MESSAGE

From the Executive

Fellow HIV Clinicians, by now I am sure that most of you know that the World Health Organization (WHO) issued new guidelines. One of the most important differences is that these guidelines suggest initiating HIV-positive individuals on antiretroviral therapy (ART) at a CD4+ count of 500 cells/µl. This has caused much debate. With fixed-dose combination (FDC) treatment (one pill once daily) and medications with low side-effect profiles now available, many of the arguments for delayed therapy have fallen away. However, there is no clear clinical evidence of a benefit to starting ART earlier. There is a transmission-prevention benefit in discordant couples as shown in the HPTN 052 study. The National Department of Health has not yet adopted the WHO guidelines, and for those of you who treat patients in the private sector, our advice is to provide careful adherence counselling, as you would to anyone initiating ART. If a patient has a CD4+ count of 350 - 500 cells/µl and is committed to therapy, has thought through the issues around lifelong adherence and is committed, then – if funding permits – start. However, if there is any doubt about the capacity of an individual to adhere to treatment, delay ART until he/she is ready.  

This edition contains a consensus statement on drug-induced liver injury (DILI) resultant from tuberculosis (TB) therapy. This statement has been a long time coming. We gathered together a group of specialists in the area, which was much like herding cats. We debated the various strategies and weighed the evidence, which is not extensive. A consensus was reached; we hope that you will find the statement useful. We will review the statement every couple of years; undoubtedly, there will be changes in the future. As we went through this process, I was struck by the paucity of research in the area of TB. Anyone of us who has treated TB has seen a case of DILI, but there are so few high-quality studies to help chose the best strategy for management.  

Finally, I know it seems far away, but the Southern African HIV Clinicians Society’s second clinical conference is scheduled for 24 - 27 September 2014. Please add this event to your diary and make plans to attend. The last one was outstanding and we are already working very hard to ensure that the next one is even better …

Francesca Conradie

President

Southern African HIV

Clinicians Society

fconradie@witshealth.co.za