s largest clinical units, began his talk recalling his visit to South Africa shortly after the release of Nelson Mandela.

“The then-government told me that HIV would never be a problem in South Africa,” Guzzard told the packed auditorium.

He said that for the past 10 years they had been trying to get people on to treatment earlier, but there were no random trials showing that starting treatment earlier should be a priority.

He disclosed that one study was investigating whether to put people with HIV on antiretroviral treatment at a CD4 count (measure of the body’s immunity) above 500.

The research was not expected to show any dramatic improvement in outcomes.

Guzzard added that studies from the US showed that patients likely to get put on to treatment earlier, such as those who were wealthy, were less likely to have a higher incidence of HIV infection.

“Thinking of cost and using the appropriate drug is more important than discussing when antiretroviral therapy should be initiated,” said Guzzard.

“We are going to be saddled with treatment for the next 40 years, so let us make it accessible.

“Doctors here need to discuss how to give the cheapest and simplest treatment to the largest number of patients.”

Speaking during Monday’s plenary session after Guzzard, Professor Tom Harrison of St George’s University of London, focused on cryptococcal meningitis – “an everyday experience for those working in state hospitals”.

He said 15 percent of all HIV-related deaths were due to cryptococcal meningitis and current treatment options did not work.

The gold standard treatment was neither available nor feasible for Africa, Harrison said.

He added that antiretroviral therapy had not led to any decrease in the incidence of cryptococcal meningitis, but had improved the long-term prognosis for patients on antiretrovirals.

He said there were enough tools – diagnostics and drugs – available to optimise the management of symptomatic cases.

Cryptococcal meningitis is a fungal infection of the tissues covering the brain and spinal cord (meninges).

It is caused by the soil fungus Cryptococcus neoformans.

Cryptococcal meningitis most often affects people with a weakened immune system.

The conference was expected to end on Wednesday. – Health-e News Service


Gender-based violence increases HIV infections

HIV infection rates of zero will never be achieved unless tackling gender-based violence is part of addressing the epidemic, an expert told HIV specialists, researchers and nurses meeting this week at the first Southern African HIV Clinicians Society conference.

Professor Rachel Jewkes, of the SA Medical Research Council, an international expert on gender-based violence, revealed that incidents of intimate partner violence, sexual abuse as children and sexual violence as adults (rape) increased the incidence of HIV infection, especially among women.

A study led by Jewkes found that almost 40 percent of adolescents from the rural Eastern Cape had been sexually abused as children. “Dealing with this violence is a normal feature of clinical caseloads,” she said, adding that the incidence of violence was under-reported.

Jewkes said there was a correlation between partner violence and an increased incidence of HIV. One of her studies found that about 12 percent of HIV cases among women could be attributed to more than one case of intimate partner violence.

About 14 percent of HIV cases among women could be attributed to ‘‘low power’’ in the relationship because it meant the woman was unable to negotiate condom use or confront her partner if she suspected he was unfaithful. – Health-e News Service