Usha Anand Rao

Risk factors for HIV infection in injection drug users and evidence for onward transmission of HIV to their sexual partners in Chennai India.

Objectives:Determining HIV prevalence in injection drug users (IDUs) and their regular sex partners in Chennai, India. Methods:A total of 226 IDUs and their regular sex partners were enrolled during April-July 2003. After informed consent was obtained, a semistructured questionnaire was administered and serum was tested for HIV antibody. Results:The HIV seroprevalence was 30% (68/226) in IDUs and 5% in their regular sex partners (11/226). While in 25% of couples only the male partner was HIV positive, 5% of the couples were concordant for HIV infection and 70% were HIV negative. Fifty-seven percent of the HIV-positive IDUs and 45% of the HIV-infected women thought that they had “no chance” or “very little chance” of getting HIV, reflecting low HIV risk perception. More than 20% IDUs reported borrowing or lending of injection equipment. In univariate analyses “sex” and “condom use” with sex workers had no bearing but “more than twice a day injecting frequency,” “history of incarceration,” “tattoos,” “recruitment from northern part of the city,” and ever-injecting drugs in drug-selling places had significant association with HIV infection in IDUs. In an adjusted model, the odds of HIV infection were 2 times higher among IDUs who had ever injected drugs in drug-selling places and 6 times higher in those who were recruited from the northern part of central Chennai. Conclusion:Reducing sharing of injection equipment and unsafe tattooing through targeted and environmental interventions, increasing HIV risk perception, and promoting safer sex practices among IDUs and their sex partners are urgent program needs.

Prevalence of Campylobacter jejuni and enteric bacterial pathogens among hospitalized HIV infected versus non-HIV infected patients with diarrhoea in southern India

A prevalence study on Campylobacter jejuni and other enteric bacterial pathogens was carried out in 200 HIV infected and 200 non-HIV infected subjects with diarrhoeal symptoms at an AIDS Hospital in southern India. Diarrhoeal specimens were inoculated onto standard culture media as well as onto Columbia and Campylobacter blood agar media for C. jejuni isolation. All the C. jejuni isolates were tested for antimicrobial susceptibility using Kirby-Bauers method. A significant difference in recovery rates was observed between the 2 groups in relation to C. jejuni (p≤0.02; 95% CI 5.5 (1–10) and Shigella spp. (p≤0.02; 95% CI 6.5 (1–12). 21 isolates of Shigella spp., 16 C. jejuni, 5 Salmonella typhi, 3 Arcobacter spp., 3 Yersinia enterocolitica, and 2 Aeromonas hydrophila were recovered from the HIV infected cases. All the C. jejuni isolates were sensitive to ciprofloxacin whereas 1 strain was resistant to nalidixic acid. Interestingly, all the 29 Shigella spp. (21 from HIV and 8 from non-HIV cases) were resistant to erythromycin and most were resistant to many other antibiotics used. Our observations underline the need for epidemiological investigations to screen C. jejuni and Shigella spp. in HIV infected subjects with diarrhoea and analyse their antibiograms periodically to minimize disease burden in HIV/AIDS.

Pneumonia and pleural effusion due to Cryptococcus laurentii in a clinically proven case of AIDS

Non-neoformans cryptococci were previously considered to be saprophytes and nonpathogenic to humans. Cryptococcus laurentii is frequently used as a biological means to control fruit rot. Interestingly, C laurentii has recently been reported to be a rare cause of infection in humans. The authors report a case of pulmonary cryptococcosis caused by C laurentii in a diabetic AIDS patient who was on antituberculosis and antiretroviral treatments. The sputum smear revealed capsulated yeast cells that were identified as C laurentii. Repeated pleural fluid culture revealed growth of C laurentii. Both respiratory samples were negative for acid-fast bacilli. Moraxella catarrhalis and Klebsiella pneumoniae were also found in the sputum, but not in the pleural fluid. The patient had a good response to oral fluconazole therapy at 600 mg/day for five weeks and was then discharged. The present article is the first to report on the rare pulmonary involvement of C laurentii in the Indian HIV population. These unusual forms of cryptococci create a diagnostic predicament in the rapid diagnosis of pulmonary cryptococcosis. A high degree of suspicion and improvement of techniques for culture and identification will contribute to the early diagnosis and treatment of unusual fungal infections.

Cold agglutinins in HIV-seropositive participants and diagnosis of respiratory disease due to Mycoplasma pneumoniae.

Objectives. Cold agglutinin (CA) titers are one among the first pathological indicators for diagnosing Mycoplasma pneumoniae disease. We prospectively studied the prevalence of CAs in 300 HIV-positive and 75 HIV-negative individuals with respiratory disease in Chennai, India. Methods. The cold agglutination test was used and retrospectively compared with the results of a particle agglutination test. Results. While CAs were positive in 51 HIV cases, particle agglutination test detected anti-M pneumoniae antibodies from 43 cases with HIV disease (P = .001). The seroprevalence of CAs was 2.6% (n = 2) among HIV-negative participants. The mean CD4 count in CApositive and -negative HIV cases was 107.4 + 121.2 and 259.2 + 247.2 cells/µL (P = .001), respectively. Conclusion. Our report suggests a basis for the existence of CAs in HIV-positive cases. Definitive diagnosis may be done only when CA detection is used in conjunction with a specific test.

Incidence of Mycoplasma Pneumoniae Infection in HIV Infected Patients With Underlying Upper and Lower Respiratory Complaints and Correlation With Various Immunological and Haematological Findings

Materials and methods The present study has been carried out on 60 HIV infected patients presenting with underlying pulmonary complaints and whose clinical presentation was consistent with disease caused by Mycoplasma pneumoniae, after obtaining informed consent subsequent to approval by the Institutional Review Board (IRB) on human ethics in Chennai where the recovery rates of Mycoplasma pneumoniae from induced sputum and throat swab specimens of HIV infected patients were compared and the haematological and immunological findings were analysed. Patients screened were from the age groups ranging from 15 to 60 years, whose respiratory specimens were cultured on PPLO glucose agar and broth, the later with 1% methylene blue. Presumptive identification of Mycoplasma pneumoniae was carried out using guidelines proposed by the Subcommittee on the Taxonomy of Mollicutes, 1979. The respiratory specimens from the HIV-infected subjects were later analysed for their recovery rates, incidence of other bacterial, fungal pathogens, AFB, Pneumocystis carinii and their correlation features with CD4+ and CD8+ lymphocytes were also analysed and compared.

Molecular Characterization of Clinical Isolates of Moraxella catarrhalis by Randomly Amplified Polymorphic DNA Fingerprinting

Moraxella catarrhalis, a less virulent microorganism that colonizes the upper respiratory tract, has recently been associated with lower respiratory disease, especially in HIV-positive immunocompromised individuals and children. Here, we correlated the DNA clustering pattern of 24 clinical isolates of M. catarrhalis for β-lactamase production and drug resistance, from different disease groups using three different arbitrarily selected primers, P1 (5′-TCACGATGCA-3′), P14 (5′-GATCAAGTCC-3′) and P17 (5′-GATCTGACAC-3′). M. catarrhalis revealed three distinct banding patterns with primer P1, four with P14 and P17. 71% (n = 17) of the isolates revealed pattern 2 with primer P1, which discriminated majority (12/21) of the isolates grouped under the major branch of the dendrogram. The minor branch had only three isolates. Separation of M. catarrhalis into two subpopulations (major and minor clusters) with primer P1 is suggestive of diverse genetic lineage. A high level of concordance between RAPD and antibiotic profile was observed. Clustering of M. catarrhalis recovered from different disease groups reflect the identical clinical background or the common geographical/temporal factors. The presence or absence of β-lactamase in a cluster confirmed their single source of origin.