As the global epidemic (plague and smallpox) has already been turned out to be a major killer of humankind on the epic scale, now the HIV/AIDS is becoming the fourth leading cause of death in the India with Global Prevalence of 0.8% [1].

In United states of America, however, AIDS cases are said to be dropping but in the developing countries though the cases continue to rise alarmingly, especially in India [2], and now the state of affairs is so unsatisfactory that the frequent cases of mass infection in economical weaker poor society due to the negligence or lack of awareness.

According to the UNAIDS and World Health Organization (WHO) reports of November 2012-13 there are approximately 35 million people living with HIV/AIDS Worldwide and 90% of them are in developing countries [3], of these, 3.2 million were children (<15 years old) and 2.1 million individuals worldwide became newly infected in this year.

AIDS (a/c“Slim Disease”) is a fatal illness caused by a retrovirus known as Human Immuno-deficiency Virus (HIV), this virus breaks down the body’s immune system, leaving the victim vulnerable to life-threatening opportunistic infections/ unusual malignancy & unusual neurological disorders [4]. HIV epidemic in India is no longer just a public health issue but have turned into a serious socioeconomic & developmental concern, because nearly 89% of reported cases are occurring in sexually active & economically productive age group of population (i.e. 15-44 years) [5]. Because of the huge population of India, the HIV epidemic in India will have a major impact on the overall spread of HIV in ‘Asia-pacific [6,7].

Prevalence of the HIV epidemic in India is highly uneven from State to State[*8, 9].highest in the south -western state (e.g.-Maharashtra, Karnataka, Tamil Nadu and Andhra Pradesh), where sexual transmission is dominant, and In North-east state (e.g.-Manipur Meghalaya, and Nagaland), where injecting drug use is common route of infection [*10, 11].

According to MPSAC report, Madhya Pradesh ranks 13 with 4755 reported cases of HIV/AIDS [12]. Indore (907 cases) remained the city with the greatest number of AIDS cases in this state followed by Bhopal (461), Jabalpur (431) and Gwalior (339) [12, 13, 14].

After ensuring confidentiality and "guarantee of anonymity" to the individuals, the data was analysed. As this study was data based and extremely influence by the rate of registration from different age/sex group, different community and different region, and social factor such as gender bias/cast bias also influence to the ‘rate to seek medical help’ in this area.

Inclusion criteria: Patients with HIC Positive cases were included in the study.

Exclusion criteria: Those patients who did not gave consent to be included in the study were excluded.

Screening of HIV positive patients: For children and adults, HIV screening was done according to adult national testing strategies and two positive HIV ‘antibody’ test results were done sequentially in a clinically symptomatic child was suggestive of HIV infection. As because of the passive transfer of maternal antibody to the fetus, children below 18 months of age HIV status was decided on the basis of two PCR test (for viral RNA) and they were termed as HIV positive when 2 PCR test were positive. PCR testing facility was not available in SGMH & SSMC Rewa and samples were sent to the higher centre. Few patients of this region were registered in other ART centre in nearby ART centre, such as Jabalpur, Bhopal and Allahabad so there might be slight difference between data and real HIV status of this areas

Ethical committee: The permission from ethical committee was obtained before starting this study and NACO guideline for diagnosis of HIV were followed for this study.

Data analysis: Pre-tested proforma was used for data collection. It was entered into Microsoft Excel 2003 and analysed using Statistical Package for Social Sciences (SPSS) v 16.0. Categorical data were represented as frequency and percentage and numerical data as mean and standard deviation.

In this study total number of ART attendees (patients) were 1224 and out of these total patients, 7.27% (n=89) were children (<15years) and 92.73% (n=1135) were adult (>15 years). Out of 89 children, 5.15% (n=63) were male and 2.12% (n=26) were female and out of 1135 adult patients, 53.26% (n=652) were male and 39.46% (n=483) were female.

About 4.9% (n=60) patients were totally asymptomatic and detected HIV positive during screening of HIV for other reasons (i.e. blood

Table-2: Socio-demographic and other profiles of HIV patients from the present study

Out of total children (n= 89), mode of transmission in 89.88% (n=80) were mother to child, 2.24% (n=2) were blood transfusion and 2.24% (n=2) were unsafe injection (history/ blame). And 3.37% (n=3) were those who had no obvious mode of transmission (i.e. unknown/ unclear,) as their mothers were either negative or died during childbirth, and no history of high-risk behaviour of child.

Table-3: Mode of transmission in HIV patients from the present study

Table-5: Persisting complaints in HIV patients (children) from the present study

With the rapid increase in the global pandemic of HIV, it is estimated that India will face the second highest burden of HIV in the world after South Africa [17]. Here out of total 1224 HIV patients 7.27% (n=89) were children <15 years of age, that were comparable to the national prevalence of HIV in children (i.e.~7.00%) according to the NACO annual report [18]. HIV patients in between 20-

In the present study, 58.41% of male patients outnumbered the 41.58% of female patients, and the average Male-Female ratio in the adult’s patients was 1.3/1, the Male-Female ratio in Madhya Pradesh was 1.07/1 [21, 22].

In comparison to other studies performed to determine the Male-Female ratio by Umesh et al in Maharashtra was 2.3/1 [5] and by Kaiser Ahmed Wani et al in Kashmir was 7/1 [23]. The variations in the Male-Female ratio of HIV patients in a particular area might be due to the influence of the populations, medical seeking behaviours of female, gender bias and the level of stigma.

In the present study, male patients (58.41%) outnumbered the female patients (41.58%) and average M/F ratio in adult patients was 1.3/1 {M/F ratio in M.P state population were - 1.07/1 in adult 15-64 years [21, 22]. It might be due to the fact that M/F ratio of HIV patient in particular area might be very much influenced by the M/F ratio of that population, medical care seeking behaviours of female in society, gender bias, and level of HIV related stigma in that society.

In the present study, at the age between 20-29 years, female patients outnumbered the male patients as male to female ratio of HIV patient between 15-19 years was 1.75/1 (7:4) that raised steeply and reversed to 0.5/1 (1:2) at age between 20-24 years and ~1/1 at age of 25-29 year (i.e. female patient outnumber the male patient). It might be assumed to be due to the fact that females get married 3-5 years earlier than males, so their sexual life began earlier so they are more vulnerable to infection at earlier age than their male counterpart.

Similarly, M/F ratio at the age of 25-29 years were 0.90/1 that reversed to 2.4/1 at age of >50 years, i.e. male patient outnumbers the female patients. probably, it might be due to the above two fact, where female get married 3-5 years earlier than males, so females get infection earlier, hence die earlier than male. In other words- at the age of 20-29 years, female patients outnumbered the male patients and at the age of >50 years, male patients outnumbered the female patients. In the present study first most common mode of transmission of HIV was sexual (88.4%), second was mother to child; MTC (6.61%) and third was unclear/unknown (3.1%.). Blood transfusion, unsafe injection, and intravenous drug usages collectively constituted <1%.

In the present study cases with neurological sign and symptom were minimum (1.9%). Loose stool and weight loss were twice more common in female, where fever, cough with fever, and lymphadenopathy were more common in male. In the present study asymptomatic patients mostly were male (M/F=2.5/1).

Finding of asymptomatic patients in study done by Umesh et al [5] (7.0%,) and by Kaiser Ahmed Wani et al [23] in Kashmir (18.0%) did not match with the present study. In a study done by Chakroverty J and Mehta H et al [25] in East India where fever constituted-70.6%, Weight loss-53.3%, chronic diarrhea -43.9%, and cough-40.3% of total complaints of HIV patients and in this study most common opportunistic infection were T.B (38.8%), OC/Dysphasia (20.30%) and diarrhea (12.7%).

Here in the present study majority of HIV children presented with four major complaints – i.e. Recurrent LRTI (43.82%), Wasting (19.10%), Tuberculosis (12.36%%) and Chronic Diarrhea. (10.11%), and Oral Candidiasis/ dysphagia, Herpes zoster/simplex (mainly labialis / oticus / ophthalmicus) and Lymphoma, constituted only 8.99%., here 5.62% children were asymptomatic.

Where a study done by Rajasekran et al in Chennai [26], out of 1768 child patients 63.1% had tuberculosis [27.5%-pulmonary, 14.9%-extra-pulmonary and 20.6% disseminated] 15.8% had LRTI (non-tubercular), 15.2% had pneumocystis cariniipneumonia, and 0.16% had lymphoma. As These findings were different from the present study so it might be due to the different natural frequency of diseases in different areas of country. The major drawback of the present study was the limited number of patients enrolled in the study, a study with higher number of subjects could provide more useful outlook towards the current demographic profile of HIV.

As the present study was done in rural area, where hygiene was poor and sanitation was bad and environment was dusty, that is why infectious complications were more common in the present study. As lungs and GIT interact to the environment directly, so contamination of these two systems i.e. Lower RTI / Upper RTI and Chronic Diarrhea/Oral Candidiasis were more frequent and were also the most common cause of fever in these patients.