Message: from the editor.
This edition of the Journal features several important contributions that demonstrate the interplay of HIV medicine with an array of health systems and social concerns. For patients presenting with meningitis symptoms, lumbar puncture (LP) is a routine investigation in most parts of the country.  But laboratory access and the ability to examine cerebrospinal fluid is limited in many primary healthcare settings across Africa, and evidence-based approaches to help identify patients who require LP (often through referral) are needed.  To help address this, Loughborough et al.  used routine hospital audit data from KwaZulu-Natal to investigate factors associated with positive LP findings. In addition to providing local insights into the aetiology and predictors of positive LP results, this original article demonstrates the value of thoughtful analysis of routinely collected clinical data. In a similar vein, Mnyani et al.  use routine antenatal and ART clinic data from Johannesburg to examine how delays in ART initiation in HIV-infected pregnant women changed after the integration of nurse-initiated management of ART (NIMART) services into antenatal care. The results are surprising: of the five health facilities surveyed, four experienced increased delays in antenatal ART initiation after the start of NIMART, suggesting that integrating ART into other primary care services is not always straightforward. In addition, in reviewing the implications of new national legislation governing health research, Strode et al.  explain how HIV prevention and treatment research involving children will be hindered, limiting the ability of research efforts to improve the health of young people across the country.
In addition to these examples of HIV-related health programme and policy research, the Journal continues to present high-quality clinical research around HIV prevention and treatment. Apalata et al.  present the results of research on the association between vaginal infections and cervicovaginal shedding of HIV. While they demonstrate no association between vulvovaginal candidiasis and HIV shedding, their data confirm that plasma viraemia is a strong--but by no means complete--predictor of HIV shedding in the female genital tract.
Also in this issue, three case reports explore the potential for iatrogenic injury in HIV-related healthcare services. First, Zingela et al.  present an important case of Stevens-Johnson syndrome in a patient receiving both antipsychotic medications and a nevirapine-based antiretroviral regimen, reminding us of the pharmacological complexities of managing mental disorders in HIV-infected patients. Meanwhile, while we usually think of healthcare providers as being at risk of HIV transmission due to needlestick injuries, Ngene et al.  present a case of a needlestick injury causing HIV exposure between patients. They attributed this particular case to overcrowding within health facilities, another demonstration of how patient safety may be compromised in overburdened health systems. Finally, Moodley et al.  present two cases of a hereditary cause of optic neuropathy, here associated with nucleoside reverse transcriptase inhibitor use. While the mutations reported here are relatively rare, this report demonstrates the complex differential diagnoses of progressive visual impairment in HIVinfected patients.
[1.] Loughborough W, Abouyannis M, Jones L, Garach S. Which clinical parameters predict a CSF diagnosis of meningitis in a population with high HIV prevalence? Southern African Journal of HIV Medicine 2014;15(2):5054. [http://dx.doi.org/10.7196/SAJHIVMED.1004]
[2.] Mnyani CN, Marinda E, Struthers H, Gulley M, Machepa R, McIntyre J. Timing of antenatal care and ART initiaion in HIV-infected pregnant women before and after introduction of NIMART. Southern African Journal of HIV Medicine 2014;15(2):55-56. [http://dx.doi.org/10.7196/SAJHIVMED.1009]
[3.] Strode A, Richter M, Wallace M, Toohey J, Technau K. Failing the vulnerable: Three new consent norms that will undermine health research with children. Southern African Journal of HIV Medicine 2014;15(2):46-49. [http://dx.doi. org/10.7196/SAJHIVMED.1014]
[4.] Apalata T, Carr WH, Longo-Mbenza B, Sturm WA, Moodley P. Association between symptomatic vulvovaginal candidiasis and HIV RNA levels in plasma and genitcal secretions among women on HAART. Southern African Journal of HIV Medicine 2014;15(2):57-64. [http://dx.doi.org/10.7196/ SAJHIVMED.975]
[5.] Zingela Z, Bronkhorst A, Qwesha WM, Magigaba BP. Fatal nevirapine-induced Stevens-Johnson syndrome with HIV-associated mania. Southern African Journal of HIV Medicine 2014;15(2):65-66. [http://dx.doi. org/10.7196/SAJHIVMED.1011]
[6.] Ngene NC, Onyia CO, Moodley J, Titus MJ. Needlestick injury in a pregnant inpatient in an overcrowded hospital. Southern African Journal of HIV Medicine 2014;15(2):66-68. [http://dx.doi.org/10.7196/SAJHIVMED.1048]
[7.] Moodley A, Bhola S, Omar F, Mogambery J. Antiretroviral therapy-induced Leber's hereditary optic neuropathy. Southern African Journal of HIV Medicine 2014;15(2):69-71. [http://dx.doi.org/10.7196/SAJHIVMED.1056]
Associate Professor, School of Public Health & Family Medicine, University of Cape Town, South Africa
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|Publication:||Southern African Journal of HIV Medicine|
|Date:||Jun 1, 2014|
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