A pilot study on the effects of curd (dahi) & leaf protein concentrate in children with protein energy malnutrition (PEM).

BACKGROUND & OBJECTIVE: In protein-energy malnutrition (PEM) there is a significant impairment of immunity, both cell-mediated and humoral, which may be reversed with nutritional rehabilitation. With the use of probiotics like curd (dahi) and micronutrient-rich leaf protein concentrate (LPC), this immune recovery may be hastened. This study was conducted to assess the impact of supplementation of curd and LPC on nutritional status, and immunity as assessed by anthropometry, haemoglobin, ferritin levels, T- cell subpopulation and C-reactive protein (CRP), in children suffering from PEM. METHODS: Eighty moderate to severely malnourished children (1-5 yr) were randomized to receive either curd or LPC in addition to WHO recommended two-step diet over 15 days. Nutritional, immunological and haematological parameters were measured before and after supplementation and compared within the groups. RESULTS: The change in weight, haemoglobin level and CD4:CD8 T-cell subpopulation was significant in both the groups after supplementation. Response of CRP was blunted in PEM. Serum ferritin decreased significantly after supplementation in both groups. INTERPRETATION & CONCLUSION: Curd and LPC when added to diet of malnourished children, may have therapeutic value by accelerating immune recovery. More studies need to be done on a larger sample to confirm these findings.

Pediatric HIV infection.

OBJECTIVE: The present cross sectional study was undertaken to study clinical profile of HIV infection in children in Northern India. METHODS: 64 children from newborn to eighteen years, presenting for confirmation of diagnosis of HIV infection or monitoring of CD4-CD8 counts in confirmed cases, were evaluated. Children were categorized as per CDC classification of Pediatric HIV. The diagnosis was confirmed by serological tests or PCR assay. CD4-CD8 counts were done by FACS Count. RESULTS: Majority of the children were between 18 months to 5 years. Adolescents comprised 24% of the case. 51.5% children were infected through the mode of mother to child transmission. 39% of the case was transfusion-mediated. Unsafe medical injections probably contributed to 6.2% and heterosexual promiscuity led to 3.1% cases. Clubbing, not described in Indian studies so far, was seen in 9.3% cases. CONCLUSIONS: HIV infection is a chronic childhood disease extending into adolescence, and contaminated blood and unsafe medical injections are still important routes of HIV transmission in India.

A cross sectional serological study of the co-infection of hepatitis b virus, hepatitis c virus and human immunodeficiency virus amongst a cohort of idus at Delhi.

A cross-sectional study was undertaken to find out co-prevalence of various infectious markers like Human Immunodeficiency Virus (HIV), Hepatitis B virus (HBV), Hepatitis C virus (HCV) and Syphilis infection amongst a cohort of injecting drug users (IDUs) in the city of Delhi. A total of 246 IDUs were enrolled during the 3 months period of the study. The results revealed a high prevalence of the viral markers studied i.e., HBV-39.59%, HCV-36.45%, HIV-36.99% and Syphilis-6.09%. A single marker infection was detected amongst 9.14% for HBV, 8.37% for HCV, 4.87% for HIV and 0.83% for Syphilis in samples tested for multiple markers. All the four markers could be detected in 1.76%. Amongst 11.16% and 27.9% of these samples, three and two markers respectively could be detected. The study revealed the problem of IV drug use and high prevalence of infectious markers including HIV in certain populations of Delhi and emphasizes the need for relevant interventions in these localised pockets.

Synergistic immunosuppression by candida in HIV infection: a cytokine based analysis.

Candida is a common opportunistic pathogen in HIV infection and is regarded a signal infection for progression to AIDS. Cytokine imbalances between Th1/Th2 groups have been described in both candida and HIV infections. A study was undertaken to assess the role of candida in furthering immunosuppression in HIV infection based on cytokine levels and CD4 cell counts. 30 Indian subjects were enrolled; 10 HIV positive patients with and 10 without mucosal candidiasis and 10 age matched controls. Th1 cytokines; interleukin (IL) 2, IL 12 and interferon (IFN) gamma, Th2 cytokines; IL 4, IL 6, IL 10 and tumor necrosis factor (TNF) alpha with CD 4 cell counts were estimated using ELISA in all subjects. CD4 cell counts were reduced in both patient groups as compared to controls; significantly more in patients with both HIV and candida infections. There was a decrease in Th1 cytokine levels in all patients; lower levels of Th1 cytokines were seen in patients with both infections. Among the Th2 cytokines, there was a significant increase in the levels of IL 6, IL 10 and TNF alpha in both patient groups; IL 10 and TNF alpha values were significantly raised in patients with dual HIV and candida infections as compared to the other patients. There was no difference in IL 4 values across the subject groups. A positive correlation between CD4 cell counts and Th1 cytokine levels and a negative correlation with Th2 cytokines were noted; these were stronger in patients with both HIV and candidiasis. Thus, there was a Th1/Th2 cytokine imbalance with CD4 cell count reduction in all HIV infected patients, which was more pronounced in patients with both infections. It can be concluded that, owing to the depressed CD4 cell count and Th1 response and increased Th2 cytokines in patients with both candidiasis and HIV as compared to patients with only HIV candidiasis may have a synergistic immunosuppressive effect with HIV in patients with dual infections.

Prevalence of transfusion associated infections in multitransfused children in relation to mandatory screening of HIV in donated blood.

Any change in risk behavior related to acquisition of human immunodeficiency virus (HIV) infection is likely to reduce simultaneously the risk for other agents transmitted through identical routes. A study carried out in the city of Delhi, India on the load of transfusion associated infections among multitransfused (MT) children in relation to mandatory screening of HIV infection in donated blood indicated unchanged prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis D virus (HDV) infections among the group of MT children transfused after the implementation of mandatory screening of HIV infections in blood banks, i.e. post-implementation period (prevalence of HBV, HCV and HDV being 32.8%, 31.3% and 1.6% respectively) compared to a group of MT children transfused over a similar duration before the implementation of mandatory screening i.e. pre-implementation period (prevalence of HBV, HCV and HDV being 28.1%, 26.6% and 1.6% respectively). However, reduction could be recorded in the prevalence of IgM and IgG classes of antibodies to both CMV and HSV-2 infections among MT children receiving transfusion during the post-implementation period (prevalence of 3.1% and 37.1% for CMV IgM and CMV IgG respectively; prevalence of 3.1% and 25% for HSV-2 IgM and HSV-2 IgG, respectively) compared to the group of MT children transfused in the pre-implementation period (prevalence of 15.6% and 56.3% for CMV IgM and CMV IgG respectively; prevalence of 18.8% and 45.2% for HSV-2 IgM and HSV-2 IgG, respectively). These reductions were statistically significant (p values < 0.02 and < 0.05 for CMV IgM and CMV IgG; p values < 0.01 and < 0.02 for HSV-2 IgM and HSV-2 IgG respectively). These observations were in accordance with the recorded reduction in the prevalence of CMV and HSV-2 infections and unaltered prevalence of HBV, HCV and HDV infections in the group of donors donating blood during the post-implementation period compared to those donating in the pre-implementation period. Study of epidemiological risk factors among blood donors showed a change in behavior towards safer sex practice with only 13.0% of donors in the post-implementation period having history of sex with one or more female commercial sex workers during their donation periods compared to 41.5% of donors in the pre-implementation period having similar history (p < 0.001). However no change could be recorded in the proportion of donors donating at frequency higher than the permissible guidelines among the two groups. The present study points out nosocomial transmission as well as limitations in the existing guidelines for screening of infectious agents in blood banks as possible incriminating factors towards acquisition of hepatitis virus infections in blood donors as well as in MT children.

Further evaluation of alternative strategy for HIV testing in India.

A total 320 sera from groups at risk for HIV were evaluated by two (198 specimens) or three (122 specimens) screening tests for confirmatory anti-HIV testing in comparison to Western Blot as gold standard. Sera positive by both screening tests showed 100% correlation with Western Blot although with a false positivity rate of 3.2%. In specimens positive by 1st screening test but negative by the second, (considered negative for anti-HIV antibody as per WHO algorithm), 8.7% were found to be Western Blot positive showing the serious problem of false negativity of the proposed WHO algorithm. Employing the system of three screening test systems did not provide additional benefit for the specimens positive by initial two screening tests since all of them were positive by third test also. However, the study involving three screening tests substantiated the need for Western Blot in discordant specimens (i.e. positive by first test but negative by second), since in this group one out of 22 (4.6%) such specimens were Western Blot positive. Considering the serious consequences of both false positive and false negative results, it is felt that alternative strategy of confirmatory anti-HIV serology, although economical may not be suitable substitute for Western Blot in India at this juncture when the prevalence of HIV infection is relatively low.

Low prevalence of human immunodeficiency virus type-1 (HIV-1) infection in population attending a major hospital in New Delhi, India.

During 4 year period between April 1990 and March 1994, 4120 specimens from the patients attending out patient departments of Medical, Surgical and Antenatal units of a major city hospital were tested for HIV infection as a part of an on-going sentinel surveillance programme. In addition, 1440 specimens from the patients attending STD clinic of the same hospital and 862 females seeking termination of pregnancy from a near by hospital were included for comparison. It was found that only 3 individuals with high risk behaviours out of 2002 females attending antenatal clinic showed evidence of HIV infection (rate 1.49 per 1000). The corresponding rate for the group of patients attending STD clinic and seeking termination of pregnancy were 3 out of 1440 (rate 2.15 per 1000) and 1 out of 862 (rate 1.16 per 1000) respectively. It was noted that prevalence of HIV infection in the hospital attending population with unspecified risk factor (medical, surgical and antenatal clinics) was not a matter of serious concern. The importance of finding out risk factors in females attending antenatal clinic is evident from the study.

HIV-2 prevalence in Uttar Pradesh.

Serum samples collected since 1989 with various patterns of reactivity for human immunodeficiency virus (HIV)-1, on the basis of screening ELISA and confirmatory Western blot (WB) test, were subjected to the detection of HIV-2 infection based on screening dot immunoassay and confirmatory WB for HIV-2. Significant prevalence of HIV-2 infection was (37.03%) among sera reactive for HIV-1 by ELISA but indeterminate by Western blot, compared with sera reactive for HIV-1 by ELISA and WB (3.29%) or negative by WB (2.63%). Out of 16 HIV-2 positive sera, 5 (31.25%) showed evidence of concomitant HIV-1 infection. This study demonstrates evidence of HIV-2 infection as early as 1989, earlier than reported so far from India.

Coxsackie B virus in the etiology of heart diseases in Delhi.

Coxsackie B group of viruses have been long considered as the precipitating factor in heart diseases. Their association with various heart diseases especially pericarditis, myocarditis and myopericarditis is known, but now their association is also known with cardiomyopathy and ischaemic heart diseases. A study was carried out on 87 patients suffering from various heart diseases and the role of Coxackie B virus infection was studied. The study included 25 control subjects. Thirty patients (34.5%) were found to be having high antibody titre for at least one of coxsackie B virus group with coxsackie B3 and B4 being the two commonest types. Serum IgM immunoglobulins were raised in acute infective disorders like pericarditis, myocarditis and myopericarditis but IgG, IgA and IgM levels were normal in ischaemic heart diseases and cardiomyopathy.

Acquired immunodeficiency syndrome (AIDS) in multitransfused children with thalassemia.

Two hundred and three multi-transfused children with thalassemia attending the Thalassemia Clinic of the Charak Palika Hospital, New Delhi were screened for human immunodeficiency virus (HIV) antibodies by ELISA and all positive cases were confirmed by Western Blot. Of the 203 children screened, 18 (8.9%) were HIV positive, and in these children a detailed immunological work up was done and compared to 18 age-matched HIV negative thalassemics as controls. The tests included absolute lymphocyte counts (ALC), absolute and percentages of CD4+ and CD8+ cells and their ratios (CD4/CD8), immunoglobulin levels (IgG, IgM and IgA) and delayed cutaneous hypersensitivity (DCH) test by Multitest CMI in all the cases and the controls. Of the 18 HIV positive children, 6 were diagnosed to have clinical AIDS as per the WHO criteria. After immunological testing, the children were further classified according to the CDC criteria. By these criteria, 11 children were classified as P1 A (asymptomatic infection, normal immune function), 1 child as P1 B (asymptomatic infection, abnormal immune function), 2 children as P2 A (symptomatic infection with non-specific findings), 1 child as P2 C (lymphocytic interstitial pneumonitis), 1 child as P2 D1 (Pneumocystis carinii pneumonia) and 2 children as P2 D2 (symptomatic infection with infections). In this paper, the clinical features of the children with AIDS is described, and the immunologic functions of these children are compared with the HIV positive asymptomatic children and with controls. These are the first cases of AIDS in the pediatric age group from India.

Relative performance of Organon kit in comparison to Du Pont for confirmatory serological testing of HIV infection by western blot test in sera from blood donors.

A total of 32 specimens with different categories of reactivity by Du Pont Western Blot kit comprising of specimens showing full spectrum of HIV-I antigen specific bands, 19 specimens showing total absence of bands and four specimens showing non-specific bands (without any interpretative importance) were subjected to Western Blot testing by Organon test. Of the nine specimens showing full spectrum of bands by Du Pont the correlation with Organon kit was 100 per cent based on WHO criteria. Four specimens with non-specific indeterminate band pattern by Du Pont failed to show any band in Organon kit, indicating that latter to be more specific.

Antimalarial antibody in relation to seroreactivity for HIV infection in sera from blood donors.

A total of 74 specimens from blood donors showing evidence of HIV infection comprising of 40 positive by both ELISA and Western Blot (true positive), 16 positive by ELISA but negative by Western Blot (false positive) and 18 specimens positive by ELISA but showing indeterminate bands in Western Blot were screened for anti-malarial antibody. The prevalence of antimalarial antibody was noted as 62.5%, 56.3% and 66.6% respectively in these groups. None of these groups had any difference in the prevalence of antimalarial antibody with the group of 60 specimens negative for HIV infection by both ELISA as well as Western Blot (true negative) which had a prevalence of antimalarial antibody as 53.3%. The mean titre of antimalarial antibody in the above categories of specimens positive for HIV infection also did not show any difference with that of true negative group. These findings point out that antimalarial antibody does not influence the serological positivity for HIV infection.

Bacteriological study of drinking water during epidemic of cholera in Delhi.

Sixty drinking water samples collected from various sources in different areas of Delhi during epidemic of cholera and gastroenteritis were analysed for bacteriological standards. Only 27 (45 per cent) samples were found to be satisfactory for human consumption. Remaining thirty-three (55 per cent) samples showed presence of coliform organisms with MPN value ranging from 10 to 1800+ per 100 ml. Among these positive samples, 31 (93.9 per cent) samples contained faecal coli. Twenty out of thirty (66.6 per cent) Hand pump, 9 out of 21 (42.8 per cent) Taps 2 out of 4 (50 per cent) Tube well and 2 out of 5 (40 per cent) of miscellaneous sources showed contamination with coliform organisms.