Page 13 - HIVMED_v21_i1.indb

Page 3 of 8 Editorial

reports would have introduced limitations but the take-home superb: clear and compelling. The author tells this story with
messages are worth noting: disclosure was more likely to compassion and respect for his subject. The art and science of
have occurred amongst older children and those whose medicine shine on these pages. This is how we learn medicine,
caregivers were more highly educated. The latter were more and how we become better doctors. I loved this read and
likely to be men, although less than 10% of the study’s recommend it to all who read this journal.
caregivers were men. Indeed, disclosure was less likely if the 8. Atuhaire C, Taseera K, Spoor C, Cumber RY, Cumber SN.
caregiver was a woman, if children had detectable viral loads Knowledge and perceptions of male immigrants in Leeds
and if the child was still taking ‘syrup’ formulations of the (UK) towards male circumcision as an HIV-prevention
antiretrovirals , namely, a younger group, if the child was strategy. S Afr J HIV Med. 2019;20(1):a823. https://doi.
noted by the caregiver to be non-adherent and if the child org/10.4102/sajhivmed.v20i1.823
was on protease inhibitors, stavudine (d4T) and/or
didanosine (ddI). This article provides the readers with Editor’s comment: Whilst the estimated prevalence of HIV
credible information. Figure 1 in this article will also give infection in the United Kingdom (UK) is low, namely, ≤ 1.5 per
HIV educators a useful outline to the important associations 1000 persons, that of UK immigrants from Eastern and
that promote disclosure/non-disclosure. Southern Africa is far higher, namely, 25–50 per 1000 persons.
6. Schutz C, Ward A, Burton R, et al. False rifampicin results Would medical male circumcision (MMC) be considered by
using Xpert MTB/RIF on urine samples in hospitalised these immigrants as a means of preventing HIV transmission?
HIV-infected patients. S Afr J HIV Med. 2019;20(1):a978. Only 10 persons were interviewed in a snowball recruitment
https://doi.org/10.4102/sajhivmed.v20i1.978 study of contacts from a local church in Leeds, UK. The
participants expressed little or no knowledge of circumcision
Editor’s comment: Recommended reading. This study is as an HIV-preventive tool. Instead and despite the group’s
from colleagues in Cape Town. Urine samples were roots from the epicentre of the epidemic, circumcision is still
collected prospectively from HIV-positive patients with merely a ‘rite of passage’. Whilst the study limitations are
microbiologically proven active TB in two independent obvious, it begs the question of the universality of HIV dogma.
cohorts between 2012 and 2016. Multiple samples from In the West, ‘Treatment as Prevention’ has replaced MMC.
each patient – including sputum, blood, tissue and urine – With current dogma promoting universal ‘test and treat (UTT)’
were subjected to culture, gene Xpert (including Xpert and ‘immediate ART for all’, should we be talking about MCC
Ultra) and line probe analysis (LPA). A total of 1704 urine in high-income countries? And what of its future in middle-
Xpert results were available from 1171 patients. Four and low-income regions in the face of more effective preventive
hundred and sixteen (24.4%; 95% CI 22.4–26.5) of the urine measures? And how effectively has MMC changed attitudes
Xpert results were positive for Mycobacterium tuberculosis to HIV prevention in eastern and southern Africa?
(MTB) and 43/413 (10.4%) were rifampicin resistant on
Xpert analysis. Of the latter group, 30/41 were confirmed September 2019
to be truly rifampicin resistant, yielding a positive 9. Manickchund N, Du Plessis C, John M-A, et al. Case
predictive value of 73.2% (95% CI 57.1–85/8). Urine tests report. Emtricitabine-induced pure red cell aplasia. S Afr
from patients NOT on TB therapy at the time of assessment J HIV Med. 2019;20(1):a983. https://doi.4102/sajhivmed.
gave more true-positive rifampicin-resistant Xpert results v20i1.983
(85.7%, 95% CI 67.3–96.0) than the urine of those on TB
treatment (53.8%, 95 CI 25.1–80.8). About 11/43 urine Editor’s comment: In this article, the authors report a female
results were falsely positive for rifampicin resistance patient with pure red-cell aplasia. She was 35 years of age
(25.6%, 95% CI 13.5–41.2). Three patients in the urine Xpert in 2014, pregnant, anaemic at baseline (haemoglobin
rifampicin-resistant group were found to have concurrent [Hb] = 8.2 g/dL) and had a low CD4 count (83 cells/mm ). Two
3
rifampicin-sensitive TB on alternative specimens tested months after starting first-line ART, namely, tenofovir +
simultaneously, that is, ‘hetero-resistant TB’. This article is emtricitabine (FTC) + efavirenz, she was found to be severely
a stimulating read and feeds the reader’s mind – a anaemic: Hb = 2.2 g/dL, normocytic normochromic. Her HIV
compulsory reading for clinicians, particularly Infectious infection was under control. Workup included a bone marrow
Diseases colleagues, fellows and registrars!!
examination, which revealed a pure red cell aplasia and a
7. Ekermans P, De Gama R, Kock C, et al. An unusual case of positive parvovirus B-19 polymerase chain reaction (PCR). The
abdominal mycobacterial infection: Case report and patient received intravenous immune globulin (IVIG) for 5
literature review. S Afr J HIV Med. 2019;20(1):a993. days and packed red cells. Over the next 11 months, she
https://doi.org/10.4102/sajhivmed.v20i1.993 required multiple transfusions and six more courses of IVIG.
Her ART was changed and the FTC stopped: tenofovir +
Editor’s comment: Highly recommended. In this case report, abacavir + efavirenz, after which the anaemia resolved.
Dr Ekermans and colleagues describe an HIV-positive 8-year- However, the patient’s parvovirus B19-PCR remained positive
old’s experience of acquired immunodeficiency syndrome in (2017). A role for lamivudine (3TC) and emtricitabine in pure
South Africa. The author does a great job of describing the red cell aplasia has been suggested by multiple reports over the
difficulties in confirming the diagnosis and isolating the past two decades. This report is a reminder of this rare drug-
organism. The histological and radiographic plates are related toxicity.

http://www.sajhivmed.org.za 5 Open Access