FROM THE
EDITOR

In the minds of many clinicians the management of

patients infected with HIV has a narrow focus involving

antiretroviral therapies, high-tech laboratory monitoring,

and so on. In the field of medicine generally, and in the field

of HIV medicine in particular, this approach falls short of

the mark. The broader issues of a more holistic approach

to the comprehensive management of the patient are

highlighted in this issue of the Journal.

In an excellent review on the nutritional management of

HIV patients Steenkamp and Dannhauser [po 31) make the

THE SOUTHERN AFR.ICAN JOUR.NAL OF HIV MEDICINE

point that there is a significant risk of nutritional deficit at

all stages of the disease and that this can compromise the

function of the immune system. They provide a practical

approach to deal with nutritional management in different

settings; at the level of basic care, when limited resources

are available, and lastly in the optimal setting. They make

specific recommendations regarding each of the stated

goals of nutrition support, namely prevention of protein

energy malnutrition, immune system support, preservation

of gastrointestinai function, and improvement of

psychosocial well-being. It should also be remembered

that patients who are going onto antiretroviral agents need

nutritional advice, in that many of these agents have

specific accompanying dietary requirements and many

have adverse effects on gastrointestinal function.

Guidelines for palliative care [po 15) benefit from a new

expanded definition for the discipline. Health care

professionals are frequently guilty of shedding

responsibility for the care of the patient, with an attitude of

'there is nothing more that can be done: These guidelines

will, it is hoped, empower health care professionals to

provide a caring and humane approach to their patients,

particularly those in end-stage disease.

The challenges of providing a community-based home-care

programme are outlined in an article by Or Laura Campbell

(p. 9), who has outlined experiences emanating from Port
Shepstone Hospital and the South Coast Hospice team.

Their experiences, recommendations and ongoing review

process provide a template for other similar national

programmes.

DES MARTIN
Editor, Southern Africon Journal of HIV Medicine
President, Southern African HIVClinicians Society

DECEMBER. 200 I