Time trends of paediatric HIV infection in North India

Paediatric HIV infection continues to pose a serious threat in the developing world. While in the developed world, mother to child transmission has been reduced to less than 3%, in India no regular zidovudine (azidothymidine) intervention programmes operate. Some 20 million babies are born each year and the number of infected babies could be >50,000 per year. The present study was designed to assess the change, if any, in the time trends of HIV infection in children over the last 15 years as observed at the surveillance centre attached to Nehru Hospital, Chandigarh. All patients reporting to the surveillance centre at the PGIME&R, Chandigarh were subjected to a detailed history and screened for HIV by the three tests protocol recommended by the WHO. In babies under 18 months of age, viral load assay or DNA analysis was done to confirm infection. Timetrends were ascertained over a 15-year period to assess the impact of information, education and communication programme launched by National AIDS Control Organisation. Data indicates that the total number of HIV positive cases increased 10-fold over the last 10 years. During 1991, 41 cases were recorded; the number increased to 439 in year 2001, and 574 in 2004 (r=0.98). A similar trend was observed in the paediatric age group. During the initial 5 years ie, 1987 to 1992 only 7 paediatric cases were documented positive while the number increased to 45 in the year 2001 to 64 in the year 2004 with a cumulative figure of 323 children. Linear regression analysis showed a highly significant trend (r=0.94). Out of the 323 cases, 44.6% were symptomatic. Maximum number of babies were observed in the age group of 3-5 years. Thirty-nine patients (12%) had acquired the infection through blood. Thus the information, education and communication programme has had very little impact on the HIV epidemic and it calls for urgent antiretroviral intervention in antenatal mothers to control the emerging paediatric HIV epidemic.     

Clinical profile of pediatric HIV infection from India

BACKGROUND: Our aim was to study the clinical profile of pediatric patients admitted with HIV infection. METHODS: The prospective study was conducted from January 2000 to October 2001 at a tertiary care referral teaching hospital in Mumbai, India. Admitted in-patients (aged 1 month to 12 years) detected to be HIV-positive (on triple ELISA test) were enrolled in the study. HIV status of patients < 18 months of age was confirmed by DNA-PCR testing. Demographic data, clinical features, investigations and outcome were recorded in a pre-designed proforma. RESULTS: Fifty HIV-positive children (31 males and 19 females; M:F = 1.6:1) were enrolled. Thirty cases were completely immunized, 9 were partially immunized while 11 were not immunized. Forty-two were perinatally infected, while eight cases were infected via blood transfusion (patients with thalassemia major on chronic transfusion therapy). Clinical features at presentation in 42 symptomatic cases included protein-energy malnutrition (90%), fever > 1 month (50%), weight loss > 1 month (50%), persistent generalized lymphadenopathy (24%) and skin manifestations (79%). The gastrointestinal (62%) and respiratory (52%) were the most commonly involved organ systems. Opportunistic infections noted included tuberculosis (19 cases), candidiasis (6 cases), Pneumocystis carinii pneumonia (4 cases), herpes zoster (3 cases) and giardiasis (1 case). Six patients died (mortality, 14%). CONCLUSIONS: Perinatal transmission is the most common mode of acquiring HIV in the pediatric age group. Most patients have protein-energy malnutrition. Tuberculosis is common in HIV-infected Indian children. Patients with HIV-encephalopathy have a poor outcome.     

HIV/TB in India: a public health challenge

The impact of HIV/AIDS epidemic on the epidemiology of TB worldwide is being noted with growing concern. Patients with HIV are more susceptible to opportunistic diseases including TB. The risk of development of TB in HIV-infected patients in India is 6.9/100 person-years compared to a 10% lifetime risk of developing TB in an HIV negative individual with Mycobacterium tuberculosis. Treatment with DOTS significantly prolongs the life of HIV-infected persons with TB. The Government of India emphasised the need for strengthening collaboration between TB and AIDS control programmes for better management of HIV-infected patients with TB. Areas with higher prevalence of HIV infection have been prioritised the RNTCP coverage and most are already implementing the RNTCP. The basic purpose of HIV-TB programme co-ordination is to ensure optimal synergy between the two programmes for prevention and control of both the diseases.     

Improving information access for public health professionals

Fundamental to our protection against biological weapons and the detection of disease outbreaks is the need to strengthen our surveillance systems. Improved electronic communications between local, state, and federal public health agencies provide a way for health officials to share information on unusual disease outbreaks and provide important health alert information. This article describes a model of a partnership between a regional medical library of the National Library of Medicine, a school of public health, and federally qualified community health centers. This project upgraded technology and provided public health professional training on Internet information and resources for local public health agencies.     

Screening for HIV infection: a healthy, "low-risk" 42-year-old man

Human immunodeficiency virus (HIV) infection meets many, if not all, of the established criteria that justify routine screening, and screening for HIV infection can be cost-effective depending on the population studied. In 2006, the Centers for Disease Control and Prevention recommended that HIV screening be included as part of routine care for most of the adult US population, but implementation of this policy has been slow. Mr Y is a 42-year-old man at relatively low risk of HIV infection who was offered testing by his primary care physician but declined it. He does not consider HIV infection to be a realistic possibility given his behavioral history and does not understand the purpose of being tested. The discussion that follows addresses the rationale for HIV screening, its potential benefits and risks, current testing options, and barriers to incorporating it into routine care.     

A user-oriented computer interface for health professionals

One of the characteristics of medical information systems, which have been most successful in being integrated into the patient care process, is a cordial type of human interface that embodies a form of input/output generator software coupled with a terminal device that facilitates the selection of input data elements from lists or “menus.” This paper reviews the nature of this involvement in patient care and describes this interface in greater detail, illustrating its intrinsic value as an appropriate human-computer interface for use by medical professionals. As with any successful management information system, a medical information system's use will ultimately be a function of the ease with which it can be incorporated into the decision-maker's (manager's) daily activity. Watson has shown that physicians, after a long orientation period, are willing to use a CRT device that presents information in a convenient manner and allows the input of new data by means of selections from tree-structured lists instead of typing. A technique more natural than the use of a light pen is to simply touch a selection with one's finger. For this reason, our hardware terminal device consists of a 15-inch diagonal CRT with 24 80-character lines activated by the touch of a finger, which passes a direct digital signal to the controlling software for appropriate action. The accompanying software described is best characterized as a nonprocedural “higher level language,” or a “meta language”, designed specifically to process frames of CRT information in such a way as to eliminate much of the inevitable programming modification process. Such a capability takes on the characteristics of a “tool” by which the non-computer-oriented professional actually creates application programs that best serve his own needs. The user is able to concentrate on thewhat of using the computer rather than thehow. The software automatically determines thehow. Its use is not limited to just the presentation of the frames but also involves a method of allowing the user to link these with each other, and with parameter tables in a user-logical fashion. In addition, the frames can be readily modified. The selected parameter becomes data that the application program processes. By means of such an optimum combination of software and hardware, the user exerts significant control over that portion of the system that he interfaces with most directly. This approach also offers considerable flexibility in the design of a system so that it can be changed as the user's needs and expectations grow. The need to reflect the user's requirements in input sequence and method of presentation has been shown to be of particular importance in the design of systems that are expected to be used by health professionals. The details of the software supporting such a technique have been described.     

A child in detention: dilemmas faced by health professionals

A 6-year-old child, held in detention with his parents pending the outcome of their application for refugee status, manifested psychological distress by repeated episodes of refusing to eat or drink. This case presented clinical and ethical dilemmas for health professionals who were constrained from acting in the child's best interests by government policy of mandatory detention.     

A computer-assisted teaching system in pharmacology for health professionals

In this report the authors describe experiences with a computer-assisted teaching system in teaching pharmacology to medical students and other health professionals. The system is composed of both computer-assisted instruction and computer-managed instruction. The "Keller Plan" philosophy was adopted, and the pharmacology course was organized into modules. Students were required to meet minimum proficiency requirements in each module and have multiple chances to reach this or higher levels. The advantages of this system are numerous. The department can provide both scheduled and independent study courses in basic pharmacology to students of different educational levels. Students can progress through a course at various speeds; that is, achievement is constant, but time is variable. Both the students and instructors are provided with frequent and rapid feedback. Most importantly, students with low aptitudes achieve significantly higher scores on the pharmacology portion of the examination of the National Board of Medical Examiners.