A Study of HIV Disease Course Among Rural Women Receiving ART
Abstract
Introduction: The present study is an attempt to evaluate and document HIV incidence and progression among women in and around Srikakulam, a remote town in the north coastal Andhra Pradesh. The results throw light on a greater effort required to be mobilized towards preventive and therapeutic care in women in rural areas.
Material & Methods: This is a retrospective study, using the data collected from ICTC (from April 2007 to March 2011) and ART center (from April 2007 to February 2010) of RIMS General Hospital, Srikakulam. The study is focused on the development of CD4 counts at regular intervals among women on ART. Opportunistic infections, deaths, transfers and the profiles of CD4 counts have also been analyzed.
Results: There is a+ significant percentage of responsiveness to therapy in the younger age group. Tuberculosis is significant in being the commonest opportunistic infection causing death with a percentage of 16.4. Maximum number of deaths (27.8 %) were associated with CD4 counts as low as 0 – 50 per cu mm, and there is a decrease in the percentages of deaths at higher range of CD4 counts. As a baseline parameter, the CD4 counts of 50 HIV seronegative women between the ages of 15-45 years are estimated. The average is 972 cells /cumm.
Conclusion: In spite of an overall decrease in the severity of the epidemic, the problem persists among women in the rural set up. The present study throws light on the need of special programmes which focus on early detection, early initiation of ART, counseling regarding barrier methods applicable to females and monitoring therapy in women.
Downloads
References
2. Gilks CF. Natural history of HIV-AIDS. In: Manson’s Tropical Diseases.21st ed. W B Saunders: 2003 .Ch 20 P. 411.
3. Gangakhedkar RR, Bentley ME, Divakar AD .Spread of HIV infection among married monogamous women attending STD clinics in India . JAMA 1997; 278 : 2090 – 2092. [PubMed]
4. Patubidn VG, Daftary SN. Natural course of HIV. In: Shaw’s Text Book of Gynecology. 15th ed. Elsevier’s Publications; 2010. Ch 11: 148.
5. Murugavel KG, Balakrishnan P, MohankrishnanJ, Solomon SS, Shankar EM ,. Establishment of T-lymphocyte subject reference intervals in a healthy adult population in Chennai, India. Indian J Med Res 2009;129:59-63. [PubMed]
6. Usha KB, Rewari BB. Diagnosis and management of HIV/ AIDS, a clinician’s perspective. 1st ed. B.I publications Private Limited ; 2004. ch 18 P. 2-9.
7. Wilkins EGL.Humanimmuno deficiency virus infection and the Human acquired immunodeficiency syndrome. Davidson’s Principles and Practice of Medicine.20th ed. John A.A Hunter ,Churchill Livingstone- Elsevier publication 2006;ch14 P. 399-401.
8. Shaefer M, James D, Henry Z, Amy C, Martin G, James G. Effect of age on baseline CD4+ and CD8+ cells and response to ART over 48 weeks in a large clinical trial database. Presented at the 1st Int. Workshop on HIV & Aging, 4-5 Oct 2010, Baltimore, USA.
9. Solmon S, Kumarswamy , Anuradha S, Vennila R, Pal JA. TB and HIV infection – an association. Indian J Med Microbiol 1994, 12: 313 – 4.
10. Kumarasamy N, Solomon S, Flanigan TP, Hemalatha R, Thyagarajan SP, Mayer KH. Natural history of human immunodeficiency virus infection among adults in Mumbai. Nat Med J India 2003;16: 126-31.
11. Nakanjako D, MayanjaKH ,Ouma J , Wanyenze R, Mwesigine D, Namle A, Sse MJ, Senkusu J, Colebunders R, Kamya MR :Tuberculosis and human immunodeficiency virus co-infection and their predictors at a hospital based HIV/AIDS clinic in Uganda. Int J Tuberc lung Dis 2010;14: 1621-8.
12. Martinson NA, Barnes GL, Moultion LH, Msandiwa R, Hausler H, Ram M, Mclntyre JA, . New regimens to prevent tuberculosis in adults with HIV infection. N Eng J Med 2011; 365 (1) ;11-20. [PubMed]
13. Hermans SM, Kiragga AN, Schafer P, Kambugu A, Hoepelman A1, Manabe YC. Incident tuberculosis during antiretroviral therapy contributes to suboptimal immune reconstitution in a large urban HIV clinic in sub-saharan Africa.http://blogs.plos.org/plos/2010/10/epigenetics-2010-a-new-collection-from-the-plos-journals/.