title: Hepatitis B, C and human immunodeficiency virus infections in multiply-injected kala-azar patients in Delhi.
abstract: Sera from 164 patients with parasitologically confirmed kala-azar and 100 patients with non-kala-azar Delhite in 2 Delhi hospitals were tested for anti-human immunodeficiency (anti-HIV) and anti-hepatitis C virus (anti-HCV) antibodies and hepatitis B surface antigens to determine which group is more likely to contract these infections. The mean age of the patients was 32.5 y (+/-6.5 y), (120 M, 44 F). Two patients were from Nepal and the others from the kala-azar endemic state of Bihar, India. As geographical controls, 50 serum samples from sex- and age-matched healthy Bihar residents were also tested for the blood-borne viral infections. All patients had been treated with injectable medicines by 1 or more local physicians before they were referred to the Delhi hospitals. The prevalence of hepatitis B virus (HBV) and HCV infection was significantly different between the 2 patient groups. While 2 kala-azar patients (1.21%) were found to be HIV-1 positive, 54 (32.9%) patients had anti-HCV antibodies detected by ELISA and 51 (31.1%) by RIBA test. The seroprevalence of HCV was only 2% in hospitalized non-kala-azar cases and 4% in the geographical controls (p < 0.001). The seroprevalence of HBV was 13.2% in hospitalized kala-azar cases, but only 1.75% in disease control cases and 1.6% in geographical control cases. The difference in infection rates between cases and controls was significant (p < 0.001). The results indicate that kala-azar patients treated locally in Bihar have a greater chance of contracting blood-borne infections. Interestingly, we found that HCV was more prevalent than HBV. These infections were most likely acquired through the re-use of needles by local medical and paramedical practitioners for administering anti-leishmanial drugs. This trend, if not checked immediately, may have drastic consequences in the horizontal transmission of HIV in Bihar.
authors.affiliation: Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi. ssingh@medinst.ernet.in
authors.forename: S
authors.initials: S
authors.lastname: Singh
authors.forename: S N
authors.initials: SN
authors.lastname: Dwivedi
authors.forename: R
authors.initials: R
authors.lastname: Sood
authors.forename: J P
authors.initials: JP
authors.lastname: Wali
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D018562:Disease Transmission, Infectious; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D015483:HIV Antibodies / Q000097:blood; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission / Q000821:virology; D015497:HIV-1 / Q000276:immunology; D006509:Hepatitis B / Q000453:epidemiology* / Q000635:transmission / Q000821:virology; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006526:Hepatitis C / Q000453:epidemiology* / Q000635:transmission / Q000821:virology; D018937:Hepatitis C Antibodies / Q000097:blood; D006760:Hospitalization; D006801:Humans; D015151:Immunoblotting; D007194:India / Q000453:epidemiology; D007273:Injections, Intramuscular; D007898:Leishmaniasis, Visceral / Q000150:complications / Q000188:drug therapy / Q000821:virology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D012307:Risk Factors; D016036:Seroepidemiologic Studies
chemical_list: D015483:HIV Antibodies; D006514:Hepatitis B Surface Antigens; D018937:Hepatitis C Antibodies