HIV epidemic in India: opportunity to learn from the past

Abstract

The World Health Organization estimates that there are now more than 1.75 million HIV-infected adults throughout India and that by the year 2000, India will have more AIDS cases than any other country in the world. The predominant HIV-1 subtype in India is C. HIV-1 subtype C replicates especially well in Langerhans cells, which are found in genital mucosal epithelium and are thought to be the cells through which vaginal infection occurs. Core groups, such as prostitutes, play a critical role in the heterosexual spread of HIV, the dominant mode of transmission in India. The second most important, and preventable, mode of transmission is through infected blood and blood products. 6-20% of HIV-positive samples from STD clinic attenders in Pune and Bombay are HIV-2 reactive either alone or in combination with HIV-1, the first evidence for a substantial spread of HIV-2 outside of Africa. The clinical presentation of AIDS in India is broadly similar to that found in other developing countries, with tuberculosis the most important HIV-associated infection. The epidemic has started to spread out of high-risk groups in the major cities and into the general population and to rural areas. This expansion must be immediately contained in order to avoid what will otherwise be a major catastrophe.