National AIDS Control Organization Research Articles

Study of patterns of sexually transmitted diseases using a syndromic approach in the era of human immunodeficiency virus from a tertiary care hospital of the Northern India

Sexually transmitted infections (STIs) increase the risk of transmission of Human Immunodeficiency Virus (HIV) infection causing immense need to understand the patterns of STIs prevailing in the regions of a country for proper planning and implementation of STI control strategies. Due to the lack of adequate laboratory infrastructure in the country, information regarding the profile of STIs relies essentially on syndromic diagnosis. To study the pattern of common STIs and the prevalence of HIV infection in patients attending the STI clinic of a tertiary care hospital in northern part of India using a syndromic approach. A retrospective analysis of data collected from the clinical records of 2700 patients over a period of 21 months (July 2012 to March 2014) was carried out at the Skin and VD Department of SMS Hospital, Jaipur. Detailed history, demographical data, and clinical features were recorded from all the patients. All patients were tested for HIV by ELISA and rapid plasma reagin. STIs were categorized in different syndromes as depicted by National AIDS Control Organization in the syndromic management of STIs. The data collected was analyzed statistically. The proportions were calculated for various syndromes and disease prevalence. The overall most common STI was balanoposthitis, followed by genital herpes, vaginal/cervical discharge, molluscum contagiosum, genital warts, nonherpetic genital ulcer disease, lower abdominal pain, and urethral discharge in decreasing order. Among the study population, 2.55% were found to be HIV-positive. Viral STIs such as molluscum contagiosum, herpes genitalis, and condylomata acuminata are on the rise among STI/RTI clinic attendees.

Awareness, Knowledge and Misconceptions about Some Reproductive Health Issues among the Married Couples in High-risk States of India

In India, the HIV/AIDS epidemic represents one of the most serious public health problems. According to National AIDS Control Organization, about half of the new infections occur among persons below 25. More than 80 per cent of the total infections are transmitted through sexual intercourse. Importantly, the infection is growing faster among the married. What makes youth more vulnerable to HIV/AIDS? Most evidence suggests that knowledge about HIV/AIDS is low among youth. Knowledge about the modes of transmission is considered to be the only means of prevention against this disease. The objective of this article is to study awareness, knowledge and misconception regarding RTI/STI and HIV/AIDS among the married couples in high-risk states of India. Data for this paper have been obtained from the Rapid Household Survey under Reproductive and Child Health Survey, Round II, during 2002–04. The states of Andhra Pradesh, Gujarat, Karnataka, Maharashtra, Manipur, Nagaland and Tamil Nadu were purposively selected for the analysis; except Gujarat all these states were in the category of high risk. A total of 82,596 married couples were considered for the study. A bi-variate technique was used for the analysis. In addition, a knowledge index was computed as a summary measure of knowledge and misconception. It was categorized into Low, Medium and High Knowledge. The analysis revealed that in Tamil Nadu around 33 per cent husbands and 27 per cent wives had high knowledge regarding HIV/AIDS. In contrast, in Gujarat 8 per cent husbands and 6 per cent wives had high knowledge. Further, the analysis illustrated the gap of knowledge between husbands and wives.

High Incidence of Zidovudine Induced Anaemia in HIV Infected Patients in Southern Odisha.

Zidovudine (AZT), a nucleoside reverse transcriptase inhibitor was the first breakthrough in AIDS therapy in 1990.This study was conducted with an aim to determine prevalence of AZT induced anaemia in HIV infected patients initiated on AZT containing anti retroviral therapy(ART) regimen and also to find out any risk factor for causing AZT induced anaemia. Study was carried out in ART centre, M.K.C.G, MCH, Berhampur between Jan 2009 and Dec 2011. HIV infected patients registered at ART centre were treated according to National AIDS Control Organisation (NACO) guidelines. Patients (n=1221) with Hb >8gm/dl were prescribed AZT based ART regimen. Patients having anaemia (<8gm/dl) were excluded from the study. Correlation of baseline characteristics (age, sex, weight, Hb level, CD4 count, World Health Organization (WHO) clinical stage) with risk of developing anaemia was also calculated. 178 (14.6%) patients on AZT regimen developed anaemia. Patients with low CD4 count were more prone to develop severe anaemia. Age, sex, weight, WHO clinical stage had no relation with development of anaemia. Incidence of AZT induced anaemia was very high and patients having low CD4 count were more susceptible to develop anaemia.

English

OBJECTIVE: The clinical consequences of HIV infection encompass a wide spectrum. The Early recognition of persons who have HIV will help in early interventions to halt or slow the progress of HIV disease and to extend fruitful lives. METHODOLOGY: This cross-sectional study was conducted among patient referred to the voluntary counseling and testing center (VCTC) from various departments in, BRIMS Teaching Hospital, Taluka Hospital, Humnabad, Taluka Hospital, Basavakalyan, Taluka Hospital Aurad and Taluka Hospital Bhalki, to find out the pattern of disease/ symptoms high risk behaviors (HRB) for HIV and HIV serostatus among the hospital patients. Following the guidelines prescribed by the National AIDS Control Organization (NACO) anonymous data were collected through interview from 500 individuals. Where a specific diagnosis of a disease was obtained mutually exclusive symptoms were considered for analysis. RESULTS: The major diseases/ symptoms observed among those patients were tuberculosis in 32.19%, STD in 29.97% prolonged explained fever in 19.41 of the patients. The overall rate of HIV seroreactivity was 17.44%. The HIV serostaus by diseases/ symptoms showed that 32.91% of patients with prolonged unexplained fever were HIV seroreacive; the rate was 12.90% among patients with skin diseases, 12.29% in STD and 12.21 in tuberculosis patients. Overall, 332 patients (66.34%) had HRD for HIA/ AIDS. The rate of HIV seroreactivity was more among patients who had HRB for HIV/ AIDS and who were referred from indoor departments (23.24%) compared to outdoor departments (13.65%). The patients suffering from prolonged unexplained fever need greater attention fro HIV screening. CONCLUSION: Early detection of HIV positive patients makes interventions possible at a very early stage and this can slow down/ block the progress of HIV disease and as a result can extend fruitful

Service oriented architecture and privacy preserving mashup of healthcare data

Mashup of health care data from different medical sources must be privacy preserved since the data recipient and/or the data provider may not always be a trusted party. Raw medical data contains person specific sensitive information like ailment, surgery etc. and hence it is susceptible to certain privacy attacks such as attribute linkage and record linkage. There are different privacy models to thwart the privacy attacks. This paper illustrates how to vertically integrate the data from mental health clinic and National AIDS Control Organization (NACO) and preserve privacy using the LKC privacy model. Keywords: Mashup, Linkage, Anonymize Utility, Diversity, Adversary, Interoperability.

Immune Activation Is Associated With Increased Gut Microbial Translocation in Treatment-Naive, HIV-Infected Children in a Resource-Limited Setting

Gut damage resulting in microbial translocation (MT) is considered a major cause of immune activation (IA) in HIV infection, but data in children are limited, particularly in the absence of antiretroviral therapy. Sixty perinatally HIV-infected, antiretroviral therapy-naive children, aged 2-12 years, were evaluated for plasma levels of lipopolysaccharide, DNA sequences encoding bacterial 16 second ribosomal DNA (16S rDNA) and soluble CD14 concurrently with markers of CD4 and CD8 T-cell IA and immune exhaustion (IE), CD4 counts, and plasma viral load. At study entry, participants were classified into immune categories (ICs): IC1 (CD4% > 25), IC2 (CD4% 15-25), and IC3 (CD4% < 15). Age-matched HIV-uninfected children served as controls. Data were evaluated at study entry and at 12 months. Levels of MT, IA, and IE were increased in patients as compared with controls, were highest in patients in IC3 group, and did not change over 12 months. MT products lipopolysaccharide and 16S rDNA correlated with each other and each correlated with plasma viral load, soluble CD14, and T-cell IA and IE. There was a correlation of IA with IE. CD4 counts and percentage were inversely correlated with MT products and underlying CD4 activation. In a natural history cohort of HIV-infected children not on therapy, MT was more pronounced in the most severely immunocompromised patients and was associated with IA. Strategies to reduce MT may help to reduce IA and prevent CD4 depletion.

G310(P) Impact Of New Prevention of Parent to Child HIV Transmission Regimen (Tenofovir+Lamivudine+Efavirenz) vs Old Regimen (Nevirapine)

AimTo assess the impact of new PPTCT (Prevention of Parent to Child HIV Transmission) regimen (TLE – Tenofovir + Lamivudine + Efavirenz) on babies born to HIV positive pregnant women...

Predicting Virological Failure with Immunological Criteria in First Line ART Patients in a Resource Poor Setting

Indroduction: National Aids control Organisation in India implementing National AIDS control program uses WHO’s immunological criteria to screen virological failure. Using immunological criteria to detect virological failure has to be assessed. Predicting virological failure with immunological criteria in resource limited settings had low sensitivity. Factors that influence the outcome are studied. Methods: Retrospective study in tertiary care centre for HIV and TB, Chennai, India. Out of 35,044 on ART between January 2008 and September 2009, 452 suspected immunological failures were referred. 273 screened for virological failure. Frequency, sensitivity/specificity, positive/negative predictive values, chi-square test, odds-ratio, independent sample t test for viral load greater than 10,000 and 1000 of each immunological criterion using Epi-Info and SPSS version 19. Results: 172 had virological failure (62.09%). Average age of failed was 37.33. Single criteria’s sensitivity was 60 to 84 for detecting virolological failure. Two or more criteria had specificity 55 to 79. Combination of two or more criteria increased odds ratio for virological failure. Positive predictive value was above 63 for all criteria. PPV was above 80 to the criterion all three positive. Conclusions: ART naive patients with >95% adherence the sensitivity of immunological criteria to detect virological failure is three times than earlier studies. Combination of criteria is more significantly associated with virological failure. Odds ratio doubled for two or more combination of criteria. Immunological criteria is affordable/acceptable for screening virological failure, with adherence > 95% and longer the duration of ART.

Legal and ethical issues in safe blood transfusion.

Legal issues play a vital role in providing a framework for the Indian blood transfusion service (BTS), while ethical issues pave the way for quality. Despite licensing of all blood banks, failure to revamp the Drugs and Cosmetic Act (D and C Act) is impeding quality. Newer techniques like chemiluminescence or nucleic acid testing (NAT) find no mention in the D and C Act. Specialised products like pooled platelet concentrates or modified whole blood, therapeutic procedures like erythropheresis, plasma exchange, stem cell collection and processing technologies like leukoreduction and irradiation are not a part of the D and C Act. A highly fragmented BTS comprising of over 2500 blood banks, coupled with a slow and tedious process of dual licensing (state and centre) is a hindrance to smooth functioning of blood banks. Small size of blood banks compromises blood safety. New blood banks are opened in India by hospitals to meet requirements of insurance providers or by medical colleges as this a Medical Council of India (MCI) requirement. Hospital based blood banks opt for replacement donation as they are barred by law from holding camps. Demand for fresh blood, lack of components, and lack of guidelines for safe transfusion leads to continued abuse of blood. Differential pricing of blood components is difficult to explain scientifically or ethically. Accreditation of blood banks along with establishment of regional testing centres could pave the way to blood safety. National Aids Control Organisation (NACO) and National Blood Transfusion Council (NBTC) deserve a more proactive role in the licensing process. The Food and Drug Administration (FDA) needs to clarify that procedures or tests meant for enhancement of blood safety are not illegal.

Changing trends in sexually transmitted infection (STI) clinic attendees - Current scenario

Background: Currently, sexually transmitted infections (STIs) form a huge public health issue in the global scenario. STIs are commonly more active than other prevailing infections in the community amongst the sexually active population and the epidemiological profile is very distinct and more dynamic than other diseases. Aims & Objectives: To understand the changing scenario of STIs and also the non-STIs among patients attending the STI clinic at the tertiary care centre. Materials and Methods: This is a tertiary care based retrospective study of all the patients attending the STI clinic at the department of Dermatology, Venereology and leprology (DVL), Gandhi Hospital, Secunderabad, for 3 years (from January 2011 to December 2013). STIs were categorized into different syndromes as per the syndromic management of STIs, as depicted by National AIDS Control Organization (NACO). Results: A total of 7,859 patients, with complaints of genital lesions, attending the STI clinic, were included in this study. Our study, from 2011 to 2013, showed a declining trend in bacterial STIs and increasing trend of fungal and viral STIs as seen in developing nations. The most common STI in males was candidial balanoposthitis, and females is vaginal/cervical discharge (candidial) followed by viral infections like genital herpes and condyloma acuminata. Conclusion: A comprehensive study of the epidemiological data is very important in order to decrease the incidence and prevalence of STIs and HIV. In order to decrease the incidence and prevalence of STIs and HIV, we need to further impart health education, counselling and improve the standards of health care facilities.

Effect of peer-led outreach activities on injecting risk behavior among male drug users in Haryana, India

BackgroundFor the past two decades, there has been an enduring HIV epidemic among injecting drug users (IDUs) in India, and the Indian national AIDS control program (NACP) led by the National AIDS Control Organization (NACO) has kept IDUs at the forefront along with other key populations, in its efforts to prevent HIV. Given this, the objective of this study is to examine the association between IDUs’ degree of exposure to peer-led education sessions (under NACP) and their needle sharing practices in Haryana, India.MethodsThe data for this study were drawn from a program monitoring system for the years 2009–2010 and 2010–2011. The relationship between IDUs’ background characteristics/injecting practices and degree of exposure to the program was assessed using chi-square and Student’s t tests. Generalized estimating equations (GEE) were used to examine changes in needle sharing practices over time by degree of exposure to peer-led education sessions. Further, the analysis was stratified by frequency of injecting drug use. All statistical analyses were conducted using STATA version 11.ResultsThe proportion of IDUs who shared needles substantially decreased from 2009 to 2011, particularly among those who attended three or more peer-led education sessions (49% vs 11%, p < 0.001) in a month. Further, subgroup analysis by frequency of injecting drugs demonstrates that this decline was significant among IDUs who injected frequently (adjusted odds ratio = 0.6, 95% confidence interval = 0.3–0.9, p = 0.043).ConclusionThe study results indicate that repeated peer-led outreach sessions are more effective than exposure to a single education session. Hence, HIV prevention programs must promote repeated peer contacts with IDUs every month (at least two meetings) in order to promote safe injecting practices and behavior change.

Service delivery through public health care system to control sexually transmitted infections in Himachal pradesh.

Introduction:The National AIDS Control Organization has designed multiple synergistic interventions to identify and control curable sexually transmitted infections (STIs).Objective:To assess the impact of services offered at designated STI clinics in the state of Himachal Pradesh, India and the profile of the attending clients.Materials and Methods:This was a two-year prospective study, conducted from April 2011 to March 2013. Training on delivering STI/RTI services was imparted to the staff of 16 designated STI clinics including recording of data. The staff in each STI clinic comprises of one doctor, one counselor, one nurse, and one laboratory technician. The clients attending these designated clinics were offered counseling, syndromic case management (SCM), and diagnostic services wherever possible. Monthly data of STI clinic attendees was collected, compiled, and analyzed.Results:A total of 65,760 clinic visits were reported, of which 32,385 (49%) visits were for index STI/RTI complaint(s). The ratio of male to female attendees was 1:2. The commonest age group accessing the STI clinics was 25-44 years (n = 38,966; 59.3%). According to SCM, 52.9% clients were managed. The commonest presenting syndrome was urethral discharge (n = 4,500; 41%) in males, and vaginal discharge (n = 13,305; 56%) in females. Genital ulcer disease was treated in 2099 cases. Laboratory tests were performed only in 6466 patients, and 39,597 antenatal mothers were screened for syphilis. Counseling services were provided to 51,298 (f = 34,804; 68%: m = 16,494; 32%) clients and of these, 48% (n = 25,056) of the clients were referred to integrated counseling and testing centers. Forty-three clients (m = 24: f = 19) were detected positive for HIV infection.Conclusion:Uniform and standardized services delivered to clients attending public health clinics can gather reliable data to monitor trends of STI infection.

Metabolic abnormalities in human immunodeficiency virus patients with protease inhibitor-based therapy

Context:Several studies have reported metabolic abnormalities in patients taking protease inhibitor (PI) based therapy from several parts of the world. But there is no prospective study in India after switching from PI sparing regimen to PI based regimen.Aims:To assess whether North-East Indian Human Immunodeficiency Virus (HIV) patients also develop similar metabolic abnormalities to PI.Settings and Design:This prospective study was conducted in Anti-retroviral therapy (ART) Centre of Excellence, at a tertiary care Medical Institute.Materials and Methods:Fifty-five patients taking PI based ART were taken for the study. These patients were started on Ritonavir based therapy, after treatment with first line drugs had failed according to National AIDS Control Organization (NACO) guidelines 2008. Glucose and lipid profiles were evaluated. American Diabetes Association (ADA) and NCEP ATP III criteria were used to categorize glucose and lipid abnormalities. International Diabetes Federation (IDF) 2006 cut-off was used for waist circumference and blood pressure.Statistical Analysis Used:Paired t-test was done whenever applicable.Results:There was a significant increase in waist circumference after 6 months of 2nd line ART from 78.0 cm to 80.2 cm (P value < 0.001). There was significant increase in both systolic and diastolic blood pressure after 6 months. In 29.8% of patients blood pressure rose to hypertensive level after 6 months. Total cholesterol, triglyceride and low density lipoprotein cholesterol also rose significantly after 6 months but not high density lipoprotein cholesterol.Conclusions:Our study showed that North-Eastern Indian patients also develop metabolic abnormalities to protease inhibitors similar to people of other races.

Assessment of neurocognitive functions in HIV/AIDS patients on HAART using the international HIV dementia scale

Background: Human immunodeficiency virus (HIV)-infected individuals on National AIDS Control Organization's (NACO)-India-Based-highly active antiretroviral therapy (HAART) regimen often continue experiencing neurological complications, referred to as HIV-associated neurocognitive disorders (HAND). Objectives: The prime objective is to assess the status of neurocognitive functions among HIV-infected individuals on HAART, using the International HIV Dementia Scale (IHDS). Materials and Methods: This prospective cohort study was carried out between October 2011 and September 2012, on 80 HIV-positive individuals, randomly selected from the ART Centre of PBM and AG Hospital, Bikaner, India. The patients were clinically examined and tested using IHDS. Results: All the subjects on HAART were found to have HAND-prevalence at 32.50%. Asymptomatic Neurocognitive Impairment (ANI) and HIV-associated Mild Neurocognitive Disorder (MND) were observed in 30 and 2.5% of the patients, respectively, and HIV-associated Dementia (HAD) was absent. Conclusion: In our study the IHDS Score was abnormal, that is, ≤10, in 32.50% of the patients, which shows probable neurocognitive impairment in the study subjects. This suggests the need to routinely screen HIV-positive patients, to recognize the neurocognitive deficits at an early stage and the IHDS may have great value as a screening test for HAND.

Metabolic abnormalities in human immunodeficiency virus patients with protease inhibitor-based therapy.

Several studies have reported metabolic abnormalities in patients taking protease inhibitor (PI) based therapy from several parts of the world. But there is no prospective study in India after switching from PI sparing regimen to PI based regimen. To assess whether North-East Indian Human Immunodeficiency Virus (HIV) patients also develop similar metabolic abnormalities to PI. This prospective study was conducted in Anti-retroviral therapy (ART) Centre of Excellence, at a tertiary care Medical Institute. Fifty-five patients taking PI based ART were taken for the study. These patients were started on Ritonavir based therapy, after treatment with first line drugs had failed according to National AIDS Control Organization (NACO) guidelines 2008. Glucose and lipid profiles were evaluated. American Diabetes Association (ADA) and NCEP ATP III criteria were used to categorize glucose and lipid abnormalities. International Diabetes Federation (IDF) 2006 cut-off was used for waist circumference and blood pressure. Paired t-test was done whenever applicable. There was a significant increase in waist circumference after 6 months of 2(nd) line ART from 78.0 cm to 80.2 cm (P value < 0.001). There was significant increase in both systolic and diastolic blood pressure after 6 months. In 29.8% of patients blood pressure rose to hypertensive level after 6 months. Total cholesterol, triglyceride and low density lipoprotein cholesterol also rose significantly after 6 months but not high density lipoprotein cholesterol. Our study showed that North-Eastern Indian patients also develop metabolic abnormalities to protease inhibitors similar to people of other races.

A study of utilization pattern, efficacy and safety of drugs prescribed for opportunistic infections in Human Immunodeficiency Virus infected patients

Objectives: The aim was to evaluate the utilization pattern, efficacy and safety of drugs prescribed for opportunistic infections (OIs) in human immunodeficiency virus (HIV) positive patients. Materials and Methods: In this observational, prospective, single center study, HIV positive patients were followed-up for a period of 1 year to record the OIs; their clinical course and outcome. Utilization pattern, efficacy and safety of the drugs used were evaluated. Rationality of treatment was assessed using National AIDS Control Organization and Standard Treatment Guidelines. Results: A total of 222 OIs were detected in 134 patients. Majority of patients (90.2%) were adults. The commonest OIs included tuberculosis (TB) (89), oropharyngeal candidiasis (OPC) (37), bacterial infections (30) and chronic diarrhea (22). Use of supportive drugs and empirical treatment of certain OIs contributed to a higher number of drugs (average of 3.5 drugs) per prescription. Drugs, prescribed in accordance with the above mentioned guidelines, were effective in most cases. Drugs were well-tolerated with only two serious adverse drug reactions (ADRs) reported. Majority of ADRs were associated with anti TB drugs. Conclusion: Tuberculosis, oropharyngeal candidiasis, bacterial infections and chronic diarrhea are the commonest OIs. Overall, a rational approach to therapy and good tolerability and efficacy of drugs was observed. Empirical treatment of infections should be minimized.

Evaluation of various techniques among clinically suspected patients of pulmonary tuberculosis with and without the presence of HIV infection

Tuberculosis (TB) remains a major global health problem in India and globally. The present study was conducted to evaluate the different diagnostic techniques in suspected cases of pulmonary tuberculosis with or without the presence of HIV (Human Immunodeficiency Virus) infection. A total of 75 clinically suspected fresh cases of pulmonary TB were asked for sputum samples for acid-fast bacilli (AFB) staining and culture on Lowenstein-Jensen (LJ) media according to Revised National Tuberculosis Control Program guidelines. A commercially available rapid test kit was also used for detection of TB antigen in sputum sample. One 5 mL blood sample each was taken for HIV testing according to National Aids Control Organisation guidelines. A total of 9 (12%) patients out of 75, were found to be HIV-positive. Among the HIV co-infected patients, there was only one patient who was both smear and culture positive rest were negative. On the other hand, among the 66 HIV-negative TB patients, 25 (37.88%) were positive on both smear and culture. None of the smear negative and culture negative samples was found to be positive for the presence of TB antigen. The overall antigen positivity rate in the entire study was 16% (12/75). The current study concluded that LJ media is highly efficient medium for recovery and diagnosis of Mycobacterium tuberculosis.

Raised Red cell distribution width is common hematological finding of HIV infection

Background: Discuss relevant laboratory findings raised RDW with age and sex distribution. Establish care guidelines for HIV infected person and altered haematopoiesis resulting in with raised red cell distribution width. Aims & Objectives: To Review the pathogenesis of the haematological manifestations of human immunodeficiency virus (HIV). Materials and Methods: Blood was collected in a sterile EDTA containing tube and processed following our established laboratory protocol and by universal precaution as per the guideline of National aids control organization (NACO, India). A complete blood counting including HB%, PCV, Red cell indices, platelet count, Red cell distribution width and total white cell count and differential was done by Automated blood cell counter analyzer of all the patient on antiretroviral therapy. The all cell count indices including WBC count with differential and platelet count, was further confirmed by manual oil immersion smear study method. Peripheral smears study was done with field A and B Stain and Leishman stain. Results: In our study out of 300 HIV cases 189 cases (63%, n=300) shows increased RDW in which male cases are 125 cases (66.48%, n=188) and female cases are 64 (57.14%, N=112). Conclusion: RDW is commonly affected haematological parameter in HIV infective cases. Higher red blood cell distribution width is associated with a worse virologic and clinical situation in HIV infected.

Metabolic abnormalities and body composition in Human Immunodeficiency Virus-infected patients receiving highly active anti-retroviral therapy

Background: With the advent of highly active antiretroviral therapy (HAART) metabolic abnormalities such as dyslipidaemia, changes in fat distribution and insulin resistance have been observed with increasing frequency in patients with Human Immunodeficiency Virus (HIV) infection. Aims: This study was undertaken to (i) assess body composition and the metabolic effects of HAART in HIV infected patients and (ii) compare the above variables between different 1 st and 2 nd ART regimens of National AIDS Control Organization of India. Methods and Material: 201 HIV patients receiving HAART for more than 3 months were studied. Body mass composition was measured using TANITA segmental body composition monitor. The metabolic parameters measured included blood glucose, serum cholesterol and serum triglycerides. Results: Lipodystrophy was observed in 21.40% patients. The mean body mass index (BMI) was 18.24 ± 3.18 and mean visceral fat mass was 4.16 kg. Altered lipid profile was observed in 26.86% patients (25.55% on 1 st line and 38.09% on 2 nd line) and impaired glucose tolerance was seen in 7.96% (6.66% on 1 st line and 19.04% on 2 nd line). Conclusions: HAART has significant effect on the body mass composition and metabolic parameters.

Barriers to antiretroviral treatment access for injecting drug users living with HIV in Chennai, South India

India's National AIDS Control Organization provides free antiretroviral treatment (ART) to people living with HIV (PLHIV), including members of marginalized groups such as injecting drug users (IDUs). To help inform development of interventions to enhance ART access, we explored barriers to free ART access at government ART centers for IDUs living with HIV in Chennai by conducting three focus groups (n = 19 IDUs) and four key informant interviews. Data were explored using framework analysis to identify categories and derive themes. We found interrelated barriers at the family and social, health-care system, and individual levels. Family and social level barriers included lack of family support and fear of societal discrimination, as well as unmet basic needs, including food and shelter. Health-care system barriers included actual or perceived unfriendly hospital environment and procedures such as requiring proof of address and identity from PLHIV, including homeless IDUs; provider perception that IDUs will not adhere to ART, resulting in ART not being initiated; actual or perceived inadequate counseling services and lack of confidentiality; and lack of effective linkages between ART centers, needle/syringe programs, and drug dependence treatment centers. Individual-level barriers included active drug use, lack of self-efficacy in ART adherence, low motivation to initiate ART stemming from a fatalistic attitude, and inadequate knowledge about ART. These findings indicate that to facilitate IDUs gaining access to ART, systemic changes are needed, including steps to make the environment and procedures at government ART centers more IDU-friendly and steps to decrease HIV- and drug use-related stigma and discrimination faced by IDUs from the general public and health-care providers. Housing support for homeless IDUs and linkage of IDUs with drug dependence treatment are also essential.