Clinical features & risk factors associated with cryptosporidiosis in HIV infected adults in India.

BACKGROUND & OBJECTIVE: Cryptosporidiosis is a leading cause of protracted, life threatening diarrhoea in HIV infected patients. Although data on prevalence are available for Indian patients, no information on risk factors for transmission exists. We therefore undertook this study to identify risk factors for transmission of cryptosporidiosis in HIV infected adults. METHODS: Both symptomatic (diarrhoeal) and asymptomatic HIV infected patients were screened for cryptosporidiosis. All Cryptosporidium spp. positive cases were enrolled in the study and interviewed to record socio-demographic information, water supply and animal contact. Data were analysed to study clinical features and potential association with species and genotype. RESULTS: Of the 28 cryptosporidial infections identified on screening 111 HIV positive patients with diarrhoea, 10 (35.7%) had chronic diarrhoea, 14 (50%) had associated fever and 8 (28.6%) had nausea. Symptomatic patients had a significantly higher number of co-infections with other enteric parasites (P=0.04) than 20 asymptomatics of 423 HIV positive individuals screened. Eleven of 17 (64%) patients with potentially zoonotic infections had diarrhoea. Patients with zoonotic species (64%) also tended to have fever more frequently than those infected with C. hominis (58%). Association between area of residence, rural or urban, water source and contact with animals and acquisition of cryptosporidiosis was not statistically significant. INTERPRETATION & CONCLUSION: Cryptosporidiosis is an important cause of morbidity in HIV infected individuals in India, resulting in chronic diarrhoea. Risk factors for potentially zoonotic transmission of cryptosporidiosis were described in this study, but larger studies need to be done for a clearer understanding of the transmission dynamics of different cryptosporidial species in developing countries.

Factors associated with treatment outcomes in pulmonary tuberculosis in northeastern Thailand.

Tuberculosis and HIV/AIDS are both prevalent in Southeast Asia and Thailand. Factors related to treatment outcomes in smear-positive pulmonary tuberculosis were evaluated in 226 adult Thai patients. Of these, 31% had a cure or a completion of therapy, 7% had treatment failure or death, and 31% had treatment interruption. The prevalence of co-morbid diseases was 52%, including 19% with HIV. Sputum cultures for Mycobacteria were carried out in 86 cases (38%), 36 of these (42%) were culture positive for Mycobacterium tuberculosis. The rate of drug resistance was 14% (5/36) of culture proven tuberculosis and the mortality rate was 4.6% (7/153) of patients with known outcomes. Of the 7 fatalities, 3 were HIV positive and 1 had multi-drug resistant tuberculosis. Factors that were significantly associated with treatment failure/death were old age (OR 44.1; 95% Cl 2.0-983.7), HIV co-infection (OR 27.5; 95% Cl 1.3-560.0), and previously treated tuberculosis (OR 9.7; 95% Cl 1.6-59.1). These high rates of drug resistance and treatment failure in this area suggest that initial sputum cultures and drug susceptibility testing for Mycobacteria should be performed in all patients who have been previously exposed to anti-tuberculous drugs, and HIV testing should be performed on all patients with tuberculosis.

Community prevalence of antibodies to human immunodeficiency virus in rural and urban Vellore, Tamil Nadu.

BACKGROUND: Human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) are becoming increasingly common in India. Currently, antenatal prevalence is a surrogate marker for HIV prevalence in the community. The association between antenatal and community prevalence of HIV needs to be validated so that estimates can be verified or adjusted appropriately. METHODS: A probability proportional to size cluster survey was conducted in the Kaniyambadi block of Vellore district and in the urban wards of Vellore town to estimate the prevalence of antibodies to rubella from August 1999 to February 2000. All personal identifier data from the serum samples were removed to yield a collection for which only the age and sex were known. Estimation of antibodies to HIV in sera from individuals between 15 and 40 years of age, was carried out by one screening ELISA and the reactive sera were further subjected to a supplementary test. RESULTS: We tested 1512 serum samples from subjects residing in rural areas and 1358 samples from those residing in urban areas. The seropositivity among rural samples was 0.66% and among urban samples 1.4%. The prevalence was almost equal among men and women and the youngest infected individual was 15 years old. CONCLUSION: The prevalence of HIV during the period of study was similar to the national surveillance data for Tamil Nadu based on antenatal women. HIV prevalence differs in urban and rural Tamil Nadu, with urban areas having a higher burden of the disease.