scholarly journals Effect of HIV Infection and Antiretroviral Treatment on Pregnancy Rates in the Western Cape Province of South Africa

2019 ◽  
Vol 221 (12) ◽  
pp. 1953-1962 ◽  
Author(s):  
Leigh F Johnson ◽  
Themba Mutemaringa ◽  
Alexa Heekes ◽  
Andrew Boulle
Keyword(s):  
South Africa ◽  
Hiv Infection ◽  
Antiretroviral Treatment ◽  
Incidence Rates ◽  
Hiv Care ◽  
Hiv Positive ◽  
Western Cape ◽  
Western Cape Province ◽  
Hiv Positive Women ◽  
Hiv Negative

Abstract Background Previous studies suggest that untreated human immunodeficiency virus (HIV) infection is associated with a reduced incidence of pregnancy, but studies of the effect of antiretroviral treatment (ART) on pregnancy incidence have been inconsistent. Methods Routine data from health services in the Western Cape province of South Africa were linked to identify pregnancies during 2007–2017 and maternal HIV records. The time from the first (index) pregnancy outcome date to the next pregnancy was modeled using Cox proportional hazards models. Results During 2007–2017, 1 042 647 pregnancies were recorded. In all age groups, pregnancy incidence rates were highest in women who had started ART, lower in HIV-negative women, and lowest in ART-naive HIV-positive women. In multivariable analysis, after controlling for the most recent CD4+ T-cell count, pregnancy incidence rates in HIV-positive women receiving ART were higher than those in untreated HIV-positive women (adjusted hazard ratio, 1.63; 95% confidence interval, 1.59–1.67) and those in HIV-negative women. Conclusion Among women who have recently been pregnant, receipt of ART is associated with high rates of second pregnancy. Better integration of family planning into HIV care services is needed.

scholarly journals Progress towards the 2020 targets for HIV diagnosis and antiretroviral treatment in South Africa

2017 ◽  
Vol 18 (1) ◽  
Author(s):  
Leigh F. Johnson ◽  
Rob E. Dorrington ◽  
Haroon Moolla
Keyword(s):  
South Africa ◽  
Antiretroviral Treatment ◽  
Routine Data ◽  
Hiv Positive ◽  
Western Cape ◽  
Hiv Diagnosis ◽  
Public And Private ◽  
North West ◽  
South Africans ◽  
Northern Cape

Background: The UNAIDS targets for 2020 are to achieve a 90% rate of diagnosis in HIVpositive individuals, to provide antiretroviral treatment (ART) to 90% of HIV-diagnosed individuals and to achieve virological suppression in 90% of ART patients.Objectives: To assess South Africa’s progress towards the 2020 targets and variations in performance by province.Methods: A mathematical model was fitted to HIV data for each of South Africa’s provinces, and for the country as a whole. Numbers of HIV tests performed in each province were estimated from routine data over the 2002–2015 period, and numbers of patients receiving ART in each province were estimated by fitting models to reported public and private ART enrolment statistics.Results: By the middle of 2015, 85.5% (95% CI: 84.5% – 86.5%) of HIV-positive South African adults had been diagnosed, with little variation between provinces. However, only 56.9% (95% CI: 55.3% – 58.7%) of HIV-diagnosed adults were on ART, with this proportion varying between 50.8% in North West and 72.7% in Northern Cape. In addition, 78.4% of adults on ART were virally suppressed, with rates ranging from 69.7% in Limpopo to 85.9% in Western Cape. Overall, 3.39 million (95% CI: 3.26–3.52 million) South Africans were on ART by mid- 2015, equivalent to 48.6% (95% CI: 46.0% – 51.2%) of the HIV-positive population. ART coverage varied between 43.0% in Gauteng and 63.0% in Northern Cape.Conclusion: Although South Africa is well on its way to reaching the 90% HIV diagnosis target, most provinces face challenges in reaching the remaining two 90% targets.

Effects of Hazardous Alcohol use on Neurocognition in HIV Positive Individuals

2017 ◽  
Vol 41 (S1) ◽  
pp. S639-S639
Author(s):  
G. Spies ◽  
G. Hoddinott ◽  
N. Beyers ◽  
S. Seedat
Keyword(s):  
South Africa ◽  
Executive Function ◽  
Alcohol Use ◽  
Hiv Infection ◽  
Test Performance ◽  
Hiv Positive ◽  
Western Cape ◽  
Hazardous Alcohol Use ◽  
Significant Difference ◽  
Hazardous Alcohol

IntroductionThere is significant evidence that HIV is brain degenerative and long-term infection can impair cognitive functioning. In South Africa, alcohol remains the dominant substance of abuse and lifetime alcohol dependence has been found to impair memory, executive function and visuospatial capabilities. The individual liability of alcohol and HIV on neurocognitive function have been well demonstrated, however there is relatively little evidence of the potentially aggravating effects of this dual burden on neurocognitive outcomes.ObjectivesThe present study is ongoing and sought to identify the effects of hazardous alcohol use on neurocognitive functioning in the context of HIV infection.AimsTo describe the association between HIV and harmful alcohol use on neuropsychological test performance in a cohort of adults in the Western Cape of South africa.Methodsparticipants (n = 50) were tested using a battery of neuropsychological tests sensitive to the effects of HIV on the brain. Self-reported alcohol use was recorded using the alcohol use identification test (AUDIT). Results The sample consisted of 47 females and 3 males. All participants were HIV-positive and on antiretroviral therapy. A total of 23 (46%) participants reported no alcohol use and 27 (54%) reported drinking alcohol on the AUDIT.Resultsrevealed a significant difference between groups on the Stroop colour word test, with poorer performance evident among the alcohol users (P = 0.008).ConclusionAlcohol use in the context of HIV infection contributes to poorer executive function. These preliminary data provide evidence for a synergistic relationship between HIV infection and alcohol use.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Vulvovaginal candidiasis: a comparison of HIV-positive and -negative women

2002 ◽  
Vol 13 (6) ◽  
pp. 358-362 ◽  
Author(s):  
Jack D Sobel
Keyword(s):  
Drug Resistance ◽  
Hiv Infection ◽  
Vulvovaginal Candidiasis ◽  
Clinical Severity ◽  
Hiv Positive ◽  
Vaginal Colonization ◽  
Hiv Positive Women ◽  
Antimycotic Drug ◽  
Widespread Dissemination ◽  
Hiv Negative

Although considerable information has accumulated in the last decade regarding rates of both vaginal colonization and vulvovaginal candidiasis (VVC) in HIV-positive women, gaps in our knowledge remain, particularly with regard to pathophysiology of clinical disease. Unfortunately, early and possibly premature conclusions were reached in the late 1980s which resulted in the widespread dissemination of information indicating that recurrent VVC (RVVC) was a manifestation of HIV infection and that women with RVVC should be tested for HIV. Unfortunately, subsequent data from cohort studies involving HIV-positive women failed to determine attack rates of symptomatic Candida vaginitis requiring therapy. Recent studies indicate that Candida vaginitis, even if more frequent in HIV infected women, is clinically similar to that experienced in HIV-negative women and does not appear to be of increased clinical severity. VVC in HIV-positive women can be treated by conventional methods including the use of maintenance suppressive antifungal therapy and most importantly RVVC in women is not in itself a sentinel of HIV infection. Ongoing concerns include vaginal acquisition of non- albicans Candida species and the development of antimycotic drug resistance in C. albicans vaginal isolates.

scholarly journals South Africa and national TB control: Are we making progress?

2017 ◽  
Vol 59 (2) ◽  
pp. 4
Author(s):  
Gboyega A Ogunbanjo
Keyword(s):  
South Africa ◽  
World Health Organisation ◽  
Incidence Rates ◽  
World Health ◽  
Hiv Positive ◽  
Western Cape ◽  
Eastern Cape ◽  
Tb Control ◽  
Kwazulu Natal ◽  
The World

South Africa accounts for the worst global tuberculosis epidemics fuelled by the spread of HIV infection. The tuberculosis (TB) incidence increased from 300 per 100,000 people in the early 1990s to more than 950 per 100,000 in 2012.1 In addition, the country remains one of the countries with the highest TB burden globally, with the World Health Organisation (WHO) statistics giving an estimated incidence of 454,000 cases of active TB in 2015.2 This means that about 0.8% of South Africa’s population of 54 million develop active TB disease annually. Of the 454 000 TB cases in South Africa in 2015, WHO estimated that about 57% (258,000) were HIV positive. It also estimated that of 157,505 whose status was known, and who were known to be HIV positive, some 85% (133,116) were on antiretroviral therapy.3 From the same 2015 report, Eastern Cape, KwaZulu-Natal and Western Cape provinces had the highest incidence rates of 692, 685 and 681 per 100,000 respectively. The most notable decline was in KwaZulu-Natal where the incidence decreased from 1,185 to 685 per 100,000 over the last five years.1

scholarly journals Quantifying clinic transfers among people living with HIV in the Western Cape, South Africa: a retrospective spatial analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e055712
Author(s):  
Ana Lucia Espinosa Dice ◽  
Angela M Bengtson ◽  
Kevin M Mwenda ◽  
Christopher J Colvin ◽  
Mark N Lurie
Keyword(s):  
South Africa ◽  
Spatial Analysis ◽  
Health Facilities ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Western Cape ◽  
Western Cape Province ◽  
Care Clinic ◽  
Living With Hiv ◽  
Over Time

ObjectivesFor persons living with HIV (PLWH) in long-term care, clinic transfers are common and influence sustained engagement in HIV care, as they are associated with significant time out-of-care, low CD4 count, and unsuppressed viral load on re-entry. Despite the geospatial nature of clinic transfers, there exist limited data on the geospatial trends of clinic transfers to guide intervention development. In this study, we investigate the geospatial characteristics and trends of clinic transfers among PLWH on antiretroviral therapy (ART) in the Western Cape Province of South Africa.DesignRetrospective spatial analysis.SettingPLWH who initiated ART treatment between 2012 and 2016 in South Africa’s Western Cape Province were followed from ART initiation to their last visit prior to 2017. Deidentified electronic medical records from all public clinical, pharmacy, and laboratory visits in the Western Cape were linked across space and time using a unique patient identifier number.Participants4176 ART initiators in South Africa (68% women).MethodsWe defined a clinic transfer as any switch between health facilities that occurred on different days and measured the distance between facilities using geodesic distance. We constructed network flow maps to evaluate geospatial trends in clinic transfers over time, both for individuals’ first transfer and overall.ResultsTwo-thirds of ART initiators transferred health facilities at least once during follow-up. Median distance between all clinic transfer origins and destinations among participants was 8.6 km. Participant transfers were heavily clustered around Cape Town. There was a positive association between time on ART and clinic transfer distance, both among participants’ first transfers and overall.ConclusionThis study is among the first to examine geospatial trends in clinic transfers over time among PLWH. Our results make clear that clinic transfers are common and can cluster in urban areas, necessitating better integrated health information systems and HIV care.

Global line-1 hypomethylation as novel biomarker for cervical cancer in Nigerian women living with HIV.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e17513-e17513
Author(s):  
Yinan Zheng ◽  
Jonah Musa ◽  
Brian Thomas Joyce ◽  
Jun Wang ◽  
Demirkan Gursel ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Hiv Infection ◽  
Dna Sequences ◽  
Human Endogenous Retrovirus ◽  
Hiv Positive ◽  
P Value ◽  
Women Living With Hiv ◽  
Hiv Positive Women ◽  
Living With Hiv ◽  
Hiv Negative

e17513 Background: Nigeria faces a high health burden of cervical cancer (CC), which is worsened by high prevalence of human immunodeficiency virus (HIV) infection. Repetitive elements (RE) are DNA sequences that occur in multiple copies throughout the human genome. HIV infection can lead to RE hypomethylation that causes genome instability, an event often seen in the early phase of tumorigenesis. We aim to examine global RE hypomethylation as a novel epigenetic biomarker for CC among HIV-positive women in Nigeria. Methods: This study involved three groups of women: a) HIV-positive with CC (n=39); b) HIV-positive and cancer-free (n=52); and c) HIV-negative with CC (n=23). We estimated three types of global RE methylation in cervical tissue using genome-wide methylation data: long interspersed nuclear elements (LINE-1), Alu, and human endogenous retrovirus (HERV). We used multiple linear regression adjusting for age, education, parity, employment, cancer stage, body mass index, and sample batch to compare the biomarkers across the HIV/ICC groups and paired t-test to compare 26 pairs of tumor vs. surrounding normal tissues, stratified by HIV status. Receiver operating characteristic curve (ROC) and area under the ROC (AUC) were used to examine the diagnostic value. Results: Among HIV-positive women, all 3 global RE methylation biomarkers were hypomethylated in CC compared to cancer-free (LINE-1: mean difference [MD]=-0.049, p-value=2.9e-8; Alu: MD=-0.011, p-value=2.0e-4; HERV: MD=-0.013, p-value=1.7e-6). Paired analyses showed a larger, more significant MD in HIV-positive stratum than HIV-negative, especially LINE-1 (MD=-0.048 vs. -0.020, p-value=0.004 vs. 0.254). LINE-1 achieved the highest AUC (0.85, 95% CI: 0.76-0.95) in distinguishing tumor tissue from normal tissue among HIV-positive women, followed by HERV (0.82, 95% CI: 0.73-0.92) and Alu (0.60, 95% CI: 0.47-0.72). Conclusions: Global LINE-1 hypomethylation may serve as a novel biomarker for CC screening and early detection for women living with HIV in low- and middle-income countries.

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