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Roundtable Presentation . S Tripathy National AIDS Research Institute 73 G Block, MIDC Bhosari, Pune-411026, India. Epidemiology of HIV/ AIDS in India. National AIDS Research Institute, Pune, India. Indian HIV/ AIDS epidemic [ Important milestones].

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Roundtable Presentation

S Tripathy

National AIDS Research Institute

73 G Block, MIDC

Bhosari, Pune-411026, India


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Epidemiology of HIV/ AIDS in India

National AIDS Research Institute, Pune, India


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Indian HIV/ AIDS epidemic[Important milestones]


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Phases of spread of HIV epidemic in India

Commonest mode of HIV spread in India is by sexual route

Mother to child transmission is on the rise

HIV spread among intravenous drug users mostly in north-eastern states

Blood transfusion associated spread is on the decline


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Factors related to HIV infection [STD clinic attendees in Pune]

* Practice of sex work

* No. of sex partners

* Receptive anal sex

* Females in sex work (FSW)

* Men having sex with FSW recently

* Lack of formal education

* Persons living away from family

* Previous / present STDs

* Absence of circumcision


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HIV/AIDS IN MANIPUR

HIV was first detected in Manipur in 1989 among intravenous drug users, HIV prevalence >70% in drug users

75.2% knew that needle sharing could lead to acquisition of AIDS, however, needle sharing was practiced by 96.8%

Drug users: predominantly male (94.8%), between 15 and 35 years (95.3%)

Median duration of drug use: 5 years, No. of times heroin used: 1 – 14 per day

SKB ICMR


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AIDS Epidemiology

  • Modes of transmission

    Sexual 84.24%

    Perinatal 26.1%

    Blood 2.99%

    IDUs 2.83%

    Others 7.32%



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Distribution in States

  • Maharashtra 10797

  • Gujarat 2141

  • Karnataka 1617

  • Tamil Nadu 18276

  • Andhra Pradesh 2565

  • Manipur 1238

  • Nagaland 298


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High prevalent States

States where HIV prevalence in antenatal women is 1% or

more.

Moderate prevalent States

States where the HIV prevalence in antenatal women is

less than 1% and prevalence in STD and other high risk

groups is 5% or more.

Low prevalent States

States where the HIV prevalence in antenatal women is

less than 1% and HIV prevalence among STD and other

high-risk group is less than 5%.


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High Prevalent states

HIV Prevalence

STD% ANC%

Andhra Pradesh 26.6 1.5

Karnataka 16.4 1.13

Maharashtra 9.2 1.75

Manipur 10.5 1.75

Nagaland 7.4 1.25

Tamil Nadu 12.6 1.13


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Moderate Prevalent States

HIV Prevalence

STD% ANC%

Goa 15.0 0.5

Kerala 6.42 0.08

Mizoram 2.2 0.33


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HIV Prevalence Trend in India

Prevalence New Infections

1998 3.5 m -

1999 3.7 m 0.2 m

2000 3.86 m 0.16 m

  • 3.97 m 0.11 m

    2003 5.1m

    Inference : New infections are declining



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Sentinel surveillance for HIV Infection in tuberculosis in Pune

patients in Pune

HIV seroprealence

%

Tuberculosis is the most likely presentation of AIDS in India


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Molecular epidemiology in Pune

HIV-1 C is the commonest prevalent subtype in India


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Clinical conditions and CD4 counts in Pune

* Oral candidiasis and weight loss were associated with and were highly

predictive of low CD4 counts

* Absence of clinical conditions were good predictors of high CD4 counts


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Clinical Profile of AIDS in South India in Pune

  • Pulmonary tuberculosis (49.1%; median duration of survival, 45 months)

  • Pneumocystis carinii pneumonia(6.1%; median duration of survival, 24 months)

  • Cryptococcal meningitis (4.7%; median duration of survival, 22 months)

  • CNS toxoplasmosis (3%; median duration of survival, 28 months)

Clinical Infectious Diseases 2003; 36:79–85


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Median CD4 Counts in AIDS Cases in South India in Pune

  • Pulmonary tuberculosis 111 cells/mL

  • Extrapulmonary tuberculosis 122 cells/mL

  • P. carinii pneumonia 87 cells/mL

  • Cryptosporidiosis 133 cells/mL

  • Cryptococcal meningitis 91 cells/mL

  • CNS toxoplasmosis 35 cells/mL

  • Cytomegalovirus retinitis 51 cells/mL

Clinical Infectious Diseases 2003; 36:79–85


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Autopsy finding in AIDS in Mumbai in Pune

  • 85 adult brains studied with at least 21 sections from each using routine and special stains

  • CNS lesions observed in 67 cases (79%)

  • Opportunistic infections were present in 33 cases (39%)

  • Toxoplasmosis (11 cases, 13%)

  • Tuberculosis (10 cases, 12%),

  • Cryptococcosis (seven cases, 8%)

  • Cytomegalovirus infection (six cases, 7%)

AIDS. 1998 Feb 12;12(3):309-13


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Generic ART Medication in India in Pune

  • Lamivudine+Zidovudine

  • Efavirenz 600mg

  • Nevirapine 200mg

  • Didanosine-EC 250mg

  • Didanosine-EC 400mg

  • Stavudine 30mg

  • Stavudine 40mg

  • Lamivudine 150mg

  • Zidovudine 300mg

  • Indinavir 400 mg


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Healthcare Resources in Pune

  • National AIDS Cotrol Organization

  • Hospitals (Government and Private)

  • Researchers

  • NGOs

  • CBOs

  • Free ART programme from the National AIDS Control Programme


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