Mode of Detection of HIV Infection – A Retrospective Study of 612 Cases

Background

Trends in mode of detection of HIV infection in the Armed Forces required to be analyzed to formulate future strategies for early detection.

Methods

A retrospective study was thus conducted in 612 newly diagnosed HIV-positive cases between January 1997 to August 2002.

Results

182(29.74%) patients had already developed Category C conditions when detected to be HIV-positive, 176(96.70%) with mycobacterial disease, majority (67.61%) of them being pulmonary tuberculosis, followed by recurrent bacterial pneumonia in 3 (1.65%), pneumocystis carinii pneumonia (PCP) in 2(1.1%) and oesophageal candidiasis in one (0.55%). Herpes zoster was the third most common mode of detection accounting for 86 (14.05%) of the cases (24.6% of them with involvement of ophthalmic branch of trigeminal nerve), after tuberculosis in 176(28.76%) and blood donors in 98(16.01%), followed by constitutional symptoms in 59(9.64%) cases, investigation for STDs in 56(9.15%), bacterial pneumonia in 6(0.98%) and oral mucosal candidiasis in only one (0.16%) case. None was detected during acute retroviral illness and only 5(0.82%) cases were detected while being investigated for generalized lymphadenopathy. Amongst the cases detected during investigation for STDs, majority (26.79%) were on STD surveillance. 22(3.60%) cases tested positive when their spouses were detected to be HIV-positive, 20(3.27%) while being screened for surgery, 4(0.65%) for posting abroad and 2(0.32%) each during investigation when child was found HIV-positive and investigation for HBV infection. Remaining 69(11.27%) patients were detected during investigation of various related or unrelated conditions including one (0.16%), which reported voluntarily after a high-risk exposure.

Conclusion

There is a need to encourage voluntary reporting and identify more number of cases during acute retroviral syndrome and PGL stage.Key Words: HIV infection, Mode of detection     

Filaria surveys in the Armed Forces: Need for a revisit

BackgroundRoutine annual filarial surveys are conducted amongst various categories of military personnel and their families as per policies in vogue in the Armed Forces. The neglect and inattention faced by this disease needs to be addressed in terms of policy, provisioning and processes while dealing with filariasis in the Armed Forces.MethodsRoutine annual filarial survey was conducted in a garrison during the months of Nov and Dec in 2013 and 2014. Blood slides from 6305 and 10,162 persons were collected in 2013 and 2014 respectively. 546 (60.66%) civilian migratory labourers were also subjected to the filarial survey.ResultsOf the blood slides collected amongst service personnel, 41 were positive for mf in 2013 and 29 in 2014 (i.e. a slide positivity rate (SPR) of 0.65% and 0.28% respectively). Out of 546 blood slides of the migratory population, 10 were found mf positive (SPR 1.83%) and three males had lymphedema.ConclusionIt is recommended that routine annual filarial survey conducted in military garrisons should include all personnel belonging to known endemic states. Newer modalities of detection of infection may be considered to replace night blood surveys. An organization-specific surveillance programme on prevention and control of Lymphatic filariasis in the Armed Forces thus may need to be launched so that we can achieve elimination.     

Incidence and Drug Susceptibility pattern of Mycobacterium tuberculosis in HIV infected Patien

Incidence of HIV infection in patients with tuberculosis was found out by serological method (ELISA) with confirmation by Western Blot analysis. Out of 2116 tuberculosis patients tested for HIV, 150 cases were found to be positive for HIV infection (5.73%). Drug susceptibility to first line antitubercular drugs was carried out in 1378 isolates from HIV negative cases and 68 isolates from AIDS cases. The overall resistance pattern to one or more drugs was seen in 13.78% of isolates from HIV negative cases as compared to 7.2% isolates in AIDS cases. Multidrug resistance (MDR) was seen in 8.9% of isolates from HIV negative cases as compared to 4.4% of isolates from AIDS cases.Key Words: Antibiotic susceptibility, HIV, Tuberculosis     

Spectrum of tuberculosis in patients with HIV infection in British Columbia: report of 40 cases.

OBJECTIVE: To review the clinical features, treatment and outcome of all known cases of tuberculosis in patients with human immunodeficiency virus (HIV) infection in British Columbia between 1984 and 1990. DESIGN: Retrospective case review. SETTING: Provincial tuberculosis registry and university-affiliated HIV clinic. PATIENTS: All people with HIV infection in whom active tuberculosis was diagnosed during the study period. RESULTS: All 40 patients identified were men; their mean age was 38 years. Of the subjects 30 (75%) were homosexual, 6 (15%) were homosexual and used intravenous drugs, 2 (5%) just used intravenous drugs, and 1 (2%) had had heterosexual contact with prostitutes; for the remaining subject the risk factor for HIV infection was not established. In all cases cultures of specimens from 15 body sources yielded Mycobacterium tuberculosis. Thirty-five of the patients had acquired immunodeficiency syndrome (AIDS), and five had HIV infection uncomplicated except for tuberculosis. In 28 (70%) of the cases no AIDS-defining disease had previously been diagnosed, and in 23 (58%) extrapulmonary tuberculosis represented the AIDS-defining disease. Symptoms at presentation included weight loss (in 80% of the cases), fever (in 75%), cough (in 70%) and night sweats (in 55%). The mean CD4 lymphocyte count was 0.2 x 10(9)/L (in 15 cases). Tuberculin skin test results were positive in 8 of 16 cases. The most striking radiologic finding was intrathoracic adenopathy. All except one of the 36 patients who received appropriate treatment responded favourably at first. Adverse reactions necessitating changes in treatment occurred in 12 (33%) of the cases. Relapse occurred after completion of therapy in two cases (one at 3 weeks and the other at 9 months after treatment was stopped). Tuberculosis was the cause of death in five cases. CONCLUSIONS: Tuberculosis in people with HIV infection commonly presents as extrapulmonary disease and precedes or coincides with other AIDS-defining opportunistic infections. In most cases tuberculosis is the AIDS-defining disease. Even though radiologic findings are often unusual physicians should suspect tuberculosis. A careful examination for evidence of disease at multiple sites should be done. The duration and choice of therapy must be adequate to avoid relapse.     

运城市HIV/AIDS患者中结核病筛查结果分析

目的:了解HIV/AIDS患者中结核病的感染情况。方法:对辖区内已登记和管理存活的HIV/AIDS患者拍胸片、痰涂片、PPD试验进行结核病筛查,按照活动性肺结核病诊断标准进行确诊。结果:390例HIV/AIDS患者中合并活动性肺结核36例。发病率9.23%,其中痰涂片阳性21例。占5.38%,痰涂片阴性15例。占3.83%。男性组合并活动性肺结核23例,发病率10.60%,女性13例,发病率7.51%,差别无统计学意义(X~2=1.09,P>0.05)。各年龄组合并活动性肺结核无统计学意义(P>0.05)。PPD试验阳性率为15.1%。结论:HIV/AIDS患者中结核病双重感染率较高。应加强时HIV/AIDS患者的结核病监测。     

2005-2012年凭祥市结核病和艾滋病（TB／HIV）双重感染人群资料分析

目的了解凭祥市结核病和艾滋病（TB／HIV）双重感染情况,为制定结核病和艾滋病的防治措施提供科学依据。方法通过结核病与艾滋病双向筛查,对凭祥市2005-2012年发现的69例TB／HIV双重感染者资料进行分析。结果2005-2012年新登记的1364例结核病人全部进行HIV筛查,检测率100．00％,检出HIV抗体阳性53例,阳性率为3．89％;对新发和可随访到的725例艾滋病患者和HIV感染者进行结核病筛查,查出活动性结核病患者16例,检出率为2．21％。69例双重感染者中,男性60例、女性9例;其中活动性肺结核患者68例,肺外结核患者l例;痰涂片阳性11例,阴性58例;HIV传播途径,血液传播24例、性传播45例;69例双重感染者全部进行了抗结核药物治疗,11例涂阳结核病患者中治愈7例、非结核死亡2例、迁出2例;34例涂阴结核病患者完成疗程;35例接受抗病毒治疗。结论TB／HIV双向筛查策略是有效发现传染源、预防和控制结核病及艾滋病流行的有效途径。     

Efficacy of single dose Nevirapine in reducing viral load in HIV positive mother in labour and transmission of HIV infection to new born babies as part of prevention of parent to child transmission

Background

Prevention of parent to child transmission (PPTCT) program was initiated in Armed Forces to reduce the vertical transmission of HIV by instituting single dose Nevirapine (sdNVP) in untreated HIV positive mothers in labour. The aim of this study was to evaluate the role of sdNVP to decrease viral load of HIV infected mother during labour and its efficacy in prevention of mother to child transmission of HIV.

Methods

Thirty antenatal women tested positive for HIV at our PPTCT centre and delivered between Jan 2006 and May 2008 were evaluated. During labour these women were given sdNVP. Newborns were given syrup Nevirapine. The babies were tested for HIV infection at 48 h and six weeks after delivery.

Results

Thirty HIV positive women delivered at our centre and four newborns were found positive for HIV infection at 48 h. After six weeks interval three neonates were detected for HIV infection as one infant at six weeks was found to be negative for HIV infection.

Conclusion

The protection rate of Nevirapine in untreated HIV positive women is not ideal. It is recommended that all HIV positive women should be offered Highly Active Antiretroviral therapy as primary mode for PPTCT.     

Efficacy of single dose Nevirapine in reducing viral load in HIV positive mother in labour and transmission of HIV infection to new born babies as part of prevention of parent to child transmission

Background

Prevention of parent to child transmission (PPTCT) program was initiated in Armed Forces to reduce the vertical transmission of HIV by instituting single dose Nevirapine (sdNVP) in untreated HIV positive mothers in labour. The aim of this study was to evaluate the role of sdNVP to decrease viral load of HIV infected mother during labour and its efficacy in prevention of mother to child transmission of HIV.

Methods

Thirty antenatal women tested positive for HIV at our PPTCT centre and delivered between Jan 2006 and May 2008 were evaluated. During labour these women were given sdNVP. Newborns were given syrup Nevirapine. The babies were tested for HIV infection at 48 h and six weeks after delivery.

Results

Thirty HIV positive women delivered at our centre and four newborns were found positive for HIV infection at 48 h. After six weeks interval three neonates were detected for HIV infection as one infant at six weeks was found to be negative for HIV infection.

Conclusion

The protection rate of Nevirapine in untreated HIV positive women is not ideal. It is recommended that all HIV positive women should be offered Highly Active Antiretroviral therapy as primary mode for PPTCT.     

Health technology assessment of varicella vaccine in the Armed Forces

BackgroundThe Indian Armed Forces, on entry, vaccinates all cadets and recruits with varicella vaccine for the prevention of varicella. This health technology assessment (HTA) report puts forth evidence for HTA of varicella vaccination in the Armed Forces in various domains namely clinical, societal, ethical, economic, and legal.MethodsThe policy question under each domain has been developed according to best-practice methods for HTA. The costs included were hospitalization cost due to varicella infection; training lost cost; the varicella vaccine cost; cost of the side effects of vaccine; and the outbreak investigation cost. The incremental cost-effectiveness ratio (ICER) for varicella cases averted and man-days saved, and quality-adjusted life years (QALYs) gained due to varicella vaccination strategy were calculated.ResultsEvidence suggests a reduction of 81% in hospitalization rates with 19392 man-days saved per 1 lakh population due to varicella vaccination strategy. The ICER for varicella cases averted is estimated to be Rs 56732/- per case averted and Rs 5687/- per man-day saved. QALYs gained due to two-dose varicella vaccination strategy is estimated to be 1152 per 1 lakh population with cost per QALY gained Rs 95735/-.ConclusionThe study showed a large reduction in hospitalizations and consequently man-days lost after the introduction of the vaccination strategy. The QALYs was another aspect of importance brought out by this study. Thus, a two-dose vaccination strategy for varicella-zoster virus (VZV) for the Armed Forces trainees is a cost-effective policy.     

The Curse of HIV: How Well Prepared is our Paramedical Force?

Background

HIV patient-care is determined by the knowledge and attitudes of the health care workers (HCWs) towards the disease and towards HIV-positive individuals. With increasing incidence of HIV, a need was felt to assess the preparedness of the health care providers in the Armed Forces.

Methods

A population based, cross-sectional, questionnaire based analytical study was undertaken among para medical workers in the setting of a medical college and tertiary care service hospital to assess the knowledge and attitudes of HCWs towards HIV.

Results

The study indicated that contrary to the expectations and general belief, important knowledge gaps regarding modes of transmission, clinical course, diagnosis and management of HIV infection still exist among the paramedical workers of the Armed Forces.

Conclusions

The present study has highlighted the urgent need to review the training curriculum of our paramedical workers at all levels and undertake intensive on the job training. The study recommends that medical officers should take full responsibility for imparting correct knowledge and ensuring correct attitude among the paramedical workers.Key Words: Health care workers (HCWs), HIV/AIDS, Knowledge and attitude, Armed Forces     

PATTERN OF SKIN DISEASES IN ARMED FORCES IN PUNE REGION

A total of 8123 Armed Forces personnel attended dermatological OPD from Jan 1989 to Dec 1994. On analysing the record it is found that 2953 (36.3%) cases had infective dermatosis and 5170 (63.7%) cases had non-infective dermatosis. Common infective dermatosis included fungal infections (17.2%), viral infections (7.7%), bacterial infections (3.6%) and arthropode infestations (7.8%). Common non-infective dermatosis included papulosquamous disorders (13.5%), pigmentary disorders (13.4%), eczemas (11.1%), acne (8.7%), alopecia (6.1%), urticaria (4.2%) and drug eruptions (1.9%).KEYWORDS: Armed Forces personnel, Infective dermatosis, Non-infective dermatosis     

Prevent,curtail and mitigate ocular injuries: Proposal for designing an eye injury registry model for the Indian Armed Forces

This article aims to propose a design for Eye Injury Registry (EIR) model for Indian Armed Forces, to make ophthalmologists and non-ophthalmologists aware about the existence as well as the usefulness of such a registry. This is a perspective study. The EIR model for Armed Forces was designed based on the relevant sources in PubMed, Scopus and Embase including registries of pioneering countries like United States and Canada. A questionnaire based on the model dimensions was developed (Cronbach's alpha>0.7) and filled by 04 senior ophthalmologists in Armed Forces, all of who had a significant experience in dealing with various types of ocular trauma, to give expert opinions, which were then applied to the proposed model to finalize it. In Armed Forces, a registry and reporting on eye injury along with a systematic collection of standard data on eye injuries will help ophthalmologists in the successful prevention. Such a registry and its large database once formed will permit elaborate epidemiologic investigations, highlighting preventable sources of injury, emerging patterns of trauma in our services, and the best possible treatment protocols to be adopted, for successful outcomes. EIR in Armed Forces can help in the collection of eye injury data, thereby improving the quality-of-care and expansion of prevention strategies for ocular injuries. It is a step to make a truly effective data bank, which will be instrumental in combating such preventable ocular injuries and in turn go a very long way in achieving the final goal of preventing up to 90% of such injuries.     

Diagnostic evaluation of extrapulmonary tuberculosis by fine needle aspiraton (FNA) supplemented with AFB smear and culture

One hundred forty-three patients, 72 males and 71 females, with extrapulmonary tuberculosis were aspirated and subjected to cytological (Ziehl-Neelsen stain) examination and culture in Lowenstein-Jensen media. Routine haematological examination and Mantoux test were done in all the cases, x-ray chest in 112, skeletal x-ray in 3 relevant cases and sputum was examined for AFB in 16 cases where pulmonary tuberculosis was associated/suspected with extrapulmonary tuberculosis. HIV status was evaluated in 51 cases and 9 (7.64%) were seropositive. FNA cytology in 102 cases (71.3%) had caseating epithelioid granulomas while smear for AFB was positive in 57 cases (39.8%). Both culture and smear were positive in 29 (20.2%) cases. Combining both smear and culture yielded positive results in 47.5% cases. It was observed that AFB positivity was higher in untreated patients and with HIV positive cases. Further more, the triad of FNAC, AFB smear and culture were cheaper, foolproof and confirmatory than costlier tests like TB IgG, IgM, RTPCR and BACTEC.     

多种健康教育方法对武警某部新兵艾滋病知信行的影响

目的通过对武警某部 90 3名新兵艾滋病多种健康教育方法干预效果评价 ,为部队全面开展此项健康教育奠定基础和提供依据。方法整群多阶段抽样选定 4组对象 ,用 4种方法 (板书授课 VCD ;多媒体授课 VCD 资料 ;同伴教育 ;同伴教育 VCD 资料 )进行教育。结果干预前后 4种方法知识得分均有显著提高 (P <0 .0 1) ,除第 3种方法外 ,其余 3种干预前后态度和行为得分也有显著提高(P <0 .0 1)。 4种方法比较 ,以第 2种效果最佳 (P <0 .0 1)。结论在新兵群体采用同伴教育进行艾滋病健康教育效果不理想 ,应采取综合方法。     

Is Patient's Preference for Medical Care Changing?

BackgroundAn assorted group of 1000 army personnel below officer's rank was surveyed to find out its preference for medical set up between that of the Armed Forces and the civil.MethodsSurvey for preference of medical treatment was done based on a structured questionnaire. The sample was taken from different states of India covering the entire nation.Results65% of the surveyed personnel preferred the Armed Forces medical set up to that of the civil. Yet 35% is a big number going for civil medical set up. About half of the above would choose alternative therapy like homeopathy and ayurveda.ConclusionTwo issues come to notice. Whether there is any scope for introducing popular alternative therapy in the Armed Forces and does an improvement in the existing medical set up in the Armed Forces change the preference of the clients?     

基于CD161的流式检测技术在艾滋病合并结核诊断效能的评价

目的 评价基于CD161的流式检测技术在艾滋合并结核感染中的应用价值。方法 用流式检测技术分别检测58例结核病患者（TB）,55例艾滋病合并结核病患者（HIV+TB）,122例艾滋病患者(HIV)及138例健康对照（HC）全血中CD161的表达水平;同时比较CD161流式检测技术、GeneXpert、TB-DNA、γ-干扰素释放试验（IGRAs）和AFB在TB-HIV中的检测阳性率。结果 TB外周血中淋巴细胞和CD161的表达水平显著低于HC,相反TB中单核细胞和OR值高于HC,但不受HIV感染影响。当OR阈值＞0.45时,分辨HC与TB-HIV时,AUC为0.91,灵敏度92.73%,特异度84.06%。在分辨TB和HC时,AUC为0.86,灵敏度74.14% ,特异度82.61%。平行比较AFB、TB-DNA、GeneXpert、IGRAs、CD161检测方法的HIV-TB阳性率,分别为20%、40 %、54.5%、38.1%和92.7%。当HIV-TB的CD4＜100 个/μL时上述5个检测技术的阳性率分别为26%、39.1%、60.8%、30.4%和82.6%。CD4≥100 个/μL患者组检出率分别为15.6%、37.5%、50%、43.7%和100%。结论 流式CD161技术在检测活动性结核及合并艾滋病中具有很好的临床诊断应用价值。     

Cutaneous Tuberculosis : A Clinico-morphological Study

Background

Cutaneous tuberculosis forms a small subset of extrapulmonary tuberculosis. The present study is an attempt to observe the clinico morphological pattern seen in cases of cutaneous tuberculosis over a period of 5 years, and to correlate them with mantoux reactivity and human immunodeficiency virus (HIV) status.

Methods

All cases of cutaneous tuberculosis observed among the dermatology in patients and those attending out patient department were included in the study. The basis of diagnosis was clinical, histopathological and microbiological. Intradermal mantoux test and serological test in the form of enzyme-linked immunosorbent assay (ELISA) for tuberculosis was done. HIV screening was carried out in 32 cases. CD4 counts were done in all HIV positive cases.

Results

A total 0.02% patient attending the dermatology centre had cutaneous tuberculosis. The spectrum of infection included 19 (51%) cases of lupus vulgaris, 7 (19%) cases of papulonecrotic tuberculids, six cases each of tuberculosis verrucosa cutis and scrofuloderma. One case had scrofuloderma and lupus vulgaris and another both scrofuloderma and papulonecrotic tuberculide. One case of lichen scrofulosorum was seen in a seven year old boy. 11 cases revealed evidence of systemic tuberculosis. Seven cases of HIV with CD4 counts between 50-500 cells/μl were observed in this study.Key Words: Cutaneous tuberculosis, HIV status     

HIV合并结核杆菌感染患者病原菌分布情况及其耐药性分析

目的 调查HIV合并结核感染患者体内的病原菌分布情况,并对患者的耐药情况进行分析。 方法 收集2014年1月—2016年1月河南省传染病医院收治的HIV/MTB双重感染及单纯结核患者136例,根据患者的感染情况将患者分为3组,56例HIV/MTB双重感染患者为HIV/MTB组,40例结核患者为MTB组,40例AIDS患者为HIV组。对3组患者进行标本采集,在MGIT管内开展相应的前处理后接种,采用绝对浓度法对培养阳性的菌株实施耐药性检测。统计患者体内的病原菌分布情况,并对其耐药性进行评价比较,记录实验结果,进行统计学分析。 结果 3组患者的一般临床资料均无结核病史。3组患者的性别、年龄等资料比较差异无统计学意义(P>0.05)。HIV/MTB组患者成功分离出菌株38例,其检出阳性率为67.86%,共分离出菌株83株,部分病原菌分布与MTB组和HIV组比较,差异存在统计学意义(P<0.05)。MTB组与HIV组患者成功分离出菌株22例、24例,其检出阳性率分别为56.41%、58.54%,共分离出菌株分别为39株、41株,2组患者均易感染革兰阴性菌,与HIV/MTB组不同,且革兰阳性菌对3组患者的感染能力较低。HIV/MTB组中有2例(3.57%)对RFP、INH、OFL、KAN均耐药,而MTB组和HIV组不存在。HIV/MTB组总初始耐药(包括耐INH、耐SM)与MTB组和HIV组比较,差异有统计学意义(P<0.05)。 结论 在HIV合并结核感染患者治疗时,应选择联合用药治疗,以针对革兰阴性致病菌为主,还应同时考虑真菌、病毒、耶氏肺孢子菌等病原体。      

High risk of active tuberculosis in HIV-infected drug users with cutaneous anergy.

OBJECTIVES--To determine the incidence of active tuberculosis in human immunodeficiency virus (HIV)-seropositive and HIV-seronegative drug injectors with cutaneous anergy and to examine the effectiveness of isoniazid chemoprophylaxis in preventing tuberculosis among drug injectors with positive tuberculin test results. DESIGN AND SETTING--Prospective observational study linked to an ongoing study of HIV infection within a New York City (NY) methadone program; subjects also underwent routine intradermal tuberculin testing and multiple-antigen delayed-type hypersensitivity skin testing. The 31-month study period ended December 31, 1990. METHODS--Anergic subjects and tuberculin reactors who were HIV seropositive were compared by HIV disease status and CD4+ T-lymphocyte levels. Tuberculosis incidence was calculated for anergics (none treated with isoniazid) and for treated and untreated tuberculin reactors, by HIV serological status. RESULTS--Among those seropositive for HIV, anergic subjects had more advanced HIV disease and fewer CD4+ cells (median 0.33 vs 0.56 x 10(9)/L, P less than .01) compared with tuberculin reactors, although neither clinical status nor CD4+ cell counts consistently predicted anergy. Five (7.6%) of 68 anergic subjects who were HIV seropositive and none of 52 anergic subjects who were HIV seronegative (n = 18) or of unknown (n = 34) HIV serological status developed active tuberculosis during the study period (P less than .05). The tuberculosis incidence rate among anergic subjects who were HIV seropositive was 6.6 cases per 100 person-years (95% confidence interval [Cl], 2.1 to 15.3). Of 25 HIV-seropositive tuberculin reactors who did not receive or complete 12 months of isoniazid prophylaxis, tuberculosis incidence was 9.7 cases per 100 person-years (95% Cl, 2.6 to 24.7; P = 0.56, compared with the rate among anergic HIV seropositives); there were no cases of tuberculosis in 53.4 person-years of follow-up for 27 HIV-seropositive tuberculin reactors who received 12 months of prophylaxis (rate difference between treated and untreated groups, 9.7 cases per 100 person-years, 95% Cl, 1.3 to 18.0). CONCLUSION--Drug injectors with cutaneous anergy who are seropositive for HIV are at high risk of active tuberculosis, similar to that among untreated HIV-seropositive tuberculin reactors. A decreased incidence of active tuberculosis was seen in HIV-seropositive tuberculin reactors receiving 12 months of isoniazid chemoprophylaxis, compared with untreated or partially treated subjects. These results support the routine use of delayed-type hypersensitivity testing to accompany tuberculin testing for drug injectors with known or suspected HIV infection, and consideration of isoniazid prophylaxis for anergic as well as tuberculin-reactive subjects who are HIV seropositive, in populations with a high prevalence of coexisting HIV and Mycobacterium tuberculosis infection.