Roundtable Presentation

1
Roundtable Presentation

• S Tripathy
• National AIDS Research Institute
• 73 G Block, MIDC
• Bhosari, Pune-411026, India

2
Epidemiology of HIV/ AIDS in India
National AIDS Research Institute, Pune, India
3
Indian HIV/ AIDS epidemicImportant milestones
4
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
5
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
6
HIV/AIDS IN MANIPUR
HIV was first detected in Manipur in 1989 among
intravenous drug users, HIV prevalence gt70 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
7
AIDS Epidemiology

• Modes of transmission
• Sexual 84.24
• Perinatal 26.1
• Blood 2.99
• IDUs 2.83
• Others 7.32

8
Status of HIV epidemic in India
9
Distribution in States

• Maharashtra 10797
• Gujarat 2141
• Karnataka 1617
• Tamil Nadu 18276
• Andhra Pradesh 2565
• Manipur 1238
• Nagaland 298

10
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.
11
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

12
Moderate Prevalent States

• HIV Prevalence
• STD ANC
• Goa 15.0 0.5
• Kerala 6.42 0.08
• Mizoram 2.2 0.33

13
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

14
Sentinel Surveillance for HIV Infection in
pregnant women in Pune
15
Sentinel surveillance for HIV Infection in
tuberculosis patients in Pune
HIV seroprealence
Tuberculosis is the most likely presentation of
AIDS in India
16
Molecular epidemiology
HIV-1 C is the commonest prevalent subtype in
India
17
Clinical conditions and CD4 counts
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
18
Clinical Profile of AIDS in South India

• 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 367985
19
Median CD4 Counts in AIDS Cases in South India

• 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 367985
20
Autopsy finding in AIDS in Mumbai

• 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 1212(3)309-13
21
Generic ART Medication in India

• LamivudineZidovudine
• Efavirenz 600mg
• Nevirapine 200mg
• Didanosine-EC 250mg
• Didanosine-EC 400mg
• Stavudine 30mg
• Stavudine 40mg
• Lamivudine 150mg
• Zidovudine 300mg
• Indinavir 400 mg

22
Healthcare Resources

• National AIDS Cotrol Organization
• Hospitals (Government and Private)
• Researchers
• NGOs
• CBOs
• Free ART programme from the National AIDS Control
  Programme