Syed Abdul Mujeeb

Seroprevalence of HIV, HBV and syphilis and associated risk behaviours in male transvestites (Hijras) in Karachi, Pakistan

In Pakistan, male sex workers are predominantly transvestites and transsexuals known as Hijras. In 1998 in Karachi, Pakistan, we studied the seroprevalence of HIV, HBsAg and syphilis and associated risk factors in Hijras. Study subjects were verbally administered a structured questionnaire that determined risk behaviours for sexually transmitted and blood-borne diseases and knowledge of AIDS/STDs. After pre-test counselling, verbal consent was taken for serological testing. The results were provided on a one-on-one post-test counselling session. Three hundred male transvestites were approached; all agreed to answer the questionnaire, 208 consented to blood testing. Of 300, 81% acknowledged commercial sex with men. Of 208, prevalence of syphilis was 37%; HBsAg 3.4%; HIV 0%. The prevalence of HIV and hepatitis B virus (HBV) is low in transvestite sex workers but that of syphilis is high. Intervention programmes implemented at this stage can have an impact on HIV and STD prevention.

An outbreak of HIV infection among injection drug users in a small town in Pakistan: potential for national implications.

Sir: With reference to the article `High incidence and prevalence of HIV-1 infection in high risk population in Calcutta India’ we would like to report the first outbreak of HIV infection among injection drug users (IDUs) in Pakistan in a small town of Sindh province--Larkana. In June 2003 the first case of HIV infection was discovered in an IDU in Larkana a small ricegrowing town of Sindh province with an estimated population 0.4 million. The city has historical importance because of close vicinity with `Moen-jo-Daro’ (The Mound of Dead)--a 4000-year-old city connected with the Indus civilization. Subsequent testing of 175 IDUs in the month of June 2003 in Larkana showed that 17 IDUs had HIV infection. The samples were initially screened on enzyme-linked immunosorbent assay Lab System and confirmed according to WHO/ National Guidelines for HIV/AIDS testing2. For the past one year increased use of injectable drugs have been noted there. The area has become a hub of drug use activities attracting users from all parts of the country. Larkana police estimates the number of IDUs to be around 1000. (excerpt)

Prevalence of Hepatitis B Surface Antigen and HCV Antibodies in Hepatocellular Carcinoma Cases in Karachi, Pakistan

Hepatocellular carcinoma (HCC) is a common cancer the world over. In Pakistan it has an incidence of 8/100 000 per annum. To assess the prevalence of Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infections in biopsy proven cases of HCC a serological study was conducted at Screening Laboratory of Blood Transfusion Services, Jinnah Postgraduate Medical Centre. Of 54 sera of HCC tested for HBV and HCV infections, 67% showed HBV infection, and 33% HCV infection. Among them 24% were positive for both HBV and HCV infections. No HBV and HCV infection was found in 24% cases of HCC. Our findings suggest viral association for most of the HCC cases reported in the country. We suggest an immediate intervention strategy to prevent the spread of HBV and HCV infections by mandatory screening of blood for HBV and HCV infections, and the use of disposable/sterilized needles, instruments for all invasive procedures. For the prevention of vertical transmission of HBV infections all pregnant women should be screened and vaccinated and HBV vaccination should also be included in EPI (expanded programme for immunization).

Temporal trends in hepatitis B and C infection in family blood donors from interior Sindh, Pakistan

BackgroundHepatitis B (HBV) and C (HCV) infections are a serious global and national public health problem. Earlier studies have reported increasing rates of hepatitis infection in Pakistan, particularly in rural areas. Pakistan has no active surveillance program to monitor trends of these infections. The objective of this study was to verify this trend in blood donors from the rural Sindh area of the country.MethodsThe study analysed the data of blood donors of interior Sindh who donated blood at JPMC blood bank from January 1, 2004 to September 15, 2007. HBsAg status was determined by using HBsAg Serodia kit and antibodies to HCV using the Detect HCV ™ V.3 Kit. Samples repeatedly reactive for HBsAg or anti-HCV were considered positive for HBV or HCV infection respectively.ResultsThe overall seroprevalence of HBV infection among donors was 6.2 % (95% CI 5.5%–6.9%) and did not change significantly over the study period. Overall seroprevalence of HBV infection in literate blood donors was 5.7 %(95% CI 4.7%–6.8%). Prevalence decreased significantly in this group over the study period (p = 0.05). No other significant trends in seroprevalence of HBV infection were seen in the stratified analyses.The overall seroprevalence of HCV among donors was 7.5% (95% CI 6.8%–8.3%) and increased significantly over the study period from 7.2% (95% CI 5.8%–8.7%) in 2004 to 8.9% (95% CI 7.4%–10.6%) in 2007 (p = 0.02). Significant increase in seroprevalence was particularly seen in literate (p = 0.03), non–first time (p = 0.01) and Sindhi speaking (p = 0.01) donors.ConclusionOur study finds a steady increase in the prevalence of HCV infection in blood donors from interior Sindh between 2004 and 2007. On the contrary, decreasing prevalence of HBV was found, particularly in literate blood donors. There may be a need to have rural community-based epidemiological studies to identify the determinants of the spread of HCV infection and also those that are limiting the spread of HBV infection particularly in the literate blood donor population.

Determination of risk factors for hepatitis B and C in male patients suffering from chronic hepatitis

BackgroundHepatitis B and C is common in Pakistan and various risk factors are attributable to its spread.One thousand and fifty consecutive male cases suffering from chronic liver disease (327 HBV and 723 HCV) were selected from the OPD of public sector hospital and a private clinic dealing exclusively with the liver patients. To compare the results 723 age and gender matched controls were selected from the blood transfusion services of the public sector hospital. A standard questionnaire was filled for all patients and controls which included the information on possible risk factors.FindingsFamily history of liver disease was significantly higher (43% and 34%) in HBV and HCV positive cases as compared to 5% in controls [odds ratio 15.6; 95% Confidence Interval CI: 10.1 -- 24.1, 10.9; 95% Confidence Interval CI: 7.3 -- 16.4] and same trend was seen for death due to liver disease in the family. Majority 74% hepatitis B positive cases had their shaves done at communal barbers but this practice was equally prevalent amongst controls (68%), thus negating it as a possible risk factor, but there is a significant risk with p < 0.05 associated with HCV in male that get their shave in barber. Very strong association of the disease was found with history of dental treatment (38% HCV 36% HBV and 21% controls) [Odd ratio 2.3; 95% CI: 1.8-3.0, Odd ratio 2.1; 95% CI: 1.5-2.8], surgery (23% HCV cases,14% HBV cases and 12% controls), history of blood transfusion was significantly higher in HCV (6%) as compared to controls (2.1%) [Odd ratio 2.9; 95% CI: 1.5-5.5]. History of taking injections for various ailments by the general practitioners (over 90% patients in both hepatitis B and C cases) was significantly higher as compared to 75% in controls [Odds ratio 3.8, 6.9; 95% CI: 2.4-6.1, 4.5-10.4] but hospitalization was not significant in HBV and HCV cases.ConclusionInjections, surgery and dental treatment appear as major risk factors for the transmission of hepatitis B and C in the community. Massive health care awareness drives need to be done for both health care providers and the public to reduce this menace.

Recycling of Injection Equipment in Pakistan

The prevalence of hepatitis C virus (HCV) infection is high in the general population in Pakistan, ranging from 2% to 6%. Reuse of injection equipment in the absence of sterilization is common, particularly in healthcare facilities that serve low-income populations. Studies have identified unsafe injection practices as a major route of transmission of HCV in Pakistan. Changing the behavior of injection providers so that they would use new freshly opened disposable syringes would improve injection safety in Pakistan. However, frequent reports of recycling of injection equipment in the local media question the safety of apparently new syringes. Clinical laboratories are one of the major sources of production of used syringes. To evaluate the resale of used syringes, we followed the course of used syringes from their initial use to their final destination.

Infection control practices in clinical laboratories in Pakistan.

Clinical laboratories in Karachi, Pakistan, were evaluated for adherence to standard precautions using an observational checklist. Among 44 laboratories, gloves were used in 2, protective gowns in 12, disinfectant in 7, and an incinerator in 7. Standard worker safety precautions are not followed at major clinical laboratories in Karachi.

Prevalence of hepatitis C virus infection among β-thalassaemia major patients

INTRODUCTION Beta-thalassaemia major is a common haemoglobin disorder in the country’. The average gene frequency is estimated to be 5.4%*. The management of P-thalassaemia major patients requires regular blood transfusion. In Pakistan blood is usually transfused without screening for hepatitis C virus (HCV) antibodies. In India HCV infection has been reported as a major cause of post transfusion hepatitis in P-thalassaemia major patients3. To ascertain the magnitude of problem of HCV infection among the /I-thalassaemia major patients in Pakistan, an unlinked anonymous study was conducted at Blood Transfusion Services, Jinnah Postgraduate Medical Centre, Karachi.

Evolving HIV Epidemic in Pakistan

Pakistan is one of the most populous countries in the world, with a current population of 145 5 million, an annual growth rate of 2.1%, an infant mortality rate of 85/1000 births, and a maternal mortality rate of 350/100,000 (Government of Pakistan, 2001). Situated in the western part of South Asia, Pakistan is bordered by Iran and Afghanistan to the west, China to the north, India to the east, and the Arabian Sea to the south.