Mode of Detection of HIV Infection - A Retrospective Study of 612 Cases.

BACKGROUND: Trends in mode of detection of HIV infection in the Armed Forces required to be analyzed to formulate future strategies for early detection. METHODS: A retrospective study was thus conducted in 612 newly diagnosed HIV-positive cases between January 1997 to August 2002. RESULTS: 182(29.74%) patients had already developed Category C conditions when detected to be HIV-positive, 176(96.70%) with mycobacterial disease, majority (67.61%) of them being pulmonary tuberculosis, followed by recurrent bacterial pneumonia in 3 (1.65%), pneumocystis carinii pneumonia (PCP) in 2(1.1%) and oesophageal candidiasis in one (0.55%). Herpes zoster was the third most common mode of detection accounting for 86 (14.05%) of the cases (24.6% of them with involvement of ophthalmic branch of trigeminal nerve), after tuberculosis in 176(28.76%) and blood donors in 98(16.01%), followed by constitutional symptoms in 59(9.64%) cases, investigation for STDs in 56(9.15%), bacterial pneumonia in 6(0.98%) and oral mucosal candidiasis in only one (0.16%) case. None was detected during acute retroviral illness and only 5(0.82%) cases were detected while being investigated for generalized lymphadenopathy. Amongst the cases detected during investigation for STDs, majority (26.79%) were on STD surveillance. 22(3.60%) cases tested positive when their spouses were detected to be HIV-positive, 20(3.27%) while being screened for surgery, 4(0.65%) for posting abroad and 2(0.32%) each during investigation when child was found HIV-positive and investigation for HBV infection. Remaining 69(11.27%) patients were detected during investigation of various related or unrelated conditions including one (0.16%), which reported voluntarily after a high-risk exposure. CONCLUSION: There is a need to encourage voluntary reporting and identify more number of cases during acute retroviral syndrome and PGL stage.

Serum Zinc Levels in Cutaneous Disorders.

Serum zinc levels were studied in 75 patients of different cutaneous disorders and 24 healthy controls. It was found to be significantly lower in acne vulgaris (71.5 ± 21.5µgm/100ml), leprosy(85.9 ± 26.9µgm/100ml) and psoriasis (93.3 ± 25.9µgm/100ml) as compared to healthy controls (105.3 ± 30.1µgm/100ml). No significant correlation was found in other cutaneous disorders studied i.e. vitiligo and aphthous ulcers where serum zinc levels were found to be 97.3 ± 26.6 µgm/100ml and 105.2 ± 23.5 µgm/100ml respectively.

Clinical and bacteriological study of urethral discharge.

A clinics-bacteriological study of 52 patients with urethritis was carried out. All the patients were evaluated clinically and bacteriologically at the beginning and end of the treatment. Majority of the patients belonged to the age group 21-30 years (58%). Incidence of gonococcal urethritis was 65% and Non gonococcal Urethritis (NGU) 35%. The common organisms causing NGU were chlamydia (28%) ureaplasma (11%) and mycoplasma (11%). Neisseria gonorrhoea was resistant to penicillin in (38%), ciprolloxacin in 67, and to noriloxaein in 6% cases. High incidence of HIV positivity was found in gonorrhoea (21%).

Spectrum of renal lesions in HIV patients.

BACKGROUND: A variety of renal lesions have been reported in HIV positive patients from western world however there is paucity of Indian data. METHODS: Over a four year period, all hospitalised HIV positive patients were screened for renal involvement. Screening was done with urinalysis. Those with abnormality in urine examination underwent further assessment with clinical, biochemical, immunological profile and renal biopsy. Renal histology was studied by light and electron microscopy. RESULTS: Twenty-five (17.6%) of the 142 patients screened, had proteinuria/abnormal urinary sediment however none of the patient had proteinuria in nephrotic range. Fourteen of these 25 patients were asymptomatic while others had AIDS. Renal biopsy was studied by light microscopy in all and by electron microscopy in 11 cases. On histology mesangioproliferative GN was encountered in eight, focal segmental glomerulosclerosis in four and collapsing GN in one patient. In two cases cryptococcal infiltration and in one lymphomatous deposits were seen in glomerulus and interstitium. In one patient interstitium showed granulomas and in other three mononuclear cell infiltration. Histology was normal in 8 (32%) patients. On EM visceral cell hyperplasia and vacuolisation was seen in all, two had collapse of glomerular basement membrane and in three cases tubuloreticular structures were seen. There was no co-relation of renal histology with duration or severity of the disease (p > 0.05). No deterioration of renal function was seen over a short follow up period of 4.2 months (1-20 months). CONCLUSION: This study highlights that HIV patients exhibiting abnormal urinary sediment usually have underlying renal lesion and at times unexpected opportunistic infections may be present.

PATTERN OF SEXUALLY TRANSMITTED DISEASES IN THE ARMED FORCES.

Pattern of sexually transmitted diseases (STDs) in 1027 male patients admitted during 1990 to 1996 were analysed. Majority of cases (86%) were in age group of 20 to 40 years. Out of total 1027 STD cases 334 (32%) were having chancroid, 237 (23%) syphilis, 122 (11.9%) lymphogranuloma venereum, 130 (12.6%) gonorrhoea, 34 (3.3%) Herpes genitalis and 170 (16.5%) other STDs. 167 STD cases (163%) were found to have HIV infection. A rising trend in prevalence of HIV infection in STD patients from 2.8% (1990) to 27.8 (1996) was noticed contrary to declining trend of STDs from 213 cases in 1990 to 79 cases in 1996. The prevalence of HIV infection was 303% in LGV, 19.3% in chancroid, 13.5% in syphilis, 17.6% in herpes genitalis, 6.7% in gonorrhoea and 11.2% in other STD cases. Out of total 167 STD cases having HIV infection 65 (40%) cases were of chancroid, 37 (22.2%) of LGV, 32(19.2%) of syphilis, 8 (4.8) of gonorrhoea, and 6(3.6%) of herpes genitalis while 17 (10.2) cases were having other STDs.

Hiv infection in patients of sexually transmitted disease.

A total of 1027 male patients suffering from sexually transmitted diseases (STD) during 1990 to 1996 were screened for HIV infection. All cases were in the age group 17 years to 48 years. One hundred and sixty-seven STD cases (16.3%) were found to have HIV infection. A rising trend in incidence of HIV infection in STD patients from 1990 (2.8%) to 1996 (27.8%) was noticed countrary to declining trend of STDs from 213 cases in 1990 to 79 cases in 1996. The incidence of HIV infection was 30.3% in lymphogranuloma venereum, 19.5% in chancroid, 13.5% in syphilis, 17.6% in herpes genitatis, 6.7% in gonorrhoea and 11.2% in other STD cases.

Pattern of skin diseases in paediatric age group and adolescents.

A total of 300 patients from first day of life to 17 years of age were analysed for pattern of skin disorders. School going children formed majority (41.3%) of cases followed by preschool children (32%). Infections formed the commonest disorder (31 %) followed by eczemas (24%), papulosquamous disorders (12%), infestation (8.6%) and urticaria (5.3%) while vitiligo, acne vulgaris, alopecia areata and genodermatoses were seen in 2.7% cases each.

A study of dermatological disorders in geriatric age group.

A total of 320 patients of more than 60 years of age were studied for dermatological changes with aging. The male female ratio of patients was 3:1. Majority of cases (60.6%) were between 60-65 years of age. Pruritus was present in 37.5% cases, wrinkles in 82.1%, senile lentigenes in 57.8%, seborrhoeic keratosis in 48.8%, cherry angioma in 48.1%, idiopathic guttate hypomelanosis in 43%, skin tags in 37%, xerosis in 28%, comedones in 19%, infection and infestation in 40%, eczematous disorders in 36.9%, papulosquamous disorders in 10%, metabolic disorders in 16%, pigmentary disorders in 8.7%, keratinisation disorders in 4.1%, vesiculobullous disorders in 2.8% and associated systemic disorders in 49.7% cases.

PATTERN OF DERMATOLOGICAL ADMISSIONS IN A REFERRAL SERVICE HOSPITAL.

The pattern of dermatological admissions based on retrospective study of 1578 Armed Forces personnel who were hospitalised during period of Jan 1984 to Dec 1994 at Command Hospital Southern Command, Pune were analysed. Average yearly admission was 144. Eczema was the most common skin disease requiring admission and accounted for 29.5 per cent cases followed by infections and infestations 25.5, papulo-squamous disorders 21.4, urticaria 4.2, connective tissue disorders 4.2, bullous disorders 2.8, and others 12.4 per cent.

PATTERN OF SKIN DISEASES IN ARMED FORCES IN PUNE REGION.

A total of 8123 Armed Forces personnel attended dermatological OPD from Jan 1989 to Dec 1994. On analysing the record it is found that 2953 (36.3%) cases had infective dermatosis and 5170 (63.7%) cases had non-infective dermatosis. Common infective dermatosis included fungal infections (17.2%), viral infections (7.7%), bacterial infections (3.6%) and arthropode infestations (7.8%). Common non-infective dermatosis included papulosquamous disorders (13.5%), pigmentary disorders (13.4%), eczemas (11.1%), acne (8.7%), alopecia (6.1%), urticaria (4.2%) and drug eruptions (1.9%).

Concurrent leprosy and HIV infection: a report of three cases.

Three cases of concurrent infection with HIV and leprosy are reported. One had developed borderline lepromatous leprosy one year after identifying HIV infection, while the other two had indeterminate leprosy and both conditions were identified at the same time in these two patients. All three cases showed satisfactory response to standard antileprosy multidrug therapy.

BETA-2-MICROGLOBULIN LEVELS IN HUMAN-IMMUNODEFICIENCY VIRUS INFECTED SUBJECTS.

We studied beta-2 microglobulin (ß-2M) levels in 44 HIV infected subjects belonging to 3 clinical stages as well as in 25 healthy controls. The method used was a competition enzyme immunoassay. In this study, levels of ß2-M were measured in two groups of HIV infected individuals, the asymptomatic and those with progressive and advanced disease, in order to affirm its role as a surrogate prognostic marker. It was found that mean ß-2M levels were 1.28 mg/L in the controls (normal range 0-2.4 mg/L), 11.41 mg/L in the HIV infected subjects, 2.69 mg/L in the asymptomatic HIV infected, 12.14 mg/L in those with persistent generalized lymphadenopathy (PGL) and 39.29 mg/L in the patients with acquired immunodeficiency syndrome. It was concluded that ß-2M levels were significantly higher in the HIV infected as compared to the controls. Further, the levels were much higher in the HIV infected with progressive diseasc/PGL and highest in those who had developed AIDS. ß-2M is an important surrogate serological marker useful in prognostication of disease process in the HIV infected. Advantages of measuring ß-2M levels over p24 antigen detection and CD4 counts were highlighted.