Download Prevalence of Human Immunodeficiency Virus (HIV), Hepatitis B

Jpn. J. Infect. Dis., 61, 79-81, 2008
Short Communication
Prevalence of Human Immunodeficiency Virus (HIV), Hepatitis B Virus,
and Hepatitis C Virus in Three Groups of Populations at High Risk of
HIV Infection in Amritsar (Punjab), Northern India
Neerja Jindal*, Usha Arora and Kamaldeep Singh
Microbiology Department, Government Medical College, Amritsar, India
(Received July 30, 2007. Accepted November 14, 2007)
SUMMARY: Three groups of populations at high risk of human immunodeficiency virus (HIV) infection, i.e.,
injecting drug users (IDUs), truckers, and attendees of sexually transmitted disease (STD) clinic of Amritsar
(Punjab), Northern India, were studied in order to determine the prevalence of HIV, hepatitis B virus (HBV), and
hepatitis C virus (HCV) infections. Of the 157 IDUs, 16.6, 17.8, and 33.7% were found to be positive for HIV,
HBV, and HCV infections, respectively. HCV showed significant difference (P < 0.01) and very high rate (8.3%)
of co-infection with HIV. In truckers, maximum seropositivity was associated with HIV (19%), i.e., significantly
higher than that of HBV (6%; P < 0.01) and HCV (3%; P < 0.01). In STD clinic attendees, the highest rate of
seroprevalence was that of HIV (4.3%), followed closely by that of HBV (3.7%), and HCV (2.6%). The present
study emphasizes the need for early screening for HBV and HCV infections of all those also at high risk for HIV
infection, and the results highlight the importance of relevant targeted interventions in these populations.
HIV TRIDOT; J. Mitra). HBsAg and anti-HCV antibodies
were detected by third-generation enzyme linked immunoassays (Hepalisa; J. Mitra and HCV Microlisa; J. Mitra). The
study received the approval of the hospital ethics committee.
The chi-square test was used for statistical analysis.
The details of risk factors of the three high-risk populations and the serological test results are given in Tables 1 and
2, respectively.
The reported prevalence rates of HIV, HBV, and HCV in
IDUs, in whom the parentral route is the predominant mode
of transmission, vary widely between developing countries
and in the USA, a developed country (3,4). In India as well,
the pattern is not uniform. The prevalence of HIV in the
present study (16.6%; Table 2) was lower than that reported
in studies from Delhi (36.9%) and Manipur (59.6%), but was
higher than that of a study from Kolkata (1.46%) (5-7). As
regards HBV, the observed rate (17.8%; Table 2) was consistent with that in a study from Kolkata (20%), but lower than
that reported in a study from Delhi (39.59%) (4,8). As
regards HCV infection, the incidence rate was 33.7% (Table
2), which corroborates with the findings from Delhi (36.45%),
but was lower than that from studies in Kolkata (42.92%)
and Manipur (92%) (6-8). This variation could be due to
differences in the IDUs studied. A high rate of seropositivity
has been observed in Manipur, a northeastern state of India,
and this high rate is primarily due to the sharing of contaminated needles (9). On the other hand, the majority (63.1%) of
the present sample was semi-literate and unskilled workers
who shared needles, although 36.9% were literate and skilled
workers who were using individual disposable syringes. A
statistically significant difference (P < 0.01) observed between
the prevalence rates of HIV and HCV infections in our study
(Table 2), which demonstrates that although all the three
infections in IDUs were transmitted via the parenteral route,
this route was the major route for the transmission of HCV.
HCV-RNA positivity was observed in almost one-third of the
HCV antibody-positive IDUs, which indicates that many
HCV-positive cases were chronic in nature. An additional risk
Hepatitis B virus (HBV) and hepatitis C virus (HCV) share
common route of infection and have high degree of epidemiological similarity with respect to high-risk groups with
concomitant human immunodeficiency virus (HIV) (1,2).
However, the prevalence rates of these infections vary according to the risk factors involved and the initial burden of
infectious markers in the community, which may differ not
only from country to country, but also in different regions of
the same country. Amritsar, a large town in Northern India,
adjacent to the border with Pakistan, is a seat of international
drug trafficking and is home to a large number of the young
people prone to drug addiction. This region also has a high
number of highly mobile long-distance truckers. A third group
of high-risk individuals is sexually transmitted disease (STD)
clinic attendees. These high-risk groups are important to consider in terms of the HIV epidemic. Therefore, the present
study was undertaken in order to determine the prevalence of
HIV, HBV (hepatitis B surface antigen [HBsAg]), and HCV
(anti-HCV antibodies) infections among injecting drug users
(IDUs), truckers, and attendees of an STD clinic in Amritsar
in the state of Punjab in Northern India.
For a period of 2 years, 157 IDUs who were first-time
patients at a detoxification center, 100 truckers who were
members of a local trucker’s union, and 350 first-time
attendees of an STD clinic at the hospital affiliated with the
Government Medical College, Amritsar were included in the
study. Their complete and relevant histories regarding sexual
behavior, drug abuse, and other risk factors was recorded.
Blood samples were collected after written consent was obtained from each subject, and after pretest counseling had
been provided. HIV antibodies were detected by ELISA (HIV
Microlisa; J. Mitra & Co., New Delhi, India), and reactive
samples were subjected to two other rapid/simple tests
(Comb AIDS-RS; SPAN Diagnostics, Ltd., Surat, India and
*Corresponding author: Mailing address: 113, Race Course Road,
Amritsar-143001 (Punjab), India. E-mail: neerjarajender@hotmail.
com
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Table 1. Risk factors among three high-risk groups
Characteristic
and risk factor
Multiple sex
partners (MSP)
MSM
Condom usage
Drug addiction
Oral
Intravenous
Needle sharing
Injecting drug
user (n = 157)
Male
Female
(n = 155)
(n = 2)
Trucker
(n = 100)
Male
Female
(n = 100)
(n = 0)
STD clinic attendee
(n = 350)
Male
Female
(n = 180)
(n = 170)
141 (90.9)
0
94 (94)
–
180 (100)
4 (2.5)
0
0
0
10 (10)
13 (13)
–
–
0
14 (7.8)
0
0
0
2 (100)
0
82 (82)
6 (6)
0
–
54 (30)
13 (7.2)
3 (1.7)
0
155 (100)
155 (100)
32 (20.6)
21 (12.35)
Figures in parenthesis represent percentage.
MSM, man who have sex with men.
Table 2. Prevalence of HIV, HBV, and HCV among three high-risk groups
Infectious marker
Injecting drug user
(n = 157)
No. positive (%)
Overall prevalence HIV
Overall prevalence HBV
Overall prevalence HCV
Prevalence - HIV alone
Prevalence - HBV alone
Prevalence - HCV alone
Coinfection - HIV, HBV & HCV
Coinfection - HIV & HBV
Coinfection - HIV & HCV
Coinfection - HBV & HCV
26 (16.6)a
28 (17.8)b
53 (33.7)c
11 (7.0)
22 (14.0)
38 (24.2)
2 (1.3)
2 (1.3)
11 (7.0)
2 (1.3)
High-risk population
Trucker
STD clinic attendee
(n = 100)
(n = 350)
No. positive (%)
No. positive (%)
19 (19.0)d
6 (6.0)e
3 (3.0)f
16 (16.0)
4 (4.0)
2 (2.0)
0
2 (2.0)
1 (1.0)
0
15 (4.3)g
13 (3.7)h
9 (2.6)i
5 (1.4)
6 (1.7)
6 (1.7)
0
7 (2.0)
3 (0.85)
0
Statistical analysis
Injecting drug users: a & b (P > 0.05) Not significant; a & c (P < 0.05) Significant.
Truckers
: d & e (P < 0.01) Significant; d & f (P < 0.01) Significant.
STD attendees
: g & h (P > 0.05) Not significant; g & i (P > 0.05) Not Significant.
attendees (Table 2); this rate is lower than that reported in
another study (13). One possible explanation for this discrepancy could be difference in the sexual behavior of the populations attending STD clinics in the two different regions. A
seroprevalence of 3.7% for HBsAg was determined in our
study, and this difference (P > 0.05) was not significantly
different from the HIV seroprevalence (Table 2). This finding
indicates that this population is almost at equal risk of both
HBV and HIV infections, possibly because of multiple sex
partners, the presence of genital ulcer diseases, and/or the
absence of HBV-interventional strategies, in particular the
lack of hepatitis B vaccination among those in our sample.
The prevalence of HCV was 2.6% in this subgroup, which
could be ascribed to the effects of tattooing, and to the sharing of razors, toothbrushes, and needles, because the sexual
route is not an efficient mode of transmission of HCV.
In India, the carrier rate of HBV is approximately 3%, and
antibodies against HCV are present in 1 - 1.5% of the general
population (14). Therefore, high prevalence rates of these
infections in the IDUs, truckers, and STD attendees in our
study reveal that these groups have a high probability of infection with HBV and/or HCV, regardless of the status of HIV
infection. As hepatopathic viral infections in HIV-positive
individuals are often chronic and subclinical, and co-infection
can lead to more aggressive liver disease, early screening
(monitoring) of all high-risk individuals for HBV and HCV,
together with HIV screening, is necessary. In addition, it has
behavior in IDUs is multiple-partner sex; this behavior was
observed in 90% of our sample (Table 1). This finding could
account for the high prevalence of HIV and HBV infections
of our study, as both diseases are efficiently transmitted via
the sexual route (2).
Nationwide, 15 - 30% of truckers are reported to be HIVpositive (10). Our findings of 19% seropositivity fell within
this range, and these results are directly related to the high
prevalence of significant risk factors of this population. The
majority of truckers in our study were sexually active and
had long been occupied in this profession, forcing them to be
away from their homes for long periods of time. These individuals had highly promiscuous sexual behavior (heterosexual
94%, homosexual 10%), and reported low and irregular condom use (Table 1). Seropositivity for HBV was 6% (Table 2)
in this group. Two other studies have reported 15.2 and 5.9
and 5.1 and 21.2% seropositivity for HIV and HBV infections, respectively (11,12) among truckers. Such findings
suggest that truckers are at high risk of acquiring both HIV
and HBV infections. In the present study, anti-HCV antibodies were detected in 3% of the truckers, which is significantly lower (P < 0.01) than the HIV prevalence rate (19%)
(Table 2). This discrepancy could be due to sexual transmission, which is the primary route of transmission of HIV and
HBV infections among truckers, and is not an efficient means
of transmission of HCV (1,4).
HIV seropositivity was observed in 4.3% of STD clinic
80
become crucial to extend vigorous, targeted interventions by
establishing health education services, support for behavioral
changes (e.g., campaigns for safer sexual practices), public
awareness of STDs, and by making both condoms and hepatitis B vaccination available and acceptable options.
7.
8.
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