HIV/AIDS in Pakistan: the context and magnitude of an emerging threat

An ALP enzyme-based electrochemical biosensor coated with signal-amplifying BaTiO3 nanoparticles for the detection of an antiviral drug in human blood serum

Tenofovir (TFV) is an antiviral drug used to treat the co-infections of HIV/HBV viruses. Accurate monitoring of TFV drug levels is essential for evaluating patient adherence, optimizing dosage, and assessing treatment efficacy. Herein, we propose an innovative electrochemical sensing approach by using the alkaline phosphatase (ALP) enzyme with the support of BaTiO3 nanoparticles. An attractive sensitivity and selectivity of the developed sensor towards TFV detection were achieved. First, the nanoparticles were synthesized by following a single-step sol-gel method and characterized through various analytical techniques, including SEM, EDX, FT-IR, BET, zeta potential, XRD, and UV-vis and Raman spectroscopy. The suggested mechanism demonstrated the formation of a strong bond between TFV and the ALP enzyme, primarily through the phosphate group, resulting in enzyme inhibition. Various parameters like nanoparticle amount, electrode modification time with enzyme and BaTiO3 nanoparticles, and drug incubation time were optimized. The biosensor demonstrated an outstanding limit of detection (LOD) of 0.09 nM and recovery percentages of 98.6-106% in human blood serum, indicating adequate repeatability and selectivity. The proposed biosensor can be converted into a portable device for measuring small sample volumes and observing patients for immediate medical care or personalized therapies. It achieved better sensitivity compared to existing methods, making it suitable for precise drug detection in microdoses.

Chemiluminescent-microparticle-immunoassay-based detection and prevalence of human immunodeficiency virus infection in Islamabad, Pakistan

An advanced detection assay is important for clinical diagnosis of human immunodeficiency virus (HIV) infection in asymptomatic individuals. The first step in timely treatment and management of the infection is the early detection of HIV. In this study, we determined the prevalence of HIV in Islamabad for the first time using a chemiluminescent microparticle immunoassay (CMIA), which is an advanced serological diagnostic technique. A total of 3659 samples were obtained from the general public in Islamabad, Pakistan, and 85 of them were found to be positive for HIV infection (2.32% prevalence). Of the positive subjects, 78.82% (67/85) were male, 10.6% (9/85) were female, and 10.6% (9/85) were of unidentified gender. The results revealed a significant relationship between age groups and HIV status. The age group of 21- to 30-year-olds was found to have the highest rate of HIV infection, and the rate of HIV infection in males was higher than in females.

Unrecognized HIV infection in asymptomatic volunteer blood donors at district Peshawar, Khyber Pakhtunkhwa, Pakistan

Acquired immunodeficiency syndrome (AIDS) is a global epidemic that impacts the lives of many individuals each year. Human immunodeficiency virus (HIV) is a retrovirus that infects human CD4+ T helper cells and macrophages thereby causing severe immune disease. The current study aimed to examine the prevalence of HIV among the blood donors of Khyber Pakhtunkhwa at Peshawar. In this study, a total of 8634 volunteers who donated blood were carefully screened for HIV using ELISA and RT-PCR techniques. Among the volunteers (n = 8634), 63 were positive by both ELISA and RT-PCR; which shows a prevalence of 0.73%. Both diagnostic techniques exhibited similar results. All the positive individuals were informed immediately and advised to start treatment to control the progression of the infection. It was concluded that HIV is on the rise in Peshawar, and routine screening and preventive measures are immediately required to address the urgent situation of HIV infection.

HIV-1 genetic diversity, geographical linkages and antiretroviral drug resistance among individuals from Pakistan

Worldwide antiretroviral therapy (ART) has reduced the mortality and morbidity rates in individuals with HIV infection. However, the increasing occurrence of drug resistance is limiting treatment options. In recent years, Pakistan has witnessed a concentrated epidemic of HIV. It is very important to identify geographical linkages and mutations that generate selective pressure and drive resistance of HIV in our population. The aim of this work was to identify genetic diversity and drug resistance patterns of HIV in Pakistan, using available sequences and bioinformatics tools, which may help in selecting effective combination of available drugs. A total of 755 Pakistani HIV gag, pol and env sequences were retrieved from the Los Alamos HIV database. Sequences were aligned with reference sequences of different subtypes. For geographical linkages, sequences of predominant subtypes were aligned with sequences of the same subtypes from different countries. Phylogenetic trees were constructed using the maximum-likelihood method in MEGA 7 software. For drug resistance analysis, sequences were entered into the Stanford University HIV Drug Resistance Database. Phylogenetic trees for studying genetic diversity showed that 82% of the sequences were of subtype A, while the rest of the sequences were of subtypes B (9.5%), K (2%), D (2%) and AE (1%). Moreover, trees that were constructed to examine geographical linkages showed close clustering of strains with those of the neighboring countries Afghanistan and India, as well as some African countries. A search for drug resistance mutations showed that 93% of the sequences had no major or minor mutations. The remaining 7% of the sequences contained a major mutation, Y115F, which causes the virus to exhibit low to intermediate resistance against lamivudine and emtricitabine. Our data indicate that HIV subtype A is the major subtype, while subtypes K, D and AE are also present in our country, suggesting gradual viral evolution and possible entry of different subtypes from neighboring countries. These data suggest that HIV is still sensitive to most of the antiretroviral drugs used in Pakistan.

Risking the Future: Unprotected Intercourse and HIV/AIDS Knowledge among Female Commercial Sex Workers in Central Bangladesh

This study examined levels of AIDS knowledge and condom practices in a sample of female commercial sex workers (CSWs) in Bangladesh. The 284 subjects were questioned about AIDS knowledge using a 12-item AIDS knowledge and patterns of condom use questionnaire. The subjects had a moderate knowledge of AIDS with 61.5 percent of the sample responding correctly to 6 or more of the 12 AIDS knowledge questions. Those with high levels of AIDS knowledge used condoms at a higher rate than those with low levels of AIDS knowledge. These CSWs were predominantly young (36.6 percent) and illiterate (62.7 percent). Street-based CSWs were at greatest risk for acquiring HIV; many reported less frequent use of condom than brothel-based CSWs. The majority knew that condoms offered protection against HIV/AIDS, although only 11 percent reported using condoms prior to the day of survey. Misconception and confusion were identified regarding modes of transmission and prevention.

Prevalence and risk factors of HIV in Faisalabad, Pakistan -A retrospective study

Background & Objective: Although the magnitude of HIV in Pakistan has been well documented, but no record of HIV prevalence in Faisalabad region exists. A retrospective study was carried out at Sexually Transmitted Infections (STIs) clinic, District Headquarter (DHQ) hospital, Faisalabad, Pakistan to find out the prevalence of HIV and related risk factors.

Methods: Between March, 2010 and December, 2012, a total of 31040 subjects were either interviewed or their medical records were reviewed. From those recruited by convenient sampling method, written informed consent was obtained and informed about the study protocol. Blood serum was tested for antibodies to HIV-1 and HIV-2 (Enzyme-linked immunosorbent assay, Western Blot).

Results: On the whole, Anti-HIV was demonstrated in 173 (0.557%) of the respondents. This gives an overall HIV prevalence of 557 per 100,000.Averaged age of the patients was 49.5 years (range: 30-45) with 85.55% male. Majority of the patients were urban dwellers (87.28%), divorced or widowed (46.82%) and uneducated (50.28%). A large proportion (78%) of the patients was injection drug users. Compared to blood donation/transfusion and sexual interactions, injection drug use was the major potential risk factor for HIV infection.

Conclusion: Most important finding was higher HIV prevalence in Faisalabad region as compared to the previous assessments at the national level. This reflects an alarming situation necessitating contextual preventive interventions. Precarious practices such as injection drug abuse, blood donation/transfusion needs to be amended and extramarital sexual contacts should be avoided.

Exploring urban male non-marital sexual behaviours in Pakistan

BACKGROUND

In Pakistan, sexual practices outside marriage are proscribed by law. We aimed to assess the range and magnitude of non-marital sexual behaviours of urban men, focusing on men having sex with men.

METHODS

In this cross sectional survey undertaken in six cities of Pakistan, we interviewed 2400 men aged 16-45 years selected through a multistage systematic sampling design. Sexual behaviours were assessed through a structured questionnaire. Multivariable analysis was used to identify association between various individual level characteristics and probability of engaging in sexual activities involving men.

RESULTS

Nearly one-third (29 percent) reported having had non-marital sex in their lifetime. Of these men 16 percent reported premarital sex, while 11 percent reported engaging in both pre- and extramarital sex. Only two percent reported exclusive extramarital sex. In total 211 respondents, 9 percent reported ever having had sexual relations with men. While 62 respondents, 2.6 percent reported exclusive sex with males. Factors that were significantly associated with MSM behaviours were being less than 27 years (adjusted OR 5.4, 95% CI 3.8-7.7, p < 0.000), less than 10 years of schooling (adjusted OR 2.1, 95% CI 1.4-3.2, p < 0.000), being unemployed (adjusted OR 2.7, 95% CI 1.6-4.3, p < 0.000), being exposed to pornographic materials (adjusted OR 4.8, 95% CI 3.0-7.7, p < 0.000) and being a migrant (adjusted OR 2.1, 95% CI 1.3-3.4, p < 0.002). Factors significantly associated with exclusive homosexual behaviour were having sexual debut at a younger age i.e. 16-22 years (adjusted OR 12.5, 95% CI: 3.8-40.7, p < 0.000), being unemployed (adjusted OR 8.8, 95% CI: 3.0-26.0, p = 0.000), having had exposure to pornographic materials (adjusted OR 3.3, 95% CI: 1.5-7.2, p = 0.002).

CONCLUSIONS

To prevent the spread of STI's in Pakistan, preventive interventions should focus on reaching out to young uneducated men offering them with appropriate counselling and skills to adopt "safe sex practices" through workplace orientation sessions; while for youth in schools, life skills education be included in the curriculum. Through public-private partnership stigmatised groups should be reached through established community networks and provided with information on accessing voluntary counseling and treatment centres.

Current Status of HIV/AIDS in South Asia

Background:

According to the United Nations Joint Program on HIV/AIDS, 33.2 million adults and children are living with the infection worldwide. Of these, two to three million are estimated to be in South Asia. All countries of the region have a low prevalence of human immunodeficiency virus (HIV). However, it is important to review the current epidemiological data to identify the trends of infection as it would have implications on prevention.

Materials and Methods:

We performed a MEDLINE search using phrases ‘South Asia’ plus ‘HIV’, ‘AIDS’, and names of individual countries in South Asia (limits: articles published in last 10 years, in English language). Clinical trials, reviews, meta-analyses, letters, editorials, and practice guidelines were all considered. The following countries were included as belonging to South Asia; Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka. Recent estimates and data on country status, and details of national control programs were obtained from websites of international agencies such as the World Bank and United Nations Joint Program on HIV/AIDS (UNAIDS).

Results and Discussion:

This review looks into many aspects of HIV infection in South Asia including country profiles with regard to infection, economic and psychological burden of illness and treatment issues in the South Asian context.

A situational analysis of HIV and AIDS in Pakistan

HIV (Human immunodeficiency virus) transmission has been reduced by protected sex and screening of blood products and other body fluids in the developed countries. It has been reported that Pakistan is at high risk of HIV/AIDS infection but presently the prevalence rate is considerably low. The number of reported cases of HIV/AIDS in Pakistan has been continuously increasing since 1987. By 2010 the total number of registered cases has reached to 6000 and this figure is on the rise with the passage of time. Some serious strategies must be implemented to control this deadly disease.

High-risk behaviours among juvenile prison inmates in Pakistan

OBJECTIVES

To assess the sexual- and drug-use-related risk behaviours of male juvenile detainees in Karachi, Pakistan.

DESIGN

Cross-sectional study.

METHODS

A cross-sectional study was conducted of prison inmates aged 15-21 years in Karachi Juvenile Prison in 2002. In total, 321 inmates were interviewed about sexual orientation and behaviours, and knowledge about human immunodeficiency virus (HIV) and sexually transmitted infections (STIs). Urine specimens were collected and tested for Chlamydia trachomatis and Neisseria gonorrhoeae using ligase chain reaction.

RESULTS

A substantial proportion (n=111, 34.6%) of the participants were sexually active. Sixty-two (19%) and 67 (21%) had had sex with a male or female before incarceration, respectively. Twenty-seven (8.4%) participants had an STI, and 50% of the 109 sexually active participants had had multiple sexual partners. Use of addictive substances was associated with sexual activity. The mean knowledge score computed from the sum of 16 items was 4.7, with a median of 2.9. A large proportion (40%) of participants knew about condoms, but very few (3.4%) had ever used one. The mean+/-standard deviation risk score from nine items was 2.4+/-1.7. On the basis of behavioural and biological markers, 117 (36.4%) participants had high-risk behaviour. In multivariate logistic regression analysis, knowledge, risk perception and age were predictive of higher risk.

CONCLUSIONS

HIV risk behaviours are common among adolescent inmates. Although inmates do have knowledge about modes of transmission and condom use, the use of condoms is significantly low. Interventions are needed for behavioural change among this group.

HIV-1 subtype A infection in a community of intravenous drug users in Pakistan

BACKGROUND

Data on the subtypes of HIV in a population help in predicting the potential foci of epidemic, tracking the routes of infection and following the patterns of the virus' genetic divergence. Globally, the most prevalent HIV infection is the HIV-1 subtype C. In Asia, predominant subtypes of HIV-1 are B, C, and CRF-01AE. During the last few years, HIV prevalence in Pakistan has taken the form of a concentrated epidemic in at least two high risk groups, namely, Intravenous Drug Users (IDUs) and Male Sex Workers (MSWs). Factors that have facilitated the proliferation of HIV infection include transmission through a large number of repatriates and needle-sharing intravenous drug users, unscreened blood transfusions, and sexual illiteracy. The HIV subtypes infecting Pakistani populations have not been explored to date. In this study, we analyzed HIV-1 subtypes from in a high-risk community of IDUs in Karachi, the largest city of Pakistan.

METHODS

Samples were collected from 34 IDUs after their informed consent. In addition, the study subjects were administered a questionnaire regarding their sexual behavior and travel history. For HIV analysis, DNA was extracted from the samples and analyzed for HIV types and subtypes using subtype-specific primers in a nested polymerase chain reaction (PCR). The results from this PCR were further confirmed using the Heteroduplex Mobility Assay (HMA).

RESULTS

We found HIV-1 subtype A in all the 34 samples analyzed. A few of the study subjects were found to have a history of travel and stay in the United Arab Emirates. The same subjects also admitted to having contact with commercial sex workers during their stay abroad.

CONCLUSION

Our study therefore shows clade A HIV-1 to be prevalent among the IDUs in Karachi. As the prevalence of HIV in Pakistan continues to rise, more work needs to be done to track the infection, and to analyze the strains of HIV spreading through the country.

Candida esophagitis: Risk factors in non-HIV population in Pakistan

AIM: Candida esophagitis is a frequent infection in immunocompromised patients. This study was designed to determine its characteristics in non-human immune deficiency virus (HIV) infected patients attending a teaching hospital.

METHODS: Clinical records of all patients coded by international classification of diseases 9th revision with clinical modifications’ (ICD-9-CM), with candida esophagitis diagnosed by esophagogastroduodenoscopy (EGD) and histopathology over a period of 5 years were studied.

RESULTS: Fifty-one patients (27 males, 24 females, range 21-77 years old and mean age 52.9 years) fulfilled the criteria (0.34% of the EGD). The common predisposing factors were carcinoma (OR 3.87, CI 1.00-14.99) and diabetes mellitus (OR 4.39, CI 1.34-14.42). The frequent clinical symptoms were retrosternal discomfort, dysphagia and epigastric abdominal pain with endoscopic appearance of scattered mucosal plaques. Another endoscopic lesion was associated with candida esophagitis in 15% patients.

CONCLUSION: Carcinomas, diabetes mellitus, corticosteroid and antibiotic therapy are major risk factors for candida esophagitis in Pakistan. It is an easily managed complication that responds to treatment with nystatin.

HIV/AIDS risk behaviors and correlates of injection drug use among drug users in Pakistan

We studied prevalence and correlates of injection drug use, awareness of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), and risky behaviors among drug users serviced by a nongovernmental organization catering to drug users in three Pakistani cities (Quetta, Peshawar, and Rawalpindi). Logistic regression analysis was used to identify correlates of injection drug use. Of 608 drug users, 99.8% were male; median age was 32 years, and 44% were married. Most (79.8%) were Pakistani; 15.3% were Afghani. The majority used heroin (98.7%), mostly by inhalation; 15.2% injected drugs. Only 41% had heard of HIV/AIDS, and 30% had been paid for donating blood. Injection drug use and needle sharing were highest in Quetta. Injecting drug users (IDUs) were nearly twice as likely to have donated blood and to have heard about HIV/AIDS compared to other drug users. Interventions to discourage transitions to injection, increase HIV testing, and safeguard the blood supply in Pakistan are urgently needed.

HIV-infected workers deported from the Gulf States: impact on Southern Pakistan

HIV prevalence is still very low in Pakistan, but its south Asian location and subgroups with recognized lifestyle risk factors suggest that Pakistan will experience expanded diffusion of HIV. We report the frequency of HIV infections identified by the AIDS Control Programme on the Sindh province of Pakistan. Most HIV-positive cases currently reported to the Sindh AIDS Control Programme are found among Pakistani workers deported from the Gulf States and among foreigners. The 58 returned workers with HIV represent 61 to 86% of reported cases in any given year during the 1996-1998 period. Five wives of returning workers have been identified with HIV. Expatriate workers in the Gulf States are tested for HIV routinely, unlike other subgroups in Pakistan. Considering the risk of HIV/AIDS due to regular introduction of HIV from returned workers, and the limited awareness surrounding sexual health and HIV/STD transmission issues in Pakistan, intervention programmes targeted at overseas workers need to be implemented to control the expansion of the HIV epidemic in Pakistan.

HIV/AIDS in Bangladesh: a national surveillance

Nationwide surveillance of HIV/AIDS from 1989 through 1996 in Bangladesh included several risk groups such as professional blood donors, patients with sexually transmitted diseases (STDs), pregnant women at antenatal clinics, commercial sex workers (CSWs), patients with tuberculosis, long-distance truck drivers, sailors, and non-residents. The population was enrolled by convenience sampling after taking informed consent. Among 70,676 persons tested, 80 (1.13 per 1000) were HIV positive. The prevalence rate was steady until 1994, and then increased rapidly. The rate among male heterosexuals was significantly higher than that in females (3.40 per 1000 versus 0.29 per 1000; odds ratio (OR) 11.60; 95% confidence intervals (CI) 6.45 to 21.16; P < 0.0001). Twelve per cent of patients with STDs had HIV. The HIV cases concentrated in 2 districts, Sylhet (25/72) and Chittagong (20/72), that border India and Myanmar (formerly Burma), respectively. Frequent movement of people of Bangladesh to India, Pakistan, Myanmar and Thailand, where HIV rates are higher, is one of the possible sources of spread of the cases. Bangladesh has the potential to avert epidemic spread of HIV at its early stage.