HIV in couples in South India; implications for prevention

Rogers, M.; Gopalakrishnan, Geetha; Kumarasamy, N.; Flanigan, Timothy P.; Carpenter, Charles C. J.; Mayer, Kenneth H.; Solomon, Suniti

doi:10.1258/0956462054094123

Cited by 19 publications

(20 citation statements)

References 14 publications

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“…Proactive risk reduction strategies targeted towards discordant couples, including prompt treatment initiation of the HIV-infected partner and empirically developed culturally-relevant couples prevention interventions, delivered promptly after enrolling into clinical care could be particularly efficacious(Allen 2003; Bunnell 2005; Rogers 2005). These findings suggest the need for continued prevention counseling that integrates reproductive health within the context of primary marital relationships as part of the roll-out of HAART programs in India.…”

Section: Discussionmentioning

confidence: 99%

Sexual risk behaviors among HIV-infected South Indian couples in the HAART era: implications for reproductive health and HIV care delivery

et al. 2011

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The current study examines sexual behaviors among HIV-infected Indians in primary care, where access to highly active antiretroviral therapy (HAART) has recently increased. Between January to April 2008, we assessed the sexual behaviors of 247 HIV-infected South Indians in care. Multivariable logistic regression models were used to determine predictors of being in a HIVseroconcordant primary relationship, being sexually active, and reporting unprotected sex. Over three-fourths (80%) of participants were HAART-experienced. Among the 58% of participants who were currently in a seroconcordant relationship, one-third were serodiscordant when first tested for HIV. Approximately two-thirds (63.2%) of participants were sexually active; 9.0% reported unprotected sex. In the multivariable analyses, participants who were in a seroconcordant primary relationship were more likely to have children, use alcohol, report unprotected sex, and have been enrolled in care for >12 months. Sexually active participants were more likely to be on HAART, have a prior tuberculosis diagnosis, test Herpes simplex type 2 antibody seropositive, and have low general health perceptions. Participants who reported unprotected sex were more likely to be in a seroconcordant relationship, be childless, want to have a child, and use alcohol. We did not document an association between HAART and unprotected sex. Among HIV-infected Indians in primary care, predictors of unprotected sex included alcohol use and desire for children. Prevention interventions for Indian couples should integrate reproductive health and alcohol use counseling at entry into care.

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Section: Discussionmentioning

confidence: 99%

Sexual risk behaviors among HIV-infected South Indian couples in the HAART era: implications for reproductive health and HIV care delivery

et al. 2011

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“…Since marriage and motherhood are important in the Indian cultural context, male spouses should be included in riskreduction programs (M.C. Rogers et al, 2005;Shankar et al, 2003;Solomon et al, 2003). Thus, the change in the title of the PMTCT services to prevention of parent to child transmission (PPTCT) (Dinakar & Indumathi, 2007).…”

Section: Discussionmentioning

confidence: 99%

Predictors of HIV positivity among pregnant women presenting for obstetric care in South India – a case-control study

et al. 2011

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Feminization of the HIV epidemic in India has increasingly burdened the public health infrastructure to provide prevention of mother-to-child transmission (PMTCT) services. A mere 20% of pregnant women in the country receive HIV counseling and testing. One of the strategies, for expansion of PMTCT services is to ascertain an accurate identification of HIV-positive pregnant women. Thus, we sought to characterize a demographic profile of pregnant women at high-risk for HIV infection. We performed a retrospective case-control study. We included as cases, all HIV-positive women identified in a PMTCT program implemented in 23 charitable faith-based hospitals in four states in South India over a period of 75 months, starting in January 2003. Thus a total of 320 HIV-positive cases were frequency matched using stratified random sampling to 365 HIV-negative pregnant women presenting for antenatal care during the same time period. Cases and controls were compared using Chi-square test for categorical variables and Student's t-test for continuous variables. Multivariate step-wise logistic regression analysis was performed. On multivariate analysis, following factors were independently predictive of HIV positivity: age ≤25 years (odds ratio [OR] 0.50; confidence interval [CI] 0.33-0.76; p = 0.001); illiteracy (OR 4.89; CI 2.79-8.57; p <0.0001); woman holding a service and/or professional job (OR 0.27; CI 0.14-0.53; p <0.0001); spouses holding a service or higher job (OR 3.13; CI 2.13-4.59; p <0.0001); being married ≤5 years (OR 2.89; CI 1.68-4.95; p <0.0001); late gestational age at presentation (OR 3.06; CI 2.04-4.59; p <0.0001); history of fetal and/or live born loss (OR 2.36; CI 1.51-3.67; p <0.0001). To our knowledge this is the first large study to evaluate factors predictive of HIV positivity among women presenting for antenatal care in the Indian setting. This type of profiling of HIV-positive pregnant women may help expand PMTCT services in a focused and cost-effective manner in India.

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“…T cell count in the HIV group was 179 cells/ll. Rogers MC et al [19] found the median CD4 count was 97 cells/ll amongst concordant men and 222 cells/ll amongst discordant men.…”

Section: Cd4? T Cell Countmentioning

confidence: 98%

Oral Microflora: A Comparative Study in HIV and Normal Patients

Hegde

Kumar

Bhat

et al. 2011

Indian J Otolaryngol Head Neck Surg

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The study was designed to compare the oral microbiota in normal and HIV-infected individuals. The study tries to establish a significant shift in oral microflora in HIV-infected patients. Antibiotic sensitivity testing was performed to establish any rise in resistance against the antibiotics. It was a two and half year prospective study conducted in a tertiary care centre. The study group consisted of eighty subjects divided into two groups of control and HIV. The age range for this group was 9-75 years. The mean age in this group was 39.7 years. The male:female ratio was 2.75:1. Tuberculosis was the most common opportunistic infection in patients with HIV infection. The most common commensal micro organism isolated was the Viridans streptococci in 60% followed by Streptococcus pneumoniae in 23.33%. HIV Group: The most common commensal micro organism isolated was the Viridans streptococci in 42%; this was followed by the Micrococci spp. in 22% cases. S. pneumoniae was isolated in 6% of cases. The colony count for Viridans streptococci showed a heavy growth in 55.56% of cases in controls whereas the same in HIV group was 62.5%. Micrococcus spp. was isolated from 11 subjects in HIV group while it was not isolated from the controls. 50% subjects in the HIV group showed a heavy growth of Klebsiella spp. whereas controls showed only moderate and scanty growth. In patients with CD4? T cell count less than 50 cells/ll we found a heavy colonization of the oral cavity with Micrococcus spp., Acinetobacter and Klebsiella spp. Viridans streptococcus was not isolated in any of the patients with CD4? T cell count less than 50 cells/ll. As CD4? T cells counts improved to 51-100 cells/ll Viridans streptococcus colonies returned and 37.5% patients showed a heavy growth. Micrococcus spp. colonies were isolated till the CD4? T cells improved up to 300 cells/ll. At counts [ 300 cells/ll the oral microbiota became comparable to that of the controls. Many of the opportunistic infections in HIV are caused by commensal bacteria which are otherwise harmless in a normal individual. Our study is unique in that such a study of the oral commensals in HIV patients has never been reported. We found an increased colonization of the oral cavity by Micrococcus spp. which is a normal commensal of the skin.

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HIV in couples in South India; implications for prevention

Cited by 19 publications

References 14 publications

Sexual risk behaviors among HIV-infected South Indian couples in the HAART era: implications for reproductive health and HIV care delivery

Sexual risk behaviors among HIV-infected South Indian couples in the HAART era: implications for reproductive health and HIV care delivery

Predictors of HIV positivity among pregnant women presenting for obstetric care in South India – a case-control study

Oral Microflora: A Comparative Study in HIV and Normal Patients

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