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Page 6 of 8 Editorial

received (fewer) such messages from their clinic or health for longer periods. No steroid toxicity and no intercurrent
professionals. Who are these 12–19-year-olds who are (opportunistic) infection (e.g. TB and fungal) were reported.
unwilling or undecided? Are these the ones who will be lost Antiretroviral therapy was not started immediately and no
to care and fail adherence? How do we ensure these also patient was on ARVs at the time of diagnosis. Ninety-one per
become confident, understand their rights and are assisted to cent of patients recovered within 3.4 months. All except one
adhere to ART? with mild residual weakness were ‘normal’ at the final
15. Van Wyk B, Davids L-A. Challenges to HIV treatment 18-month follow-up visit. The authors – from the Neurology
adherence among adolescents in a low socio-economic Department of the University of KwaZulu-Natal (UKZN),
setting in Cape Town. S Afr J HIV Med. 2019;20(1):a1002. Durban, South Africa – discuss the differential diagnosis and
https://doi.org/10.4102/sajhivmed.v20i1.1002 point out that since the rollout of ‘Universal Test and Treat’ in
2017, few additional cases have been reported.
Editor’s comment: This is a descriptive record of challenges 17. Laughton B, Naidoo S, Dobbels EFMT, et al.
faced by 15 adolescents (aged 10–19 years) living with HIV Neurodevelopment at 11 months after starting
since birth, and receiving support from a primary care clinic antiretroviral therapy within 3 weeks of life. S Afr J HIV
in the greater Cape Town district. The participants were Med. 2019;20(1):a1008. https://doi.org/10.4102/
interviewed in 2016 and had been on antiretroviral therapy sajhivmed. v20i1.1008
for a minimum of 6 months. Group and individual discussion
focused on barriers to and facilitators of adherence. The Editor’s comment. Recommended reading. This is an
themes identified by the authors are not new: the conflict important, prospective, observational study of 29 infants
between school and clinic, the need for greater ‘HIV- born to mothers living with HIV (MLWH). All infants were
competency’ of households and the provision of adolescent- started on antiretroviral therapy (ART) within 21 days of
friendly health services. Limitations are acknowledged: small their birth. Twenty-four of the mothers (83%) were on ART
numbers, incomplete data saturation and the absence of a at the time of delivery. Twenty-three (79%) infants were
wide spectrum of views including that of defaulters. females. Infant viral load (VL) level at birth was 3904 (The
However for me, the strength of this study includes the median infant VL level at birth was 3904 (range, 259-16,022)
verbatim comments of the participants. For a brief moment, copies/mL. Viral suppression (VL < 400 copies/mL) on
the reader hears what it is like to be young and stigmatised ART occurred at 19.1 weeks (median, range 15, 36) of age.
and shamed by HIV and AIDS. This is why adherence is so The Global Griffiths Mental Development Scales (GMDS),
difficult. It is not simply a matter of healing our youth; it is an early neurodevelopmental assessment tool, found the
rather about society and the ongoing wider response to infant’s developmental scores to be normal at 11.5 ± 0.8
people living with HIV. months. This was despite the fact that 9/29 (31%) infants
16. Moodley K, Bill PLA, Patel VB. Motor lumbosacral had a detectable bloodstream VL at the time. Of the five
radiculopathy in HIV-infected patients. S Afr J HIV Med. central nervous system (CNS) domains assessed, locomotor
2019;10(1):a992. https://doi.org/10.4102/sajhivmed. skills scored the lowest and hearing and language the
v20i1.992 highest. The authors acknowledge that this study is small
and the results are preliminary. Nonetheless, these data
Editor’s comment: This is a short report of 11 young (median suggest that ART started at this extremely young age is safe
age = 29 years) people living with HIV naïve to antiretroviral and beneficial. The authors inform us that a larger study is
therapy (ART), who experienced a slowly progressive, already underway. This article is another milestone along
bilateral and symmetrical, isolated, lower motor neurone the way to beating the virus and to the well-being of future
weakness of the lower limbs. The latter were areflexic and generations,
flaccid. The remainder of the neurological examination, 18. Archary M, Fairlee L, Slogrove A. Opinion piece. Current
including higher function, sensation and sphincter control, perspectives on paediatric HIV management from the
were normal. A diagnosis of subacute motor lumbosacral Mexico International AIDS Society Conference, 2019.
radiculopathy was made. The mean duration of symptoms S Afr J HIV Med. 2019;20(1):a1027. https://doi.org/
was 6.5 months (interquartile range [IQR] 3–7.5 months). Six 10.4102/sajhivmed.v20i1.1027
were female patients. Cerebrospinal fluid (CSF) was notable
for an elevated protein and the presence of mononuclear Editor’s comment: Recommended reading. This is a summary
cells. Tests for malignancy and various infecting organisms of presentations and discussions held at the following
were negative. The group’s median CD4 cell count was meetings: the 11th International Workshop on Pediatric HIV
3
3
3
327 cells/mm (IQR 146 cells/mm – 457 cells/mm ). and the 5th Workshop on Children and Adolescents
Unfortunately, serum and CSF HIV viral load levels were not HIV-Exposed and Uninfected, and the International AIDS
drawn. On magnetic resonance imaging (MRI), gadolinium Society (IAS) Conference in Mexico, July 2019. The authors
enhancement was visible in the lumbar ventral roots. remark that despite general success in controlling vertical
Electromyography (EMG) confirmed abnormal activity of transmission, there were 160 000 new global paediatric HIV
the lumbar and lower limb muscles. All the patients were infections in 2018. They further add that ‘sub-Saharan Africa
treated for up to 4–6 weeks, with large amounts of oral is struggling with meeting UNAIDS 90-90-90 goals for
prednisone (1.5 mg/kg/day). Steroids were sometimes given children and adolescents living with HIV’. This is nevertheless

http://www.sajhivmed.org.za 8 Open Access