Table of Content Volume 8 Issue 3 - December 2018

 

 

Frequency of HIV sero-positivity among antenatal mothers and general patients admitted in a tertiary care hospital in Thane, Maharashtra – A hospital-based study

 

S Khadse¹, S Kartikeyan², R Zade^3*, P Sawardekar⁴, C Rajawade⁵, R Dube⁶, S Alam⁷

 

{¹Dean} {²Professor and HOD, ³Assistant Professor, Department of Community Medicine} {⁵In-Charge, Medical Record Department} {^6,7Interns} Rajiv Gandhi Medical College and Chhatrapati Shivaji Maharaj Hospital, Kalwa Thane, Maharashtra, INDIA.

 

Abstract               Objectives: The objectives of this comparative retrospective study were to compare the frequency of HIV sero-positivity among antenatal and postnatal mothers admitted in tertiary care hospital with the frequency among all patients admitted in various wards in tertiary care hospital. Materials and methodology: Retrospective data were collected from medical record section of tertiary care hospital and records of inpatients in various wards and intensive care units were screened thoroughly. Hospital records of patients admitted in antenatal and postnatal wards for year 2017 and 2018 till month of September were screened and age of mothers, gravidity-parity status and HIV status were recorded. Results: The frequency of HIV sero-positivity among antenatal and postnatal mothers admitted in year 2017 and 2018 till September were 0.38% and 0.43% respectively. In comparison, the frequency of HIV sero-positivity among the general patients admitted during the same period was 0.26% in 2017. The percentage of deaths among HIV sero-positive patients was 12%. Conclusion: Though the prevalence of HIV infection in overall admitted patients is less than state average, case death rate among HIV infected patients is too high(12%). It alarms the need of early diagnosis or screening of HIV infection and start of ART in general population is equally important.

Key Word: HIV Sero-positivity, ART, Medical Record Section

 

 

 

INTRODUCTION

India is categorized as a low prevalence nation for HIV with a seroprevalence rate of less than 1% among the adult population.¹ In view of our large population pool of one billion plus, a mere 0.1 per cent increase in the prevalence rate will raise the number of persons living with HIV by over half a million. In India, the predominant mode of HIV transmission is through heterosexual contact,² therefore, unsuspecting women are at high risk of getting the infection. The trend of new or incident infections, especially in young people who have recently become sexually active, is the most sensitive marker to track the course of the HIV epidemic. Unfortunately, incidence is hard to measure directly, but prevalence in young women is an indirect but useful proxy.³ HIV prevalence has been increasing among pregnant women in many regions within the country. Illiteracy, early marriage, violence and sexual abuse against women are the major socioeconomic reasons for their vulnerability to HIV infection. Government of India has initiated free antiretroviral therapy (ART) roll out programme since 2004. Currently, there are over 211 free ART centers all over the country providing antiretroviral therapy. Studies from developing countries have reported reduction in mortality in the post highly active antiretroviral therapy (HAART) era.^4,5 Hence, it is expected that AIDS would be transformed from a fatal disease into chronic manageable condition in India. A study from south India has reported a dramatic decrease in mortality from 25 to 5 deaths per 100 person years in HIV infected individuals between 1997 and 2003 after initiation of HAART.⁶ However, a retrospective study from Andhra Pradesh in southern India reported more deaths in HAART era as compared to pre HAART era.⁷ This was attributed to less awareness of HIV status by patients and/or late diagnosis of HIV infection resulting in late initiation of ART. Thus, lack of access to ART continues to contribute to higher mortality in HIV infected individuals. Though there are some reports on causes and prevalence of HIV related deaths in India^8,9 very few reports are available on mortality on large cohorts followed for a longer period of time.^10,11 There could be problems in registration of deaths, more specifically, cause-specific mortality reporting. In many instances, the cause of death may be attributed to the opportunistic infections but there may not be a mention of HIV/AIDS status either due to failure to diagnose the underlying HIV disease or avoidance of mention of the underlying condition of HIV/AIDS due to confidentiality related concern. Hence this study is conducted to know the frequency of HIV positive in antenatal postnatal mothers and other general patients. Mortality data due to HIV AIDS is also studied retrospectively.

 

METHODOLOGY

The study was carried out in Chhatrapati Shivaji Maharaj hospital Kalwa Thane. It is a Thane Municipal corporation tertiary care hospital serves for majority of urban and rural population of Thane district since more than 25 years. It is a retrospective study done for year Jan to Dec 2017 and Jan onward till September 2018. Retrospective data was been collected from Medical Record section of hospital. Data related to total admissions in various ward, admission in Antenatal and postnatal ward was been collected. Age and GPLA status was been studied from each In hospital record file. Death Data due to HIV AIDS was been compiled from various wards and ICU. Frequency and proportion was been calculated. Data related to start of ART prophylaxis to the newborn born to HIV positive mothers was collected from ART

 

RESULTS

Retrospective data analyzed for Antenatal ward. A total of 6703 deliveries conducted in 2017, out of which 26 were HIV positive mothers, similarly in 2018 till month of September total deliveries conducted were 5262 out of which 23 mothers were HIV positive. Thus frequency of HIV positivity for year 2017 and 2018 found to be 0.38% and 0.43% respectively. (Fig 1 and Fig 2).

 

 

                Figure 1: Frequency of HIV positivity in antenatal mothers in  Figure 2: Frequency of HIV positivity in antenatal mothers in

year 2018                                                                 year 2017

 

Table 1: Age distribution and HIV positivity status in antenatal mothers

Majority of HIV positive mothers were found in age group of 20-25years (50.81%) followed by 26-30 (38.80) years of age.

Table 2: Age distribution and HIV positivity status in antenatal mothers

Majority of HIV positive mothers were found in age group of 20-25years (56.52%) followed by 26-30 (39.14) years of age in 2018.

Table 3: HIV positivity and GPLA status in antenatal mothers

As per Parity, approximately 60% of HIV positive mothers were second gravida.

 

Table 4: IPD and OPD wise frequency of HIV positive general patients

Category of patients	IPD			OPD
Year	Total patients	Total HIV positive patients	Percentage of HIV positive patients	Total patients	Total HIV positive patients	Percentage of HIV positive patients
2017	28631	75	0.26	369500	225	0.060
2018	26406	90	0.34	272080	167	0.061

 

Figure 3: IPD and OPD wise frequency of HIV positive general patients

Frequency of HIV positive general patients were found be 0.26% and 0.060 in year 2017 for Inpatient and outpatient department respectively. A little rise (0.34%) of HIV positive patients was the major finding in year 2018.

 

Table 5: Year wise HIV AIDS case fatality rate

Case fatality rate due to HIV AIDS were found to be 12% and 17% in year 2017 1nd 2018 respectively.

 

Table 6: Sex wise HIV AIDS case fatality rate

Table 5 depicted that more deaths due to HIV AIDs in male patients as compared to female patients markedly seen in 2018.

 

DISCUSSION

 In our study HIV sero-positive frequency among antenatal mothers were found to be 0.38% and 0.43% for year 2017 and 2018 which is similar as finding (0.5%) of study done in Cuttack Odisha.¹² Studies conducted by Khokar et al in a tertiary care hospital in Gujurat and Farhana Aljabri et al in South India observed the prevalence rate of HIV as 0.39% and 0.27% respectively.^13,14 Different authors have reported different seropositivity rates, ranging from 0.16 % to 0.88%. The figures vary widely between the various states of India. Parmeshwari et al from Namakkal District, Tamil Nadu; Kulkarni et al from Nanded, Maharashtra and Nagdeo et al (2007) from Hingna, Nagpur, Maharashtra reported seroprevalence rate of 0.70%, 76% and 0.72% respectively.^15,16,17 In our study majority of HIV positive mothers were found in age group of 20-25years (56.52%) followed by 26-30 (39.14) years of age in 2018. Similarly, a recent study done by Sayare et al Akola, Maharashtra revealed that the maximum no of client tested positive were in the age group of 20-29 years comprising of 77.8%.¹⁸ A study carried out in western India by Ukey et al in 2003-2004 reported that the most affected age group was 18-24 years.¹⁹ It indicates the prevalence was high among newly sexually active pregnant women. Young women are more vulnerable to HIV epidemic and the virus is more easily passed to young women because of their immature vaginal tract. In Nayak’s study out of total 8 HIV-positive pregnant women 7 (87.5%) were in the age group of 20 to 30 years, followed by 1 (12.5%) in the age group of less than 20 years.¹² Giri et al found in their study of the total 50 HIV positive women17 (34%) were aged 18-23 years, 21 (42%) aged 24-28 years.²⁰ In our study approximately 60% of HIV positive mothers were second gravida followed by primipara 28% which is comparable with Nayak’s study majority (62.5%) were second gravid¹² contrary to the study done by Patil et al where majority (53.83%) were primigravida and 46.2% were multigravida.²¹ Ashtagi et al in their study observed that among the HIV-positive pregnant women attending ANC clinic 63.83% were multigravida and 36.17% were primigravida.²² In our study case fatality rate due to HIV AIDS were found to be 12% and 17% in year 2017 1nd 2018 respectively which is comparable with overall mortality in Pune study where deaths observed in the hospitalized patients was 26.3.²³ However, the our study was carried out in a tertiary care government hospital wherein a large number of patients could have been admitted at terminal stages due to various illnesses attributing to higher mortality. Though there are some reports on causes and prevalence of HIV related deaths in India very few reports are available on mortality on large cohorts followed for a longer period of time. In our findings case fatality rate due to HIV AIDs in male patients was found to be more as compared to female patients markedly seen in 2018. Mortality in our study was lower than those reported from Sub-Saharan Africa (8 – 26%²⁴ and higher than that from Taiwan in pre HAART era⁴ (10.2 per 100 person years). A collaboration of 12 prospective cohort studies from Europe and the United States has shown that combined ART halved the average mortality rate in HIV-infected individuals.²⁵ All the patients who died of HIV AIDs were on antiretroviral therapy which was known from hospital admission file but confirmed initiation of ART and duration of ART could not make out from the records. Similarly, all HIV sero- positive antenatal mothers were kept on ART. In continuation with above all newborn babies born to HIV sero- positive antenatal mothers were started on antiretroviral therapy.

 

CONCLUSION

Though the prevalence of HIV infection in overall admitted patients is less than state average(18.4%) and in antenatal mothers(1.8%), case death rate among HIV infected patients is too high(16%). It alarms the need of early diagnosis or screening of HIV infection and start of ART in general population is equally important. Therefore, it may be recommended that even though the curative treatment for HIV is not available at present we can minimize, if not prevent, the pediatric HIV infection by early screening of pregnant mothers for HIV followed by perinatal short-term chemotherapy, safe delivery practices and modified infant feeding.

 

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