November 29, 1995
Media Contact: Marc Kusintz
Phone: (410) 955-8665
In the first study of its kind in India, researchers from Johns Hopkins and the National AIDS Research Institute in India have found evidence there of one of the highest rates of HIV transmission ever reported.
The findings, based on patients attending sexually transmitted disease (STD) clinics in the city of Pune, support the warning by the World Health Organization (WHO) that India may face the largest burden of HIV infection of any country in the world by the end of this decade. WHO currently estimates that India has more than 1.5 million HIV-infected persons.
"Our study was the first to study the AIDS epidemic in India over time," says Robert Bollinger, M.D., assistant professor of infectious diseases and senior author of the paper. "Previous studies simply identified who was infected at the time of the study and gave only a snapshot of the epidemic."
The study appears in the December issue of the Journal of Infectious Diseases.
"Our findings mean that further studies should be done to determine if the same rate of transmission is occurring in similar risk groups throughout India," Bollinger says.
The study was done because the researchers previously found that, by 1993, one fifth of patients at STD clinics in Pune were already infected with HIV. The team followed 851 uninfected patients visiting the clinics about once every three months between 1993 and 1995. Most (85 percent) of the participants were men. About 60 percent of the women were prostitutes.
During the study period, the researchers followed several groups of patients who visited the STD clinics at various times to determine how many in each group became infected with HIV. A total of 62 people followed in these groups became infected with HIV, despite having been treated for STDs and advised on how to avoid HIV infection. The team estimated that the risk of HIV infection over time in these groups was more than 10 percent per year of follow-up, one of the highest rates of HIV transmission ever reported from such a risk group.
The incidence of infection was higher in women (14.1 percent per year) than in men (9.4 percent per year). Among prostitutes, the incidence of infection was 26.1 percent per year.
The researchers also found that the risk of HIV infection was seven times higher than normal in people with recurrent genital ulcer disease (open sores caused by a sexually transmitted disease), and three times higher in those with either recurrent urethritis or cervicitis. Urethritis is an inflammation of the urethra, the tube through which urine flows from the bladder to outside the body; cervicitis is inflammation of the cervix, the opening of the womb.
The study also found that among people who used condoms during the previous three months, there was a 56 percent reduction in the risk of infection with HIV.
"Although India has many important public health problems, it's particularly important to study the AIDS epidemic there, especially because it might worsen other public health problems, such as tuberculosis," Bollinger says. "But we hope that our findings will help researchers design programs for slowing the rate of infection in India. This is especially important because there is no effective vaccine available yet."
Other authors of the study include Sanjay M. Mehendale, Raman R. Gangakhedkar, Anand D. Divekar, Manjusha R. Gokhale, Arun R. Risbud, Ramesh S. Paranjape and Jeanette J. Rodriques (the National AIDS Research Institute, Pune, India), Rajiv R. Sule, Sumil N. Tolat (B.J. Medical college, Pune), Vijay D. Jadhav (Dr. Kotnes Municipal dispensary, Pune; Ronald S. Brookmeyer and Mary E. Shepherd (Johns Hopkins); and Thomas C. Quinn (National Institute of Allergy and Infectious Diseases and Johns Hopkins).
The study was supported by the National Institute of Allergy and Infectious Diseases, Family Health International and the Fogarty International Program.