HIV and cancer registry linkage identifies a substantial burden of cancers in persons with HIV in India.

We utilized computerized record-linkage methods to link HIV and cancer databases with limited unique identifiers in Pune, India, to determine feasibility of linkage and obtain preliminary estimates of cancer risk in persons living with HIV (PLHIV) as compared with the general population.Records of 32,575 PLHIV were linked to 31,754 Pune Cancer Registry records (1996-2008) using a probabilistic-matching algorithm. Cancer risk was estimated by calculating standardized incidence ratios (SIRs) in the early (4-27 months after HIV registration), late (28-60 months), and overall (4-60 months) incidence periods. Cancers diagnosed prior to or within 3 months of HIV registration were considered prevalent.Of 613 linked cancers to PLHIV, 188 were prevalent, 106 early incident, and 319 late incident. Incident cancers comprised 11.5% AIDS-defining cancers (ADCs), including cervical cancer and non-Hodgkin lymphoma (NHL), but not Kaposi sarcoma (KS), and 88.5% non-AIDS-defining cancers (NADCs). Risk for any incident cancer diagnosis in early, late, and combined periods was significantly elevated among PLHIV (SIRs: 5.6 [95% CI 4.6-6.8], 17.7 [95% CI 15.8-19.8], and 11.5 [95% CI 10-12.6], respectively). Cervical cancer risk was elevated in both incidence periods (SIRs: 9.6 [95% CI 4.8-17.2] and 22.6 [95% CI 14.3-33.9], respectively), while NHL risk was elevated only in the late incidence period (SIR: 18.0 [95% CI 9.8-30.20]). Risks for NADCs were dramatically elevated (SIR > 100) for eye-orbit, substantially (SIR > 20) for all-mouth, esophagus, breast, unspecified-leukemia, colon-rectum-anus, and other/unspecified cancers; moderately elevated (SIR > 10) for salivary gland, penis, nasopharynx, and brain-nervous system, and mildly elevated (SIR > 5) for stomach. Risks for 6 NADCs (small intestine, testis, lymphocytic leukemia, prostate, ovary, and melanoma) were not elevated and 5 cancers, including multiple myeloma not seen.Our study demonstrates the feasibility of using probabilistic record-linkage to study cancer/other comorbidities among PLHIV in India and provides preliminary population-based estimates of cancer risks in PLHIV in India. Our results, suggesting a potentially substantial burden and slightly different spectrum of cancers among PLHIV in India, support efforts to conduct multicenter linkage studies to obtain precise estimates and to monitor cancer risk in PLHIV in India

Impact of targeted interventions on heterosexual transmission of HIV in India

<p>Abstract</p> <p>Background</p> <p>Targeted interventions (TIs) have been a major strategy for HIV prevention in India. We evaluated the impact of TIs on HIV prevalence in high HIV prevalence southern states (Tamil Nadu, Karnataka, Andhra Pradesh and Maharashtra).</p> <p>Methods</p> <p>A quasi-experimental approach was used to retrospectively compare changes in HIV prevalence according to the intensity of targeted intervention implementation. Condom gap (number of condoms required minus condoms supplied by TIs) was used as an indicator of TI intensity. Annual average number of commercial sex acts per female sex worker (FSW) reported in Behavioral Surveillance Survey was multiplied by the estimated number of FSWs in each district to calculate annual requirement of condoms in the district. Data of condoms supplied by TIs from 1995 to 2008 was obtained from program records. Districts in each state were ranked into quartiles based on the TI intensity. Primary data of HIV Sentinel Surveillance was analyzed to calculate HIV prevalence reductions in each successive year taking 2001 as reference year according to the quartiles of TI intensity districts using generalized linear model with logit link and binomial distribution after adjusting for age, education, and place of residence (urban or rural).</p> <p>Results</p> <p>In the high HIV prevalence southern states, the number of TI projects for FSWs increased from 5 to 310 between 1995 and 2008. In high TI intensity quartile districts (n = 30), 186 condoms per FSW/year were distributed through TIs as compared to 45 condoms/FSW/year in the low TI intensity districts (n = 29). Behavioral surveillance indicated significant rise in condom use from 2001 to 2009. Among FSWs consistent condom use with last paying clients increased from 58.6% to 83.7% (p < 0.001), and among men of reproductive age, the condom use during sex with non-regular partner increased from 51.7% to 68.6% (p < 0.001). A significant decline in HIV and syphilis prevalence has occurred in high prevalence southern states among FSWs and young antenatal women. Among young (15-24 years) antenatal clinic attendees significant decline was observed in HIV prevalence from 2001 to 2008 (OR = 0.42, 95% CI 0.28-0.62) in high TI intensity districts whereas in low TI intensity districts the change was not significant (OR = 1.01, 95% CI 0.67-1.5).</p> <p>Conclusion</p> <p>Targeted interventions are associated with HIV prevalence decline.</p

Viral Diseases of Public Health Importance in India: Current Priorities with Special Emphasis on Prevention

India faces problems with both communicable and non communicable diseases. The major non communicable diseases are cancer, cardiovascular disease and diabetes mellitus. This article focuses on communicable diseases (infectious diseases) especially viral infections of public health importance. The infections include bacterial, parasitic and viruses. It could be said that fungal infections by the nature of the spread are not of public health concern. The viral infections are transmitted by the respiratory route, water and food borne route, vectors and blood and blood products, sexual route and are of major concern. Efforts are aimed at early detection, prevention by use of vaccines and sentinel surveillance. For the success of public health programmes sentinel surveillance of diseases is mandatory. India has got several programme initiatives addressing the problem. The programs include IDSP, VBDCP and NACO. The approximate cumulative annual prevalence of infectious disease in India ranges from 100 to 200 million individuals affected in one year. India should aim to improve case detection by strengthening laboratory services with manpower training and nationwide quality control scheme, sentinel surveillance activity and prevention by improving the efficiency and scope of UIP. Also, creation of a single portal of infectious disease data handling hub to collect information from different sources will help avoid overlap and duplication of reporting

HPV Genotype Distribution in Cervical Intraepithelial Neoplasia among HIV-Infected Women in Pune, India

<div><h3>Background</h3><p>The distribution of HPV genotypes, their association with rigorously confirmed cervical precancer endpoints, and factors associated with HPV infection have not been previously documented among HIV-infected women in India. We conducted an observational study to expand this evidence base in this population at high risk of cervical cancer.</p> <h3>Methods</h3><p>HIV-infected women (N = 278) in Pune, India underwent HPV genotyping by Linear Array assay. Cervical intraepithelial neoplasia (CIN) disease ascertainment was maximized by detailed assessment using cytology, colposcopy, and histopathology and a composite endpoint.</p> <h3>Results</h3><p>CIN2+ was detected in 11.2% while CIN3 was present in 4.7% participants. HPV genotypes were present in 52.5% (146/278) and ‘carcinogenic’ HPV genotypes were present in 35.3% (98/278) HIV-infected women. ‘Possibly carcinogenic’ and ‘non/unknown carcinogenic’ HPV genotypes were present in 14.7% and 29.5% participants respectively. Multiple (≥2) HPV genotypes were present in half (50.7%) of women with HPV, while multiple ‘carcinogenic’ HPV genotypes were present in just over a quarter (27.8%) of women with ‘carcinogenic’ HPV. HPV16 was the commonest genotype, present in 12% overall, as well as in 47% and 50% in CIN2+ and CIN3 lesions with a single carcinogenic HPV infection, respectively. The carcinogenic HPV genotypes in declining order of prevalence overall included HPV 16, 56, 18, 39, 35, 51, 31, 59, 33, 58, 68, 45 and 52. Factors independently associated with ‘carcinogenic’ HPV type detection were reporting ≥2 lifetime sexual partners and having lower CD4+ count. HPV16 detection was associated with lower CD4+ cell counts and currently receiving combination antiretroviral therapy.</p> <h3>Conclusion</h3><p>HPV16 was the most common HPV genotype, although a wide diversity and high multiplicity of HPV genotypes was observed. Type-specific attribution of carcinogenic HPV genotypes in CIN3 lesions in HIV-infected women, and etiologic significance of concurrently present non/unknown carcinogenic HPV genotypes await larger studies.</p> </div

Association between participants’ characteristics and presence of HPV (any HPV types, carcinogenic HPV types, single carcinogenic HPV type, multiple carcinogenic HPV types, HPV16, and non-HPV16 carcinogenic types) in HIV-infected women in Pune, India: results of multivariable logistic regression analyses.

<p>Footnotes to <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0038731#pone-0038731-t002" target="_blank">Table 2:</a> Abbreviations: HPV: human papillomavirus, STI: sexually transmitted infection, ART: antiretroviral therapy,</p><p>AOR: adjusted odds ratio, 95%CI: Lower limits and upper limits of the 95% Confidence intervals. All Odds ratios presented in this table are adjusted (through multivariable logistic regression) for the covariates presented.</p

Bar graphs showing HPV genotype prevalence by CD4+ cell count categories among HIV-infected women in Pune, India.

<p>HPV prevalence levels (as percentages) are displayed on the Y-axis, with various carcinogenicity groupings (any HPV type, carcinogenic HPV type, possibly carcinogenic HPV types, and non/unknown carcinogenic types) shown as individual bar graphs grouped by CD4+ count categories (≤199, 200–299, 300–399, 400–499, ≥500 /µL) on X-axis.</p

Bar graphs showing HPV genotype prevalence by age categories among HIV-infected women in Pune, India.

<p>HPV prevalence levels (as percentages) are displayed on the Y-axis, with various carcinogenicity groupings (any HPV type, carcinogenic HPV type, possibly carcinogenic HPV types, and non/unknown carcinogenic types) shown as individual bar graphs grouped by age categories (≤25, 26–30, 31–35, 36–40, & ≥41 years) on X-axis.</p

Relationship of prevalent carcinogenic HPV genotypes (present singly or concurrently with carcinogenic types) with risk of CIN2+ and CIN3 in HIV-infected women in Pune, India.

<p>Footnotes to <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0038731#pone-0038731-t003" target="_blank">Table 3:</a> Abbreviations: OR: Odds ratios, 95%CI: Lower limits and upper limits of the 95% Confidence intervals, CIN: Cervical intraepithelial neoplasia, HPV: human papillomavirus.</p>1<p>Odds ratios adjusted for age, number of lifetime sexual partners, CD4+ cell counts, and presence of other carcinogenic HPV types.</p>2<p>Odds ratios adjusted for age, number of lifetime sexual partners, and CD4+ cell counts.</p>3<p>Odds ratios not adjusted for any factors due to small sample size.</p

Prevalence of HPV genotypes, overall and stratified by CIN status, among HIV-infected women in Pune, India.

<p>Footnotes to <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0038731#pone-0038731-t001" target="_blank">Table 1:</a> Abbreviations: ‘Carc’: Carcinogenic, ‘Non/Un.’: Non/unknown, CIN: cervical intraepithelial neoplasia, HPV: human papillomavirus, 95%CI: Lower limits and upper limits of the 95% Confidence intervals.</p>*<p>CIN1 =  CIN1 on Colposcopy/histopathology & ASC-US/LSIL on cytology, CIN2 =  CIN2 on colposcopy/histopathology & HSIL on cytology; 3 women did not undergo colposcopy or cytology, hence the sum of numbers of women with confirmed cervical disease status is n = 275, not n = 278.</p