HIV in South Africa

Satoh, Suzuka; Boyer, Elisa

doi:10.1016/s0140-6736(19)31634-4

Cited by 29 publications

(14 citation statements)

References 1 publication

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“…South Africa has the highest prevalence of HIV infection globally with more than 7 million positive individuals. 18 The presence of HIV infection, especially those with low CD4 and unsuppressed viral load, should alert the attending clinician to search for increased thrombo-embolic events either in the form of pulmonary embolism or veno-thromboembolism like BCS. HIV infection increases the risk for developing TB by 10-fold and TB pericarditis by 40%–75%.…”

Section: Discussionmentioning

confidence: 99%

A rare case of constrictive pericarditis with Budd–Chiari syndrome due to right atrial thrombosis

Pillay

Moffat

2021

SAGE Open Medical Case Reports

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Patients living with HIV (PLWH) with previous pulmonary tuberculosis, presenting with disproportionate ascites to peripheral congestion, should alert the clinician to consider constrictive pericarditis and Budd–Chiari syndrome (BCS). Constrictive pericarditis is the scarring and loss of the pericardial sac elasticity. The aetiology of constrictive pericarditis varies between developed and developing countries, with infective causes like tuberculosis being significant in South Africa. Budd–Chiari syndrome is a group of disorders characterised by hepatic venous outflow obstruction. The level of obstruction in Budd–Chiari syndrome varies globally. In Asia, South Africa, India, and China, obstruction is predominantly found in the inferior vena cava while in Western countries, hepatic vein obstruction occurs. Patients living with HIV are at increased risk of arterial and venous thromboembolism. The clinician must consider Budd–Chiari syndrome in patients living with HIV presenting with ascites. In patients living with HIV, tuberculosis co-infection has been associated with a higher risk of pericarditis. Both constrictive pericarditis and Budd–Chiari syndrome share a remarkably similar clinical presentation, with ascites and hepatomegaly. There is a dearth of literature on co-existent constrictive pericarditis and Budd–Chiari syndrome. We describe a 31-year-old HIV-infected female, on anti-retroviral therapy (CD4 count 208 cells/uL, undetected viral load), with previous pulmonary tuberculosis, who presented with a 2-month history of abdominal swelling, peripheral oedema, and New York Heart Association grade 4 dyspnoea. Examination revealed an elevated jugular venous pulsation with CV waves, atrial fibrillation, right-sided S3 gallop, pansystolic murmur (3/6) at the left sternal border, tender hepatomegaly, and massive ascites with minimal peripheral oedema. The discordant size of ascites prompted investigations, namely, ultrasound abdomen, echocardiogram, and computed tomography (chest and abdomen). These revealed constrictive pericarditis and Budd–Chiari syndrome with thrombus formation in the right atrium, hepatic vein, and inferior vena cava. She was initiated onto anti-coagulation, anti-tuberculosis therapy and referred for pericardiectomy. Clinicians must maintain a suspicion for constrictive pericarditis and Budd–Chiari syndrome in HIV-infected patients, especially in those with a previous tuberculosis, presenting with features of right heart failure.

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Section: Discussionmentioning

confidence: 99%

A rare case of constrictive pericarditis with Budd–Chiari syndrome due to right atrial thrombosis

Pillay

Moffat

2021

SAGE Open Medical Case Reports

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“…Whilst many South Africans kept dawdling with "Jerusalema dance challenge" unusually set in Ramaphosa's [29] "Statement on progress in the national effort to contain the COVID-19 pandemic", hardly were they mindful of the challenges bequeathing the "new normal" as exclusively buttressed in the September 16 th Presidential address. The reality of an economy half of whose GDP shrunk in the wake of a devastating global pandemic (see Figure 2), reveals a horrid acuity of the country's double dilemma, especially when it still battles another virus (HIV/AIDS epidemic) with "the largest HIV seropositive population in the world" [31]. Thus, in lieu of a higher expectation coming from both government and the global community, many South Africans might probably be oblivious of the difficult times ahead with regards to their actual obligations in a restructured economy, or worse in "what will become [our] new normal for as long as the coronavirus is with us" [27].…”

Section: The Challenge Of the "New Normal" In The Post-pandemic Economic Recovery Processmentioning

confidence: 99%

Microscopic Examination of the New South African Economic Reconstruction and Post-Pandemic Recovery Plan

Ede¹,

Jili²

2021

JPSIR

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South Africa is certainly not the only country affected by the novel Coronavirus pandemic in Africa -though it currently stands as the worse-hit country by the virus, but it is presently on the list of some of the countries that defiantly take advantage of the rare opportunity imbedded in the adversity of the pandemic to reset the economic landscape. The country is promptly on route to a recovery that is one-of-a-kind in the continent, from a pandemic that saw half of its GDP depleting within months. In one of his regular situational updates to the nation, President Cyril Ramaphosa announced a comprehensive Masterplan with which South Africa aims to swim against the tide of the recession caused by Coronavirus pandemic. The midmonth announcement which upheld the remaining quarter of the hapless year 2020, unveiled the new recovery Plan for the nation known as THE SOUTH AFRICAN ECONOMIC RECONSTRUCTION AND RECOVERY PLAN (ERRP). Whilst the President and the people preciously revel the new ERRP and the much-anticipated reconstruction of the economy of the country in order to address widening inequality now relapsed by the pandemic, we painstakingly examine it in detail to divulge the numerous "new" effects that inundate the decadal Plan.

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“…Sub-Saharan Africa has the highest prevalence of HIV-1 infection worldwide ( 1 ). Dolutegravir is an HIV-1 integrase strand transfer inhibitor with a favourable safety profile and high barrier to viral resistance ( 2 ).…”

Section: Introductionmentioning

confidence: 99%

Pharmacogenetics of Dolutegravir Plasma Exposure Among Southern Africans With Human Immunodeficiency Virus

Cindi

Kawuma

Maartens

et al. 2022

The Journal of Infectious Diseases

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Background Dolutegravir is a component of preferred antiretroviral therapy (ART) regimens. We characterised the pharmacogenetics of dolutegravir exposure following ART initiation in the ADVANCE trial in South Africa. Methods Genome-wide genotyping followed by imputation was performed. We developed a population pharmacokinetic model for dolutegravir using non-linear mixed-effects modelling. Linear regression models examined associations with unexplained variability in dolutegravir area under the concentration-time curve (AUCVAR). Results Genetic associations were evaluable in 284 individuals. Of nine polymorphisms previously associated with dolutegravir pharmacokinetics, the lowest P-value with AUCVAR was UGT1A1 rs887829 (P = 1.8 × 10−4), which was also associated with log10 bilirubin (P = 8.6 × 10−13). After adjusting for rs887829, AUCVAR was independently associated with rs28899168 in the UGT1A locus (P = 0.02), as were bilirubin concentrations (P = 7.7 × 10−8). In the population pharmacokinetic model, rs887829 T/T and C/T were associated with 25.9% and 10.8% decreases in dolutegravir clearance, respectively, compared to C/C. The lowest P-value for AUCVAR genome-wide was CAMKMT rs343942 (P = 2.4 × 10−7). Conclusions In South Africa, rs887829 and rs28899168 in the UGT1A locus were independently associated with dolutegravir AUCVAR. The novel rs28899168 association warrants replication. This study enhances understanding of dolutegravir pharmacogenetics in Africa.

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HIV in South Africa

Cited by 29 publications

References 1 publication

A rare case of constrictive pericarditis with Budd–Chiari syndrome due to right atrial thrombosis

A rare case of constrictive pericarditis with Budd–Chiari syndrome due to right atrial thrombosis

Microscopic Examination of the New South African Economic Reconstruction and Post-Pandemic Recovery Plan

Pharmacogenetics of Dolutegravir Plasma Exposure Among Southern Africans With Human Immunodeficiency Virus

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