Transfusion associated HIV infection in patients with haematologic disorders in southern India.

Seventy patients with congenital coagulation disorders (group A) and 202 other patients (group B) attending the Haematology clinic at the Christian Medical College and Hospital, Vellore (India) were screened for HIV infection between March 1989 and April 1991. Fifty five patients in group A and 131 patients in group B had received blood or blood products in the past. Nineteen transfused patients (9 in group A and 10 in group B) had received blood or blood products exclusively from the hospital blood bank and none of them was HIV infected. Among the remaining 167 transfused patients, 14 (30.4%) of the 46 patients in group A and 6 (4.9%) of the 121 patients in group B were found to be positive for HIV. In group A, 13 of the 14 infected patients had received commercially available cryoprecipitate which was thus found to be the most frequent source of infection. In group B the source of infection was most probably unscreened HIV infected blood which was transfused.

Sequence analysis of human T cell lymphotropic virus type I strains from southern India: gene amplification and direct sequencing from whole blood blotted onto filter paper.

Human T cell lymphotropic virus type I (HTLV-I) infection in India has been found to be associated with adult T cell leukaemia/lymphoma (ATLL) and HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) among life-long residents of southern India. To examine the heterogeneity of HTLV-I strains from southern India and to determine their relationship with the sequence variants of HTLV-I from Melanesia, 1149 nucleotides spanning selected regions of the HTLV-I gag, pol, env and pX genes were amplified and directly sequenced from DNA extracted from whole blood blotted onto filter paper and from peripheral blood mononuclear cells, obtained from one patient with HAM/TSP, two with ATLL and eight asymptomatic carriers from Andhra Pradesh, Kerala and Tamil Nadu. Sequence alignments and comparisons indicated that the 11 HTLV-I strains from southern India were 99.2% to 100% identical among themselves and 98.7% to 100% identical to the Japanese prototype HTLV-I ATK. The majority of base substitutions were transitions and silent. No frameshifts, insertions, deletions or possibly disease-specific base changes were found in the regions sequenced. The observed clustering of the Indian HTLV-I strains with those from Japan, as determined by the maximum parsimony method, suggested a common source of HTLV-I infection with subsequent parallel evolution. Amplification of DNA from blood specimens collected on filter paper may be useful for the study of other blood-borne pathogens.

High prevalence of HTLV antibodies in wild-caught bonnet monkeys in southern India.

The prevalence of human T-lymphotropic virus (HTLV) type-1 antibodies was determined in the bonnet monkeys, living naturally, within about 30 km radius of Vellore (south India). Sera from 157 animals, collected between January 1982 and May 1993 were screened for the presence of HTLV-I infection by a particle agglutination test (PAT). When sera repeatedly reactive in PAT were subjected to indirect immunofluorescence and western blot tests, 63 (40%) were confirmed to be positive for HTLV-1 antibody. These findings are significant in the light of recent reports that HTLV infection is endemic to southern India.

The epidemiology of AIDS in the Vellore region, southern India.

OBJECTIVE: To describe the epidemiology of patients with AIDS in Vellore region, Southern India. DESIGN AND METHODS: Sixty-one patients with AIDS were diagnosed and treated between July 1987 and June 1992. Information on their demographic characteristics and probable modes of acquiring HIV infection was collected at interviews with them and their spouses. RESULTS: There was a progressive increase in the number of patients seen over the 5 years. The mean ages of the 51 men and the 10 women were 33 and 29 years, respectively. Of the 44 patients from our district (population, 5 million), 28 were from Vellore town and 10 from rural areas. Forty-seven (92%) men had frequently used prostitutes. Of the women, four were prostitutes, one had had multiple sex partners and five had not had extramarital sexual contact. One man and one woman had no other risk factor except blood transfusion. Thirty-one (51%) patients had died by August 1992. CONCLUSION: The AIDS epidemic in this region is in its early ascending phase, with a doubling time of approximately 1 year. Most men with AIDS were infected by heterosexual contact with prostitutes, while some women were prostitutes themselves. Together with the male-to-female ratio of 5:1, these results suggest that the male population at risk has sex with a much smaller population of female prostitutes, constituting the major chain of transmission. HIV infection is occurring in both urban and rural populations.

PIP: Between July 1987 and June 1992 physicians diagnosed AIDS in 61 patients at the Christian Medical College Hospital in Vellore, India. They noted that there were 200 AIDS cases reported in the same period in the region, but they extrapolated AIDS cases to be 7656. Yet even the figure of 7656 was likely to be an underestimate, because this hospital does not treat most patients in the district or in the town. The number of cases at this hospital doubled each year. The mean age of the 51 men was 33 years, and 29 years for the 10 women (male-to-female ratio - 5:1). 23% of cases were from rural areas. Most cases (71% for men and 80% for women) were married and lived with their spouses. 47 (92%) of the men had had sexual intercourse with prostitutes, suggesting that this was the leading means of HIV transmission. 4 married women were prostitutes and their husbands knew and/or encouraged them to work as prostitutes. 4 other married women had had no extramarital sexual affairs and were infected by their HIV positive husbands who had had sexual intercourse with prostitutes. The only risk factor for 2 patients was blood transfusion. The most common signs and symptoms of AIDS included considerable weight loss (62%), fever for more than 30 days (56%), tuberculosis (52%), oral candidiasis (41%), and chronic diarrhea (31%). By August 1992, 31 (51%) patients had died.

The detection of HIV-2 infection in southern India.

To determine the prevalence of HIV-2 infection in southern India, we tested two sets of sera, selected from among the samples which had been collected between January 1988 and October 1990 from high risk subjects and tested for HIV-1 antibody. They were screened for HIV-2 antibody by ELISA and repeatedly reactive sera confirmed by HIV-2 Western blot and line immunoassay. In the first set of 604 sera, only one (0.16%) was positive for HIV-2. In the second set of 24 sera, selected on the basis of having indeterminate HIV-1 Western blot profiles, again one (4%) was positive for HIV-2. The two HIV-2 infected subjects were residents of Madras or Visakhapatnam. Residents of Vellore region constituted 88 and 75 per cent of the two sets of subjects; none was positive for HIV-2. Our results show the prevalence of HIV-2 in the port-cities of southern India. Since it will spread to other regions continuous monitoring for this infection is essential in order to determine when to establish HIV-2 screening in addition to the existing HIV-1 screening of donor blood for transfusion.

PIP: While HIV-1 is the principal etiologic agent of AIDS throughout the world, the genetically distinct HIV-2 has been recently credited with causing AIDS especially in the countries of West Africa. HIV-2 infection was first reported in India in the city of Bombay in 1991. This paper reports findings from an HIV-2 seroprevalence study of blood sera in southern India. Sera sampled were selected from among those collected from January 1988 to October 1990 from high-risk subjects and tested for antibody to HIV-1. Sera were screened for HIV-2 with ELISA and repeatedly reactive sera were confirmed with Western blot for HIV-2 and line immunoassay. 1 serum (0.16%) of the 604 sera initially tested was positive for HIV-2. Another serum was found positive in the 2nd set of 24 sera (4%). The 2 infected subjects were residents of Madras or Visakhapatnam. Although residents of the Vellore region respectively comprise 88% and 75% of the 2 sets of subjects, none was found to be positive for HIV-2. Since these findings confirm the existence of HIV-2 in India, the authors stress the need to monitor its spread in order to determine when blood from donors should start being screened for both HIV-1 and HIV-2.

Reduction of the cost of testing for antibody to human immunodeficiency virus, without losing sensitivity, by pooling sera.

The sensitivity of testing pooled sera instead of individual sera for antibody against human immunodeficiency virus (HIV) was evaluated using a non-competitive enzyme-linked immunosorbent assay (ELISA). For this purpose, 42 HIV antibody positive sera were titrated and introduced into 42 sets of pools of 2, 4, 8, 16, 32 or 64 sera in such a manner that each pool had one positive sample and the rest, HIV antibody negative sera. When the pools were tested in ELISA, all pools with high titred antibody positive sera were reactive irrespective of pool size, while some of the pools containing medium or low titred sera were non-reactive when pool size exceeded 16. Subsequently the pool size was limited to 16. When 208 previously unscreened samples were tested in 52 pools of 4, 26 pools of 8 or 13 pools of 16 sera, or individually, 6 antibody positive sera were correctly identified. Thus, it was found that the pooling method did not reduce the sensitivity of ELISA test, whereas the cost was reduced to less than half of that of individual testing.

T-lymphocyte mediated injury of beta cells in dual-aetiology diabetes mellitus in Swiss albino mouse.

Earlier we had described a dual aetiology diabetes mellitus (DADM) in mice injected with a sub-diabetogenic dose of streptozotocin (SD-SZN) and afterwards infected with coxsackie B3 virus (CBV). Further experiments were conducted to understand the mechanism of diabetogenesis. In in vitro stimulation and proliferation tests, the splenic lymphocytes (SLC) of mice given either SD-SZN or CBV infection showed lower responses to two T cell mitogens than those of control mice, indicating an immunosuppressive effect. Unexpectedly, SLC of mice given both SD-SZN and CBV showed enhanced response, indicating immunoactivation; they were not stimulated to proliferation in response to CBV antigen, indicating that the immunoactivation was not directed against CBV, but against streptozotocin or cellular elements. When mice were depleted of T cells by injecting with anti-thymocyte serum, the diabetogenic effect of SD-SZN and CBV infection was abrogated, without diminishing the replication of virus in the pancreas. Thus beta cell injury in DADM appears to be T cell-mediated.

Clinical and laboratory profile of AIDS in India.

The clinical features and results of laboratory investigations of the first 19 Indian patients with AIDS seen in our hospital are presented. Weight loss, fever, and diarrhea were the most common symptoms. Tuberculosis (TB) was the most common secondary infectious disease; among 13 patients, seven had only pulmonary TB, five had pulmonary and extrapulmonary TB, and one had only extrapulmonary TB. Oropharyngeal candidiasis was found in 11 patients. Other secondary infections were predominantly by virulent bacteria. Opportunistic infections other than candidiasis were infrequent; one patient had cryptococcosis, two had symptomatic cryptosporidiosis, one had noncoagulase-positive staphylococcus septicemia, and one had cytomegalovirus retinitis. Reduced lymphocyte counts (particularly of the CD4 subset), anemia, hypoalbuminemia, hyperglobulinemia, and elevated liver enzyme levels were frequent laboratory findings. Six patients are under follow-up, two are lost to follow-up, and 11 have died. Lymphocyte counts less than 500/mm3 were only seen in those patients who subsequently died. Response to antituberculosis therapy was good in several patients. Thus, the clinical profile of Indian patients with AIDS is not different from the common picture of patients of low socioeconomic and poor hygienic standards; patients presented with TB, undernutrition, and multiple infections. Therefore, a large population of patients with AIDS in India will not be recognized unless they are tested for evidence of HIV infection.