Page 8 - SAHCS HIVMed Journal Vol 20 No 1 2019

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 6 Editorial

Editorial

Dear Members of the Southern African HIV Clinicians’ Society and Readers of the Southern African
Author:
David C. Spencer 1 Journal of HIV Medicine.

Affiliation: This is an update of articles published in the SAJHIVMED between May and July 2019. We hope
1 Division of Infectious
Diseases, Department of that by going through this summary you will visit the journal and look at the published material
Medicine, Helen Joseph yourself. The articles address contemporary and regional issues in HIV medicine. The topics
Hospital, University speak to all aspects of the epidemic: epidemiology, public health, prevention, clinical medicine,
of the Witwatersrand, tuberculosis and opportunistic diseases, management guidelines, opinion pieces, editorials and
Johannesburg, South Africa
case reports. For the teachers, trainers, healthcare managers and administrators among us, there
Corresponding author: is a wealth of local information in these papers. Please acknowledge our talented researchers by
David Spencer, reading what they write. I am sure you will want to thank the authors, our reviewers and our
[email protected] publishers (AOSIS). I wish you an enjoyable read with the Southern African Journal of HIV Medicine.
How to cite this article:
Spencer DC, Editorial. S Afr J May 2019
HIV Med. 2019;20(1), a1037. 1. Aigbodion SJ, Motara F, Laher AE. Occupational blood and body fluid exposures to human
https://doi.org/10.4102/
sajhivmed.v20i1.1037 immunodeficiency virus post-exposure prophylaxis. South Afr J HIV Med. 2019;20(1):a958.
https://doi.org/10.4102/sajhivmed.v20i1.958
Copyright:
© 2019. The Authors. Recommended reading: This is a must-read for all practising in the southern African region and
Licensee: AOSIS. This work
is licensed under the for final-year medical students in particular who will soon become interns and nurses who are
Creative Commons already working on the wards of our hospitals.
Attribution License.
This is a well-written, descriptive (anonymous questionnaire), cross-sectional study reflecting the
experience over 2 years of interns exposed to HIV-positive blood or body fluids in four large
Gauteng public hospitals affiliated to the University of the Witwatersrand. The study data were
collected at the end of 2017 from 175 doctors aged 24–30 years who collectively provided n = 182
incidence reports of occupational exposure to HIV, served as the sample for the study. The
prevalence of exposure was more or less identical whether the intern was gaining experience in
surgery, OBGYN or medicine. More than a fifth (n = 30, 22%) had more than one exposure. While
most initiated post-exposure therapy within 24 h (79% on first-exposures, and 89% on their third
exposure) only two-thirds viz. 63% (first exposure) and 62.5% (third exposure) completed the 28-
day antiretroviral (ART) course. (How many started ART within 2–4 h?) Taking all exposures into
account, the full 28-day course was completed by only n = 51 (36.2%). A third took only two
antiretrovirals (ARVs) as post-exposure prophylaxis (PEP). A total of n = 33 (18%), were unaware of
alternative treatment options. Two (1.1%) seroconversions are reported and documented. Are the
number of ARVs used in PEP important? ‘There is no evidence to suggest that a three-drug regimen
is superior to a two drug regimen’. The authors do not seem to think so. They have a point. But not
all ARVs are equal in potency nor do all offer the same level (barrier) to viral resistance. Three-drug
regimens, usually boosted protease inhibitor (bPI) based, reflect a time when ARVs were generally
less potent or more toxic than now and when regimens that combined different classes of ARV
demonstrated greatest efficacy. The authors acknowledge limitations: the cross-sectional and
retrospective nature of the data, the limited range of the questions and insufficient data on exposure
to ART-resistant virus. PEP studies cannot be randomised controlled trials nor can they be placebo-
controlled. These studies are therefore important despite their limitations.

PS: The 2019 Southern African HIV Clinicians’ PEP guidelines are under preparation and will be
available in this journal early in 2020. If I was a prospective intern, I would be hoping that my
senior in the unit would give me complimentary copies of these two articles before I started work!
NB The society’s last PEP guidelines were formulated in 2015. A more up-to-date edition is
Read online:
Read online:
Scan this QR recommended.
Scan this QR
code with your
code with your
smart phone or
smart phone or 2. Mndzebele S, Matonyane LG. Sexual behaviours, awareness and perceptions towards
mobile device voluntary medical male circumcision among students in Dr Kenneth Kaunda District, South
mobile device
to read online.
to read online.
Africa. South Afr J HIV Med. 2019;20(1):a846. https://doi.org/10.4102/sajhivmed.v20i1.846
http://www.sajhivmed.org.za 1 Open Access