Clinical features & HIV progression as observed longitudinally in a cohort of injecting drug users in Manipur.

Study on a cohort of injecting drug users (n = 76) was initiated in June, 1994 with the objective of documenting the clinical presentation of HIV and its progression with time. The participation in the study was voluntary. An informed consent was taken from the subjects before they were enrolled in the study. The subjects were followed up every 45 days for clinical and laboratory examination and analysis made after 27 months of the study. The study had a follow-up rate of 65 per cent. The commonest feature observed in stage I (n = 47) was persistent generalized lymphadenopathy (83%), in stage II (n = 40) was body weight loss < 10 per cent (37.5%), in stage III (n = 32) was pulmonary tuberculosis (56.3%) and in stage IV (n = 9) was cryptosporidial diarrhoea > 1 month (3 cases). Kaposi's sarcoma was detected in one subject. The median time taken for conversion from the date of seroconversion to stage III of HIV infection was observed to be 3.15 yr (95% CI = 2.98-3.58 yr). The rate of HIV progression seems to be significantly faster than that observed in industrialized countries. Age is a cofactor in the rate of progression of HIV. Tuberculosis is the commonest opportunistic infection.

A cross-sectional study on factors including HIV testing and counselling determining unsafe injecting practices among injecting drug users of Manipur.

In India, a steep increase in the prevalence of HIV (0% to 50% within six months) among the IDUs has been reported in Manipur, a north eastern state in 1990. In spite of large scale intervention program like educational campaign and widespread voluntary HIV testing in this state, the infection has quickly spread to the heterosexual population at large. The determinants of risk taking behaviors like sharing of unclean needle among the IDU population has been explored in this paper. A cross sectional study has been carried out among all of the 488 IDUs who attended any detoxification centers and prison during last two years at Imphal, the capital city of this state. Self reported behaviors based on the pre-scheduled interview were recorded and participation rate was satisfactory. The data was compared to a similar survey carried out by us in 1990. Although there has been decline in risk behavior among the IDUs, a logistic regression analysis reveals that unsafe needle sharing behavior is not influenced by the knowledge on HIV transmission, educational status or history of HIV testing or serostatus of the individual. The limitation of cross sectional nature of the study, bias due to collection of data in prison, self reported behavior, possible differences with street samples of the addict are discussed.