Francois W D Venter

• PhD
• Divisional Director at University of the Witwatersrand

In total, 1.3 million people acquired human immunodeficiency virus (HIV) in 2023, well behind the UNAIDS goal of <370 000 infections by 2025. Novel 6-monthly injectable pre-exposure prophylaxis (PrEP) medication lenacapavir is highly efficacious and could be epidemic-changing. However, without equitable access infection rates will continue. Gilead...

Background CYP2B6 slow metabolisers have higher efavirenz concentrations, which are further increased by isoniazid inhibiting efavirenz’s accessory metabolic pathway. Objectives We investigated the association between CYP2B6 genotype and toxicity in people living with HIV (PLWH) on isoniazid and efavirenz. Method We enrolled participants from the...

Background As in much of sub-Saharan Africa, substantial HIV testing gaps remain in South Africa, particularly among adult men ages 20–35, young people ages 15–24 and key populations. Innovative strategies, such as HIV self-testing (HIVST), are needed to reach such under-served populations. We evaluated a range of HIV self-test kit distribution mod...

This Viewpoint discusses the optimal treatment duration of glucagon-like peptide-1 receptor agonists in people with obesity and the benefits of off-ramping, the tapering of these antiobesity medications following an initial treatment period.

Objectives Treatment‐related weight gain and metabolic complications with antiretroviral integrase‐based regimens, especially among Black women, suggest the need for alternative options. Methods We conducted a 48‐week, open‐label, single‐arm, single‐centre, phase IIIb switch study to evaluate the tolerability, safety and efficacy of switching from...

Background Weight gain is common after antiretroviral initiation, especially among females, those of black race and lower baseline CD4, although this may potentially be due to lower baseline weight. Use of tenofovir disoproxil fumarate or efavirenz can suppress weight gain. Methods Data were pooled from the ADVANCE (n = 1053), NAMSAL (n = 613) and...

Background Non-communicable diseases (NCDs) are responsible for 51% of total mortality in South Africa, with a rising burden of hypertension (HTN) and diabetes mellitus (DM). Incorporating NCDs and COVID-19 screening into mass activities such as COVID-19 vaccination programs could offer significant long-term benefits for early detection interventio...

Introduction Evidence‐based intervention strategies to improve adherence among individuals living with chronic conditions are critical in ensuring better outcomes. In this systematic review, we assessed the impact of interventions that aimed to promote adherence to treatment for chronic conditions. Methods We systematically searched PubMed, Web of...

Objectives To develop consensus data statements and clinical recommendations to provide guidance for improving cardiometabolic health outcomes in people with HIV based on the knowledge and experience of an international panel of experts. Methods A targeted literature review including 281 conference presentations, peer-reviewed articles, and backgr...

Background People with HIV (PWH) on integrase inhibitor-based regimens may be at risk of excess weight gain, but it is unclear if this risk is consistent across settings. We assessed weight change over 48 weeks among PWH who were transitioned to tenofovir disoproxil fumarate/lamivudine/dolutegravir (TLD). Design We conducted a prospective cohort s...

Low- and middle-income countries are facing a growing burden of noncommunicable diseases (NCDs). Providing HIV treatment may provide opportunities to increase access to NCD services in under-resourced environments. We conducted a systematic review and meta-analysis to evaluate whether use of antiretroviral therapy (ART) was associated with increase...

Background ADVANCE compared 3 World Health Organization–recommended first-line regimens in participants with HIV who were antiretroviral naive. Methods This randomized, open-label, noninferiority trial enrolled participants living with HIV with no antiretroviral exposure in the previous 6 months to 1 of the following arms: tenofovir alafenamide (T...

Background HIV and antiretroviral therapy (ART) have been associated with increased cardiovascular disease (CVD) risk in high‐income countries. The authors studied the longitudinal association between HIV and ART and nonlaboratory Framingham Risk Score (FRS) in a middle‐income country. Methods and Results This longitudinal analysis of the NCS (Ndl...

Background: Protease inhibitors (PIs) have been recommended as World Health Organization second-line antiretroviral therapy (ART) for low- to middle-income countries for two decades. As dolutegravir-based regimens have become widely available, the future role of PIs is uncertain. Objectives: To describe the characteristics of patients on PI-based A...

The Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) study found a 35% reduction in major adverse cardiovascular events for people with human immunodeficiency virus who received daily pitavastatin. However, how this evidence will change practice is far from certain. Here, we outline evidence gaps and political and healthcare delivery c...

Background Non-communicable diseases (NCDs) are responsible for 51% of total mortality in South Africa, with a rising burden of hypertension (HTN) and diabetes mellitus (DM). Incorporating NCD and COVID-19 screening into mass activities such as COVID-19 vaccination programs could offer significant long-term benefits for early detection intervention...

Introduction The ADVANCE and NAMSAL trials evaluating antiretroviral drugs have both reported substantial levels of clinical obesity in participants. As one of the main risk factors for metabolic syndrome, growing rates of obesity may drive metabolic syndrome development. This study aims to evaluate the risk of metabolic syndrome in the ADVANCE and...

Metabolic disease is increasing in people with HIV (PWH) in South Africa, but little is known about self-perceptions of body size, health, and nutritional behavior in this population. We performed a cross-sectional analysis of individual-level data from the 2016 South Africa Demographic and Health Survey. This survey measured HIV serostatus and bod...

Differentiated service delivery is recommended to improve the uptake of HIV testing and treatment for people living with HIV. One service delivery option yet to be fully capitalised on is community pharmacies. There are approximately 3,580 registered community pharmacies in South Africa. A total of 1,110 (31%) of these pharmacies are corporate chai...

Aims We sought to evaluate the yield and linkage-to-care for diabetes and hypertension screening alongside a study assessing the use of rapid antigen tests for COVID-19 in taxi ranks in Johannesburg, South Africa. Methods Participants were recruited from Germiston taxi rank. We recorded results of blood glucose (BG), blood pressure (BP), waist cir...

Background Partner-delivered HIV self-testing kits has previously been highlighted as a safe, acceptable and effective approach to reach men. However, less is known about its real-world implementation in reaching partners of people living with HIV. We evaluated programmatic implementation of partner-delivered self-testing through antenatal care (AN...

Objective: Renal toxicity is more common with tenofovir disoproxil fumarate (TDF) than with tenofovir alafenamide fumarate (TAF). We investigated whether polymorphisms in genes relevant to tenofovir disposition affect renal toxicity among HIV-positive Southern Africans. Methods: Genetic sub-study of adults was randomized to initiate TAF or TDF t...

Tenofovir disoproxil fumarate (TDF) and tenofovir alafenamide (TAF) are prodrugs of the nucleotide analogue tenofovir, which acts intracellularly to inhibit HIV replication. Whereas TDF converts to tenofovir in plasma and may cause kidney and bone toxicity, TAF mostly converts to tenofovir intracellularly, so it can be administered at lower doses....

Objective: Novel antiobesity treatments are highly effective in recent clinical trials. Access to these medications is needed to supplement lifestyle and surgical interventions for millions living with obesity worldwide, but high prices are limiting. This study aimed to review current treatment costs and calculate potential estimated minimum price...

Background: The integrase strand transfer inhibitor (INSTI) dolutegravir is recommended in World Health Organization guidelines, but is associated with weight gain. We evaluated weight change in patients switching from efavirenz to dolutegravir in first-line antiretroviral therapy (ART) in Johannesburg, South Africa. Methods: We conducted a pros...

Background Long-acting injectable cabotegravir pre-exposure prophylaxis (PrEP) is recommended by WHO as an additional option for HIV prevention in sub-Saharan Africa, but there is concern that its introduction could lead to an increase in integrase-inhibitor resistance undermining treatment programmes that rely on dolutegravir. We aimed to project...

Background: Dolutegravir, a component of the preferred first-line antiretroviral therapy regimen, has been associated with increased weight gain. South Africa has a high prevalence of obesity, especially among women. Understanding dolutegravir exposure in patients with obesity is important for dose optimisation. Objectives: We compared the pharmac...

Background: Current cardiovascular risk assessment in people living with HIV is based on general risk assessment tools; however, whether these tools can be applied in sub-Saharan African populations has been questioned. Objectives: The study aimed to assess cardiovascular risk classification of common cardiovascular disease (CVD) risk prediction m...

Reporting of HIV self-test results to encourage linkage to HIV care for those who receive a positive test result is a common challenge faced by HIV self-testing programs. The impact of self-testing programs is diminished if individuals who obtain a self-test do not use the test or seek confirmatory testing and initiate HIV treatment following a pos...

Background: Viral rebound during antiretroviral treatment (ART) is most often driven by suboptimal adherence in the absence of drug resistance. We assessed the diagnostic performance of point-of-care (POC) tenofovir (TFV) detection in urine for the prediction of viral rebound and drug resistance during ART. Methods: We performed a nested case-co...

Background Dolutegravir has been associated with neuropsychiatric adverse events (NPAEs), but relationships between dolutegravir concentrations and NPAEs are unclear. Objectives To determine in an African population whether a concentration–response relationship exists between dolutegravir and treatment-emergent NPAEs, and whether selected loss-of-...

Background: The COVER trial evaluated whether nitazoxanide or sofosbuvir/daclatasvir could lower the risk of SARS-CoV-2 infection. Nitazoxanide was selected given its favourable pharmacokinetics and in vitro antiviral effects against SARS-CoV-2. Sofosbuvir/daclatasvir had shown favourable results in early clinical trials. Methods: In this clinic...

Introduction: Standard-of-care antiretroviral treatment (ART) monitoring in low- and middle-income countries consists of annual determination of HIV-RNA viral load (VL) with confirmatory VL testing in case of viral rebound. We evaluated an intensified monitoring strategy of three-monthly VL testing with additional drug exposure and drug resistance...

Research on older people with HIV in sub-Saharan Africa finds high rates of comorbidity in addition to HIV, suggesting they will require increasing assistance from informal social networks. Data are scarce on social network dynamics of older people with HIV in the region, and research is needed to understand how their social networks provide suppor...

Early in the HIV epidemic, living with HIV and ageing were mutually exclusive in African countries. Increased accessibility of antiretroviral therapies has changed this. Much is known of the experience of older South Africans as caregivers in the HIV epidemic, but less of the social support experience of those ageing with HIV. This chapter presents...

A growing body of work examines sexuality in later life in sub-Saharan Africa, but we know little about the sexual health of older people with HIV in this region. Using data from Uganda and South Africa, we examined sexual health and risk in older people with HIV and examined similarities and differences based on nationality and gender. Over 40% of...

[This corrects the article DOI: 10.4102/sajhivmed.v22i1.1312.].

Background: Dolutegravir is a component of preferred antiretroviral therapy (ART) regimens. We characterised the pharmacogenetics of dolutegravir exposure following ART initiation in the ADVANCE trial in South Africa. Methods: Genome-wide genotyping followed by imputation was performed. We developed a population pharmacokinetic model for doluteg...

Objectives Cardiovascular disease (CVD) is a major problem globally. Truck drivers have an increased risk of CVD due to a sedentary lifestyle, irregular working hours and behavioural choices. We aimed to get insight into the contribution of night shift work to CVD risk in long-distance truck drivers in South Africa. Design A cross-sectional study....

Objective This study described the demographics, treatment information and identified characteristics associated with virological failure and being lost to follow-up (LTFU) for patients with HIV on first-line and second-line antiretroviral therapy (ART) regimens in a large South African cohort. Design A quantitative retrospective cohort study usin...

Background: Prevalence of HIV, smoking, and pulmonary infections in South Africa are high. Objectives: We investigated the role of smoking and HIV status on lung function. Methods: This is a secondary analysis of a cross-sectional study conducted in South Africa. Data included demographics, pulmonary risk factors and a spirometry test to obtain t...

Digital tools can support community-based decentralized testing initiatives to broaden access to COVID-19 diagnosis, especially in high-transmission settings. This operational study investigated the use of antigen-detecting rapid diagnostic tests (Ag-RDTs) for COVID-19 combined with an end-to-end digital health solution, in three taxi ranks in Joha...

Introduction: Pretreatment drug resistance (PDR) prevalence in sub-Saharan Africa is rising, but evidence of its impact on efavirenz (EFV)-based antiretroviral treatment (ART) is inconclusive. We determined the impact of PDR on outcomes of EFV-based ART in a subanalysis of a randomised clinical trial comparing different ART monitoring strategies i...

Dolutegravir is associated with more weight gain than efavirenz in people starting antiretroviral therapy (ART). We investigated the concentration–response relationships of efavirenz and dolutegravir with weight gain. We determined concentration–response relationships of dolutegravir and efavirenz (both combined with tenofovir disoproxil fumarate a...

Irregular work times promote inconsistent completion of the Pittsburgh Sleep Quality Index (PSQI) among shift workers. We aimed to demonstrate the importance of testing the internal consistency and construct validity of the PSQI and of the Epworth Sleepiness Scale (ESS) by presenting the methodology in a sample of long-haul truckers in South Africa...

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is transmitted mainly by aerosol in particles <10 µm that can remain suspended for hours before being inhaled. Because particulate filtering facepiece respirators (‘respirators’; e.g. N95 masks) are more effective than surgical masks against bio-aerosols, many international organisations...

Multiple factors make adherence to antiretroviral therapy (ART) a complex process. This study aims to describe the barriers and facilitators to adherence for patients receiving first-line and second-line ART, identify different adherence strategies utilized and make recommendations for an improved adherence strategy. This mixed method parallel conv...

Dolutegravir (DTG) is now a component of preferred first-line antiretroviral therapy (ART) worldwide. ADVANCE and NAMSAL were two landmark clinical trials conducted exclusively in sub-Saharan Africa, which studied the effectiveness of DTG-based first-line regimens for ART-naive individuals. In this review, we examine the data from these studies to...

Progression in the development of antiretroviral therapy has been remarkable, with new agents continuing to appear as options for modern regimens, including in low-and-middle income countries where the HIV epidemic is concentrated. Here, we reflect on progress made in guiding regimen changes to public health programmes, and the challenges facing se...

Background: HIV programmes world-wide currently make decisions regarding new antiretroviral therapy (ART) regimens with less side-effects and higher resistance barriers, which may improve adherence and viral suppression. Economic evaluation helps inform these decisions. Methods: We conducted an economic evaluation of three ART regimens included...

Obesity develops in a substantial number of people initiating and maintaining modern antiretroviral therapy. The comorbidities associated with obesity make significant weight gain and metabolic changes a major consideration in clinical trials studying different regimens’ potency and safety. It is as yet unclear what role individual antiretrovirals...

[This corrects the article DOI: 10.4102/sajhivmed.v21i1.1152.].

Background Weight gain is being observed for a wide range of antiretroviral treatments. Weight gains are higher for people taking first-line integrase inhibitor based treatments, especially those including TAF/FTC. Weight gains are higher for women and people of colour. Clinical obesity increases the risks of cardiovascular disease, diabetes, adver...

Background: With the roll-out of antiretroviral treatment (ART), the life expectancy of people with HIV and, hence, morbidity from non-communicable diseases, including pulmonary diseases, have increased. Objectives: This research study aims to investigate whether HIV infection and ART use are associated with pulmonary function, given the high freq...

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is transmitted mainly by aerosol in particles <10 µm that can remain suspended for hours before being inhaled. Because particulate filtering facepiece respirators ('respirators'; e.g. N95 masks) are more effective than surgical masks against bio-aerosols, many international organisations...

Introduction: Same-day initiation (SDI) of antiretroviral therapy (ART) for HIV consistently increases ART uptake, but concerns remain about higher attrition from care after initiation. We analysed 12-month retention in the SLATE SDI trials. Methods: SLATE I (Simplified Algorithms for Treatment Eligibility I, enrolment 06 March-28 July 2017) and...

We support an affirming approach to managing the transgender and gender diverse (TGD) client, centering on the individual’s agency, autonomy and right to selfdetermination, as opposed to practices that pathologise and stigmatise transgender identity, imposing barriers to accessing healthcare services. Transgender and gender diverse individuals have...

Purpose of review: HIV treatment has evolved since the introduction of antiretroviral therapy (ART) in the 1990s. Earlier treatment strategies, and the introduction of integrase inhibitors in preferred first-line ART have fundamentally changed cardiovascular side effects due to HIV infection and ART. This review provides an update on cardiovascula...

Background Despite advances in availability and access to antiretroviral therapy (ART), HIV still ranks as a major cause of global mortality. Hence, the aim of this study was to develop and internally validate a risk score capable of accurately predicting in‐hospital mortality in HIV‐positive patients requiring hospital admission. Methods Consecut...

Background: Studies have associated HIV with an increased risk of obstructive lung disease (OLD). Objectives: We aimed to identify the predictive factors for impaired lung function in an urban, African, HIV-positive population. Method: A cross-sectional study was performed in Johannesburg, South Africa, from July 2016 to November 2017. A question...

Executive summaryInitial recommendations for protecting health care workers (HCWs) against COVID-19 were based on an early and incomplete understanding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission; namely, that it occurred mainly via large respiratory droplets (>10 µm) that were inhaled into the nasopharynx, directly...

Background: Suboptimal antiretroviral therapy (ART) adherence is associated with viral resistance, opportunistic infections and increased mortality. Objectives: To determine the rates of ART non-adherence and its associations, and also the reasons for ART non-adherence, among HIV-positive patients presenting to a major central hospital emergency...

Objective: Integrase inhibitors, including dolutegravir (DTG), are associated with weight gain and obesity, especially when combined with tenofovir alafenamide (TAF). Obesity increases the risk of adverse pregnancy outcomes (APOs). This study aimed to predict the risk of APOs caused by treatment-associated obesity, using a hypothetical sample base...

Introduction Insight into inflammation patterns is needed to understand the pathophysiology of HIV and related cardiovascular disease (CVD). We assessed patterns of inflammation related to HIV infection and CVD risk assessed with carotid intima media thickness (CIMT). Methods A cross-sectional study was performed in Johannesburg, South Africa, inc...

Introduction: Same-day initiation (SDI) of antiretroviral therapy (ART) for HIV consistently increases ART uptake, but concerns remain about higher attrition from care after initiation. We analysed twelve-month retention in the SLATE SDI trials. Methods: SLATE I and SLATE II were individually randomized trials at public outpatient clinics in Johann...

Role of community engagement in HIV self screening in South Africa

Africa’s readiness to the respond to the SARS-COV-2 pandemic was tested due to reliance on rapid turn-around-time of polymerase chain reaction results for clinical management, isolation and quarantine decisions. The HIV Molecular Laboratory in Johannesburg, South Africa is one of the largest automated HIV molecular laboratories worldwide, performin...

Multiple factors make adherence to antiretroviral therapy (ART) a complex process. This study aims to describe the barriers and facilitators to adherence for patients receiving first-line and second-line ART, identify different adherence strategies utilized and make recommendations for an improved adherence strategy. This mixed method parallel conv...

Introduction Dolutegravir has replaced efavirenz in most low‐ and middle‐income countries, due to better tolerability and formidable resistance profile, but dolutegravir side effects suggest alternatives are needed. We evaluated doravirine resistance in South Africa as a first step to assess whether doravirine may replace dolutegravir. Methods A r...

Introduction HIV self-testing (HIVST) presents a convenient, private approach that removes barriers to providing HIV testing services. The Self-Testing Africa (STAR) Initiative aims to scale up HIVST among priority and undertested populations. HIVST has the potential to help maintain testing services during the social distancing restrictions implem...

Objective: To evaluate the long-term risks of type 2 diabetes mellitus (T2DM) and cardiovascular disease secondary to weight gain and clinical obesity associated with the initiation of integrase strand transfer inhibitors (INSTIs) and tenofovir alafenamide (TAF) in the ADVANCE trial using validated risk equation tools. Design: Retrospective data...

Background Prolonged hospitalization places a significant burden on healthcare resources. Compared to the general population, hospital length of stay (LOS) is generally longer in HIV-positive patients. We identified predictors of prolonged hospital length of stay (LOS) in HIV-positive patients presenting to an emergency department (ED). Methods In...

[This corrects the article DOI: 10.4102/sajhivmed.v20i1.1010.].

Letter by Venter et al. on editorial by Schoub (Dial down the rhetoric over COVID-19 vaccines. S Afr Med J 2021;111(6):522-523. https://doi.org/10.7196/SAMJ.2021.v111i6.15740).

Background The use of a combination of the integrase inhibitor, cabotegravir, and the non-nucleoside reverse transcriptase inhibitor, rilpivirine, in a long-acting injectable form is being considered as an antiretroviral treatment option for people with HIV in sub-Saharan Africa. We aimed to model the effects of injectable cabotegravir–rilpivirine...

Introduction With over 500 000 infections and nearly 12 000 deaths, South Africa (SA) is the African epicenter of the current Coronavirus (COVID-19) pandemic. SA has implemented a 5-stage Risk-Adjusted Strategy which includes a phased national lockdown, requiring social distancing, frequent hand washing and wearing face masks. Strict adherence to t...