Research - (2020) Volume 11, Issue 6
, DOI: 10.37421/jar.2020.11.811
Citation: Abhay Srivastava."Clinical Profile of HIV Sero-Positives Attending ICTC Centre in District Aligarh, Uttar Pradesh: A Descriptive Analysis " J AIDS Clin Res 11 (2020): 811 doi: 10.37421/jar.2020.11.811.
Copyright: © 2020 Srivastava A. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Background: HIV seems to be a major public health challenges for all over the world especially in developing countries like India.
Objective: To study the sociodemographic profile of people living with HIV/AIDS attending a standalone ICTC centre at Jawahar Lal Nehru Medical College and Hospital Aligarh in Uttar Pradesh.
Materials and Methods: A record-based study was carried out among the HIV-positive patients who were attending the ICTC center at Jawahar Lal Nehru Medical College, AMU Aligarh.
Result: Prevalence of HIV infection was found to be 5.04% in and around Aligarh region. Males were more commonly affected than females with a ratio of 1.6:1. Majority of HIV positive patients (35.82%) belonged to 25-34 years of age group. Most common clinical presentation was fever (46.9%) among HIV positive patients followed by weight loss (36.88%) and diarrhoea (32.55%). Sexual transmission (61.19%) was the most common route of HIV transmission seen in our study. Most of the patients had a baseline CD4 count level below 200/μl.
Conclusion: The majority of HIV/AIDS-affected persons were in the economically productive age group. The educational level, occupation, socioeconomic status, marital status, and affected region were found to be associated. Heterosexual is the commonest mode of transmission. Most of the patients reported at an early phase of disease.
Acquired Immune Deficiency Syndrome (AIDS) • Antiretroviral Treatment (ART) • Human Immunodeficiency Virus (HIV) • CD4 count • Standalone ICTC • Social Stigma
HIV remains a global infection worldwide majorly affecting the Asian and African countries. It is a leading public health challenge in developing countries like India.
According to UNAIDS DATA 2018, 36.9 million (31.1-43.9 million) people are living with HIV globally with adults 35.1 million (29.6-41.7 million) and children (<15 years) 1.8 million (1.3 million-2.4 million). A total of 1.8 million (1.4-2.4 million) were newly infected with HIV with adults 1.6 million (1.3-2.1 million) and children (< 15years) 180 000 (110 000-260 000). Nearly 940 000 (670 000-1.3 million) deaths were recorded globally in the year 2017. Conjunct Asia and the Pacific data however show a decline of 14% in new HIV infections during 2010-2017 and 39% decline in annual deaths related to AIDS and associated illnesses. The report also says that the region has exhibited tremendous reduction in incidence: prevalence ration of 0.05 (0.04-0.08) in 2017 consistently approaching an epidemic transition benchmark of 0.03 .
In India, HIV Estimation Technical report 2017 displays adult HIV prevalence as 0.22% (Male 0.30% and Female-0.22%) which has continuously declined from 0.38% in 2001-03 to present value of 0.22%. Prevalence of HIV was highest in Mizoram at 2.04% among all states and Union Territories in India followed by Manipur at 1.43% and Nagaland at 1.15%. Collectively 3.30 lakh PLHIV are found in India with Maharashtra at the top of the list contributing nearly 15% of total PLHIV. Andhra Pradesh and Telangana jointly contribute highest estimated PLHIVs whereas Uttar Pradesh is one of those eight states which account for three fourth of total estimated PLHIV in India. UP has been estimated to have 1.34 lakhs PLHIV according to the report .
Currently 79% Indians know their HIV status. In India, according to NACO 2017 report national adult (15-49 years) HIV prevalence is estimated at 0.22% (0.16-0.30%) among whom 0.25% were males and 0.19% were females. According to the report prevalence among female sex workers was 2.2%, among MSM 4.3% while IVD users the prevalence was 9.9%. HIV prevalence in Uttar Pradesh state was 0.22% (NACO Annual report 2016-2017). According NACO 16-17 report HIV positivity seems higher amongst IDUs, TGs and Truckers which seems consistent with previous year results .
Demonstration of antibodies in bloodstream remains the mainstay in HIV testing which can be done through ELISA test, rapid test kits and western blot test . Both screening and confirmatory tests can be covered under these test names. Detection of anti-HIV antibodies in whole blood, serum or plasma is the central component of HIV diagnosis. Specific test kits are also available for urine and saliva testing. Since HIV virus exists in two different serological forms viz HIV-1 and HIV-2, differentiation must be done between the two as treatment is different for both. As per NACO guidelines rapid test kits are used to detect >99.5% HIV-infected individuals and a <2% false positives. The serological test kits are divided in to four generations based on what type of antigen is being tested. Rapid test kits for screening are available as Dot Blot Assay (Immunoconcentration), Agglutination assay, Immunochromatographic assay and Dipstick and comb assay based on Enzyme Immune Assay (EIA).
The study was carried out at a standalone ICTC centre under the Department of Microbiology in a medical college of Aligarh district, Uttar Pradesh wherein all reporting subjects were consecutively enrolled for HIV testing. The study setting serves as a referral centre for the nearby cities in and around Aligarh, catering to an overall population of nearly 37 lakh people.
The study was approved by Institutional Ethics Committee. Detailed information on socioeconomic status, personal, sexual and clinical manifestations was also collected.
All subjects were tested for HIV by three EIA (Enzyme Immune Assay) based rapid tests namely Combaids, Meriscreen and Trispot . Data related to baseline CD4 count and ‘outcome after one year’ of enrolment were also extracted. The period of study was two years from November 2015 to October 2017.
Majority of seropositive cases in our study belongs to lower socioeconomic group i.e., labour group and in male subjects which increases the financial burden to the society. Female patients were underreported because of fear of being discriminated in the society and this problem should be addressed by increasing awareness programmes. The labourer groups found to be commonly affected group considering as a linkage between high risk group and general population. As heterosexual route seems to be commonest mode of transmission, our government programme should be more focused towards safe sex practices. Low incidence of HIV infection among graduate student in our study shows the importance of educational status. Maximum patients in our study visited the ICTC centre at level of CD4 count level below 200 μl which shows need of much more awareness about early health seeking behaviour among high risk group person as well in general populations. Various socio-demographic factors were observed in our study which can helps in better understanding their impact on controlling the infection and framing the programmes better running by government agency.
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