2. Epidemiology of HIV/ AIDS in India National AIDS Research Institute, Pune, India

3. Indian HIV/ AIDS epidemic [ Important milestones] HIV infection reported among intravenous drug users in Manipur State 1989 Indian pharmaceutical companies marketed ARV drugs with considerable price reduction 2001 India PMTCT feasibility studies initiated by NACO 2000-01 Indian National AIDS Control Programme was launched 1991 First report of HIV infections in sex workers in Chennai, first report of AIDS in Mumbai 1986

4. Phases of spread of HIV epidemic in India Commonest mode of HIV spread in India is by sexual route Mother to child transmission is on the rise HIV spread among intravenous drug users mostly in north-eastern states Blood transfusion associated spread is on the decline Children of HIV infecteddrug users Children of HIV infected women Phase IV Spouses of drug users Spouses of male STD pts Low/ No risk population Phase III Other drug users Male STD patients Bridge population Phase II Intravenous drug users Female sex workers At risk population Phase I

5. Factors related to HIV infection [STD clinic attendees in Pune] * Practice of sex work * No. of sex partners * Receptive anal sex * Females in sex work (FSW) * Men having sex with FSW recently * Lack of formal education * Persons living away from family * Previous / present STDs * Absence of circumcision

6. HIV/AIDS IN MANIPUR HIV was first detected in Manipur in 1989 among intravenous drug users, HIV prevalence >70% in drug users 75.2% knew that needle sharing could lead to acquisition of AIDS, however, needle sharing was practiced by 96.8% Drug users: predominantly male (94.8%), between 15 and 35 years (95.3%) Median duration of drug use: 5 years, No. of times heroin used: 1 – 14 per day SKB ICMR

8. Status of HIV epidemic in India

10. High prevalent States States where HIV prevalence in antenatal women is 1% or more. Moderate prevalent States States where the HIV prevalence in antenatal women is less than 1% and prevalence in STD and other high risk groups is 5% or more. Low prevalent States States where the HIV prevalence in antenatal women is less than 1% and HIV prevalence among STD and other high-risk group is less than 5%.

14. Sentinel Surveillance for HIV Infection in pregnant women in Pune

15. Sentinel surveillance for HIV Infection in tuberculosis patients in Pune HIV seroprealence % Tuberculosis is the most likely presentation of AIDS in India

16. Molecular epidemiology HIV-1 C is the commonest prevalent subtype in India

17. * Oral candidiasis and weight loss were associated with and were highly predictive of low CD4 counts * Absence of clinical conditions were good predictors of high CD4 counts Clinical conditions and CD4 counts 0.70 0.50 0.97 0.07 0.695 184.5 6 Fever 0.73 0.62 0.95 0.19 0.11 167 13 Diarrhoea 0.70 0.33 0.94 0.07 0.66 210 9 Rash 0.81 0.77 0.97 0.24 0.015 157 13 Weight loss 0.71 0.34 0.67 0.38 0.32 291 47 Lymphadeno-pathy 0.75 0.60 0.85 0.36 0.26 195 29 Pulm. TB 0.73 0.55 0.91 0.23 0.34 179 18 Herpes zoster 0.82 0.75 0.96 0.29 0.007 151 16 Oral candidiasis NPV PPV Spec Sens p Median CD4 Patients Clinical condition