AFRO-NETS> Kaiser Daily HIV/AIDS Report-Fri, 17 Aug 2001

[Cecilia Snyder <csnyder@ccmc.org>]

Kaiser Daily HIV/AIDS Report-Fri, 17 Aug 2001 
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AIDS Healthcare Foundation to Sponsor Clinic in Durban, South Africa

The Hollywood, Calif.-based AIDS Healthcare Foundation will open the 
first "internationally sponsored" treatment center in South Africa, 
on Aug. 30, the Los Angeles Times reports. Medical experts and clinic 
administrators from Los Angeles will "set up" the clinic in Durban, 
but a South African group, the Network of AIDS Communities, will man-
age daily operations. The clinic, called "Ithembalabantu," or the 
"people's hope" in Zulu, will begin treating patients in mid-
September and will receive $200,000 in funding each year from the 
foundation, the Times reports. The idea for the clinic originated 13 
months ago when AIDS Healthcare Foundation President Michael 
Weinstein "check[ed] on" HIV services during the international AIDS 
conference in Durban.  Weinstein met with leaders of the South Afri-
can group, who told him of the AIDS "crisis" in the region, which 
"prompted" foundation officials to begin the clinic project. The 
foundation also runs nine clinics in Los Angeles, one in Oakland, 
California., and facilities in New York and Jacksonville, Fla. (Pool, 
Los Angeles Times, 8/17).       

SCIENCE & MEDICINE

WHO Protocol for Treating Respiratory Infections in HIV Patients 
Questioned

A Kenyan study of the effectiveness of following the WHO protocol for 
respiratory tract infections in HIV patients has demonstrated that 
the recommended treatments "often failed those diagnosed with pneumo-
nia," the Lancet reports. The research team, led by Christina Mwa-
chari of the Center for Respiratory Disease Research, diagnosed 597 
cases of RTI in 251 of 380 HIV patients at a Nairobi outpatient 
clinic between July 1997 and January 1999, according to the study 
published in the Aug. 1 issue of the Journal of Acquired Immune Defi-
ciency Syndromes. Patients who were older and widowed and who had 
lower T-cell counts and less education were at greatest risk of RTIs.  
The WHO recommended "first-line" therapy ampicillin was successful in 
treating 79% of the cases and the second-line therapy trimethoprim 
and sulfamethoxazole was successful in 10% of the cases. "Non-
protocol" antibiotics were required to treat 11% of the cases (Ash-
raf, Lancet, 8/18). The WHO protocol was "significantly more success-
ful in patients with bronchitis", with only 3% of bronchitis cases 
requiring non-protocol treatment versus 32% of pneumonia cases. Most 
of the pneumonia patients who did not respond to either first- or 
second-line WHO therapies responded to oral erythromycin or azithro-
mycin.

Significance of the Findings

  According to Mwachari, RTIs are the "most common cause of morbidity 
and mortality in HIV-1-positive individuals in sub-Saharan Africa."  
The failure of WHO-recommended treatments in nearly a third of pneu-
monia patients "suggest[s] that research is urgently needed to iden-
tify alternative treatment strategies for these patients", Reuters 
Health reports. Although they were largely successful, "[w]ithout 
more supportive evidence, oral ampicillin and trimethoprim-
sulfamethoxazole cannot be recommended for treatment of pneumonia in 
our population of HIV-1-infected adults," Mwachari said, adding that 
those with "clinical signs and symptoms suggestive of pneumonia might 
benefit from treatment with a macrolide antibiotic and should be hos-
pitalized if symptoms worsen or persist" (Reuters Health/HIV and 
Hepatitis.com, 8/16). According to Robert Scherpbier, a task manager 
for WHO's Stop TB program who coordinates the RTI treatment guide-
lines, Mwachari's recommendation to use a macrolide is "consistent 
with guidelines of, for example, the American Thoracic Society". How-
ever, "[i]ts appropriateness for clinicians in developing countries 
depends on its inclusion in the national essential drug list," he 
said. WHO is planning on revising the guidelines soon and Mwachari's 
recommendations "should be considered", he added (Lancet, 8/18).

The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, 
a free service of The Henry J. Kaiser Family Foundation, by National 
Journal Group Inc. c 2001 by National Journal Group Inc. and Kaiser 
Family Foundation. All rights reserved.

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