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Roundtable Presentation  <ul><li>S Tripathy </li></ul><ul><li>National AIDS Research Institute </li></ul><ul><li>73 G Bloc...
Epidemiology of HIV/ AIDS in India National AIDS Research Institute, Pune, India
Indian HIV/ AIDS epidemic [ Important milestones] HIV infection reported among intravenous drug users in Manipur State 198...
Phases of spread of HIV epidemic in India Commonest mode of HIV spread in India is by sexual route Mother to child transmi...
Factors related to HIV infection  [STD clinic attendees in Pune] * Practice of sex work * No. of sex partners * Receptive ...
HIV/AIDS IN MANIPUR HIV was first detected in Manipur in 1989 among intravenous drug users, HIV prevalence >70% in drug us...
AIDS Epidemiology  <ul><li>Modes of transmission </li></ul><ul><li>Sexual 84.24% </li></ul><ul><li>Perinatal 26.1% </li></...
Status of HIV epidemic in India
Distribution in States <ul><li>Maharashtra 10797 </li></ul><ul><li>Gujarat 2141 </li></ul><ul><li>Karnataka 1617 </li></ul...
High prevalent States   States where HIV prevalence in antenatal women is 1% or  more. Moderate prevalent States States wh...
High Prevalent states <ul><li>HIV Prevalence </li></ul><ul><li>STD% ANC% </li></ul><ul><li>Andhra Pradesh  26.6 1.5 </li><...
Moderate Prevalent States <ul><li>HIV Prevalence </li></ul><ul><li>STD% ANC% </li></ul><ul><li>Goa 15.0 0.5 </li></ul><ul>...
HIV Prevalence Trend in India <ul><li>Prevalence  New Infections </li></ul><ul><li>1998 3.5 m - </li></ul><ul><li>1999 3.7...
Sentinel Surveillance for HIV Infection in pregnant women in Pune
Sentinel surveillance for HIV Infection in tuberculosis  patients in Pune HIV seroprealence % Tuberculosis is the most lik...
Molecular epidemiology HIV-1 C is the commonest prevalent subtype in India
* Oral candidiasis and weight loss were associated with and were highly predictive of low CD4 counts * Absence of clinical...
Clinical Profile of AIDS in South India <ul><li>Pulmonary tuberculosis (49.1%; median duration of survival, 45 months) </l...
Median CD4 Counts in AIDS Cases in South India <ul><li>Pulmonary tuberculosis  111 cells/ m L </li></ul><ul><li>Extrapulmo...
Autopsy finding in AIDS in Mumbai <ul><ul><li>85 adult brains studied with at least 21 sections from each  using routine a...
Generic ART  Medication in India <ul><li>Lamivudine+Zidovudine </li></ul><ul><li>Efavirenz 600mg </li></ul><ul><li>Nevirap...
Healthcare Resources <ul><li>National AIDS Cotrol Organization </li></ul><ul><li>Hospitals (Government and Private) </li><...
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28831

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  1. 1. Roundtable Presentation <ul><li>S Tripathy </li></ul><ul><li>National AIDS Research Institute </li></ul><ul><li>73 G Block, MIDC </li></ul><ul><li>Bhosari, Pune-411026, India </li></ul>
  2. 2. Epidemiology of HIV/ AIDS in India National AIDS Research Institute, Pune, India
  3. 3. Indian HIV/ AIDS epidemic [ Important milestones] HIV infection reported among intravenous drug users in Manipur State 1989 Indian pharmaceutical companies marketed ARV drugs with considerable price reduction 2001 India PMTCT feasibility studies initiated by NACO 2000-01 Indian National AIDS Control Programme was launched 1991 First report of HIV infections in sex workers in Chennai, first report of AIDS in Mumbai 1986
  4. 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 Children of HIV infecteddrug users Children of HIV infected women Phase IV Spouses of drug users Spouses of male STD pts Low/ No risk population Phase III Other drug users Male STD patients Bridge population Phase II Intravenous drug users Female sex workers At risk population Phase I
  5. 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. 6. 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
  7. 7. AIDS Epidemiology <ul><li>Modes of transmission </li></ul><ul><li>Sexual 84.24% </li></ul><ul><li>Perinatal 26.1% </li></ul><ul><li>Blood 2.99% </li></ul><ul><li>IDUs 2.83% </li></ul><ul><li>Others 7.32% </li></ul>
  8. 8. Status of HIV epidemic in India
  9. 9. Distribution in States <ul><li>Maharashtra 10797 </li></ul><ul><li>Gujarat 2141 </li></ul><ul><li>Karnataka 1617 </li></ul><ul><li>Tamil Nadu 18276 </li></ul><ul><li>Andhra Pradesh 2565 </li></ul><ul><li>Manipur 1238 </li></ul><ul><li>Nagaland 298 </li></ul>
  10. 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. 11. High Prevalent states <ul><li>HIV Prevalence </li></ul><ul><li>STD% ANC% </li></ul><ul><li>Andhra Pradesh 26.6 1.5 </li></ul><ul><li>Karnataka 16.4 1.13 </li></ul><ul><li>Maharashtra 9.2 1.75 </li></ul><ul><li>Manipur 10.5 1.75 </li></ul><ul><li>Nagaland 7.4 1.25 </li></ul><ul><li>Tamil Nadu 12.6 1.13 </li></ul>
  12. 12. Moderate Prevalent States <ul><li>HIV Prevalence </li></ul><ul><li>STD% ANC% </li></ul><ul><li>Goa 15.0 0.5 </li></ul><ul><li>Kerala 6.42 0.08 </li></ul><ul><li>Mizoram 2.2 0.33 </li></ul>
  13. 13. HIV Prevalence Trend in India <ul><li>Prevalence New Infections </li></ul><ul><li>1998 3.5 m - </li></ul><ul><li>1999 3.7 m 0.2 m </li></ul><ul><li>2000 3.86 m 0.16 m </li></ul><ul><li>3.97 m 0.11 m </li></ul><ul><li>2003 5.1m </li></ul><ul><li>Inference : New infections are declining </li></ul>
  14. 14. Sentinel Surveillance for HIV Infection in pregnant women in Pune
  15. 15. Sentinel surveillance for HIV Infection in tuberculosis patients in Pune HIV seroprealence % Tuberculosis is the most likely presentation of AIDS in India
  16. 16. Molecular epidemiology HIV-1 C is the commonest prevalent subtype in India
  17. 17. * 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 Clinical conditions and CD4 counts 0.70 0.50 0.97 0.07 0.695 184.5 6 Fever 0.73 0.62 0.95 0.19 0.11 167 13 Diarrhoea 0.70 0.33 0.94 0.07 0.66 210 9 Rash 0.81 0.77 0.97 0.24 0.015 157 13 Weight loss 0.71 0.34 0.67 0.38 0.32 291 47 Lymphadeno-pathy 0.75 0.60 0.85 0.36 0.26 195 29 Pulm. TB 0.73 0.55 0.91 0.23 0.34 179 18 Herpes zoster 0.82 0.75 0.96 0.29 0.007 151 16 Oral candidiasis NPV PPV Spec Sens p Median CD4 Patients Clinical condition
  18. 18. Clinical Profile of AIDS in South India <ul><li>Pulmonary tuberculosis (49.1%; median duration of survival, 45 months) </li></ul><ul><li>Pneumocystis carinii pneumonia(6.1%; median duration of survival, 24 months) </li></ul><ul><li>Cryptococcal meningitis (4.7%; median duration of survival, 22 months) </li></ul><ul><li>CNS toxoplasmosis (3%; median duration of survival, 28 months) </li></ul>Clinical Infectious Diseases 2003; 36:79–85
  19. 19. Median CD4 Counts in AIDS Cases in South India <ul><li>Pulmonary tuberculosis 111 cells/ m L </li></ul><ul><li>Extrapulmonary tuberculosis 122 cells/ m L </li></ul><ul><li>P. carinii pneumonia 87 cells/ m L </li></ul><ul><li>Cryptosporidiosis 133 cells/ m L </li></ul><ul><li>Cryptococcal meningitis 91 cells/ m L </li></ul><ul><li>CNS toxoplasmosis 35 cells/ m L </li></ul><ul><li>Cytomegalovirus retinitis 51 cells/ m L </li></ul>Clinical Infectious Diseases 2003; 36:79–85
  20. 20. Autopsy finding in AIDS in Mumbai <ul><ul><li>85 adult brains studied with at least 21 sections from each using routine and special stains </li></ul></ul><ul><ul><li>CNS lesions observed in 67 cases (79%) </li></ul></ul><ul><ul><li>Opportunistic infections were present in 33 cases (39%) </li></ul></ul><ul><ul><li>Toxoplasmosis (11 cases, 13%) </li></ul></ul><ul><ul><li>Tuberculosis (10 cases, 12%), </li></ul></ul><ul><ul><li>Cryptococcosis (seven cases, 8%) </li></ul></ul><ul><ul><li>Cytomegalovirus infection (six cases, 7%) </li></ul></ul>AIDS. 1998 Feb 12;12(3):309-13
  21. 21. Generic ART Medication in India <ul><li>Lamivudine+Zidovudine </li></ul><ul><li>Efavirenz 600mg </li></ul><ul><li>Nevirapine 200mg </li></ul><ul><li>Didanosine-EC 250mg </li></ul><ul><li>Didanosine-EC 400mg </li></ul><ul><li>Stavudine 30mg </li></ul><ul><li>Stavudine 40mg </li></ul><ul><li>Lamivudine 150mg </li></ul><ul><li>Zidovudine 300mg </li></ul><ul><li>Indinavir 400 mg </li></ul>
  22. 22. Healthcare Resources <ul><li>National AIDS Cotrol Organization </li></ul><ul><li>Hospitals (Government and Private) </li></ul><ul><li>Researchers </li></ul><ul><li>NGOs </li></ul><ul><li>CBOs </li></ul><ul><li>Free ART programme from the National AIDS Control Programme </li></ul>
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