Chest Diseases Clinic at Sassoon General Hospital in Pune in western india. Four hundred tuberculosis patients were screened for HIV infection at 6 monthly ...
Symposium on HIV & TB
Ind J Tub.; 2002,49,17
3. SENTINEL SURVEILLANCE FOR HIV INFECTION IN TUBERCULOSIS PATIENTS IN INDIA S.Tripathi 1*, D.R. Joshi2** S.M. Mehendale3*, P. Menon4***, A.N Joshi5, S.V. Ghorpade6** MJ. Patil7 and R.S. Paranjape8**
Summary: Sentinel surveillance for HIV infection was carried out in tuberculosis patients attending the Tuberculosis and Chest Diseases Clinic at Sassoon General Hospital in Pune in western india. Four hundred tuberculosis patients were screened for HIV infection at 6 monthly intervals, initially over a period of two years from 1995 to 1997. and subsequently at yearly intervals, till 2000. Results showed that the HIV seropre.alence increased from 10% in JulyAugust 1995 to 21.25% in January-February 1996. Subsequently, the HIV seroprevalence remained stable between 21 to 23% till January-February 1999. However, between January-February 1999 to January-February 2000. there was a statistically significant increase in the HIV seroprevalence from 22.25% to 28.75%. The increase in HIV seroprevalence was significant in male tuberculosis patients between the ages of 20 and 50 years. Key Words .-Sentinel surveillance, HIV infection. Tuberculosis
INTRODUCTION Presence of HIV infection in India was first detected in 1986 when a few commercial sex workers were found to be seropositive in the state of Tamil Nadu in south India1. Subsequently, the number of HIV infected individuals has been increasing gradually and it is estimated that at present, there are about 3.5 million HIV infected individuals in India. The number of detected AIDS cases has also been increasing gradually and the commonest opportunistic infection seen in this group of patients is tuberculosis2,3. Pune city is situated in the western part of India, 192 kilometres south east of Bombay. In Pune and in Bombay, studies have shown that a significant proportion of patients attending sexually transmitted diseases clinics and commercial sex workers were infected with HIV4. In HIV infected individuals, as the immunocompromised state progresses, the latent tuberculosis foci in these individuals get reactivated, leading to active tuberculosis. In India, about 60% of the adult population is infected with the tubercle
bacilli, as shown by a positive Mantoux test. Thus, a major proportion of HIV infected individuals in India are likely to develop active tuberculosis due to reactivation of the latent focus of tuberculous infection, caused by the immunocompromised state. To study the HIV seroprevalence in tuberculosis patients in Pune, a sentinel surveillance for HIV infection was initiated at the Tuberculosis and Chest Diseases Clinic at Sassoon General Hospital in Pune, in July 1995.
METHODOLOGY Sera from 400 consecutive tuberculosis patients were collected over 8 to 10 weeks, initially at 6 monthly intervals from 1995 to 1997 and subsequently, at yearly intervals till the year 2000, from patients attending the tuberculosis clinic at Pune. Diagnosis of pulmonary tuberculosis was carried out by sputum smear examination for acid fast bacilli using the direct smear method and/or chest skiagram. Serological detection of anti-HIV antibodies was done by the Innotest HIV-l/HIV-2 antibody test (Innogenetics N.V., Belgium) or the
1 Assistant Director* 2. Professor and Head of Department** 3 Deputy Director* 4. Research Officer*** 5 District Tuberculosis Officer 6 Professor** 7. District Leprosy Control Officer 8 Officer-in-Charge* * National AIDS Research Institute (1CMR), Pune ** Tuberculosis and Chest Diseases Clinic, Sassoon General Hospital, Pune
*** Tuberculosis Research Centre. Chennai
Corresponence: Dr S Tripathy, Assistant Director, National AIDS Research Institute, 73 G Block, MIDC, Bhosari, Pune 411026
Indian Journal of Tuberculosis
18 Biochem Detect-HIV ELISA test (Biochem ImmunoSystems Inc., Canada). Samples found to be reactive by ELISA were tested further by a supplementary test, Immunocomb II HIV 1 and 2 Bispot test (Orgenics, Israel) or the Capillus HIV-1/ HIV-2 test (Cambridge Diagnostics Ireland Ltd., Galway, Ireland). Statistical analysis of the data obtained was carried out using the Epi Info Version 6.0 software from the Centres of Disease Control, Atlanta, USA.
Table l:SentineI Surveillance for HIV Infection among tuberculosis patients in Pune Period
No. Tested
HW Seroprevalence
Odds Ratio
July-Aug ‘95 Jan - Feb ‘96
400 400
10.00% 15.75%
1.00 1.73
July-Aug ‘96 Jan-Feb ‘97 Jan-Feb ‘98 Jan-Feb ‘99 Jan-Feb 2000
400 400
21.25% 21.50% 23.25% 22.25% 28.75%
2.26 2.35 2.79 2.58
400 400 400
3.74
χ2 value for linear trend was 44.7 and p
