Day: October 14, 2025

Categories : Ethics and Law HIVTags : Leave a comment

Pharmacists Can Treat People with HIV, Appeal Court Rules

On By ModernMedia

“Legitimate and compelling public interests” to allow pharmacists to initiate antiretroviral treatment, says judge

By Tania Broughton

Pharmacists can initiate people with HIV on antiretroviral treatment, the Supreme Court of Appeal has ruled. Photo: GroundUp Staff

The Supreme Court of Appeal (SCA) has dismissed, with costs, an appeal by a doctor’s organisation, the IPA Foundation, aimed at stopping specially trained pharmacists from treating people with HIV and TB.

The IPA first took its dispute with the South African Pharmacy Council (SAPC) to the Gauteng High Court in Pretoria. In 2023, Judge Elmarie van der Schyff ruled in favour of the pharmacists, giving a judicial go-ahead for the council to introduce its Pharmacy-Initiated Management of Antiretroviral Treatment (PIMART) initiative.

However the IPA Foundation, intent on having the initiative set aside, took this ruling on appeal to the SCA. In that court, five judges this week ruled against it. The ruling came nearly 11 months after the case was heard, far more than the three months that judicial norms provide for when a judgment is reserved.

Read the judgment

Justice Tati Makgoka, writing for the court, said the initiative was created in response to a persistent rise in new HIV infection rates.

The SAPC, at the department’s request, deemed PIMART suitable for addressing this issue.

“As the high court correctly found, the SAPC evaluated the risks associated with pharmacists initiating first-line ART [antiretroviral treatment] and TPT [tuberculosis preventive therapy] as well as providing medicines for PrEP [Pre-Exposure Prophylaxis of HIV] and PEP [Post Exposure Prophylaxis of HIV], considering the risks when deciding to approve the PIMART training.

“The uncontested evidence presented by the SAPC demonstrates that the approved accreditation process for PIMART was rigorous and thorough,” Makgoka said.

In her previous judgment, Van Der Schyff had noted that a pilot project had emphasised the value of the initiative, which was in line with the World Health Organisation’s vision to promote widely accessible primary health care.

“The untapped value of pharmacists in fighting HIV was also emphasised by the efficient role pharmacies played in meeting health care needs and providing health care services during the Covid-19 pandemic,” she said.

“The need to widen access to first line ART and TPT therapy on a community level is not a figment of SAPC’s imagination but a dire need that is also evinced in other countries.”

The IPA Foundation had approached the Pretoria court, under the Promotion of Administrative Justice Act (PAJA), seeking to review and set aside the SAPC’s decision to implement PIMART.

IPA claimed that the SAPC had failed to give interested parties an adequate opportunity to comment before the initiative was implemented. It further contended that PIMART unjustifiably encroached on the domain of medical practitioners and was in conflict with legislation.

On appeal, the IPA persisted with these arguments.

Dealing with the background, Justice Makgoka said the SAPC had published a notice in the government gazette in March 2021 regarding the proposed adoption of PIMART, giving interested parties 60 days to comment. This resulted in government approval later that year.

It was only after this that the IPA submitted its comments and objections.

Following engagements, the IPA lodged the review application in the high court.

On the issue that the IPA and its members claimed they were not given sufficient notice of PIMART, because it was advertised in the government gazette during the Covid-19 pandemic – Makgoka said there was no suggestion that the pandemic had “paralysed the administrative functions” of the IPA.

Remarkably, the judge said, the IPA had not suggested that the notice did not come to its attention, finding that adequate notice had been given. Makgoka said that several other organisations had submitted comments during the prescribed period.

He said the IPA had also not challenged the validity of the Pharmacy Act, which specified publication in the gazette and in the absence of that, it was not open for it to say the publication was inadequate.

Makgoka said the IPA had introduced the issue of “rationality” only in its notice of appeal. However, the court had dealt with this because there was no prejudice to the SAPC.

In ruling on this issue, he said PIMART was a crucial intervention in the public interest, which had been devised by a group of medical experts.

“Through PIMART, the SAPC aimed to improve access to healthcare. Contrary to the IPA’s contentions, PIMART is an essential intervention in the fight against HIV/AIDS. Its introduction constitutes a rational legislative and practical measure with the competence of the SAPC as an organ of the state in enhancing access to healthcare for HIV treatment, in fulfilment of the state’s obligation under the Constitution,” Makgoka said.

“These are legitimate and compelling public interests.”

He said the IPA was wrong in believing that PIMART was a blanket licence for pharmacists to treat HIV patients.

“Its scope is limited and applies only to accredited pharmacists. It will not alter the scope of practice for medical practitioners. The fact is that medical practitioners do not have the exclusive rights to care for people living with HIV/AIDS. This is a collaborative effort involving various health professionals.”

The IPA had also submitted that pharmacists were not authorised to prescribe schedule 3, 4 and 5 medicines without a prescription.

However, the judge said, the Medicines Act carved out an exception to this with authorisation of the Director-General. It was through this that PIMART-accredited pharmacists could apply for permits to prescribe schedule 3 – 5 substances.

The appeal was dismissed with costs.

Certainly not all doctors oppose the idea of pharmacists initiating patients with HIV on treatment: the South African HIV Clinicians Society stated: “We look forward to supporting the rollout of PIMART which will further contribute to South Africa’s HIV response and progress towards the 2030 target of eliminating HIV as a public health concern.”

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Read the original article.

Categories : Antibiotics Respiratory DiseasesTags : Leave a comment

Targeted Steroid Use Might Offer a Universal Complimentary Treatment for TB

On By ModernMedia
Tuberculosis bacteria. Credit: CDC

While steroids like dexamethasone are used in certain tuberculosis cases (eg, TB meningitis), their impact on immune cells is not well understood. Given the renewed interest in the steroid dexamethasone, as a host-directed treatment during the COVID-19 pandemic, a Trinity College Dublin team provides evidence that treating patients with steroids may enhance the function of their macrophages to kill the mycobacteria, while diminishing pathways of inflammatory damage. The study is published now in the journal Scientific Reports.

The team’s goal was to determine whether dexamethasone impacts the macrophage’s ability to fight TB. Although glucocorticoids can reactivate TB, they are paradoxically the only adjunctive host-directed therapies that are recommended by the World Health Organization for TB. Steroids are given to patients alongside antimicrobials in certain circumstances, however, scientists don’t fully understand the effect of these drugs on the immune system, especially innate immune cells such as macrophages.

The researchers studied immune cells called macrophages derived from the blood of healthy volunteers or isolated from lung fluid donated by patients undergoing routine bronchoscopies. By treating and infecting these macrophages in the lab with Mycobacterium tuberculosis (Mtb), the scientists could examine and understand how dexamethasone affects the immune response that protects the lungs during infection.

Key findings from the study

  • Dexamethasone a potent glucocorticoid reduces glycolysis in human lung and blood derived macrophages. This reduces the amount of energy available in the cell.
  • Dexamethasone reduced the production of both pro and anti-inflammatory cytokines measured in the study, IL-1β, TNF, IL-6, IL-8 and IL-10. Although helpful for immunity, limiting the production can also limit damage from excessive inflammation.
  • Mtb-infected macrophages have increased survival when they were treated with dexamethasone. This suggests that dexamethasone may protect macrophages from dying due to the harmful effects of infection or detrimental immune responses to infection.
  • Dexamethasone reduces bacterial burden in infected macrophages, and we have identified that this is at least partly mediated by autophagy and phagosomal acidification. Dexamethasone can enhance the macrophages’ ability to degrade and clear bacteria helping to overcome infection with Mtb.

This study identifies that macrophages from different sources have differential responses to glucocorticoids. This highlights that tissue origin can influence how macrophages react to drugs, which may be important for targeting treatment strategies. This is one of the first studies to show that dexamethasone can reduce inflammation while preserving or enhancing antimicrobial function in primary human lung macrophages infected with Mtb.

How could this research change a patient’s life?

The findings support the use of steroids as an extra therapy in conjunction with existing antimicrobial therapies in TB treatment, especially in cases with excessive inflammation. Steroids might also be useful with antimicrobials in TB preventative therapy, to reduce progression from latent TB infection to active TB disease. This study opens avenues for macrophage-targeted steroid therapies that balance inflammation control with antimicrobial defence.

For now, researchers hope this study will hasten the recovery of TB patients who experience debilitating symptoms, often for months into existing therapy.

Dr Donal Cox, Senior Research Fellow, Clinical Medicine, Trinity College Dublin said:

“Our study shows that dexamethasone, which is known to dampen inflammation, can also help macrophages fight tuberculosis more effectively. This challenges the assumption that steroids always suppress immunity and opens the door to smarter, targeted adjunctive therapies that balance inflammation control with antimicrobial defence.”

Prof Joseph Keane, Professor of Medicine, Trinity College Dublin and Consultant Respiratory Physician, St James Hospital said:

“In clinical practice, steroids are the most under-used adjunctive therapy for TB. We often rely on steroids to manage inflammation in tuberculosis, particularly in severe forms like TB meningitis. What’s reassuring from this study, is that dexamethasone not only tempers inflammation but also appears to support the macrophage’s ability to control infection. This study provides new evidence to help us redefine steroid use in TB care—targeting inflammation without compromising antimicrobial defence.”

Next steps for this research

Developing steroid therapies that can be specifically targeted to lung macrophages via mechanisms such as inhaled nanoparticles might be an option to translating this into better therapy. The team also wants to identify how steroids altered different metabolic pathways in human lung macrophages and not in blood derived macrophages so they can exploit this to make steroid therapies better in the future.

Source: Trinity College Dublin

Categories : Ageing Metabolic DisordersTags : Leave a comment

Small Reductions in Cholesterol Could Slash Risk of Dementia for Those with Certain Genetics

On By ModernMedia
Photo by Kampus Production: https://www.pexels.com/photo/a-man-in-blue-sweater-sitting-beside-man-in-white-long-sleeves-7551646/

Low cholesterol can reduce the risk of dementia, a new University of Bristol-led study with more than a million participants has shown.

The research, led by Dr Liv Tybjærg Nordestgaard while at the University of Bristol and the Department of Clinical Biochemistry at Copenhagen University Hospital – Herlev and Gentofte, found that people with certain genetic variants that naturally lower cholesterol have a lower risk of developing dementia.

The study, which is based on data from over a million people in Denmark, England, and Finland, has been published in the journal Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association. 

Some people are born with genetic variants that naturally affect the same proteins targeted by cholesterol-lowering drugs, such as statins and ezetimibe. To test the effect of cholesterol-lowering medication on the risk of dementia, the researchers used a method called Mendelian Randomisation – this genetic analysis technique allowed them to mimic the effects of these drugs to investigate how they influence the risk of dementia, while minimising the influence of confounding factors like weight, diet, and other lifestyle habits.

By comparing these individuals to individuals without these genetic variants, the researchers were able to measure differences in the risk of dementia. They found reducing the amount of cholesterol in the blood by a small amount (one millimole per litre) to be associated with up to 80% reduction in risk of developing dementia for certain drug targets.

“What our study indicates is that if you have these variants that lower your cholesterol, it looks like you have a significantly lower risk of developing dementia,” said Dr Nordestgaard, who now works in the Department of Clinical Biochemistry at Copenhagen University Hospital – Bispebjerg and Frederiksberg hospital.

The results suggest that having low cholesterol, whether due to genes or medical treatment, can help reduce the risk of dementia. However, the study does not say anything definitive about the effect of the medicine itself.  

One of the challenges is that dementia typically does not appear until late in life, and therefore research in the area typically requires a very long period of follow-up. 

It is still not known exactly why high cholesterol can increase the risk of dementia, but one possible explanation proposed by Dr Nordestgaard is that high cholesterol can lead to atherosclerosis. 

“Atherosclerosis is a result of the accumulation of cholesterol in your blood vessels,” Dr Nordestgaard said.  “It can be in both the body and the brain and increases the risk of forming small blood clots – one of the causes of dementia. 

“It would be a really good next step to carry out randomised clinical trials over 10 or 30 years, for example, where you give the participants cholesterol-lowering medication and then look at the risk of developing dementia,” Dr Nordestgaard added. 

The study used data from the UK Biobank, the Copenhagen General Population Study, the Copenhagen City Heart Study, the FinnGen study, and the Global Lipids Genetics Consortium.

Source: University of Bristol

Categories : CancerTags : Leave a comment

Acidic Tumour Environment Promotes the Survival and Growth of Cancer Cells

On By ModernMedia
Cancer cells reshape their mitochondria (stained yellow) when exposed to acidosis. The composed image shows two cells under neutral pH (left) compared to an acidic environment (right), where mitochondria form elongated networks.

Tumours are not a comfortable place to live: oxygen deficiency, nutrient scarcity, and the accumulation of sometimes harmful metabolic products constantly stress cancer cells. A research team from the German Cancer Research Center (DKFZ) and the Institute of Molecular Pathology (IMP) in Vienna has now discovered that the acidic pH value in tumour tissue – known as acidosis – is a decisive factor in how pancreatic cancer cells adapt their energy metabolism to survive these adverse conditions. The results were published in the journal Science.

Poor blood circulation and increased metabolic activity often create hostile conditions in tumours: typical symptoms include a lack of oxygen, glucose, and other nutrients, the accumulation of sometimes harmful metabolites, and acidification of the tumour environment, known as acidosis.

The team led by Wilhelm Palm from the DKFZ and Johannes Zuber from the IMP investigated how cancer cells adapt to these harsh conditions. First, the researchers systematically switched off each gene individually in pancreatic cancer cells using the CRISPR-Cas9 gene editing tool and then tracked how its loss affected the survival and growth of the cells under defined stress conditions. These experiments were initially conducted in culture dishes. The genes identified using this approach were then specifically switched off in mice with pancreatic cancer, and the effects were compared with the results from the cell culture.

The comparative analysis of hundreds of such genes relevant to cancer cell growth under stress conditions surprisingly showed that the metabolism of cancer cells in the mouse model was strongly influenced by adaptations of their energy balance to tumour acidosis. The metabolism of cancer cells within a tumour differs significantly from that in conventional cell culture and can best be replicated by an acidic environment.

“It is not just the lack of oxygen or nutrients that changes the metabolism in the tumour – it is primarily the acidification of the tumour environment,” explains Wilhelm Palm. Acidosis helps cancer cells switch from sugar-based energy production (glycolysis) to more efficient energy production through respiration in the mitochondria. These cell structures, known as organelles, are also referred to as the “powerhouses of the cell.”

The researchers were able to show that the acidic pH value triggers profound changes in the mitochondria. Normally, they are present in cancer cells as small, fragmented structures. Under acidic conditions, however, they merge into extensive networks that are significantly more efficient.

This is possible because acidosis inhibits the activity of the signalling protein ERK. Overactivation of this signalling pathway normally causes mitochondria in cancer cells to repeatedly divide into many small fragments. If this fragmentation does not occur as a result of tumour acidosis, mitochondria can use various nutrients more efficiently for energy production. If genetic intervention prevents the mitochondria from fusing, cancer cells lose their metabolic flexibility and grow much more slowly in the acidic environment of a tumour.

“Our results show that acidosis is not simply a by-product of tumour metabolism, but an important switch that controls the energy supply and survival strategies of cancer cells,” explains co-study leader Johannes Zuber. In the long term, these findings could open up new avenues for therapies that specifically target the energy metabolism of tumours.

Source: German Cancer Research Center

Categories : General Interest PaediatricsTags : Leave a comment

A Decade of Hope and Healing: Surgeons for Little Lives Marks 10 Years of Transforming Paediatric Care

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Every day for ten years, Surgeons for Little Lives has stood beside children and families, providing life-saving care and support.

Professor Jerome Loveland, Founder and Chair of Surgeons for Little Lives at the Chris Hani Baragwanath Academic Hospital paediatric surgery department

For the past ten years, Surgeons for Little Lives has stood as a lifeline for thousands of children at Chris Hani Baragwanath Academic Hospital (CHBAH) in Soweto – the largest hospital in the southern hemisphere. In a healthcare system often stretched to its limits, this dedicated non-profit organisation has filled critical gaps with compassion, resilience and an unwavering belief that every child deserves the best possible care.

Since its founding in 2015, Surgeons for Little Lives has walked hand-in-hand with doctors, nurses, patients and families, not only providing vital resources but transforming the hospital experience for young patients. From upgrading surgical wards and equipment, to nurturing the next generation of paediatric specialists and creating welcoming, family-friendly spaces that offer comfort in the darkest moments – its work has made healing more than just a medical process. It’s become a human one.

“Our first ten years have shown what’s possible when people come together with one shared purpose: to save and uplift the lives of children,” says Professor Jerome Loveland, Founder and Chair of Surgeons for Little Lives. “We are deeply proud of what has been accomplished – but we know the need is growing. That’s why we will continue, every single day, to build capacity, inspire future leaders, and give every child a fighting chance at a brighter future.”

Why this work matters

South Africa has one of the highest burdens of paediatric surgical disease in the region. Children make up nearly 40% of the population, yet there are too few specialists and limited facilities to meet the demand. Severe burns, congenital conditions, childhood cancers and trauma are common, and without surgery many children would not survive.

At CHBAH alone, the paediatric surgery department sees more than 11,000 patients each year and performs over 2,300 operations. Surgeons for Little Lives works closely with the Department of Health to turn overstretched wards into spaces where children can recover with dignity.

3,650 days of achievement

Hospitals can be intimidating places for children. Surgeons for Little Lives has transformed the hospital environment with projects like an outdoor play area for recovering patients, family sleep-over facilities, and a fully revamped Ward 32 with a library, playroom, and upgraded bathrooms. Most recently, the organisation launched the Wells Paediatric Burns Unit, which doubled ICU beds, improved infection control, and added rehab spaces. For families, these changes mean children receive life-saving surgery and care in an environment designed with their needs in mind.

Beyond facilities, Surgeons for Little Lives has created programmes that focus on children’s emotional and physical wellbeing. Healing Through Art & Music gives young patients a way to process trauma through creativity and the SCAN programme, launched in 2023, helps to detect and prevent child abuse. In partnership with the South African Breastmilk Reserve, Surgeons for Little Lives also set up lactation support for new mothers. Other practical initiatives – from discharge packs to Mandela Day donations – have provided small comforts that make a big difference in long hospital stays.

Training for the future

Paediatric surgeons are scarce, and training takes years. Over the past decade, Surgeons for Little Lives has supported the journey of 17 qualified surgeons and backed another 15 registrars currently in training, supplying equipment like surgical loupes and funding access to academic opportunities. In 2024, the first Rolls Royce Oncology Fellow, Dr Andinet Beza from Ethiopia, trained at CHBAH before returning home with new skills. “This initiative, along with other training efforts, is helping to build the next generation of paediatric surgeons equipped to deliver world-class care. Training these specialists is a responsibility we take seriously and a privilege we don’t take for granted,” says Prof Loveland.

Community and partnerships

Community engagement has been central to the success of Surgeons for Little Lives. Fundraising events such as Bara Ride and Joberg2C, together with job shadowing opportunities for young people, have brought South Africans closer to the realities of paediatric care. Volunteers and donors provide not just resources but also comfort to families who spend weeks or months at a child’s bedside.

“This impact has only been possible thanks to the support of partners,” says Prof Loveland. “Contributions from corporates, foundations, and philanthropists have funded essential equipment, upgraded facilities, supported family-centred programmes, and helped fill critical gaps in care, ensuring that more children receive the treatment they need.”

10 years in numbers

  • 11,000+ patients seen in the paediatric surgery department each year
  • 2,300+ operations performed annually at CHBAH
  • 3,000+ burns patients treated since 2015
  • Mortality halved in the burns unit after upgrades
  • ICU beds increased from 6 to 11 in 2025
  • 17 paediatric surgeons trained; 15 registrars in training
  • Hundreds of families supported with sleep-over spaces, counselling, lactation services and more

Join us

Surgeons for Little Lives invites supporters, partners and the wider community to join in building the next chapter. By funding new projects, volunteering time or raising awareness, everyone can help ensure that more children get the surgery and support they deserve.

For its 10th anniversary, the organisation is calling on the public to donate R365 – one rand for every day of the year. In hospital that amount can cover burn dressings for a child, a week of meals for a parent at their child’s bedside or supplies for play therapy to make recovery less frightening, among many other things.

Every rand counts. Every day makes a difference.

For more information or to get involved, visit surgeonsforlittlelives.org.