Background: The human immunodeficiency virus (HIV) burden among adults in India is estimated officially by direct extrapolation of annual sentinel surveillance data from public-sector antenatal and sexually transmitted infection (STI) clinics and some high-risk groups. The validity of these extrapolations has not been systematically examined with a large sample population-based study.

Among the identified factors, male circumcision was estimated to have the highest relative impact on reducing HIV per unit population, but the feasibility of this intervention in India needs further investigation. The low explanatory power in the regression models of the usually considered risk factors for HIV suggests that better understanding of HIV dynamics at the population level in India is needed.

BackgroundUnderstanding the prevalence and risk factors for common causes of ulcerative genital disease in the general population would inform current STI syndromic management and HIV testing strategies in high HIV prevalence regions of India.MethodsPersons 15-49 years old from 32 rural and 34 urban clusters were sampled using a stratified random method to represent adults in the high HIV prevalence Guntur district in Andhra Pradesh state. Interviews were conducted and dry blood spots were collected on 12,617 study participants. Testing for HSV-2 and syphilis was performed.ResultsAdjusted HSV-2 and syphilis seroprevalence rates were 4.70% and 2.08% for men and 7.07% and 1.42% for women. For men, tattooing, >3 lifetime sex partners, tobacco use, and sex with men in the past 6 months were associated with HSV-2 or syphilis (ORs, 1.66-2.95, p < 0.05). Male circumcision was positively associated with HSV-2 infection (OR, 1.37, p = 0.028) though this could be due to residual confounding. In women, greater than one lifetime partner remained significantly associated with HSV-2 in multivariate analysis (OR, 2.61; 95% CI, 1.39-4.87). Among all behavioral risk factors and other covariates in women and men, HIV infection exhibited the strongest association with HSV-2 and syphilis (ORs, 8.2-14.2, p < 0.001). The proportion of individuals with HSV-2 who were HIV infected was less than the proportion with syphilis who were HIV infected (11.8% vs. 22.7%; p = 0.001).ConclusionsNearly one in four persons surveyed in this population-based study that were seroprevalent for syphilis, were also HIV infected. Common population risk factors for syphilis, HSV-2 and HIV and high rates of co-seroprevalence suggest that HIV testing, STI testing and service strategies for these would benefit from direct linkage in India.

Central nervous system cryptococcosis is an important cause of mortality among human immunodeficiency virus (HIV) reactive patients. A retrospective study was conducted on a total of 1,863 HIV reactive hospitalized patients suspected of cryptococcal meningitis. Three hundred and fifty-nine cerebrospinal fluid specimens of these cases were screened for various cryptococcal investigations. Thirty-nine out of 359 (10.86%) showed a definite diagnosis of cryptococcosis with a mortality rate of 25.64%. Prevalence of cryptococcal meningitis in the total HIV reactive cohort was 2.09%. Concurrent cryptococcal meningitis and tuberculosis was seen in 33.3% cases. A high index of clinical suspicion and routine mycological surveillance is required to help an early diagnosis and appropriate therapy, as majority of patients respond well to therapy if treated early.

This study evaluated the ability of the Murex HIV Ag/Ab Combination assay to detect human immunodeficiency virus (HIV) antibodies in 12 617 dried blood spots (DBSs) on filter paper. The assay had an overall sensitivity of 99.6% and a specificity of 99.9%. In view of its ability to detect p24 antigen and both HIV-1 and HIV-2 antibodies in samples collected in the form of DBSs, the Murex Ag/Ab Combination assay is suitable for use as a standard screening assay for seroprevalence studies, as well as for routine diagnostic use in clinical laboratories.