Medical Focus 2022 - Vol 4 No 3

Introduction

An update on pre-exposure prophylaxis for HIV: Oral and injectable forms

The World Health Organization recommends that pre-exposure prophylaxis (PrEP) be considered for populations where the annual incidence of HIV is greater than 3%. South Africa has a high overall incidence rate (approximately 1.2% for people aged 15-49 in 2021), but this risk is highly heterogeneous, and many groups are likely to benefit from some form of PrEP. Although risk scoring systems do exist, anyone who is sexually active and at a non-trivial risk of HIV acquisition is a potential PrEP candidate.

Inflammatory biomarkers in the management of HIV-associated tuberculosis

Remarkable progress has been made to contain the HIV-driven tuberculosis pandemic in sub-Saharan Africa. The antiretroviral treatment rollout and improving tuberculosis treatment outcomes have proved to be a remarkable public health success. However, tuberculosis, although curable, remains a leading cause of death in 21st century African communities. More than 90% of tuberculosis cases are drug susceptible, and potentially curable. Imprecise diagnostic strategies for tuberculosis in the HIV era, in large part, drive this ongoing tragedy. Tuberculosis needs to be diagnosed promptly and treatment instituted early to improve outcomes and reduce transmission. Further mortality reductions can only be achieved when tuberculosis is rapidly and reliably detected.

NADIA and friends: How recent studies are changing our approach to HIV treatment failure

There is a basic principle in our approach to patients failing their antiretroviral therapy that says that we never change only one drug in a failing regimen, as it would be the equivalent to monotherapy. We were taught to always change at least two drugs in a failing anti-retroviral regimen. However, recent data is turning this principle on its head.