Browsing by Author "de Vries, E"

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    Sexuality in patients with human immunodeficiency virus at Embhuleni hospital in Mpumalanga province
    (2013) de Vries, E; Gwyther, L; Mkhabela, M
    Objectives: This study explored issues of sexuality in people living with AIDS who were on highly active antiretroviral therapy (HAART). Design: This was a descriptive quantitative study. Data were collected with an administered questionnaire and entered in Excel®. Statistical analysis included frequency tables, summary statistics and 95% confidence intervals. Setting and subjects: The respondents were purposively sampled from the 850 patients attending the antiretroviral clinic at Embhuleni Hospital in Mpumalanga province. Outcome measures: The questionnaire included questions on sexual practices, number of partners, sexual experience and fertility wishes, comparing respondents’ experience before and after HAART. Results: There was a response rate of 100%, with 102 questionnaires completed. There was a significant difference between the responses to questions on sexual desire, sexual performance, sexual enjoyment and satisfaction regarding frequency of intercourse before and after HAART. Respondents reported a better sexual experience before HAART (t = 2.4387, p-value = 0.0165). There was a statistically significant difference between the number of partners before and after initiation of HAART (p-value = 0.000). Although 96% of respondents rated condom use as being very important, 11% never used condoms during sex and 21% indicated that they had had unprotected sex in the previous six months. Eighteen per cent of respondents said it was very important for them to have a child and 20% were planning to have a child in the future. A quarter of respondents had not disclosed their HIV status to their partners. The majority (95%) of respondents indicated that it was very important to them that health workers discussed their sexual needs with them. Conclusion: Sexuality in HIV is complex, with components described as the “Ps” of sexuality: practices, partners, pleasure, pressure and pain, procreation and power. In this study, participants reported a better sexual experience before HAART. Healthcare professionals need to develop the skills to discuss sexuality, intimacy and fertility wishes with patients. This discussion will enhance healthcare professionals’ understanding of patients’ experiences of their illness and should allow for a more effective patient-centred approach to care.
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    Warfarin-induced skin necrosis in HIV-infected patients with tuberculosis and venous thrombosis
    (2010) Bhaijee, F; Wainwright, H; Meintjes, G; Wilkinson, R J; Todd, G; de Vries, E; Pepper, D J
    Background. At the turn of the century, only 300 cases of warfarin-induced skin necrosis (WISN) had been reported. WISN is a rare but potentially fatal complication of warfarin therapy. There are no published reports of WISN occurring in patients with HIV-1 infection or tuberculosis (TB). Methods. We retrospectively reviewed cases of WISN presenting from April 2005 to July 2008 at a referral hospital in Cape Town, South Africa. Results. Six cases of WISN occurred in 973 patients receiving warfarin therapy for venous thrombosis (0.62%, 95% CI 0.25 - 1.37%). All 6 cases occurred in HIV-1-infected women (median age 30 years, range 27 - 42) with microbiologically confirmed TB and venous thrombosis. All were profoundly immunosuppressed (median CD4+ count at TB diagnosis 49 cells/µl, interquartile range 23 - 170). Of the 3 patients receiving combination antiretroviral therapy, 2 had TB-IRIS (immune reconstitution inflammatory syndrome). The median interval from initiation of antituberculosis treatment to venous thrombosis was 37 days (range 0 - 150). The median duration of parallel heparin and warfarin therapy was 2 days (range 1 - 6). WISN manifested 6 days (range 4 - 8) after initiation of warfarin therapy. The international normalised ratio (INR) at WISN onset was supra-therapeutic, median 5.6 (range 3.8 - 6.6). Sites of WISN included breasts, buttocks and thighs. Four of 6 WISN sites were secondarily infected with drug-resistant nosocomial bacteria (methicillin-resistant Staphylococcus aureus (MRSA), Acinetobacter, extendedspectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae) 17 - 37 days after WISN onset. In 4 patients, the median interval from WISN onset to death was 43 days (range 25 - 45). One of the 2 patients who survived underwent bilateral mastectomies and extensive skin grafting at a specialist centre. Conclusion. This is one of the largest case series of WISN. We report a novel clinical entity: WISN in HIV-1 infected patients with TB and venous thrombosis. The occurrence of 6 WISN cases in a 40-month period may be attributed to (i) hypercoagulability, secondary to HIV-1 and TB; (ii) short concurrent heparin and warfarin therapy; and (iii) high loading doses of warfarin. Active prevention and appropriate management of WISN are likely to improve the dire morbidity and mortality of this unusual condition.