AUGUST 2004                                             THE SOUTHERN AFRICAN JOURNAL OF HIV MEDICINE  4

The rate of co-infection with HIV and tuberculosis (TB) leaves
local doctors in no doubt as to the importance of secondary
preventive therapy against tuberculosis. Gavin Churchyard’s
study, described in this issue, showed that isoniazid reduced
the incidence of recurrent TB in miners by 55% compared with
no prophylaxis. He suggests that international guidelines be
expanded to include recommendations for secondary
preventive therapy in settings where TB prevalence is high,
such as in South Africa.

A lot has been said about the Bangkok Conference particularly
regarding the prevention of mother-to-child transmission and
the related issue of resistance when nevirapine is used as a
single agent.  Neil Martinson and Steven Miller cover this topic
thoroughly and eloquently in two separate articles, followed
by an informative overview of the entire conference by
Francois Venter, who hopes that papers presented at the 2006
Toronto Conference will offer more analysis of raw data as
opposed to anecdotal experience.

Beset by problems, including disclosure on birth certificates,
trends in AIDS mortality are difficult to determine, but
Sudeshni Naidoo and Francis Mburu studied HIV/AIDS
mortality among inpatients at Motebang Hospital in Lesotho
and found that over a 15-year period AIDS had modified the
mortality trend by raising the death rate of younger adults,
thereby deviating from the natural trend.  Almost 70% of all
deaths at the hospital were due to communicable diseases,
maternal, perinatal and nutritional conditions, of which 
70 - 80% were due to AIDS-related conditions.  The
researchers believe that their data will serve as a basis on
which to evaluate the impact of current and future
interventions, e.g. the proposed provision of antiretroviral
drugs.

Bloemfontein researchers studied supplementary infant
feeding as an important vector of disease transmission and
determined the level of microbial contamination in bottle
feeds given to infants living in Mangaung.  Nearly 85% of
bottle feeds tested were classified as unfit for human
consumption, leading Fredrick Veldman and Jaco Brink to
underline the need to address the content of feeding literacy
programmes.

Two interesting case studies are presented in this issue
,followed by a legal opinion on the importance of funeral and
estate planning by Elsabé Klinck. 

Much work still needs to be done in southern Africa to
improve the treatment and care of HIV-infected people and
their families and communities. It is hoped that the national
antiretroviral roll-out will gain momentum and give hope,
better health and longer lives to those people who qualify for
treatment according to the National Guidelines (CD4+ count
< 200 cells/µl irrespective of WHO stage, or WHO stage IV
disease irrespective of CD4+ count).   

In the interim, a national guideline committee of Society
experts from both the private and public sectors has compiled
a guideline for the management of HIV-infected people not
yet requiring or qualifying for antiretroviral treatment.  It is
hoped that this will assist health care professionals in
maintaining the health of infected people for as long as
possible prior to the need for antiretroviral therapy.  It will be
published shortly.  

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

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