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Page 4 of 8 Editorial

Suggested additional reading HIV-negative matched controls. The median age of the
patients was 37 years. Two-thirds (62%) were women.
• Tsukamoto T. Hematopoietic stem/progenitor cells and Recruits were asked about cough, cough accompanied by
the pathogenesis of HIV/AIDS. Front Cell Infect mucus or phlegm, breathlessness, wheeze and so on. The
Microbiol. 2020 Feb 21;10:60. https://doi.org/10.3389/ participants were also examined, had their blood tested
fcimb.2020.00060 (HIV status confirmed, HIV viral load [VL] and CD4 cell
• Durandt C, Potgieter JC, Mellet J, et al. HIV and count) and completed a ‘quality of life’ questionnaire. The
haematopoiesis. S Afr Med J. 2019 Sep 10;109(8b):40–45. PLWH were subdivided into three groups: ‘the antiretroviral
https://doi.org/10.7196/SAMJ.2019.vi09:8b.13829 therapy (ART)-naïve’ (26%), ‘on first-line ART’ (24%) and ‘on
• Knuesel SJ, Sawalla Guseh J II, Karp Leaf R, Ciaranello AL, second-line ART’ (50%). Those on ART were recruits from
Eng GM. Case 6-2018: A 35-year-old woman with headache, randomised controlled trials (RCTs) and demonstrated a
subjective fever, and anemia. N Engl J Med. 2018;378: 753–760. high level (> 90%) of viral suppression. Their CD4 levels
https://doi.org/10.1056/NEJMcpc1712223 (median) were largely normal: namely, first-line ART,
CD4 = 413.5 (range: 278.5–574.3) and second-line ART,
10. Cloete CM, Hampton J, Chetty T, et al. Evaluation of a CD4 = 619 (range: 429–798) cells/mm , respectively. Those
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health system intervention to improve virological ‘initiating’ therapy, that is, naïve to ART when tested, also
management in an antiretroviral programme at a municipal demonstrated relatively preserved median CD4 levels,
clinic in central Durban. S Afr J HIV Med. 2019;20(1):a985. namely, CD4 = 281 (range: 191–400.8) cells/mm . Moreover,
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https://doi.org/10.4102/sajhivmed.v20i1.985 indeed, the authors note that ‘the frequency of respiratory
symptoms did not differ by HIV status after adjustment for
Editor’s comment: ‘What are the gaps in service delivery that age and sex’. ‘Breathlessness (however) was associated with
allow for clinical failure/poor viral control?’ This is a detailed, older age, female sex, obesity, a previous history of
prospective clinic-based study undertaken between 2011 and respiratory infection and airway hyper-reactivity (asthma)’.
2015. The investigators divided the study into three periods: Chronic lung disease has been described in Africans living
pre-intervention, intervention and post-intervention. The with HIV. The participants in this study were young and
intervention required checking every 10th patient file most had accessed reliable ART for several years, exhibited
(n = 1538) with (1) an in-depth file review, (2) recording of immune (peripheral CD4 cell) reconstitution and reliable
viral loads (VL) and the ‘retention-in-care’ status of the client viral suppression. How should HIV clinicians be monitoring
and (3) an assessment of the ‘viral load-management process’. the health of our patients’ respiratory tract? Will the
Gaps were identified and interventions were implemented. Coronavirus disease 2019 (COVID-19) pandemic require a
Outcome measurements improved over the 4 years of the rethink of our patients’ respiratory safety?
study, namely, the number of appropriate VL tests and
the filing of results increased from 78% to 92% (p = 0.0009),
the number of patients who accessed their VL result increased Suggested additional reading
from 59% to 86% (p < 0.0001) and fewer patients, from 81% to
27%, required changes to antiretroviral therapy (ART) • Desai SR, Nair A, Rylance J, et al. Human
following the intervention. The detailed description in this immunodeficiency virus-associated chronic lung disease
report suggests a huge commitment from the clinic staff and in children and adolescents in chest radiographic and
high-resolution computed tomographic findings. Clin
the research team. Sustainable? The study required outside Infect Dis. 2018;66(2):274–281. https://doi.org/10.1093/
funding and the salaries of additional staff. Sustainable? vid/cix778
Gaps are noted: continuing high patient volumes, the • Shaddock EJ, Richards GA, Murray J. Lung fibrosis in
ongoing and urgent priority of ART-initiation, the need for deceased HIV-infected patients with pneumocystis
and absence of dedicated pharmacists in HIV clinics and so pneumonia. S Afr J HIV Med. 2012;13(2):64–67.
on. The authors point out that the third UNAIDS 90 or (95)%
goal is achievable, that is, reliable long-term VL suppression 12. Bharuthram N, Feldman C. The diagnostic utility of bone
by 2030. This sounds optimistic. ‘Is this effort reproducible on marrow examination in an infectious diseases ward. S Afr
a large scale?’
J HIV Med. 2019;20(1):a974. https://doi/org/10.4102/
11. Kummerow M, Shaddock EJ, Klipstein-Grobusch K, et al. sajhivmed.v20i1.974
Unexpected low frequency of respiratory symptoms in an
HIV-positive urban sub-Saharan population compared to Editor’s comment: This is a retrospective review of
an HIV-negative control group. S Afr J HIV Med. consecutive bone marrow aspirate and trephine (BMAT)
2019;20(1):a1010. https://doi.org/10.4102/sajhivmed. examinations of 327 patients admitted to the infectious
v20i1.1010 diseases ward of a large academic hospital in Johannesburg
from 2012 to 2014. Most of the patients (314;96%) were people
Editor’s comment: This is a cross-sectional study of 547 living with HIV (PLWH). ‘What is the utility of BMAT in the
adults living in Johannesburg between July 2016 and context of HIV infection?’ A peripheral white blood cell
November 2017. Two-thirds of the patients were people (WBC) cytopenia of ≤ 4 × 10 /L predicted a ‘unique’ diagnosis
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living with HIV (PLWH) (n = 347, 63%). The remainder were (odds ratio [OR] 2.38, 95% CI 1.37–4.14, p = 0.002) and the

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