N.B. Nair | Indian Science Journal
New Delhi (ISJ) ? Incidence of HIV/AIDS in Kala Azar or Visceral Leishmaniasis (VL) patients is emerging as a public health concern in India, according to a recent study by international medical humanitarian Medecins Sans Frontieres (MSF) or Doctors Without Borders.
?The risk of developing VL is estimated to be between 100 and 2300 times higher in HIV-infected individuals than in those who are HIV-negative,? said Dr. Temmy Sunyoto, Medical Coordinator of MSF in India. MSF has treated more than 11,000 Kala Azar patients in Vaishali district of Bihar since 2007. Its field teams have noticed co-existence of HIV/AIDS in Kala Azar patients since 2012 and have been documenting it systematically since then.
The evidence of prevalence of HIV-VL co-infection in India is scarce, although estimates range from 2-5.6%. In certain age groups it is considerably higher, upto 12.8 %, said Dr. Sunyoto presenting a paper on the subject at the recent MSF Scientific Day in Delhi. She said the virus survives and multiply within macrophages, which are enhanced by HIV co-infection and accelerate progression of disease.
HIV and VL mutually influence each other as they both affect cellular immunity; as a consequence, the risk of VL may be up to 2300 times higher in an HIV-infected individual. Conversely, concurrent VL accelerates HIV progression. VL occurs in co-infected patients when they have already developed advanced HIV disease (AIDS) with low CD4 count.
?The most important problem is treatment; compared to VL patients who are not infected with HIV, cure rates for HIV co-infected patients are lower, drug toxicity is increased, mortality rates are higher, and relapses are common, Dr. Sunyoto told Indian Science Journal
Currently there is no specific guidelines for treatment of co-infected patients. The National Vector Born Diseases Control Programme (NVBDCP) and National Aids Control Programme (NACO) are currently developing such a guideline, however limited are the evidence.
HIV infection weakens the body�s immunity system - the ability to fight off infections or any infectious disease is reduced. Therefore, HIV-infected patients are more likely to develop symptomatic VL due to reactivation of a dormant infection or clinical manifestation following primary infection.
Dr. Sunyoto suggests multidisciplinary management of both the diseases to improve the condition of the patients. She said, MSF study found failure to start ART (antiretroviral treatment) was an independent risk factor for mortality compared to those started ART prior to VL treatment. Therefore, timely initiation of ART should be considered a main focus in the management of these patients.
While the incidence of HIV/AIDS has been on the decline in traditionally high prevalence states in India, Bihar has registered an increase in the number of cases of the deadly disease. A report compiled by NACO and Indian Council of Medical Research (ICMR) indicates the number of cases of HIV/AIDS has been increasing in the 10 low-prevalence states including Bihar. These states now account for 57% of new infections. West Bengal, Gujarat, Bihar, Uttar Pradesh and Odisha are estimated to have more than 1 lakh PLHIV each and together account for another 29% of HIV infections in India.
Image courtesy: MSF India