A new HIV treatment programme tailored to the needs of students was launched at the Cape Peninsula University of Technology (CPUT) earlier this year.

According to South African National Aids Council (SANAC) figures, 37% of new HIV infections in South Africa in 2016 were in women and girls between the ages of 15 and 24. The prevalence in women and girls in this age group were four times that of men and boys in the same age group.

These figures spurred CPUT into action. In July this year they rolled out an antiretroviral treatment programme with the aim of granting students easier access to treatment.

The programme is called “ART clubs” – an initiative that will ensure that students known to be living with HIV are managed and cared for locally. According to a CPUT statement, students will not have to miss out on class time due to waiting hours at offsite clinics and it is expected that adherence to treatment will improve.

Former President of the CPUT Student Representative Council Sipho Mokoena told Spotlight that the programme is progressing well, although the university was reluctant to share figures on its progress. Mokoena however said: “I was looking at the statistics and they showed at least 63% of registered CPUT-students known to be living with HIV have been collecting their medicine from the HIV-unit at the Bellville campus.”

Mokoena said at least seven students make use of this service daily.

CPUT has 8 campuses in the Western Cape. The programme is currently only available at the Bellville campus. It will be rolled out to the other 7 campuses from next year.

Spokesperson for CPUT Lauren Kansley said the ART-programme for now will inclusively deal with referrals from other CPUT campuses to the Bellville campus clinic. She said this will help to provide access to the programme.

Kansley would not be drawn on statistics relating to the project. Attempts to get information from the two nurses running the HIV unit were also unsuccessful. Kansley said: “As per instruction from our HIV/Aids unit who deals directly with Higher Education AIDS (HEAIDS) we never reveal institutional statistics on infection rates.”

(HEAIDS is a non-profit company under the leadership of the Department of Higher Education and Training that coordinates and runs health services at tertiary education institutions.)

She did say they are pleased with the uptake thus far although they expected more students. She attributed the lower than expected uptake to the unit opening during recess when there were fewer students around.

Confidentiality concerns

Spotlight visited the HIV unit on the Bellville campus. It is small and close to the often-crowded student centre. During the visit, a peer educator was counselling a student and the conversation was audible in the waiting area.

When approached for comment on their progress, the HIV/AIDS peer educator was reluctant to share any information. She said she was employed by HEAIDS and was told not to give any information.

Attempts to get input from the head of the HIV unit Melanie Marais was also unsuccessful.

Mokoena expressed concern over privacy at the unit. He said there is an ongoing issue of stigma that may prevent students from accessing the service.

“Some students feel that they are not as comfortable as they could have been because the HIV-unit is quite small and gets crammed but there are also others who do not mind.”

He said some students are also affected mentally because they want to be accepted rather than looked down upon.

“The SRC has tried to make treatment and counselling accessible to students and closing hours of the counselling unit have been extended from 4pm to 8pm”, he said. 

Resource constraints

According to Kansley there are resource constraints. “We do not have enough staff to support and assist in these programmes. We currently have two nursing practitioners who have successfully completed the Nurse Initiated Management of Antiretroviral Treatment (NIMART) course offered by the Department of Health and Khethi’ Impilo”, she said.

CPUT is working with the Western Cape Department of Health. “The department accredited the institution’s student health clinic as a decanting site where life-saving medication can be rolled out”, Kansley said.

The latest data available on HIV prevalence among students show a prevalence of 3,4% and among those that are sexually active, a prevalence of 3.8%. This HEAIDS study of 2008/2009 sampled 17 062 students in 21 of the 23 universities in the country. T

wo thirds of the sample was students that were sexually active, AfricaCheck reported. There has since been no new data on HIV prevalence among students in higher education institutions.

This article first appeared in Spotlight.

Liviwe Finca

Regular fasting is associated with lower rates of heart failure and a longer lifespan, according to two new studies.

Researchers sought to shed new light on the centuries-old debate about how fasting affects health. Recent studies have shown it contributes to reductions in blood pressure, “bad” LDL cholesterol and insulin resistance, a condition that can raise blood sugar. A 2017 study showed alternate-day fasting was as effective as daily calorie restriction for losing weight and keeping the pounds off.

A profound effect

The new studies focused on data from patients evaluated for heart disease in Utah and other Rocky Mountain states. The research included hundreds of members of The Church of Jesus Christ of Latter-day Saints, also known as Mormons, who typically fast one Sunday each month, for up to 24 hours.

In the first study, researchers zeroed in on how fasting impacts life span. About 2 000 people who had undergone a cardiac catheterisation procedure were followed for an average of 4.4 years, including 389 “routine fasters” who had been fasting regularly for at least five years.

After adjusting for various factors, researchers discovered the routine fasters had a 45% lower mortality rate than the non-fasters during the follow-up period.

“It’s very interesting … it’s a more profound effect than we anticipated,” said researcher Dr Benjamin Horne, who recently presented the preliminary findings at the American Heart Association’s Scientific Sessions.

Horne also was involved in the second fasting study, which used the same patient data to see how routine fasting affects heart failure and heart attacks. After adjusting for various factors, there was no significant difference in heart attacks, but routine fasters had a 71% lower rate of developing heart failure than non-fasters.

A very different lifestyle

“That’s a huge difference, and frankly, it was a little unexpected,” said Horne, director of cardiovascular and genetic epidemiology at Intermountain Medical Center in Salt Lake City, Utah.

Krista Varady, an associate professor of nutrition at the University of Illinois at Chicago, called it “an important study that hasn’t been done before. There’s a lot of short-term clinical trials for intermittent fasting, but we definitely don’t have any long-term data in humans looking at whether it can prevent things like heart failure.”

Varady, who was not involved in the research, said the study was limited by the fact that most of the fasters were Latter-day Saints.

“They lead a very different lifestyle compared to the average American,” she said. “For instance, they don’t smoke, don’t drink alcohol and are slightly more physically active. It just makes sense they’re going to live longer and have a lower chance of heart disease.”

Even though researchers adjusted for some of those factors, she said, “It is very difficult to tease apart the effects of fasting versus an otherwise healthy lifestyle in this population, despite the use of statistical corrections.”

The hours build up

A number of hot diet trends encourage people to restrict their eating to a window of eight to 12 hours and fasting the remaining 12 to 16 hours. But participants in the two new studies fasted even more hours each day, over the course of an average of 42.2 years, Horne said.

“We think that long-term fasting of about one day, once a month, over a period of decades is making the body activate those beneficial mechanisms for a few hours each day between dinner and breakfast when it usually wouldn’t. … Those hours build up over long periods of time and provide the benefits,” he said.

The research was limited by being an observational study that doesn’t prove cause and effect, Horne said. He’d like to see future studies that explore why fasting seems to protect against heart failure, and he also called for a large study on the psychological benefits of fasting.

“Some people who’ve started fasting say they unexpectedly feel they have more self-control over their appetite,” he said. “Potentially, there’s a direct result between fasting and the strengthening of the mind so people are able to eat a better diet.”

Varady called for future studies that follow people who restrict eating in a variety of ways – such time-restrictive fasters and alternate-day fasters. “This is a nice first step, but we need to do long-term research on different people doing different types of fasting.”

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Canadian researchers have reported a new twist on the spate of deaths and lung damage from vaping in the United States.

A 17-year-old boy may well be the first case of a novel type of lung injury from vaping. The condition is similar to “popcorn lung”, which is seen in workers exposed to the chemical flavouring diacetyl, an ingredient used to produce microwave popcorn, researchers said.

Several toxic compounds

When inhaled, the chemical causes inflammation and obstruction of the small airways in the lungs.

“The type of lung injury our patient suffered is different from the pattern of injury seen in the outbreak of cases in the US, meaning that there is more than one way vaping can harm the lungs,” said lead researcher Dr Karen Bosma, an associate scientist at the Lawson Health Research Institute in London, Ontario.

“We don’t know for certain what chemical or ingredient is causing the problem, but we do know that several compounds found in e-liquids can be toxic when inhaled, so no vaping products can be considered free of risk,” she said.

In this Canadian case, the teen came down with a life-threatening case of bronchiolitis after a week of persistent coughing. The boy was hospitalised and put on life support.

Bosma’s team suspected that the problem was related to flavoured e-cigarettes. Indeed, the family said their son had regularly used flavoured e-liquids including those that contained THC, the active ingredient in marijuana.

The boy’s condition was so serious that his doctors referred him to a lung transplant centre.

A warning to others

Although the teen avoided needing a lung transplant, his lungs were permanently damaged. He continues to recover and has sworn off e-cigarettes, marijuana and tobacco, the researchers said.

Vaping has health risks and the potential short and long-term effects of vaping remain unknown, Bosma said. Non-smokers, pregnant women and young people should not vape, she cautioned.

“The patient, his family and his health care team want to use his case as a warning to others,” Bosma said. “What happened to our patient could happen to anyone.”

The report was published in the journal CMAJ.

In the United States, the number of those stricken with a severe lung illness tied to vaping has reached 2 172, according to the US Centers for Disease Control and Prevention.

Cases have now been reported in every state except Alaska, the agency noted.

In September, President Donald Trump pledged to ban sale of most flavoured e-cigarettes in the United States. But the New York Times reported this week that under pressure from lobbyists and political advisers, Trump has not yet taken action, saying only that he wants to study the issue.

Unregulated products

Meanwhile, the US death toll from vaping-related lung illness stands at 42, spread across 24 states and the District of Columbia. Deaths have involved patients ranging from the ages of 17 to 75, with a median age of 52.

The CDC noted that more than 85% of cases involved products that contained THC.

Experts said an oily chemical known as vitamin E acetate appears to be involved, which is used in a variety of products, but when heated and inhaled it can cause severe lung damage.

“These are products that are not regulated with regards to the substances being inhaled,” explained Dr Albert Rizzo, chief medical officer of the American Lung Association.

While these compounds may be safe to swallow, they can become toxic and cause lung damage when they’re heated and inhaled as a vapour, he said.

People shouldn’t vape, Rizzo said. “If they don’t, they shouldn’t start. If they are vaping, they should stop because these products have not been evaluated by any regulatory agency in this country and there’s no evidence as to their safety or efficacy,” he said.

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Routine fasting may reduce the risk of heart failure and death in patients who have cardiac catheterisation, a new study suggests.

It included more than 2 000 patients who had cardiac catheterisation between 2013 and 2015. They were followed for 4.5 years afterward.

Better health outcomes

Those who fasted regularly had a higher survival rate during follow-up than those who did not, according to researchers at Intermountain Healthcare Heart Institute in Salt Lake City, Utah. Fasting was a strong predictor of survival and lower risk of heart failure even after lifestyle behaviours, medications, heart risk factors and other health problems were taken into account.

“It’s another example of how we’re finding that regularly fasting can lead to better health outcomes and longer lives,” principal investigator Benjamin Horne said in an institute news release. Horne is the institute’s director of cardiovascular and genetic epidemiology.

Intermittent fasting is a diet method where one skips food or limits calories for up to 24 hours, or limits the time spent eating during the day, such as from 7 a.m. to 3 p.m.

While the study only found an association and does not prove fasting improves survival, the researchers said the findings do suggest that routinely not eating and drinking for short periods may have an effect and warrant further study.

They noted that fasting affects a person’s red blood cell count, as well as levels of haemoglobin and human growth hormone. It also lowers sodium and bicarbonate levels, and activates metabolic processes that contribute to better heart health, they said.

Not for everyone

“With the lower heart failure risk that we found, which is consistent with prior mechanistic studies, this study suggests that routine fasting at a low frequency over two-thirds of the life span is activating the same biological mechanisms that fasting diets are proposed to rapidly activate,” Horne said.

Routine fasting over a period of years conditions the body to activate its benefits quicker than usual, the researchers said.

They pointed out, however, that fasting is not for everyone. Women who are pregnant or breastfeeding should not fast, nor should young children or frail older adults.

Fasting is also not an option for organ transplant recipients, people with a suppressed immune system, those with chronic diseases and those with eating disorders.

Those who take medications for diabetes, blood pressure or heart disease should only fast under a doctor’s supervision, the researchers added.

The findings were presented at the American Heart Association’s annual meeting, in Philadelphia. Research presented at meetings is typically considered preliminary until published in a peer-reviewed journal.

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