Page 12 - HIVMED_v21_i1.indb

Page 2 of 8 Editorial

and linked positively to higher CD4 levels, namely > 25% on HIV-positive adults with laboratory-confirmed measles.
and counts >500 cells/mm³, p = 0.001. Orphans missing both Thirty-three adults with measles were identified, of whom 24
parents were at greater risk of low NVP blood levels, namely, underwent HIV testing. Of the 24 tested for HIV, 18 (75%)
uOR 1.37, 95% CI 0.69–2.68. Sub-therapeutic NVP levels were were HIV-positive and six were HIV-negative. The remainder
less likely amongst those orphans who were aware of their of the adult measles group (n = 9) were not tested. Most of the
HIV status, that is, had experienced full disclosure (uOR 0.65, HIV-positive were women (13/18; 72%). Although the
95% CI 0.34–1.24). The limitations of this study are important: authors remarked that demographics, clinical findings and
the cross-sectional design, the absence of an age-matched laboratory data between the HIV-positive and HIV-negative
‘non-orphan’ comparator-arm, reliance on caregiver ‘self- patients were similar, serious disease, for example,
reporting’ and the wider lack of applicability of blood NVP pneumonia and respiratory failure, was more frequent in the
levels to adherence management in Africa. The fact that viral HIV-positive (OR 5.0, 95% CI 0.48–51.8, p = 0.34). The duration
loads are still not routinely available everywhere in sub- of hospital stay for the HIV-positive patients was significantly
Saharan Africa is an inescapable subtext to this study. Is longer (p = 0.03), and of the three adult measles deaths, all
therapeutic NVP monitoring needed in Africa? It added were in the HIV-positive (OR 2.9, 95% CI 0.13–65.3, p = 0.56).
The median CD4 count of the HIV-positive patients was
value to this study. However, a wider role will be limited by 109 cells/mm³. Unfortunately, the authors do not provide
costs and accessibility.
further analysis, for example, individual CD4s, viral loads,
3. Vujanovic M, Brkic-Jovanovic N, Ilic D, et al. Associations antiretroviral therapy used and microbiology of the
of visceral fat thickness and anthropometric measurements secondary infections. Do HIV-positive adults exposed to
with non-alcoholic fatty liver development in male measles require re-vaccination or vaccination if this was
patients mono-infected with human immunodeficiency missed in childhood? This is not addressed in this article,
virus. S Afr J HIV Med. 2019;20(1):a968. https://doi. which is an important question. According to Loevinsohn
org/10.4102/sajhivmed.v20i1.986 (2019:836–844, in suggested reading below), ‘the measles
vaccine should be given to potentially susceptible but
Editor’s comment: In this article from Serbia, 88 HIV- asymptomatic HIV-positive adults and be considered for
positive men on antiretroviral therapy (ART) were enrolled those with symptomatic HIV infection even if NOT severely
in a study evaluating a link between visceral fat thickness immunosuppressed’.
(VFT) as measured with abdominal ultrasound and
the routine anthropometric measurements of obesity, Suggested additional reading
cardiovascular risk and non-alcoholic steatohepatitis
(NASH). The study took place over 18 months between • Loevinsohn G, et al. Measles seroprevalence and vaccine
September 2016 and April 2018. The average age of the men responses in human immunodeficiency virus-infected
was 39.9 ± 9.9 years and the following anthropometric adolescents and adults: A systematic review. Clin Infect
measurements were taken: waist and hip circumference Dis. 2019 Aug 16;69(5):836–844. https://doi.org/10.1093/
(WC, HC), waist–hip and waist–height ratios (W/HipR, cid/ciy980.
W/HtR) and the body mass index (BMI). Hepatic steatosis • Moss WJ. Measles. Seminar. Lancet. 2017;390:2490–2502.
was diagnosed on sonography. Those with steatosis were https://doi.org/10.1016/S0140-6736(17)31463-0
more likely to have elevated random blood glucose levels, • Measles vaccination: A WHO position paper. April 2017.
raised BMI and raised WC, HC, W/HipR and W/HtR in Recommendations. Vaccine. 2019 Jan 7;37(2):219–222.
addition to elevated VFT (p < 0.001). Age ≥ 38.5 years was https://doi.org/10.1016/j.vaccine20178.07.066).
associated with an increased risk of the condition; 90.6% of
those aged > 38.5 years with a VFT > 31.98 mm had hepatic 5. Van Elsland SL, Peters RPH, Grobbelaar C, et al.
steatosis. The authors discuss these results in the context of Disclosure of human immunodeficiency virus status to
children in South Africa: A comprehensive analysis. S Afr
low- and middle-income countries where access to reliable J HIV Med. 2019;20(1):a884. https://doi.org/10.4102/
non-invasive tests for hepatic steatosis is limited. The study sajhivmed.v20i1.884
limitations include its cross-sectional design, the absence of
women and children and the lack of detailed information Editor’s comment: Recommended reading. In this cross-
on antiretrovirals used by the men and the duration of their sectional study from the Western Cape, the authors ask the
treatment.
following questions: how many children know their HIV
4. Diana NE, Feldman C. Measles in adults: A comparison status and what factors assist our understanding of non-
of hospitalised HIV-infected and HIV-uninfected patients. disclosure? It is a well-written report with data that deserve a
S Afr J HIV Med. 2019;20(1):a877. https://doi.org/10/ wide audience. The total cohort was 185. All were on
4102/sajhivmed.v20i1.877 antiretroviral therapy and their ages ranged from 3 to 14
years. Most (145; 76.3%) had not experienced full disclosure,
Editor’s comment: South Africa experienced an unusually whilst 17 (8.9%) had experienced. A further 28 (14.7%)
large outbreak of measles between 2009 and 2011. In this received ‘partial’ disclosure. The cross-sectional nature of the
descriptive study from the wards of the Charlotte Maxeke study, the small number of ‘disclosed’ children and the
Johannesburg Academic Hospital, the authors present data dependence on questionnaires, clinic records and caregiver’s

http://www.sajhivmed.org.za 4 Open Access