This week in the BMJ
Volume 324, Number 7331, Issue of 26 Jan 2002Background conditions explain the rapid progression of HIV in rural Africa
Background conditions explain the rapid progression of HIV in rural Africa
Disease progression associated with infection with HIV seems to be
rapid in rural Africa. However, this is most likely to be due to the
high prevalence of conditions in the general population that could be
taken for the symptoms and signs of infection with HIV-1. Morgan and
colleagues (p 193) found that even though these conditions were more
common in people infected with HIV-1, they were also common in
uninfected controls.
![[To top]](/icons/back.gif){kind=icon}
Magnetic resonance angiography can select patients for endarterectomy
Magnetic resonance angiography is sufficiently accurate to detect
patients with 70-99% carotid stenosis. Westwood et al (p 198)
conducted a systematic review to compare the diagnostic performance of
magnetic resonance angiography with conventional angiography in
patients with symptomatic carotid stenosis. They found that the
technique was highly sensitive and specific in detecting the degree of
stenosis that identifies suitable candidates for surgery. Magnetic
resonance is less invasive than conventional angiography.
Fusidic acid cream is an effective treatment for impetigo
The combination of topical fusidic acid and povidone-iodine
shampoo was found to be much more effective than placebo and
povidone-iodine shampoo in treating impetigo in children. In a
randomised controlled trial Koning et al (p 203) also found more
adverse effects in the children who were given placebo cream.
Staphylococcus aureus was the most common cause of the
infection, and none of the strains isolated were resistant to fusidic acid.
Surgical advances prevent deaths in older heart bypass patients
The age of patients undergoing coronary artery bypass grafting has
risen sharply, but the risk of death within two years of the operation
and the need for readmission has declined significantly in men. Similar
time trends are seen in women but do not reach significance. Pell and
colleagues (p 201) say that these improvements are likely to reflect
developments in surgical technique. The failure of the results to reach
statistical significance in women may simply reflect the fact that
fewer procedures are carried out in women.
HIV prevention strategies lack resources and international commitment
Ninety five per cent of new infections of HIV are in the world's poor
countries, and heterosexual transmission is responsible for most of
these. According to Lamptey (p 207), programmes promoting condom use
and treating sexually transmitted diseases are effective in preventing
the spread of HIV. However, large scale prevention efforts have been
successful in only a few countries because of lack of resources and
international commitment. Without access to retroviral drugs, most of
the 40 million people currently living with HIV will die. Such drugs
reduce viral load in genital fluids and so may help prevent
transmission of HIV and other sexually transmitted
diseases.
Developing an HIV vaccine is within reach
If we fail to provide the world with an effective HIV vaccine, it will
not be because of lack of ability or resources, but because of
politics. Makgoba and colleagues (p 211) say that an affordable,
appropriate, and effective vaccine is within reach and should be
developed within the next 7-10 years. Equitable public-private
partnerships between researchers, manufacturers, and distributors are
the best strategy for developing the vaccine. How it will be
distributed will be a test of international ethics and humanitarian objectives.
Mother to child transmission of HIV is still a huge problem
Over 600 000 infants worldwide are infected with HIV from their mothers
every year. Transmission rates are up to 35% when there is no
intervention and below 5% when antiretroviral treatment and
appropriate care are available. McIntyre and Gray (p 218) report that
implementing programmes to prevent mother to child transmission has
been difficult and slow in poor countries; they say that future
research should focus on preventing postpartum infection and on
operational issues.
Drug companies should make HIV drugs free to poor countries
The boards and executives of drug companies could catalyse action
against the AIDS epidemic by immediately reducing the costs of HIV
drugs in poor countries to zero, argues the president of the Institute
for Healthcare Improvement (p 214). However, the chairman of
GlaxoSmithKline states that his company offers its medicines to poor
countries at preferential prices that cover basic costs
so the company can make a sustainable commitment to provide its
medicines for the long term (p 216). The chairperson of South
Africa's Treatment Action Campaign (p 217) says that the
international community's lack of political will to provide antiretrovirals to people with HIV and AIDS is more dangerous than the
South African president's belief that poverty is the cause of
AIDS.
Traditional birth attendants could help prevent perinatal HIV transmission
Traditional birth attendants could have a key role in preventing
perinatal transmission of HIV. Bulterys and colleagues (p 222) say
that it may be possible to train traditional birth attendants to
perform confidential HIV counselling and testing. With appropriate training, supervision, and support they could offer HIV prevention services and help with antiretroviral prophylaxis at delivery. Most
traditional birth attendants are illiterate, argues Walraven (p 224),
and this will have major constraints in training them to provide high
quality care.
What's new
Keep updated
Services
Tools
Online poll
Resources
Print issues
