HIV infection in low risk areas: Cases from outskirts of Chennai city

Abstract

Twenty years after the first documented human immunodeficiency virus (HIV) infection in India the epidemic is no longer restricted to high risk groups in urban areas. According to studies it has spread to low risk populations in rural as well as urban areas. Trends in the general population are monitored by observing HIV prevalence (the percentage of people within a particular group infected at any given time) among pregnant women. We report a prevalence rate of 0.468% for the year 2008 from Kelambakkam and surrounding villages in areas close to Chennai city. This is a report from a multi specialty hospital on the outskirts of Chennai city which has an acquired immune deficiency syndrome (AIDS) testing center under Tamil Nadu state AIDS control society (TANSACS). Over the past one year from January 1 to December 31 2008 4052 people were screened with an average of 300 to 350 tests done every month. All tests were conducted with the consent of patients. The kits used for testing were Comb Aids (J Mitra and Company New Delhi India / Span Diagnostics Ltd Surat India) HIV Tridot (J Mitra New Delhi India) and HIV ELISA (Enzyme-linked immunosorbent assay) supplied by J Mitra and Company New Delhi India. All the kits used were those approved and supplied by National AIDS control organisation (NACO). We report on an overall prevalence rate of 0.468% for the year 2008. The prevalence rate among males was slightly higher at 0.696% when compared to females which stood at 0.318%. Their age groups ranged from 15 to 60 years. There were 13 males and six females who were positive for HIV antibodies. All positive serum samples were tested using three different kits following NACO guidelines which included an ELISA test. There were three couples who tested positive. In the entire year there was one antenatal female patient who was positive and the spouse had tested negative. There were no children (less than 14 years) who tested positive for HIV among the 113 serum samples tested. This hospital caters to the semi urban area around Kelambakkam on the outskirts of Chennai city with the surrounding villages Kolathur Kolapakkam Kandigai Mambakkam Sholinganalur and Tambaram up to and inclusive of Chengelpatu district. In a recent study from Karnataka Bagalkot district a largely rural district in South India approximately 6700 individuals aged 15-49 years were randomly sampled from 10 villages and six towns. HIV prevalence was 2.9% overall 2.4% in urban areas and 3.6% in rural areas [odds ratio (OR) 0.65; 95% confidence interval (CI) 0.45-0.95. Multiple sexual partners receiving money for sex lower education levels and a history of medical injections were significantly associated with HIV infection in this study. Our study reports an overall prevalence rate of 0.468% for the year 2008. Since the first report of HIV infection in India in 1986 the virus has spread all over the country although there are geographic variations. There are an estimated 2.5 million people infected with HIV with an overall estimated adult prevalence below one per cent. Surveys carried out in different sub-populations have yielded prevalence estimates but data on HIV incidence is limited. Both HIV serotypes 1 and 2 exist in India and HIV-1 C is the commonest subtype reported. Sexual transmission of HIV is the most important mode of transmission. Spread of HIV in intravenous drug use settings is localized mostly in the north eastern regions and metropolitan cities and parent to child transmission is on the rise. Andhra Pradesh Karnataka Tamil Nadu and Maharashtra constitute 75% of HIV positive cases. It is believed that heterosexual contact is responsible for about 85% of all new HIV-1 infections in India. To conclude at this center we report an overall HIV prevalence rate of 0.468%.This is an on going study as this center is an AIDS testing center under TANSACS. All antenatal patients undergo a voluntary testing and we have had only one positive antenatal case in the entire year of 2008. (full text)