Comorbidities among HIV-infected injection drug users in Chennai, India.

BACKGROUND & OBJECTIVE: HIV-infected injection drugs users (IDUs) are known to have high rates of co-infections. A few reports exist on comorbidities among HIV-infected IDUs in India. We carried out a retrospective study to analyse data on comorbidities in India and treatment challenges faced when treating HIV-infected IDUs in India. METHODS: A retrospective chart review of 118 HIV-infected IDUs who accessed care at the YRG Centre for Substance Abuse-Related Research, Chennai, between August 2005 and February 2006 was done. Demographic, laboratory and clinical information was extracted from medical records. Descriptive demographic and clinical characteristics and distributions of comorbidities across CD4 cell count strata were analysed. RESULTS: All IDUs were male with a median age of 35.5 yr. The majority were married with average monthly income less than INR 3000 per month. The prevalence of hepatitis B and C infections were 11.9 and 94.1 per cent, respectively. Other common co-morbidities included oral candidiasis (43.2%), tuberculosis (33.9%), anaemia (22.9%), lower respiratory tract infections (16.1%), cellulitis (6.8%), herpes zoster (9.3%) and herpes simplex (9.3%). Among participants with CD4+ < 200 cells/microl, the prevalence of TB was 60 per cent. INTERPRETATION & CONCLUSION: IDUs in Chennai were commonly co-infected with HBV, HCV and tuberculosis, complicating use of antiretroviral and anti-tuberculous therapy. The current regimens available for the management of HIV and TB in India may need to be re-assessed for IDUs given the potential for increased rates of hepatotoxicity.

Usefulness of an observational database to assess antiretroviral treatment trends in India.

BACKGROUND: Human immunodeficiency virus (HIV) observational cohorts, which are established worldwide, support comparative studies across different regions. They have played an important role in developing international and country-specific HIV treatment and care guidelines. We describe the YRG CARE Chennai HIV observation database (YCHOD) and highlight its utility in monitoring trends in antiretroviral treatment use and HIV disease outcomes in India. METHODS: The baseline characteristics, time trends in antiretroviral treatment, trends in incidence of acquired immune deficiency syndrome (AIDS)-defining illness and mortality following the introduction of highly active antiretroviral therapy (HAART) in India were assessed using YCHOD. RESULTS: Till January 2005, 7647 HIV-positive patients had registered in YCHOD. A majority of the patients were men (69%) and had a mean age of 32 years. At baseline, 14% had an existing AIDS-defining illness. Among patients who required therapy by the WHO criteria, 14% initiated antiretroviral therapy (ART) in 1996 and 35% in 2000. Since the dramatic cost reduction of generic HAART in 2001, there has been an increase in the proportion of patients receiving ART to 57% in 2004. In patients who were started on HAART, the incidence of at least one AIDS-defining illness was 2% in 2001, and this decreased to 0.48% in 2004. CONCLUSION: We feel observational cohorts are useful as a surveillance tool for monitoring trends in treatment and disease progression. Standardized observational data collected systematically on HIV-infected individuals will help to assess the cost-effectiveness of ART and in planning ART strategies for India.