m SOUTHtRN MRICAN JOURNAL O~ HIV MtOICINt ------------ JULY 2002

SOMETHING TO OFFER

UNOA-GAIL BEKKER

Managing Editor

Encouraging it is that more than just an isolated few are
talking of expanded access to highly active antiretroviral

therapy (HAARn for the people of Africa I The W9rld Health

Organisation conservatively estimates that some 6 million

people in developing countries are in need of life-
sustaining antiretrovirals right now, in the year 2002, yet

only 230 000 have access, and most live in one country -

Brazil. In April 2002 the WHO came up with guidelines on

scaling up antiretroviral therapy in resource-limited

settings, the Global Fund is being mobilised and local
activist organisations are shifting their emphasis on

mother-to-child (MTCn prevention programmes to include

general access to HAART. Not that the pressure on the need

for MTCT prevention and improved MTCT programmes

should abate for even a moment. Fourteen weeks ago I had

the awesome experience of giving birth to a wonderful

little boy who has subsequently turned our lives around

and filled us with such joy. But along with the joy I have

been struck by how much anxiety, both rational and

irrational, goes with the whole experience. I have feared for

his safe delivery, his state of health, my ability to feed him,

our coping with him and his acceptance of us, and so on
and on. And then I tried to imagine what it must be like to

be a young mother who suspects or discovers her positive

HIV status, and must await with trepidation the possible

additional calamity that her infection has passed to her

child. Such anxiety must be intolerable, yet in this country

many brave young women face it daily. As a medical
profession we have something that can be offered to them.

Our present MTCT strategies are not a panacea and will not

save all, but giving a mother the opportunity to do as much

as she can for her unborn child may compensate for some

of the anxiety.

It is two years since the publication of the HIV Clinicians

Society's first antiretroviral guidelines. The current issue of
the journal is devoted entirely to the issues surrounding

antiretroviral therapies. The eagerly awaited revised

guidelines have seen changes brought about due to the

availability of new drugs and the dramatic price decreases

in drugs. The WHO recommendations have been borne in
mind, as have the recommendations of our international

reviewers (IAS, Prof. Stefano Vella/Prof. Joep Lange; IAPAC,
Jose Zuniga - USA; UK - Prof. Brian Gauard; Australia -

Prof. Oavid Cooper; and Argentina - Praf. Pedro Cahn).

DES MARTIN
Editor, Southern African Journal ofHIV Medicine
President, Southern African HIVClinicians Society

I would like to take this opportunity to thank the guidelines

committee IOr Des Martin, Or Mark Cotton, Prof. Gary

Maartens, Or Oave Spencer, Or Mark Andrews, Or Francois

Venter and Prof. Robin Wood) who met in March 2001

under the chairmanship of Or Steven Miller. These

guidelines represent a good balance between the standard

of care and the economic resources available to provide

this optimal care. It is to be noted that the guidelines

concentrate on first- and second-line therapies and that

third- and fourth-line therapies and salvage therapies

should be managed by clinicians who have expertise in

dealing with such failures. It is recommended that

clinicians access the Society's treatment network for help

and advice in this regard. This edition also sees an update

in review form of the various issues that impact on the use

of antiretroviral therapies and provides an insert that

should prove useful as a quick desktop reference guide for
clinicians in their daily practices.

FROM THE
EDITORS