Commentary: Early antiretroviral therapy for HIV infection in sub-Saharan Africa, a challenging new step

Approximately 33 million people worldwide are living with HIV infection, and more than 2 million individuals are newly infected each year (1). Sub-Saharan Africa bears the majority of the disease burden, with 67% of all HIV cases and 75% of all HIV/AIDS related deaths occurring in this region (2). Although access to antiretroviral therapy has improved significantly over the past decade, antiretrovirals are available to only about 30% of those who need them (2). Availability of antiretroviral therapy greatly impacts the endocrine manifestations of HIV infection: individuals treated with antiretrovirals may develop peripheral fat loss, abdominal obesity, insulin resistance, and hyperlipidemia, whereas untreated individuals may develop undernutrition, wasting, and end-organ effects of opportunistic infections such as primary adrenal insufficiency secondary to adrenal destruction (Box 10.2.4.1). In all individuals with HIV infection, regardless of treatment, gonadal function, thyroid function, and bone mineral density may also be decreased, and salt and water balance may be affected (Box 10.2.4.2). The purpose of this chapter is to review the endocrine manifestations of HIV infection, including pathogenesis and treatment.

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The Cost-Effectiveness of Cotrimoxazole in People With Advanced HIV Infection Initiating Antiretroviral Therapy in Sub-Saharan Africa

JAIDS Journal of Acquired Immune Deficiency Syndromes ◽

10.1097/qai.0b013e3182478dc0 ◽

2012 ◽

Vol 60 (1) ◽

pp. e8-e14 ◽

Cited By ~ 7

Author(s):

Taiwo O. Abimbola ◽

Barbara J. Marston

Keyword(s):

Cost Effectiveness ◽

Antiretroviral Therapy ◽

Hiv Infection ◽

Sub Saharan Africa ◽

Sub Saharan ◽

The Cost

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Clinical Experience with Parotid Gland Enlargement in HIV Infection: A Report of Five Cases in Nigeria

The Journal of Contemporary Dental Practice ◽

10.5005/jcdp-6-1-136 ◽

2005 ◽

Vol 6 (1) ◽

pp. 136-145 ◽

Cited By ~ 8

Author(s):

Foluso J. Owotade ◽

Olawunmi A. Fatusi ◽

Kehinde E. Adebiyi ◽

Sunday O. Ajike ◽

Morenike O. Folayan

Keyword(s):

Antiretroviral Therapy ◽

Parotid Gland ◽

Hiv Infection ◽

Clinical Experience ◽

Needle Aspiration ◽

Sub Saharan Africa ◽

Parotid Swelling ◽

Sub Saharan ◽

Gland Enlargement ◽

Hiv Aids

Abstract A changing picture of oral lesions associated with HIV/AIDS has been documented. With the use of antiretroviral therapy, salivary gland swellings and other less common conditions associated with HIV/AIDS are now becoming more common. Our review of the literature showed the presence of parotid swelling in HIV-1 infection has increased from a range of 5-10% to 20% in AIDS. However, to the best of our knowledge, none from sub-Saharan Africa, which is the epicenter of the HIV infection and where access to antiretroviral therapy is poorest, has been primarily reported in literature. This report documents five cases of bilateral parotid gland enlargement as the presenting clinical manifestation of HIV/AIDS. The combination of a fine needle aspiration (FNA) biopsy, ultrasound imaging, and histological diagnosis increased the accuracy of diagnosis. While two patients had access to antiretroviral therapy, other modes of management were cystic aspiration and parotidectomy. One of the patients treated with parotidectomy had facial nerve injury, and the short-term aesthetic outcome between surgical treatment and antiretroviral therapy did not appear different. However, all our patients were lost to follow-up within a 2-year period. For a resource-constrained environment like Nigeria where stigma and discrimination is high and access to antiretroviral therapy is limited, there is a need to understand how best to manage a lymphoepithelial lesion in HIV/AIDS patients. Citation Owotade FJ, Fatusi OA, Adebiyi KE, Ajike SO, Folayan MO. Clinical Experience with Parotid Gland Enlargement in HIV Infection: A Report of Five Cases in Nigeria. J Contemp Dent Pract 2005 February;(6)1:136-145.

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