Profile of HIV serodiscordant couples in a tertiary care center.

BACKGROUND: Globally, 36.7 million people are infected with Human Immunodeficiency Virus (HIV). Of these 36.7 million people, 2.1 million are in India. Integrated counseling and testing centers are the cornerstones of early access to prevention and support services. The term "serodiscordant couple" refers to a couple where one partner is HIV-positive and the other HIV-negative. AIM: To study the serodiscordance rates in a cohort of people attending integrated counseling and testing center. MATERIALS AND METHODS: Aretrospective descriptive study of data from integrated counseling and testing center from January 2013 to December 2014 was done. RESULTS: Of the 7489 persons tested, 306 persons were positive for HIV (192 males and 114 females) with a prevalence of 4 percent. Of the 126 couples tested, serodiscordance was found in 46 couples, while 80 couples were seroconcordant. The overall prevalence of HIV serodiscordance was 36.5 percent. Male positive and female negative couples (M+ F-) were 35 (76.0%) and female positive and male negative (F+ M-) were 11 (23.9%). Discordant M+ F- couples were significantly higher than discordant F+ M- couples (P < 0.001). Most participants were aged between 21 and 40 years. The average age of men was 41.91 years and that of women was 34.21 years. The average age difference between life partners was 7.7 years. Significant association was seen between age and gender, as females were found to be younger (P value = 0.001). LIMITATION: Information regarding years of married life, number of sex partners or sexual behavior pre- and post-detection were not collected. Thus, our data present only the magnitude of serodiscordance in a cohort but does not analyze the other predictors of serodiscordance. CONCLUSION: Serodiscordant relationships occur more commonly in India than is presumed. Our study highlights the profile of serodiscordant couples in this part of the country. Effective measures to prevent transmission of HIV within a serodiscordant relationship are necessary steps in halting the HIV epidemic.

National scale-up of HIV testing and provision of HIV care to tuberculosis patients in Kenya.

SETTING: Kenya, one of the 22 tuberculosis (TB) high-burden countries, whose TB burden is fuelled by the human immunodeficiency virus (HIV). OBJECTIVE: To monitor and evaluate the implementation of HIV testing and provision of HIV care to TB patients in Kenya through the establishment of a routine TB-HIV integrated surveillance system. DESIGN: A descriptive report of the status of implementation of HIV testing and provision of HIV interventions to TB patients one year after the introduction of the revised TB case recording and reporting system. RESULTS: From July 2005 to June 2006, 88% of 112835 TB patients were reported to the National Leprosy and TB Control Programme, 98773 (87.9%) of whom were reported using a revised recording and reporting system that included TB-HIV indicators. HIV testing of TB patients increased from 31.5% at the beginning of this period to 59% at the end. Of the 46428 patients tested for HIV, 25558 (55%) were found to be HIV-positive, 85% of whom were provided with cotrimoxazole preventive treatment and 28% with antiretroviral treatment. CONCLUSION: A country-wide integrated TB-HIV surveillance system in TB patients can be implemented and provides essential data to monitor and evaluate TB-HIV related interventions.

AIDS -- how false positives affect Africa.

PIP: The World Health Organization (WHO) estimates of AIDS cases in Africa are based on the results of trials using the two main HIV serodiagnostic tests: the ELISA and the Western Blot. Some AIDS specialists believe that these tests are not accurate enough to confirm HIV positivity. In fact, they may be most meaningless in Africa because the widespread ill-health there contributes to false positive reactions. Malnutrition and associated chronic diseases are the key causes of ill-health in Africa. The US Centers for Disease Control and Prevention considers the ELISA to be only a screening test to detect suspicious blood samples and not a confirmatory test. In the US, the Western Blot is used as a confirmatory test. False positives could be avoided if scientists could use a suitable gold standard (i.e., HIV isolation). Yet HIV has yet to be unequivocally isolated. In fact, according to Neville Hodgkinson, the entire HIV story might be a monumental error. In Africa, due to cost considerations, most people are diagnosed with HIV based on the findings of a single test. Yet many supposedly HIV-infected persons may actually be suffering from influenza, malaria, or malnutrition, all of which can produce positive HIV results. During the second half of the 1980s, there was no public acknowledgment of inadequacies in the HIV test. In 1994, a professor of public health at Harvard, scientists at the University of Kinshasa, and the health ministry in Zaire found that a supposed association with leprosy and HIV infection as detected by the ELISA was actually due to false positives. When they retested using the Western Blot and radioimmunoprecipitation analysis, the number of the 57 leprosy patients found to be HIV positive fell from 37-41 to 2 and the number of contacts found to be HIV positive fell from 9-12 to 0. An non-validated test (i.e., ELISA) has technical problems and pitfalls in interpretation and is vulnerable to shipping, climatic and storage conditions, and subject to unmeasured and immeasurable cross-reactivities, and may give false positive results.^ieng

Cost-effectiveness and total costs of three alternative strategies for the prevention and management of severe skin reactions attributable to thiacetazone in the treatment of Human Immunodeficiency Virus positive patients with tuberculosis in Kenya.

SETTING: Severe skin reactions due to thiacetazone (T) in Human Immunodeficiency Virus (HIV) positive tuberculosis patients have been reported in several publications, one of them from Kenya. However, the abandoning of T may not be feasible in Kenya as this may increase the cost of drugs by about three-fold per regimen. OBJECTIVE: To compare the cost-effectiveness and total cost of three strategies in which T is replaced with ethambutol (E). DESIGN: Three strategies are compared with a baseline strategy in which T is not replaced. The indicator for cost-effectiveness is the cost-per-averted-death attributable to T. RESULTS: Education of patients on the possibility of side-effects and replacement of T with E is the most cost-effective strategy at HIV prevalence rates of 1-90%. Abandonment of T and replacement with E is the most cost-effective at over 90% HIV prevalence. CONCLUSION: In Kenya, education of patients on the possibility of skin reactions should be preferred at low range HIV prevalence rates. Routine HIV testing would be the most attractive strategy in the middle range, and total replacement of T with E is to be preferred in the higher range of HIV prevalence.

PIP: In Kenya, the National Leprosy Tuberculosis Programme (NLTP) used previously reported data from Nairobi to compare the cost-effectiveness and total costs of a hypothetical strategy with three intervention strategies for the prevention and management of severe skin reactions caused by thiacetazone in treating HIV-positive patients with tuberculosis (TB). The hypothetical strategy was continued use of thiacetazone despite adverse skin reactions. The intervention strategies included patient education about possible side effects of anti-TB drugs (discontinue use if skin rash develops, report situation to clinic, replace thiacetazone with ethambutol when other skin diseases have been excluded), abandonment of thiacetazone and replacement with ethambutol, and HIV testing and pre- and post-test counseling. NLTP currently used the education strategy. It assumed a mortality rate of 5%. When the HIV prevalence rate is 1-90%, the education strategy is the most cost-effective strategy. In terms of total costs, the education strategy was also the most inexpensive strategy regardless of the HIV prevalence. At an HIV prevalence rate greater than 65%, the abandonment of thiacetazone strategy was the cheapest strategy. When the assumed mortality rate was 3%, the cost per averted death for the education strategy was reduced from about US$120 to about US$80 and the education strategy became the most cost-effective strategy over the entire range of HIV prevalence. In addition, the cost of HIV testing significantly increased the cost per averted death. Thus, the findings of this study are truly sensitive to different program conditions. Based on these findings, the authors recommended that the education strategy be applied with a range of HIV prevalence of 1-45%, that HIV testing be applied with a range of 46-72%, and that total abandonment be applied with an HIV prevalence greater than 72%.

Setting up HIV serology for the Karonga leprosy vaccine trial in Malawi.

As part of the leprosy vaccine trial taking place in Karonga District, Northern Malawi, it is essential to establish whether the presence of HIV infection in the population is affecting the incidence rate or clinical presentation of leprosy or the effectiveness of the trial vaccines. To obtain the appropriate information, a rapid and economical HIV testing protocol, which could be performed in a rural laboratory and would be robust under variable environmental conditions, had to be developed. This paper reports on the development/evaluation phase of a multitest protocol based on commercially available particle agglutination and ELISA anti-HIV antibody detection kits. The protocol was devised by first evaluating a range of kits in London using a battery of African and non-African sera and then field testing 1455 sera in Malawi, which included 184 sera from leprosy patients and 60 sera from syphilis patients to check for cross-reactivity. According to the protocol developed, all sera are screened initially both by indirect ELISA (Organon) and using a rapid and economical modification of the Serodia particle agglutination test. Positives are retested using both a competitive ELISA (Wellcome or Behring) and the standard Serodia particle agglutination test. The validity of this multitest protocol was confirmed by Western blotting a large sample of the positive and negative Malawian sera in London. Factors affecting kit selection, and problems associated with individual kits, are discussed. While the specific multitest protocol developed for Malawi might not be suitable for every project, the principle of developing economical alternatives to Western blotting is an important consideration for any field investigation of HIV.