Over to the Overberg

Drive Northwest from Cape Town through the winelands for about an hour and you come face to face with a huge range of mountains – the start of the Overberg. An impressive road tunnel takes you through the mountain, and you exit into the most beautiful valley. The towns here have English and Scottish names: Worcester, Robertson, McGregor, but the language spoken is predominately Afrikaans. Many wines familiar to Europeans are produced here – Graham Beck for example. Most of the land not given over to vines is farmed for fruit and vegetables; many of the people attending the HIV clinics here are farm workers.

Marelize Mathee, dietitian at Eben Donges Hospital in Worcester, kindly introduced me to the HIV clinic, and showed me round the hospital. This 300 bed district hospital is in the middle of a rebuild, and the new wards are impressive – no real difference to facilities in Europe. Nutritional supplements and tube feeds were being delivered to the wards alongside freshly cooked meals.

The adult HIV clinic was in full swing when I arrived. Five hundred patients are on ARV treatment there. I was pleased to see that nutrition was at the heart of the care on offer. Any malnourished patients were receiving food supplements and advice.

The team at the hospital were inspirational – caring, and obviously dedicated to their patients. They were interested to hear about the HIV clinic at Guy’s and St. Thomas’. One of their concerns was how the metabolic side effects experienced by some of the patients on ARVs might develop here. One of the ARVs widely used in South Africa – d4T – is now thought to be one of the most closely associated with fat wasting; for this reason this drug is rarely seen in the UK now. My concern, shared with many others, is that over the next few months and years, lipoatrophy will become a relatively commonplace side effect. Alternatives to d4T not commonly associated with lipoatrophy, such as Tenofovir, are still not available, but I understand that both pharmaceutical companies and the Department of Health are under pressure to come up with the goods.

Having spent the last 10 years supporting people experiencing lipodystrophy, I hope the delay in introducing a wider range of ARVs will be minimal.