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Indian Journal of Community Medicine

Surveillance of HIV Infection in Haryana

Author(s): D.R. Arora, Veenu Gupta, B. Arora*

Vol. 25, No. 1 (2000-01 - 2000-03)

Department of Microbiology and Pathology*, Pt. B.D. Sharma PGIMS, Rohtak

Abstract:

Research question: What is the overall seropositivity rate of HIV infection and its trend?

Objective: To study the seropositivity of HIV infection in different groups of people.

Study design: Detection of antibodies against HIV-1 and HIV-2 by two or more ELISA, rapid, simple and Western blot assay.

Setting: Department of Microbiology, Pt. B.D. Sharma PGIMS, Rohtak.

Participants: One lac, sixty six thousand, eight hundred and sixty six individuals.

Study variables: Different groups of people like suspected AIDS cases and their relatives, intravenous drug users, thalassemia patients, patient attending STD clinics and other OPDs, patients on dialysis, jail inmate, pregnant women and blood donors.

Statistical analysis: Proportions.

Results: A total of 595 individuals were found HIV positive amongest 1,66,866 individuals screened for HIV antibodies. Overall seropositivity was 3.6 per thousand. Highest seropositivity rate was observed among relatives of HIV positive individuals (216.7 per thousand) followed by suspected AIDS cases (73.7 per thousand) and intravenous drug users (66.7 per thousand). HIV seropositivity among patients attending chest and tuberculosis department was 9.7 per thousand, 6.5 per thousand in STD patients and it was 1.1 per thousand among pregnant women. Among 212 HIV positive individuals, 96.2% were harbouring HIV-1, 1.9% HIV-2 and 1.9% both HIV-1 and HIV-2. Of the 595 HIV positive individuals, 67 were full blown AIDS cases. Most important mode of acquiring HIV infection in the present study was sexual contact.

Keywords:HIV, Seropositivity, AIDS.

Introduction:

Prevalence of human immunodeficiency virus is increasing globally.1-3 It has been predicted by World Health Organization that by 2000 A.D. India will have the maximum number of HIV infected individuals. 4 For the effective control of transmission of this infection, it is important to know its prevalence and epidemiology. Aim of the present study was to know the trend of HIV infection.

Material and Methods:

A total of 1,66,866 blood samples from different groups of individuals were screened for the presence of HIV antibodies during September 1986 to August 1999 at department of Microbiology, Pt. B.D. Sharma PGIMS, Rohtak.

Antibodies against HIV were detected by using two or more ELISA, rapid, simple and Western blot assay.

Results:

Of a total of 1,66,866 individuals screened for the presence of HIV antibodies, 595 were found to be HIV positive. Four hundred and sixteen of these were adult males, 141 were adult females, 32 were male children and 6 female children.

Seropositivity trend:

The trend of seropositivity in the last 13 years at this centre was investigated. Overall seropositivity from the years 1986 to 1999 was 3.6 per thousand. HIV seropositivity was zero upto 1988 which increased to 0.3 per thousand in 1989 then there was marked increase in seropositivity to 7.1 per thousand in 1996 to 14.4 per thousand in 1999 as shown in the figure.

Seropositivity in various groups:
Table I: HIV seropositivity in different groups of population

Category Number
screened
Seropositive Seropositivity
rate per
thousand
1. Relatives of HIV positive individuals 180 39 216.7
2. Suspected AIDS cases 258 19 73.7
3. Intravenous drug users 30 2 66.7
4. Thalassaemia patients 398 5 12.6
5. Patients attending chest and tuberculosis OPD 8300 81 9.7
6. Patients attending STD clinic 17764 116 6.5
7. Patients attending other OPD's
(Medicine, Surgery and Gynae etc.)
48472 275 5.6
8. Patients on dialysis 2966 7 2.4
9. Pregnant women 31193 33 1.1
10. Jail inmates 1306 1 0.8
11. Blood donors 55969 17 0.3

Table I shows seropositivity in different selected groups of population. Highest seropositivity (216.7 per thousand) was observed among relatives of HIV positive individuals followed by suspected AIDS cases (73.7 per thousand) and intravenous drug users (66.7 per thousand). HIV seropositivity in patients attending chest and tuberculosis OPDs was 9.7 per thousand, in STD patients 6.5 per thousand and in pregnant women it was 1.1 per thousand.

Among 595 HIV positives, HIV typing was done in 212 which revealed that 96.2% (204) were infected with HIV-1 alone, 1.9% (4) were infected with HIV-2 alone, whereas 1.9% (4) had mixed infection with HIV-1 and HIV-2.

Of the 595 HIV positive individuals, 67 were found to be cases of full blown AIDS. Of the 67 AIDS cases, weight-loss, pyrexia of unknown origin, tuberculosis, chronic diarrhoea, candidiasis, generalized lymphadenopathy, neurological involvement and herpes simplex infection were seen in 42,35,31,28,12,11,8 and 7 cases respectively. The mode of transmission of HIV was sexual in 39(58.2%) and parentral in 6(9%) cases. In the remaining 22 (32.8%) cases the mode of acquiring infection could not be detected.

Discussion:

AIDS surveillance centre was established in the department of Microbiology at Pt. B.D. Sharma PGIMS, Rohtak, in September, 1986. The prevalence of HIV infection in this region has increased many folds in the last 13 years. The cumulative prevalence of HIV seropositivity was 3.6 per thousand. Similar trend has been reported by Malik and Malik.5

The highest seroprevalence rate in our study was in the relatives of HIV positive individuals (216.7 per thousand) and in suspected AIDS cases (73.7 per thousand). The prevalence was lowest in the blood donors (0.3 per thousand).

Studies conducted by ICMR surveillance centre have indicated the HIV seropositivity rate among pregnant women as 1-5 per thousand.6 In our study, overall seropositivity rate among pregnant women was 1.1 per thousand. In another study5, this seropositivity rate was 2.9 per thousand. HIV seroprevalence among intravenous drug users was 66.7 per thousand which is lower than that reported from Amritsar.7 Variability in intravenous drug users related HIV seroprevalence has been documented earlier.8

Tuberculosis is a frequent and important opportunistic infection in patients infected with HIV. The prevalence of HIV among them varies from 1% in a study conducted at Chennai9 to 10% among tuberculosis patients in Mumbai.10 In our study, the overall prevalence of HIV infection observed was 9.7 per thousand in patients attending chest and tuberculosis department.

In our study, AIDS cases presented with more than one symptoms. Most common symptom was weight loss (62.6%), pyrexia of unknown origin (52.2%), tuberculosis (46.2%), chronic diarrhoea (41.7%) and candidiasis (17.9%). Though in many studies, unusual opportunistic pathogens like Pneumocystis carinii and Toxoplasma gondii have been reported to be extremely common.11 In present study, tuberculosis was the most common infection followed by candidiasis and meningitis.

We conclude that tuberculosis, candidiasis and meningitis are the prominent infections in HIV positive individuals in North Indian population. Hence steps should be taken for early diagnosis and treatment of tuberculosis especially for atypical mycobacteria and multidrug resistant tuberculosis. For better management, continuous monitoring of infections in HIV positive individuals is suggested. To ascertain exact epidemiology of opportunistic infections, further studies in a large number of HIV positive individuals are required. As majority of the infections are sexually acquired, promotion and provision of condoms may go a long way in preventing transmission of HIV infection.

Acknowledgements:

We gratefully acknowledge the technical help rendered by Sh. Satya Pal, Senior laboratory technician of our department.

References:

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  2. Martens TE, Burton A, Stoneburner R: Global estimates and epidemiology of HIV infusion and AIDS. AIDS 1997; 8(Suppl 1): S361-S372.
  3. Srikanth P, John TJ, Jeyahumari H et al: Epidemiological features of acquired immunodeficiency syndrome in Southern India. Indian J Med Res 1997; 105: 191-7.
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  5. Malik A and Malik A: Prevalence of HIV infection in Aligarh, Indian J Med Micro 1998; 16(3): 123-5.
  6. Anonymous: Turning point in HIV/AIDS Research: Vision of Hope. ICMR Bulletin 1996; 12: 121-32.
  7. Mohan U, Jindal N, Kaur M: Prevalence of immunodeficiency virus among intravenous drug users in Amritsar. Indian J Med Micro Biol 1998; 16(3): 105-7.
  8. Brettle R, Flegg PF, MacCallum LR: Injection drug use related HIV and AIDS. In: Recent advances in STD and AIDS. Harris JRW and Foster SM (eds.) Edinburgh: Churchill Livingstone, 1991: 91.
  9. Raviglione MC, Narain JP, Kochi A: HIV associated tuberculosis in developing countries, clinical features, diagnosis and treatment. Bulletin WHO 1992; 70: 515-26.
  10. Jain MK, John TJ and Keusch GT: Epidemiology of HIV and AIDS in India. J AIDS 1994; 28(Suppl): 883-900.
  11. Gradon JD, Tripone JG, Schnittman SM: Emergence of unusual opportunistic pathogens in AIDS - a review. Clin Inf Dis 1992; 15: 134-57.
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