Abstract
Background and Objectives:In 2004 Pakistan escalated from ‘low-prevalence’ to ‘concentrated’ phase of HIV epidemic. Despite global decline in HIV incidence since 1997, rate of HIV infections in Pakistan is persistently rising since 1990. Available literature focusses on key populations or localized outbreaks limited by short study duration and regional applicability of results. We studied HIV seroconversion trends over a period of 8 years in a geographically diverse population and evaluated associated risk factors.Methods:A desk review of HIV surveillance data from 2010 to 2017 was carried out at Armed Forces Institute of Pathology. A case was defined as any adult employed in organization ‘X’, initially screened for HIV but later seroconverted on ELISA and western blot. Case-control study was conducted on cases diagnosed in 2017. Age and sex matched controls were identified from same population sub-group. Structured telephonic interviews were conducted and statistical analysis done at 5% margin of error.Results:The annual HIV diagnosis rate remained relatively stable till 2015 (< 40 /100,000/yr) after which it rose sharply to 60/100,000/yr in 2016 .Upward trend continued in 2017 to reach 125/100,000/yr (>200% increase from baseline). Acquisition of HIV was significantly associated with commercial sex activities (OR=9; 95% CI: 1.25-395).Conclusion:HIV seroconversion rates among employees of organization X have increased significantly in the past two years. Unlike HIV outbreaks previously reported from Pakistan, sexual route seems to be the predominant mode of transmission. Focus is mandated on prevention of sexual transmission of HIV at national level as well for all vulnerable populations.
Highlights
In 2004, Pakistan escalated from ‘low prevalence’ to ‘concentrated’ phase of HIVCorrespondence: October 5, 2019 March 17, 2020 epidemic.[1,2] Sporadic cases as well as outbreaks of HIV are increasingly being reported from many parts of the country.[3]
HIV diagnosis rates were calculated for every year using population denominators from payrolls to rule out the possibility of an apparent rise in HIV positive tests due to increase in size of study population
Rising incidence of HIV observed in our study is consistent with the rising trend of HIV in Pakistan’s general population as well as known key populations
Summary
In 2004, Pakistan escalated from ‘low prevalence’ to ‘concentrated’ phase of HIVCorrespondence: October 5, 2019 March 17, 2020 epidemic.[1,2] Sporadic cases as well as outbreaks of HIV are increasingly being reported from many parts of the country.[3]. In 2004, Pakistan escalated from ‘low prevalence’ to ‘concentrated’ phase of HIV. The tide of HIV epidemic was checked in 1997 when global incidence of HIV infections started to fall.[7] Pakistan is among the few countries where HIV cases are persistently increasing since 1990.4,8 Evidence based forecasts suggest that the rising trend is likely to continue.[9]. In 2004 Pakistan escalated from ‘low-prevalence’ to ‘concentrated’ phase of HIV epidemic. We studied HIV seroconversion trends over a period of 8 years in a geographically diverse population and evaluated associated risk factors. Conclusion: HIV seroconversion rates among employees of organization X have increased significantly in the past two years. Unlike HIV outbreaks previously reported from Pakistan, sexual route seems to be the predominant mode of transmission. Focus is mandated on prevention of sexual transmission of HIV at national level as well for all vulnerable populations
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