Prevalence of occult hepatitis B & C in HIV patients infected through sexual transmission.

BACKGROUND: Prevalence of Hepatitis B virus (HBV) and Hepatitis C virus (HCV) markers including active and occult infection has not been described in diverse cohorts among HIV-infected patients in India. Earlier studies have explained the role of HBV/HCV co-infection in cohorts of injection drug users (IDUs) but the sexual co-transmission of HBV/ HCV is not completely understood. OBJECTIVE: The objective of this study was to assess the prevalence of occult HBV & HCV infection in HIV positive sexually acquired transmission risk group. MATERIALS AND METHODS: 58 sexually acquired HIV positive patients were taken up for the study of occult HBV/HCV co-infection. Data on demographics, sexual behaviour, sexually transmitted diseases (STD), medical history, laboratory tests viz., serum ALT and CD4 count were recorded. HBV serology included HBsAg, anti HBs, IgG anti HBc and HBV DNA (PCR). HCV serology included anti HCV & HCV RNA (RT-PCR). RESULTS: Occult HBV infection (HBV DNA) was observed in 12.2% (7/58 with HBsAg -ve and IgG anti HBc +ve subjects) while an overall prevalence of HBV DNA was 13.7% (12% occult & 1.7% in HBsAg+ve patients). Out of 58 HIV positive patients 29.3% demonstrated reactivity for any marker of past or current HBV infection. (HBsAg 1.7%, anti HBs 10.3% anti HBc IgG 17.2%). 4/58 (6.8%) revealed anti HCV positivity along with HCV RNA positivity by RT-PCR while 6/58 (10.3%) individuals revealed an occult HCV infection (anti HCV negative). The overall HCV RNA prevalence was 17.2%. 2 out of 58 (3.4%) individuals were positive for occult infection of both HBV DNA & HCV RNA (Triple infection HIV/HBV/ HCV). The HBV/HCV co-infected group (n = 18) showed a significantly high ALT (114.3 + 12.3 U/I) & low CD4 count (202.5 + 33.7 cells/mm3). The percent prevalence of HBV/ HCV co-infection was higher in the illiterate group, in men less than 30 years of age, and in those who were married and exhibited polygamous activity. CONCLUSIONS: The study demonstrated that in HIV infected patients testing only serological viral markers like HBsAg, antiHBcIgG & anti HCV, fails to identify the true prevalence of co-infection with HBV & HCV. Qualitative PCR for HBV DNA & HCV RNA detects co-infection in patients who are negative for serological markers. Also, in subjects who had only a sexual risk factor for parenterally transmitted infections, HIV may enhance the sexual transmission of HBV and HCV.

Incidence of cardiac autonomic neuropathy and its correlation with retinopathy, micro-albuminuria and glycated haemoglobin in non-insulin dependent diabetes mellitus.

Forty non-insulin dependent diabetes mellitus (NIDDM patients were subjected to bedside evaluation of cardiovascular autonomic reflexes. Autonomic neuropathy was detected in 23 patients (57.5%); orthostatic hypotension in 6 (15%), abnormal blood pressure response to sustained handgrip in 8 (20%), abnormal Valsalva ratio in 10 (25%), abnormal heart rate response to deep breathing in 12 (30%) and abnormal heart rate response to standing in 11 patients (27.5%). Incidence of parasympathetic neuropathy was 57.5% in comparison to 20% sympathetic neuropathy One abnormal cardiac reflex was seen in 6 (15%), 2 in 13 (32.5%) and 3 or more in 4 patients (10%). Raised glycated haemoglobin was seen in 17 patients,retinopathy in 3 and micro-albuminuria in 11 patients with autonomic dysfunction and in 13, 0 and 3 patients respectively in NIDDM patients without autonomic neuropathy. Positive correlation of cardiac autonomic neuropathy was seen with retinopathy and micro-albuminuria.