Seroprevalence of human immunodeficiency virus in pregnant women: A hospital based study from North Delhi.

Sir,

India launched its Prevention of Parent to Child Transmission (PPTCT) programme in 2002 and it has considerably scaled up since 2007.[1]

A global estimate of 0.8% of adults aged 15-49 years worldwide are living with human immunodeficiency virus (HIV) (35.0 million people were living with HIV at the end of 2013).[2] HIV prevalence among antenatal care (ANC) clinic attendees is estimated to be 0.40% in Delhi according to the National AIDS Control Organization (NACO) 2010-2011. Pregnant women comprise the low-risk population and estimation of seroprevalence in this group is considered a proxy for the general population. HIV prevalence among ANC clinic attendees is low at 0.40%. This, in turn, provides essential information for an effective implementation of AIDS control programs and also for the monitoring of HIV spread within a country. Very few studies are available from North India showing the current trend in HIV prevalence in the antenatal population, in fact none from this area, which led us to carry out the present study at a government hospital in North India.

This study was carried out in the Department of Pathology/Microbiology at the 450 bedded Kasturba Hospital, a government hospital in North Delhi. A retrospective analysis was done from data obtained and PPTCT for the period of January 2011 to December 2013. Approval was taken by the Institutional Ethical Committee. The data were analyzed using the Chi-square tests for statistical analysis.

Data were collected and analyzed from a total of 15,727 pregnant women tested during 3 years from January 2011 to December 2013 [Table 1]. The mean age was found to be 26 years (coefficient of variation = 11.65: Standard deviation ± 3.03 years). The youngest HIV positive female was 19 years while the oldest was 34 years. Age group most commonly involved was of 20-30 years (28/33:84.84%) followed by those ≥31 years (12.12%). None was found to be seroreactive for HIV-2 antibodies. The seroprevalence of HIV reactive women in the present study was 0.20%, 0.19%, and 0.23% in 2011, 2012, and 2013. Significant value was seen in prevalence from 2011 to 2012 (P < 0.05) and between 2012 and 2013 (P < 0.05). Spouse positivity was noted in 58.33%, 100% and 72.72% cases from 2011, 2012, and 2013, respectively. Postpregnancy 25 patients delivered live babies (75.75%:25/33), 6 were either MTP or stillbirth (18.18%), and 2 patients were lost to follow-up (6.06%). Of the total 61% were primigravida and 33% were multigravida, whereas status was unknown for 4 patients.

Table 1

Year-wise prevalence rates of HIV in pregnant women at a tertiary care center in North Delhi

HIV seroprevalence from the present center was found to be 0.2%, on an average, from 2011 to 2013. HIV prevalence among ANC clinic attendees was about 0.2% in 2003. Heterosexual contact remains the major mode of transmission.[3] The present study, even though not representing the general population, provides clear insight of a decreasing trend of HIV seroprevalence at the rate of 0.2% among pregnant women in India. As per the official data from India's NACO,[3] Delhi, and the adjoining North Indian states are categorized as low prevalence areas for HIV. The NACO sentinel surveillance data for the state of Delhi reported HIV prevalence of 0.25% in 2003, 0.38% in 2004,[1234] and 0.25% in 2005 and a continuous decline was reported till 2008.[567] There was a sharp rise in HIV positive cases from 2007 to 2010[8] [Figure 1]. Average seroprevalence was documented to be 0.4% in 2011. Little data is available for trends after 2011. Besides the data from NACO, there is no other study reported from this part of India for comparison of our findings. This slight dip in prevalence could be a result of effective awareness programs and education regarding HIV, especially in young adults after the implementation of National AIDS control programme (NACP II, 1999-2006). The NACP II sought to shift focus from raising awareness to changing behavior through interventions in high-risk groups. Intervention programs such as HIV awareness and safe sex education are usually focused on young adults and our data show a favorable impact of such programs. Limitation of the present study includes the limited sample size in a single hospital study.

Figure 1

Graph showing prevalence of human immunodeficiency virus positivity from year 2003 to 2013

Sinha and Roy[9] observed 0.74% (5/669) of HIV positive women in year 2008, whereas Ray et al reported 0.1% positivity (1/1563).[10] Another study from Delhi from 2005 to 2007 reported prevalence to be 0.68%, 0.70%, and 0.68%, respectively.[11]

Our study indicates a lower trend of HIV prevalence. The data observes the spread of HIV in pregnant women. Percentage prevalence of HIV in a population dictates the percentage of perinatal transmission which in turn projects the pediatric AIDS population. Pediatric HIV infection can be minimized using a multipronged approach inclusive of antenatal screening followed by perinatal antiretroviral therapy, safe delivery practices, and modified infant feeding.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.