HIV/AIDS Scenario in JN Hospital, Manipur - A perspective
- Part 1 -

Dr K Priyokumar Singh *

HIV/AIDS once a dreaded and fatal disease to start with has now become a chronic manageable disease. This disease which was detected from the gay persons in LOS Angles in 1981 has been showing continuous and progressive medical achievements in regards to its effect on human body on diagnosis of complications and in its treatment modalities. With the availability of ART/HAART (Anti-retroviral Therapy/Highly active anti-retroviral treatment) from 1996 onwards this disease has changed from a medical challenge to a socio-economic human problem.

Manipur had the first HIVV/AIDS in the year of 1989-90 from a female IDU patient. The spectrum of the disease was then very confusing. There was no proper awareness of the disease amongst the medical professionals and the health authorities. There were no proper NGO/CBO's working in HIV/AIDS. NACO gradually came into being and then the disease has been put under its strict vigilance.

To start with the management of this disease came up first for its awareness and to manage the various O.I's (Opportunistic Infection) specific to HIV/AIDS. And many OI's were not diagnosed properly leading to many avoidable deaths in Manipur and elsewhere.

The diseases like Cryptococcal meningitis, Penicilliosis, Toxoplasmosis, Pnenmocystis Carinii Pneumonia (P.C.P), Cytomegalovirun retinitis (CMV-retinitis), malignancies lilie Kaposis Sarcoma, Lymphoma, Progressive muItifocal Leucoencephalopathy, (PMLE), etc were not properly diagnosed due to lack of knowledge and awareness, leading to many deaths which nowadays are being cured or prevented.

With the coming of ART, first with Zidovudine and followed by other drugs which are able to control HIV multiplication by various combinations of them called the HAART (Highly Activc Anti-Retroviral Treatment) has changed the very outlook of HJV/AIDS from fatal disease to a chronic manageable disease ARV drugs in the beginning was scantily available and were very costly.

It was beyond the reach of common people and many persons succumbed to the disease. With the effort of various NGO/CBO's and the NACO (National Aids Control Organization) started free ART roll out from April 2004. In Manipur, the first centre of free ART was at RIMS (Regional Institute of Medical Sciences). Then the free ART came to J.N. Hospital in the Dec. 2004. Since then this dreaded disease has been under medical control, but many new areas came up for further attention by various Government and NGO's.

From the hospital records of J.N. Hospital Porompat a 5 year data was prepared which shows the trend and challenges in the management of HIV/AIDS in Manipul'.

Table 1 Hospital Admission 2003-2007

The table shows the decrease in male admission from78.68% in 2003 to 64% in 2007 whereas the female admission increasing from 21.32% in 2003 to 36% in 2007. The trend shows the importance of HIV/AIDS in the whole population particularly to the female population.

Table 2. Risk Factors

In Manipur, the most common mode of HIV transmission is through sharing of injecting equipments by people who inject drugs. Manipur being on the cross road of "Golden Triangle" of drugs trafficking route, it became the main route of transmission. Other routes of HIV transmission are also prevalent in the State as given in the table 2.

Manipur shows the heterosexual route being from 20.32% in 2003 to 27% in 2007, an increasing trend showing the importance of this route in HIV/AIDS transmission. The IDU spread has shown a downward trend from 62.08% in 2003 to 52.11 % in 2007. This shows the various importance of AIDS Awareness programmes by the Govt. & various NGO's. But a lot more are to be done to bring down the rate of transmission.

Another serious situation in Manipur is about the Mother to Child Transmission (MTCT) which has shown rapid upward trend from 1.89% in 2003 to 11.1 % in 2007. This area should be given proper attention and the PPTCT programme need more effective application so as to bring down this rapid increase.

The mode of transmission by Blood transfusion has considerably declined in the coming years from a figure of 4.26% in 2003 to a figure of 0.79% by 2007. This is due to mandatory testing of blood for viral bodies before Blood transfusion.

Another area where we need a closer counseling for all patients of HIV-reactive route of transmission-"Non-specific" where no reason was given by the person. The figure varies from 10.2% in 2003 to 8.20% in 2007.

Coming to deaths from HIV/AIDS in J.N. Hospital, it is seen comprising from a figure of 18.95% in 2003 to 17.46 % in 2007, showing, no apparent increase in deaths, but a slightly decreased ratio.

The figure is only from the Hospital records but the unreported deaths after discharging from hospital when terminally ill, are not in the record. This high death rate is mainly from the HIV/HCV co-infection which is a major challenge nowadays.

The opportunistic infection (O.I) in HIV/AIDS, which has seen recorded in the Hospital admission are shown as below:

1) Tuberculosis (both nulmonarv & extra-pulmonary)

It shows that T.B. infections vary from 38.3% in 2003 to 32.27% in 2007. It is seen that TB is the commonest O.I. in HIV/AIDS as found by other outside studies. The programme needs more effective application to bring from the % of infection.

2) Cryptococcal Meningitis:

The figure shows that cryptococcalmeningitis is the O.I. next to T.B. and the % has shown a slight downward trend, but still very persistent in our Hospital.

3) P.C.P (Pneumocytis Carinii pneumonia)

This O.I. once a serious problem often confused with pulmonary tuberculosis has been decreasing from a figure of 18.48% in 2003 to 5.55% in 2007. The main reason for this decreasing trend may be due to HAART and the primary prophylaxis of co-triamoxazole.

4) Penicillosis (P. marneffii)

Penicilliosis is also common in HIV/AIDS in Manipur. For the first time in India, Penicilliosis was diagnosed from Manipur in J.N. Hospital. This is mostly a skin manifestation, previously misdiagnosed as molluscum contagiosum because of its similarity in skin lesion. If not diagnosed in time, it is a fatal disease. The treatment by Intraconazole is very satisfactory.

Table 3

The figure shows a decreasing trend in Penicililosis infection from 5.69% in 2003 to 4.76% in 2007

To be continued....