Indian J Sex Transm Dis Indian J Sex Transm Dis
Official Publication of the Indian Association for the Study of Sexually Transmitted Diseases
Indian J Sex Transm Dis
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   2009| January-June  | Volume 30 | Issue 1  
    Online since September 5, 2009

 
 
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ORIGINAL ARTICLES
Cost of treatment: The single biggest obstacle to HIV/AIDS treatment adherence in lower-middle class patients in Mumbai, India
Eknath Naik, Beata Casanas, Amar Pazare, Gauri Wabale, John Sinnott, Hamisu Salihu
January-June 2009, 30(1):23-27
DOI:10.4103/0253-7184.55476  PMID:21938110
Background: This study analyzes the social, economic and behavioral factors most frequently associated with adherence to Highly Active Antiretroviral Treatment (HAART) in urban India. Materials and Methods: Data was collected in a metropolitan teaching hospital in Mumbai using a cross-sectional survey design. Face-to-face interviews were conducted with 152 patients. The semistructured survey included both open and closed ended questions on socio-demographic, economic and behavioral factors. Factors affecting treatment adherence were analyzed. Results: The median age of patients was 40.5 years, 73% were males and all were heterosexual. Patients had been given ART from six months to five years (median is equal to 3.5). Ninety per cent lived at home and commuted to the clinic by bus or train. Behaviorally, 37% were sexually active, but only 55% used condoms. In assessing adherence, income, education, knowledge of their drugs, transportation, side effects, cost of treatment, distance from clinic and personal clinic satisfaction were analyzed. We found that 75% of patients reported cost of HAART to be the single greatest obstacle to adherence (p less than 0.01). Additionally, those claiming knowledge of their drugs were 2.3 times more likely to be adherent (p less than 0.03), while those who abused drugs or alcohol were 53% less likely to be adherent (p less than 0.03). There was no correlation with other factors. Conclusions: Our study population was representative of the lower middle class of India. It found that an educated, employed group considered the cost of treatment to be a significant obstacle for successful therapy. Additionally, it showed a significant increase in adherence when patients had knowledge of their HAART medications. Therefore, reducing the cost of medication as well as teaching about antiretroviral medications are both likely to improve adherence.
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Frequency of HBV, HCV and HIV infections among hospitalized injecting drug users in Kashan
M Sharif, Alireza Sherif, Mansour Sayyah
January-June 2009, 30(1):28-30
DOI:10.4103/0253-7184.55477  PMID:21938111
Context: Infectious diseases including HIV and viral hepatitis constitute a major health issue, with high prevalence among injecting drug users (IDUs). Aims: The present study assessed the frequency of HIV, and hepatitis B and C viruses (HBV and HCV) among 200 IDUs, hospitalized between 2001 and 2006, in Shahid Beheshti Hospital of Kashan, Iran. Setting and Design: A population-based cross-sectional study in Iran. Materials and Methods: A total of 200 subjects participated in this study. Serological markers including HBsAg, anti-HCV antibodies and HIV were assessed by ELISA method using Monobid kits made in US. Demographic data was collected by using a questionnaire, which was designed by a researcher. Statistical Analysis Used: Frequencies were determined by employing SPSS:PC version 15.0, and Chi-square and Fisher's exact tests were used to compare proportions. Results: The mean age of subjects was 36.5 ± 10.2 years. Approximately 88.5% (177 cases) were male and 11.5%. (23 cases) were female. The frequency of positive infection test results for males with respect to HBV, HCV, and HIV was 4% (8 cases), 10.5% (21 cases), and 1.5% (3 cases); and for females it was 0.5% (1 case), 1.5% (3 cases), and 0% (0 case), respectively. Conclusion: This study demonstrates that the frequency of HBV, HCV, and HIV infection in the IVD user in Kashan, Iran, is relatively high and this condition is more serious in male than female drug addicts. It is very important, especially for health providers and policy makers, to recognize the risk factors of HBV, HCV and particularly HIV infection in this area and design effective preventive programs.
  6 3,575 171
Profile of attendee for voluntary counseling and testing in the ICTC, Ahmedabad
Rashmi Sharma
January-June 2009, 30(1):31-36
DOI:10.4103/0253-7184.55479  PMID:21938112
Human immunodeficiency virus (HIV) testing with pre and postcounseling aiming behavior change communication (BCC) for core/bridge population is the main element of holistic model of health care. Voluntary counseling and testing center (VCTC) remodeled as integrated counseling and testing center (ICTC)-general is the 'gateways to care'. It was hospital-based cross sectional study of 811 clients registered at VCTC of Kesar SAL Hospital from January to December 2007. These patients either came voluntarily or by referral. Anonymous and unlinked information was collected on predesigned schedule and data was analyzed to find out the seropositivity, demographic characteristics (among attendees and HIV positives), and epidemiological vulnerability of different segments of population. Among the attendees, 64% were males, 75% in the age group of 20-49 years, 80% were currently married, and 70% were literate (<10 th standard). Also, 66% clients were gainfully employed, while one-fourth were housewives; 98% lived with families, 75% were referred by doctors, and only 19% walked in directly. Dominant reason for visiting ICTC was the history/presence of high risk behavior (HRB) (34%). 35% indulged in heterosexual route; other HRB (men having sex with men or MSM and injecting drug users or IDU) were rare. There were more positive among males, 20-49 years of age group, those living singly, unmarried, divorcee, widow(er) and separated. Similarly positives were more amongst illiterates, less educated and those engaged in unskilled and semi skilled jobs. Adolescent students (>14 years) accounted for one-fifth of the total positives. Direct walk in clients were more positive compared to those referred by doctors. Those who confessed of history/presence of HRB accounted for all except 3 (85%) positives. 51% indulged in heterosexual sex followed by MSM (8%). Overall sero positivity was 4.8%; high in males, 30-49 years age, unmarried and divorcee etc. Sero prevalence decreased with improvement in education and also with improvement in job nature. It was also high in those living alone compared to those staying with their family. Such study shall in evaluating the performance of ICTC and designing the information, education, and communication (IEC) to increase the client uptake in terms of quality and quantity.
  5 5,449 294
Prevalence and clinical presentation of Cryptococcal meningitis among HIV seropositive patients
Vasant Baradkar, M Mathur, A De, S Kumar, M Rathi
January-June 2009, 30(1):19-22
DOI:10.4103/0253-7184.55474  PMID:21938109
A total of 573 HIV seropositive and clinically suspected cases of Cryptococcal meningitis were included in the study, from January 2006 to January 2007. CSF samples were processed by negative staining with 10% Nigrosin, cultured on Sabouraud's dextrose agar, biochemical tests, such as urease test and brownish growth in Niger seed agar. The prevalence of Cryptococcal meningitis was found to be 2.79%. The most common signs and symptoms were: fever (100%), headache (100%), altered sensorium (100%), and neck stiffness (90%). All the patients responded to intravenous Amphotericin B treatment.
  5 4,785 390
CASE REPORTS
Genital elephantiasis as a complication of chromoblastomycosis: A diagnosis overlooked
Nidhi Sharma, YS Marfatia
January-June 2009, 30(1):43-45
DOI:10.4103/0253-7184.55486  PMID:21938115
Over the decades, causes of genital elephantiasis have changed only to become elusive to etiological diagnosis. This is a case of 20 year old male who presented with genital elephantiasis occurring due to lymphatic obstruction caused by chromoblastomycosis and super added erysipelas. The diagnosis of chromoblastomycosis was clenched by biopsy. We describe this case for the rarity of its occurrence.
  3 8,874 218
LETTERS TO EDITOR
Recurrent venous thromboses in HIV-2 patient
Uday Arun Phatak
January-June 2009, 30(1):57-58
DOI:10.4103/0253-7184.55480  PMID:21938122
  3 2,771 127
ORIGINAL ARTICLES
Clinico-epidemiological profile of HIV/TB coinfected patients in Vadodara, Gujarat
Ragini Ghiya, Eknath Naik, Beata Casanas, Ricardo Izurieta, Yogesh Marfatia
January-June 2009, 30(1):10-15
DOI:10.4103/0253-7184.55472  PMID:21938107
Introduction: The HIV epidemic has posed major, almost insurmountable, challenges to tuberculosis control efforts across the world. This study analyzes the prevalence and disease profile of HIV/AIDS coinfection in Vadodara, Gujarat, India. Materials and Methods: This study was conducted in the HIV Referral Clinic at Vadodara, India. Using convenience sampling method, 246 HIV-positive patients coinfected with tuberculosis were enrolled. A detailed history of every case was taken followed by a thorough physical examination. Baseline and follow up laboratory and radiological investigations were carried out as appropriately warranted. Results: Out of 500 HIV positive patients who presented to the clinic during the study period, 246 (49.2%) were coinfected with tuberculosis. Out of 246 coinfected cases, 35(14.2%) presented with demonstrable and documented tuberculosis whereas in 211(85.8%) cases, tuberculosis was extemporaneously detected by actively screening the patients. Sixty nine percent of patients were males, while 10.5% of cases were below fifteen years of age. The majority (68%) of patients had manifestations of extrapulmonary tuberculosis; but pulmonary tuberculosis, which is a more common presentation in HIV-negative cases, was present in only fifty five percent of this segment of the population. Abdominal tuberculosis was the most common site (74%) amongst extrapulmonary tuberculosis involvement, followed by clinically palpable lymph nodes (22%) and pleural effusion (17%). Conclusion: The prevalence of tuberculosis in HIV-positive patients in this study (49%) was substantially higher than that reported in previous studies. However, this could be attributed to a selection and/or a diagnosis bias. This study used abdominal ultrasound for the diagnosis of tuberculosis which might have obviously increased the prevalence. Moreover, these cases were not confirmed by biopsy or other definitive TB diagnostic methods.
  3 6,540 585
CASE REPORTS
Oral squamous papilloma and condyloma acuminatum as manifestations of buccal-genital infection by human papillomavirus
Helena Lucia B dos Reis, Priscila C Rabelo, Maria Rubia F de Santana, Dennis Carvalho Ferreira, Antonio C Filho
January-June 2009, 30(1):40-42
DOI:10.4103/0253-7184.55484  PMID:21938114
Genital infection by human papillomavirus (HPV), a sexually transmitted disease (STD), has increased considerably due to the changes in sexual behaviour and an increase in the practice of oral sex. HPV, in a parallel manner, has been closely studied due to its oncogenic potential. We present the case of a 27-year-old patient, with a multi-partner sexual history and frequent practice of oral sex, who suffered from warts lesions on the genitalia and tongue. Squamous papilloma was diagnosed from a tongue biopsy. The treatment of the oral lesion was by way of surgery, without relapse in the first two years. Our discussion in this report is regarding the HPV infection in the oral cavity.
  2 9,641 356
LETTERS TO EDITOR
Correct and consistent use of condoms
JP Majra
January-June 2009, 30(1):53-53
DOI:10.4103/0253-7184.55487  PMID:21938119
  2 5,834 509
Detection of enteric parasites in HIV positive patients with diarrhea
A De, K Patil, M Mathur
January-June 2009, 30(1):55-56
DOI:10.4103/0253-7184.55483  PMID:21938120
  2 2,447 199
ORIGINAL ARTICLES
Reproductive tract infections in HIV positive women: A case control study
Archana Sharma, YS Marfatia, Megha Modi
January-June 2009, 30(1):16-18
DOI:10.4103/0253-7184.55473  PMID:21938108
Background: Human immunodeficiency virus (HIV) infection primarily affects women during their reproductive years, and the coexistence of reproductive tract infections (RTIs) is not surprising given the fact that HIV is mainly acquired via heterosexual contact. Aim: The aim of the study was to compare the occurrence of RTIs among infected and noninfected women. Materials and Methods: A case control study of 83 HIV positive women, tested by two enzyme linked immunosorbent assay (ELISA) and a matched control of 87 HIV negative women were screened for RTIs. They were submitted to gynecological examination and cervical cytology. Results: The mean age for HIV positive women was 30 years and that for HIV negative women was 27 years. 18% HIV positive women had menstrual irregularities compared to 6% in seronegative group ( P = 0.024). Vaginal infections including sexually transmitted infections (STIs) were found in 47 (57%) HIV positive women and 30 (34%) HIV negative women ( P = 0.0037). Vaginal candidiasis was the most common infection (34%) in HIV positive women, followed by trichomoniasis (12%). Human papilloma virus (HPV) infection was seen in nine HIV positive women versus none in HIV negative women. Cervical cytology showed inflammation in 53 (64%) HIV positive women compared to 27 (31%) HIV negative women ( P = 0.000023). Genital neoplasia, including carcinoma in situ was observed in 2 (2.5%) HIV positive women and in none of the HIV negative women. Conclusion: It is seen that reproductive tract morbidities are common in HIV positive women. So it is imperative that HIV positive women have a complete gynecological evaluation including a Papanicolaou (PAP) smear with aggressive screening of STIs.
  2 3,907 359
RESIDENTíS PAGE
Cytolytic vaginosis: A review
Anupama Suresh, Aparna Rajesh, Ramesh M Bhat, Yashaswi Rai
January-June 2009, 30(1):48-50
DOI:10.4103/0253-7184.55490  PMID:21938117
  2 8,586 488
LETTERS TO EDITOR
Profile of sexually transmitted diseases in children at Rohtak
VK Jain, Surabhi Dayal, Kamal Aggarwal, Sarika Jain
January-June 2009, 30(1):53-55
DOI:10.4103/0253-7184.55491  PMID:21938118
  1 2,988 188
ABSTRACTS
Human papillomavirus vaccine
Priyanka Singhal, YS Marfatia
January-June 2009, 30(1):51-52
  - 3,133 297
CASE REPORTS
Wolf in lamb's skin: Vulval carcinoma mimicking bartholin gland abscess
Ashwini U Nayak, N Sundari, G Nandini
January-June 2009, 30(1):46-47
DOI:10.4103/0253-7184.55489  PMID:21938116
Vulvar cancer is a rare malignancy, representing approximately 4% of the female genital tract malignancies. This case emphasizes the importance of considering the unusual diagnosis of vulval cancer in a young woman when confronted with a large or recurrent Bartholin gland lesion, and underlines the need for careful pathological examination of such specimens.
  - 3,542 160
Progressive varicella syndrome in the setting of pediatric AIDS: An eye opener
Subramania M Adityan, N Nagarajan, D Amal Raja, R Shanmuganathan, G Lakshmipriya
January-June 2009, 30(1):37-39
DOI:10.4103/0253-7184.55481  PMID:21938113
Varicella zoster virus (VZV) infections are known to be atypical and severe in immunocompromised patients. An eight-year-old girl presented with extremely painful, atypical skin lesions and features of meningitis and pneumonitis. On investigation, she was found to be human immunodeficiency virus (HIV) infected, with very low CD4 count. A diagnosis of 'progressive varicella syndrome' was made, and the child was started on antiretroviral therapy and IV acyclovir. This resulted in a complete resolution of all the clinical features. However, the skin lesions promptly relapsed when acyclovir was withdrawn. Oral Acyclovir was started, and had to be continued to keep the disease under control.
  - 2,408 153
LETTERS TO EDITOR
Treatment of balanitis of Zoon's with tacrolimus 0.03% ointment
Ram Chander, Taru Garg, Sushil Kakkar, Saurabh Mittal
January-June 2009, 30(1):56-57
DOI:10.4103/0253-7184.55482  PMID:21938121
  - 5,973 246
NEWS AND FILLER
Diagnostic approach to gonorrhoea: Limitations
Rachna Verma, Seema Sood, Manjubala , Arti Kapil, VK Sharma
January-June 2009, 30(1):61-64
DOI:10.4103/0253-7184.55475  
  - 2,964 327
PHOTO QUIZ
Unilateral vulval swelling: What is the diagnosis?
Stuti Mahajan, Jaspreet Sarna, YS Marfatia
January-June 2009, 30(1):59-60
DOI:10.4103/0253-7184.55478  PMID:21938123
  - 3,398 230
REVIEW ARTICLE
CCR5 inhibitors: Emerging promising HIV therapeutic strategy
Padmasri Kutikuppala Surya Rao
January-June 2009, 30(1):1-9
DOI:10.4103/0253-7184.55471  PMID:21938106
Though potent anti-HIV therapy has spectacularly reduced the morbidity and mortality of human immunodeficiency virus (HIV)-1 infection in the advanced countries, it continues to be associated with substantial toxicity, drug-drug interactions, difficulties in adherence, and abnormal cost. As a result, better effective, safe antiretroviral drugs and treatment strategies keep on to be pursued. In this process, CCR5 (chemokine receptor 5) inhibitors are a new class of antiretroviral drug used in the treatment of HIV. They are designed to prevent HIV infection of CD4 T-cells by blocking the CCR5. When the CCR5 receptor is unavailable, 'R5-tropic' HIV (the variant of the virus that is common in earlier HIV infection) cannot engage with a CD4 T-cell to infect the cell. In August 2007, the FDA approved the first chemokine (C-C motif) CCR5 inhibitor, maraviroc, for treatment-experienced patients infected with R5-using virus. Studies from different cohort in regions, affected by clad B HIV-1, demonstrate that 81-88% of HIV-1 variants in treatment naïve patients are CCR5 tropic and that virtually all the remaining variants are dual/mixed tropic i.e., are able to utilize both CCR5 and CXCR4 coreceptors. In treatment experienced patients, 49−78% of the variants are purely CCR5 tropic, 22−48% are dual/mixed tropic, and 2-5% exclusively utilize CXCR4. A 32 bp deletion in the CCR5 gene, which results in a frame shift and truncation of the normal CCR5 protein, was identified in a few persons who had remained uninfected after exposure to CCR5 tropic HIV-1 virus. This allele is common in white of European origin, with prevalence near to 10%, but is absent among East Asian, American Indian, Tamil Indian, and African ethnic groups. HIV-infected individuals, who are heterozygous for CCR5 delta 32, have slower rates of disease progression. The currently available data supports the continuation of the development of CCR5 antagonists in different settings related to HIV-1 infection. If safety issues do not emerge, these compounds could be positioned for use from very early stage of HIV infection to salvage strategies that would be an emerging therapeutic novel strategy for HIV/AIDS patients.
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