Seroprevalence of Human Immunodeficiency Virus and the rising epidemic of Human Immunodeficiency Virus among injecting drug users of district Patiala.

Sir,

Through this letter, we wish to draw an attention to the rapid rise in the cases of Human Immunodeficiency Virus (HIV) and high seroprevalence of HIV among injecting drug users (IDUs) in District Patiala, Punjab.

Although adult HIV prevalence at national level has shown a decline in the past decade, the HIV epidemic in India continues to be concentrated among high-risk groups. A total number of people living with HIV/AIDS in India is estimated at around 20.9 lakhs.[1]

Injecting drug use (IDU) is a major risk factor that is fuelling the spread of HIV in India. Percentage prevalence of HIV among IDUs in India is 7.4%.[1]

According to National AIDS Control Organization (NACO) (2013), Punjab has emerged as a pocket of high HIV prevalence among IDUs with a seroprevalence of 21.1%,[2] which is the highest for any state in the country.

This revelation by NACO and the dearth of relevant and substantial epidemiological data in the region prompted us to conduct a 3 years study on the individuals who were referred to the Integrated Counselling and Testing Centre Laboratory of our Department of Microbiology.

Five milliliter of venous blood sample was collected. Blood was allowed to clot for 45 min at room temperature and serum was separated after centrifugation. Samples were tested for HIV-1 and HIV-2 antibodies according to NACO guidelines, using the test kits COMBAIDS - RS Advantage-ST, Signal HIV Flow Through HIV 1 and 2 Spot/Immunodot Test Kit, and BIO LINE SD HIV 1/2 3.0.

48,828 patients were tested for HIV. Out of 48828 patients, 2073 (4.25%) were HIV-positive. The national average is 0.27%. Out of 2073 HIV-positive patients, 1269 (61.2%) were males. The acquisition of HIV infection by heterosexual contact was found in 66.7% (1384) cases. This was followed by injecting drug users that emerged as the second most common mode of transmission in our study. Injecting drug use was reported as a risk factor in 174 cases, recording a seroprevalence of 8.4%. Similar, were the results obtained by Arora et al,[3] who showed injecting drug use as route of transmission in 9.1% cases in their study conducted in Amritsar, Punjab which is also a high-risk area such as ours. Lack of awareness, rampant drug trafficking, needle sharing, and occupational vulnerability could be cited as potential causes for high seroprevalence among IDUs in Patiala.

Mother-to-child transmission (158 cases) was recorded in 7.67% of positive cases. Blood transfusion was found to be a risk factor in 4.3% (83 cases) of the positive patients. Men who have sex with men (15 cases) was the least common mode of transmission as per our study, with a seroprevalence of 0.7%. The cause of HIV transmission was unknown (253 cases) in 12.2% cases.

Seroprevalence was found highest among individuals belonging to the age group of 35-49 years (41%), followed by 25-34 years (22.6%), 50 years and above (22.5%), 15-24 years (9.7%), and 14 years and below (4.2%). Persons in the age group between 35-49 years and 25-34 years represent the working class and are sexually active, which could increase their vulnerability.

The findings of the study should be viewed as an eye-opener. The seroprevalence of HIV among the general population as well as IDUs of Patiala, has exceeded the national average by a significant margin. Until recently, Punjab did not figure out prominently on the IDU map of this country, whereas discouragingly, at present HIV infection among IDUs in Punjab is the highest, higher even than North-eastern states such as Manipur, which had held the much-maligned spot for almost 26 years. IDUs bear a poorer prognosis,[4] engage in risky sexual behavior,[5] show sub-optimal response to anti-retroviral treatment[6] and are at an increased risk of hepatitis C virus co-infection,[7] a cause of significant morbidity and mortality. Special interventions for IDUs urgently need to be scaled up and implemented with a wider scope to improve access for the beneficiaries. People, who inject drugs and their sexual partners also need counseling, education, behavioral interventions, and access to condoms to prevent sexual transmission and limit the increasing prevalence of HIV infection among injecting drug users not only in Punjab but across the nation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.