A quicker, simpler test for tuberculosis (TB) in people living with HIV is not being used widely enough in South Africa, despite new evidence of its benefits, according to international humanitarian organisation Doctors Without Borders (MSF).

The TB LAM test can quickly diagnose the disease in HIV patients – providing a result in as fast as 33 minutes, compared to conventional tests which can take up to two days. This was revealed at the 9^th International Aids Society (IAS) Conference on HIV Science in Paris.

Advantages over sputum tests

It is effective for patients with CD4 counts (the measure of a person’s immunity) of 200 and below, and uses urine instead of sputum to detect TB bacteria. It is only effective in this group because people who are very sick excrete a high amount of bacteria in their urine – enough for the test to detect.

At only $3 (±R39) per test it is also an affordable option and does not require a laboratory or special expertise and can be performed by nurses and even trained lay people.

“The TB LAM test has advantages over sputum tests for patients with late stage HIV who don’t present with the usual signs of TB and usually find it difficult to produce sputum,” MSF’s Dr Amir Shroufi told Health-e News.

“There have been concerns over its accuracy but for patients with severe immunosuppression (very weak immune systems), our experience plus a rapidly evolving evidence base shows that this is a useful test that can help clinicians make quick decisions to start advanced HIV patients on treatment, when any delays have serious consequences.”

But he said South Africa has been slow to act on this evidence and scale-up its use.

Most deaths in people living with HIV in South Africa are caused by TB.

Good for very vulnerable patients

Shroufi said researchers in Stokholm are working on a more sensitive version of the test so it can be used for all patients – regardless of their health status. 

Deputy Director General at the Department of Health (DoH) Dr Yogan Pillay said that the reason for the delay in scale-up is that the DoH had to develop an algorithm for its use and pilot it before it could advise provinces on how to implement it.

“We had a consultation about the algorithm about two weeks ago and we have adopted it for use across the country. So LAM is in, and it’s currently being scaled up. We just need to get the traction of the hospital CEOs and the clinicians to start using it,” he said.

Sekai Chenai Mathabire-Rucker, a Zimbabwean researcher who won an award for her research on the TB LAM test in Paris this week, said that the test has significant advantages for very vulnerable patients.

“Patients who come in with low CD4 counts are often so sick they can’t walk, some are even unconscious. These patients often cannot provide sputum and need treatment as quickly as possible. Unlike with sputum tests, the TB LAM test can provide results in under an hour and patients can be started on treatment the very same day. This quick time-to-treatment saves lives,” she said. – Health-e News.

Amy Green

In partnership with SA’s top medical aesthetic companies

Visible signs of sun damage such as loss of elasticity, wrinkling, excess pigmentation, as well as damage from acne, stretchmarks or scarring need more intense exfoliation with deeper medical peels – using agents such as Trichloroacetic Acid (TCA), salicylic acid (BHA) and vitamin-A derived retinoic acid. They act by penetrating to the skin’s upper dermis, producing dramatic and lasting improvements.

The added bonus: they have a general firming and tightening effect as they stimulate healthy collagen and elastin as well as resurfacing the skin, for a smoother, more radiant complexion.

Vital to know: Skin Renewal firmly believe that a doctor or trained skincare professional must assess your skin, your needs and your medical condition before recommending the correct chemical peel for you, as not all skin types can have the same treatment, and it can be a dangerous procedure with permanent unwanted consequences if not applied correctly. For this reason, you should also always have a trusted, reputable medical peel brand.

Unfortunately, penetrating this deeply does increase the risk of some discomfort both during treatment and in recovery, with some downtime – visible skin flaking and redness – for up to a week. You may need some pre- and post-peel care, which you should follow diligently.

Peel options

Obagi legendary Medical Blue Peel, applied by a trained doctor, gets its blue hue from a dye solution that ensures the TCA is released slowly into the skin, so it is less irritating and penetration and depth of peeling is controlled, making it a very safe option to use. Obagi recommend a prep and maintenance skin care range for lasting results, and one peel once a year.

The benefits of the Yellow Peel is that it can be used on all skin types and treats post-inflammatory hyperpigmentation, uneven texture (including areas such as the elbows, knees and legs), back acne and sun damaged areas.

Need to know: Its downtime lasts 3 to 4 days, and it may be repeated every 4 weeks. A series of 4 peels is recommended.

The 3D Peel series is your option for more advanced skin. Performed by a trained medical doctor, Modified Jessners solution (Lactic Acid, Salicylic Acid, Resorcinol), TCA and Retinoic Acid are used to treat, among others,  sun damage, pre-cancerous spots, post-inflammatory hyperpigmentation and superficial acne scarring. It achieves similar results to far more aggressive and invasive peels, is more controlled, comfortable and well tolerated.

Need to know: 3D peel is not suitable for all skin types, and is not recommended for use if you have certain medical conditions (confirmed by the doctor at your consultation). It has a seven-day downtime.

The lights fantastic

When you have more extensive sun damage or deep, severe pigmentation, you need to act in the deeper layers of the skin’s dermis without damaging surrounding skin. This is where light technology plays its role.

The state-of-the-art Fraxel™ DUALlasergives you 2 lasers in 1: the original 1550nm Restore wavelength targets skin texture and improves deep lines and acne scars, while the 1927 Thulium laser treats all forms of pigmentation. Approved by the American FDA, this gentle treatment resurfaces the skin from the inside out with dramatic reversal of sun damage and pigmentation with hardly any downtime. 

Need to know: Suitable for all skin types and tones, the two lasers can be used together or separately, and show results in as little as 2-3 treatments.

Pearl rejuvenation laser targets fine lines, uneven texture and discoloration. It gives you very targeted skin resurfacing with a revolutionary new wavelength and computer-guided scanning device that is programmed to remove specific layers of tissue uniformly – offering mild to very aggressive peeling to treat a variety of conditions from age spots to deep wrinkles and scars.

Resurfacing results are seen in as little as one treatment, but 2-3 may be recommended for severe conditions.

Need to know: Suitable for fair to medium-depth complexions only. A local anaesthetic is applied before treatment.

A natural protective dressing forms on the surface, protecting the treated skin from weeping and minimising downtime.

The CO2 (Carbon Dioxide) laser removes the outer layers of damaged skin, simultaneously stimulating the regeneration of healthy skin underneath. It is used to treat deeper facial lines, wrinkles, uneven pigmentation, scarring and sun damage on the face, around the eyes and mouth, on cheeks, hands, neck and chest.

Need to know: Not recommended for darker skins such as skin types 5 and 6 (see the Fraxel DUAL treatment for darker complexions).

Local anesthetic is applied before treatment to relieve any potential discomfort.

A full skin consultation with a Skin Renewal doctor is absolutely vital in order to discuss suitability for this treatment.  

There is some downtime: skin will be red and ooze slightly for 5 to 7 days, so you may not want to be seen. No make-up may be used until skin has healed.

Home Care

Besides using recommended home care products that enhance the benefits and soothe your skin post peel, exfoliation treatments make your skin more sun-sensitive. Sunscreen of SPF 50 should be used daily, and sun exposure avoided.

To find out more about exfoliation treatments suitable for your skin type and the four pillars to addressing ageing skin, visit Skin Renewal at www.skinrenewal.co.za, or contact 0861 SKIN SA (7546 72) to book your individual assessment.

Take the quick Beyond Beauty Survey and you could win a R2000 Skin Renewal voucher to spend in our online store, with free delivery within South Africa. T&Cs apply.