Epidemiology of hiv in india

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 epidemic
[Important milestones]
1986 First report of HIV infections in sex workers in
Chennai, first report of AIDS in Mumbai
1989 HIV infection reported among intravenous
drug users in Manipur State
1991 Indian National AIDS Control Programme was
launched
2000-
01
India PMTCT feasibility studies initiated by
NACO
2001 Indian pharmaceutical companies marketed
ARV drugs with considerable price reduction

4. Phases of spread of HIV epidemic in India
Phase I At risk
population
Female sex
workers
Intravenous
drug users
Phase II Bridge
population
Male STD
patients
Other drug
users
Phase III Low/ No risk
population
Spouses of male
STD pts
Spouses of
drug users
Phase IV Children of HIV
infected women
Children of HIV
infecteddrug
users
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 >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. 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
2001 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
0
1
2
3
4
5
1995 1996 1997 1998 1999 2000
HIV seroprevalence (%)

15. 0
5
10
15
20
25
30
35
1995 1996 1997 1998 1999 2000
Sentinel surveillance for HIV Infection in tuberculosis
patients in Pune
HIV
seroprealence
%
Tuberculosis is the most likely presentation of AIDS in India

16. HIV-1 Subtypes in India
Location # of Subtypes Year
Bombay 29 28 - 1 - 1992-93
Bombay/Goa 7 7 - - - 1992-93
Punjab 12 8 - - 4 1994
Hyderabad 4 - 4 - - 1994
Pune 15 14 - 1 - 1994
Delhi 3 2 1 - - 1994
Vellore 27 25 - 2 - 1996
Pune 46 44 1 1 - 1998
Manipur + 1998
C B A non-C
Samples
TOTAL 143 128 6 5 4
Molecular epidemiology
HIV-1 C is the commonest prevalent subtype in India

17. Clinical
condition
Patients Median
CD4
p Sens Spec PPV NPV
Oral
candidiasis
16 151 0.007 0.29 0.96 0.75 0.82
Herpes zoster 18 179 0.34 0.23 0.91 0.55 0.73
Pulm. TB 29 195 0.26 0.36 0.85 0.60 0.75
Lymphadeno-
pathy
47 291 0.32 0.38 0.67 0.34 0.71
Weight loss 13 157 0.015 0.24 0.97 0.77 0.81
Rash 9 210 0.66 0.07 0.94 0.33 0.70
Diarrhoea 13 167 0.11 0.19 0.95 0.62 0.73
Fever 6 184.5 0.695 0.07 0.97 0.50 0.70
* 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

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
Clinical Infectious Diseases 2003; 36:79–

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
Clinical Infectious Diseases 2003; 36:79–8

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 12;12(3):309-13

21. Generic ART Medication in India
• Lamivudine+Zidovudine
• 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