Browsing by Author "Taljaard, Jantjie"

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    Benefit v. risk when using chloroquine in patients with severe COVID-19 disease
    (Health & Medical Publishing Group, 2020-04-02) Decloedt, Eric H.; Allwood, Brian W.; Parker, Arifa; Koegelenberg, Coenraad F. N.; Blockman, Marc; Taljaard, Jantjie; Reuter, Helmuth
    ENGLISH ABSTRACT: Chloroquine (CQ) is widely advocated as treatment for coronavirus disease 2019 (COVID-19), including the president of the USA publicly supporting the use of hydroxychloroquine (HCQ) as a ‘game-changer’ on the social media platform Twitter. CQ and HCQ are structurally similar, with HCQ having an N-hydroxyl-ethyl side-chain in place of the N-diethyl group.[1] Currently only CQ is being marketed in South Africa. We encourage the development of curative directed therapy against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using appropriate designed trials and regulatory oversight, and caution against the indiscriminate use of CQ or HCQ. Careful patient selection is essential, including assessing prognosis, anticipated benefit and potential harms prior to initiating CQ/HCQ therapy.
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    Clinical evolution, management and outcomes of patients with COVID-19 admitted at Tygerberg Hospital, Cape Town, South Africa : a research protocol
    (BMJ Publishing Group, 2020-08-06) Allwood, Brian W.; Koegelenberg, Coenraad F. N.; Irusen, Elvis; Lalla, Usha; Davids, Razeen; Chothia, Yazied; Davids, Ryan; Prozesky, Hans; Taljaard, Jantjie; Parker, Arifa; Decloedt, Eric; Jordan, Portia; Lahri, Sa'ad; Moosa, Rafique; Schrueder, Neshaad; Du Toit, Riette; Viljoen, Abraham; English, Rene; Ayele, Birhanu; Nyasulu, Peter; COVID-19 Research Response Team
    Introduction The outbreak of the SARS-CoV-2 virus causing COVID-19, declared a global pandemic by the WHO, is a novel infection with a high rate of morbidity and mortality. In South Africa, 55 421 cases have been confirmed as of 10 June 2020, with most cases in the Western Cape Province. Coronavirus leaves us in a position of uncertainty regarding the best clinical approach to successfully manage the expected high number of severely ill patients with COVID-19. This presents a unique opportunity to gather data to inform best practices in clinical approach and public health interventions to control COVID-19 locally. Furthermore, this pandemic challenges our resolve due to the high burden of HIV and tuberculosis (TB) in our country as data are scarce. This study endeavours to determine the clinical presentation, severity and prognosis of patients with COVID-19 admitted to our hospital. Methods and analysis The study will use multiple approaches taking into account the evolving nature of the COVID-19 pandemic. Prospective observational design to describe specific patterns of risk predictors of poor outcomes among patients with severe COVID-19 admitted to Tygerberg Hospital. Data will be collected from medical records of patients with severe COVID-19 admitted at Tygerberg Hospital. Using the Cox proportional hazards model, we will investigate the association between the survival time of patients with COVID-19 in relation to one or more of the predictor variables including HIV and TB. Ethics and dissemination The research team obtained ethical approval from the Health Research Ethics Committee of the Faculty of Medicine and Health Sciences, Stellenbosch University and Research Committee of the Tygerberg Hospital. All procedures for the ethical conduct of scientific investigation will be adhered to by the research team. The findings will be disseminated in clinical seminars, scientific forums and conferences targeting clinical care providers and policy-makers.
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    HBV and HIV viral load but not microbial translocation or immune activation are associated with liver fibrosis among patients in South Africa
    (BioMed Central, 2018-05-08) Maponga, Tongai Gibson; Andersson, Monique I.; Van Rensburg, Christoffel J.; Arends, Joop E.; Taljaard, Jantjie; Preiser, Wolfgang; Glashoff, Richard H.
    Background: Co-infection with HIV negatively impacts the progression of chronic hepatitis B virus (HBV) infection, including causing rapid progression to liver fibrosis. Sub-Saharan Africa represents arguably the most important intersection of high endemicity of both chronic hepatitis B virus (HBV) infection and HIV infection. Methods: We recruited 46 HBV/HIV-co-infected; 47 HBV-monoinfected; 39 HIV-monoinfected; and 37 HBV/HIV-uninfected patients from Tygerberg Hospital, Cape Town, South Africa. All HIV-infected patients were on antiretroviral therapy for ≥3 months. Liver stiffness measurements were assessed using the Fibroscan (Fibroscan 402, Echosens). Cell-based immunomarkers were measured by flow cytometry. Soluble serum/plasma immunomarkers were measured by Luminex technology and enzyme immunoassays. HIV (COBAS/Ampliprep TaqMan HIV-1) and HBV viral loads (in-house assay) were also performed. Results: HBV/HIV co-infected patients showed significantly higher levels of immune activation %CD8+/HLA-DR+/CD38+ (median 30%, interquartile range: 17–53) and %CD8+/PD-1 (median 22%, interquartile range: 15–33), p ≤ 0.01 compared to all other study groups. Despite this, the HBV-mono-infected group had the highest proportion of patients with advanced liver fibrosis (≥13 kPa) as measured by Fibroscan (18%). HBV mono-infected patients showed highest expression of most cytokines including IL-17 and basic fibroblastic growth factor. There was significant positive correlation between detectable HIV and HBV viral replication and liver fibrosis but not immune activation or gut translocation. Discussion: Highly-active antiretroviral therapy, including tenofovir, is effective against both HIV and HBV. Earlier therapy in the co-infected patients may therefore have controlled viral replication leading to better fibrosis scores when compared to HBV mono-infection in this study. On-going HBV and HIV viraemia, rather than microbial translocation or immune activation, appear to be the drivers of liver fibrosis. Moderate to advanced liver fibrosis in HBV-mono-infection may well indicate poor access to screening and treatment of HBV infection.
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    The HIV/HBV co-infected patient : time for proactive management
    (Health and Medical Publishing Group, 2015-02) Andersson, Monique I.; Preiser, Wolfgang; Van Rensburg, Christo; Taljaard, Jantjie; Hoffmann, Christopher J.; Pathology: Medical Virology
    Hepatitis B virus (HBV) infection affects around 240 million people worldwide, with the highest prevalence of disease in Africa and Asia. Hepatocellular carcinoma (HCC) is the second most common cancer in men in Africa, and in around 75% of cases is associated with chronic HBV infection. HIV disproportionately affects sub-Saharan Africa. HIV/HBV co-infection is associated with worse outcomes than HBV monoinfection. Identifying patients who are co-infected enables assessment of liver health and the institution of HCC surveillance. HBV rapid tests are available and could be performed alongside HIV screening. Suppression of HBV viral load reduces complications and improves outcomes. Tenofovir has potent activity against HBV and is becoming increasingly available across sub-Saharan Africa as first-line therapy for HIV. HIV/HBV co-infected patients should be started on HBV active therapy, irrespective of CD4 count. Lifestyle modification, including weight management, avoidance of traditional herbal medication and alcohol restriction, improves liver health and should be encouraged. Confirmation of hepatitis A immunity is prudent. While access to more sensitive tests is limited in sub-Saharan Africa, alpha-fetoprotein and ultrasound scanning is advised for HCC surveillance. Screening and if necessary HBV vaccination of susceptible household and sexual contacts is indicated.
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    Optimising influenza vaccination during a SARS-CoV-2 epidemic in South Africa could help maintain the integrity of our healthcare system
    (Health & Medical Publishing Group, 2020) Preiser, Wolfgang; Mendelson, Marc; Taljaard, Jantjie
    ENGLISH ABSTRACT: The novel infectious disease coronavirus disease 2019 (COVID-19), first reported in late December 2019 in Wuhan, China, seems increasingly unlikely to be contained, resulting in the first pandemic of this decade. Approximately 81% of those infected develop a relatively mild respiratory illness only. While this is good news, the risk of severe disease is higher for the elderly and persons with chronic illness.
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    Psychopathology and coping in recently diagnosed HIV/AIDS patients : the role of gender
    (Health & Medical Publishing Group, 2003) Olley, Benjamin O.; Gxamza, Faniswa; Seedat, Soraya; Theron, Hugo; Taljaard, Jantjie; Reid, Emile; Reuter, Helmuth; Stein, Dan J.
    ENGLISH SUMMARY : Background: Although there is growing literature on the psychological responses to and the psychopathology associated with HIV/AIDS, few investigations have focused on the role of gender. This study compared psychiatric morbidity, coping responses, and disability in male and female outpatients recently diagnosed with HIV/AIDS. Method. One hundred and forty-nine patients (44 male, 105 female) with HIV/AIDS (mean ± standard deviation (SD) months since diagnosis 5.8 ± 4.1) attending an infectious diseases clinic at Tygerberg Hospital, Cape Town, were evaluated. Subjects were assessed using the MINI International Neuropsychiatric Interview (MINI), the Carver Brief COPE, and the Sheehan Disability Scale. In addition, negative life events and risk behaviours were evaluated. Results. Fifty-six per cent of patients were diagnosed with a psychiatric disorder, most commonly major depression (34.9%), dysthymic disorder (21.5%), post-traumatic stress disorder (14.8%), and alcohol dependence (10.1%). There were no significant gender differences in the prevalence of mood disorders in the sample. Men, however, were more likely than women to meet diagnostic criteria for alcohol abuse or dependence, and to engage in certain risky sexual behaviours. Women were more likely to suffer from post-traumatic stress disorder, and to use coping strategies of planning and religion to deal with the illness. There were no significant gender differences in disability. Conclusion. Psychiatric disorders are common in recently diagnosed HIV/AIDS patients in South Africa. Clinicians should be aware of the high prevalence of mood disorders in both men and women, and of gender-different responses such as increased alcohol and substance use and more risky sexual behaviour in men.
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    A rare phenomenon of atypical lipodystrophy in a patient on HAART in the absence of a protease inhibitor regimen
    (The South African journal of HIV medicine, 2010-09) Mitha, Mohammed; Cupido, Gordon; Taljaard, Jantjie
    Lipodystrophy is a complication of patients on antiretroviral (ARV) medication; however, it is commonest in patients on long-term treatment and those on protease inhibitor (PI) regimens.1,2 We present a rare case of atypical lipodystrophy, presenting as multiple subcutaneous lipomas, in a patient who had been on a non-PI ARV regimen for 6 weeks.
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    Symptomatic hyperlactataemia and lactic acidosis in the era of highly active antiretroviral therapy
    (Health & Medical Publishing Group, 2005) Eshun-Wilson, Ingrid; Soentjens, Patrick; Zeier, Michele; Taljaard, Jantjie
    ENGLISH ABSTRACT: No abstract available