Pakistan: A=94%, B=35%, C=1%, E=10%, HIV= 0.09, AIDS= 17,000

February 15, 2000

Pakistan

-------------

Populated = 141 million people

7th most populated Nation

% of population with a virus

-------------------------------------

HAV = 94%

HBV = 35%

HCV = 1%

HDV = NL

HEV = 10%

HGV = NL

TTV = NL

------

Total = 140%

HIV = 0.09%

HIV = 64,000 cases

AIDS = 17,000 cases

HAV

------

Pediatrics 2000 Feb;105(2):436-8

Liver failure attributable to hepatitis A virus infection in a developing

country.

Shah U, Habib Z

Boston, MA 02114-3114, USA.

In young children hepatitis A virus (HAV) infections are usually subclinical

events. However, HAV is also associated with progressive hepatic failure and

even death in some patients. This study was undertaken to characterize the

course of hepatitis A-related acute liver failure in children from a

developing country where hepatitis A is endemic and produces significant

morbidity. Patients <15 years of age with confirmed hepatitis A, seen at the

Aga Khan University Hospital between January 1991 and August 1998 were

identified using the patient registry. Of the 2735 patients seen with

hepatitis A, 232 were admitted to the hospital. Of these 30 patients

developed progressive hepatic dysfunction and liver failure. During this

period, 45 children were admitted with liver failure attributable to other

causes. Of the patients admitted with

hepatitis A-related liver failure, 25 (83.3%) were encephalopathic

at presentation and 36.7% of the patients died. The prothrombin time was the

most significant predictor of survival. There was a significant difference

between those who survived and those who died on discriminant analysis with

respect to age, grade of hepatic encephalopathy, duration of

hospitalization, prothrombin time, and duration of jaundice when taken as a

group. There is a striking prevalence of liver dysfunction progressing to

hepatic failure among children seen at a hospital in Karachi, Pakistan. This

study demonstrates the significant morbidity and

mortality that can attend HAV infections in children

in a developing country despite tertiary medical facilities. The risk of HAV

and its sequelae could probably be effectively reduced in these settings

with improved sanitation and universal immunization.

PMID: 10654972, UI: 20120919

Indian J Pediatr 1994 Sep-Oct;61(5):545-9

Hepatitis A, B and C seroprevalence in Pakistan.

Agboatwalla M, Isomura S, Miyake K, Yamashita T, Morishita T, Akram DS

Department of Pediatrics, Civil Hospital, Karachi, Pakistan.

A cross sectional study was conducted to determine the seroprevalence of

Hepatitis A, B, and C virus in healthy Pakistani children. HAV IgG antibody

was assayed in 258 subjects and it was found that

94% children by 5 years of age had HAV IgG-antibody.

The overall seroprevalence of HAV IgG antibody was 55.8% and IgM 5.3%.

HBVsAb levels assayed in 236 healthy children showed a seroprevalence of

2.97%. Similarly, HCV antibody seroprevalence was found to be a low 0.44% in

healthy children.

HAV is a major cause of Hepatitis,

as compared to HBV and HCV which are of low endemicity.

PMID: 7538098, UI: 95263116

HBV

------

J Travel Med 1997 Dec 1;4(4):187-188

Hepatitis and Travel Abroad: A Case Report.

Abid M, O'Brien SJ, Boxall EH, Skidmore SJ

Senior Registrar in Public Health Medicine, Communicable Disease

Surveillance Centre - West Midlands, Birmingham, UK.

Several distinct infections are grouped as hepatitis. Although they are

similar in many ways, they differ in etiology and in some epidemiologic,

immunologic, clinical and pathologic characteristics. As well, their

prevention and control vary greatly. The case reported here is a patient who

developed hepatitis during a visit to Pakistan, then a second infection upon

return to the UK. Subsequent tests indicate that the first episode was

probably due to hepatitis E virus (HEV), an enterically transmitted

hepatitis virus which is common in developing countries where poor

sanitation is common and which causes both epidemics and sporadic cases.1,2

On her return to the UK, the patient developed acute

hepatitis B following the receipt of injections

for her illness in Pakistan. We present this case to describe a patient who

appeared to develop two sequential episodes of acute viral hepatitis

associated with travel to Pakistan, and to highlight the risks of infection

associated with administration of parenteral drugs while on prolonged visits

to developing countries.

PMID: 9815513

Indian J Gastroenterol 1990 Oct;9(4):291-2

Immunogenicity of yeast-derived hepatitis

B vaccine in Pakistani adults.

Zuberi SJ, Lodi TZ, Hassan R, Alam SE

Pakistan Medical Research Council, Research Centre, Jinnah Postgraduate

Medical Centre, Karachi.

A study of the immunogenicity and safety of 20 micrograms recombinant DNA

yeast derived hepatitis B vaccine was conducted in 153 Pakistani adults. All

participants were in good physical condition, had negative hepatitis B

serological markers (HBsAg, anti-HBs, anti-HBc) and normal ALT. Anti-HBs

developed in 33%, 81% and 98% of subjects one month after the first, second

and third dose respectively. Minor systemic and local

side-effects were observed in 39%

of individuals. We conclude that yeast derived hepatitis B vaccine is safe,

effective and immunogenic in Pakistani adults.

Publication Types:

Clinical trial

PMID: 2258214, UI: 91078853

JPMA J Pak Med Assoc 1978 Jan;28(1):2-3

Prevalence of hepatitis B surface antigen and antibody in healthy subjects

and patients with liver disease.

Zuberi SJ, Lodi TZ, Samad F

The frequency of Hepatitis Bs antigen and antibody was determined in healthy

subjects and patients with acute and chronic liver disease. The frequency of

HBs Ag in healthy subjects was 2.9% and

HBs Ab 35%.

The high prevalence of antibody in normal individuals suggests a constant

non-parenteral sub-clinical exposure to hepatitis virus. Thirty-three per

cent patients with acute viral hepatitis, 20% with cirrhosis and 10% with

hepatocellular carcinoma were HBs Ag positive, while HBs Ab was detected in

22% cases of acute viral hepatitis and 37% with other liver disorders. This

pattern of prevalence of HBs Ab suggests that hepatitis B virus may be an

important etiological agent in acute and chronic liver disease in Pakistan.

PMID: 96284, UI: 78197333

MMW Munch Med Wochenschr 1976 Aug 27;118(35):1093-6

[incidence of viral hepatitis in travelers in the tropics. Experiences with

gamma globulin prophylaxis].

[Article in German]

Schuz R, Meyer-Glauner W

The occurrence of virus hepatitis during their residence was determined in

2755 persons returning from the tropics in 1975. The incidence was

particularly

high in those returning from India, Pakistan

and Afghanistan. There was also a greater risk of the disease for travelers

in Ethiopia, the countries on the West coast of Africa and some South

American States. On the average, persons returning form the tropics fell ill

10 times more frequently with virus hepatitis during their residence in the

tropics than in the Federal Republic. Particularly endangered occupational

groups were the staffs of the health services and the social workers.

Immunization with gamma globulins

prevented an attack of virus hepatitis in all cases for a period of 4-6

months. Later, the effect of the immunization could no longer be

established.

PMID: 60699, UI: 76267320

HBV + HCV

----------------

J Hosp Infect 1998 Feb;38(2):133-7

Frequency of parenteral exposure and seroprevalence of HBV, HCV, and HIV

among operation room personnel.

Mujeeb SA, Khatri Y, Khanani R

Blood Transfusion Services, Jinnah Postgraduate Medical Centre, Karachi,

Pakistan.

A study was designed to determine the frequency of needle-stick injuries,

immunization status for hepatitis B virus (HBV) and sero-prevalence of HBV,

hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infections

among operation room personnel.

Self-assessment questionnaires were completed and blood tested for HBsAg,

anti-HBc (total), anti-HCV and anti-HIV. Of 114 operation room personnel

studied, the majority (58.8%) reported more than four needle-stick injuries

per year, 36.8% one to three needle-stick injuries per year, while 4.4%

reported no needle-stick injury in the last five years. Thirty-six percent

of personnel had received a complete course of hepatitis B vaccination.

There was serological evidence of hepatitis

HBV virus and/or HCV infections in 31% of the studied population.

Four percent [4%] were reactive for HCV infection, 7.5% for HBsAg infection

and

25.43% for anti-HBc (total);

none was HIV positive.

Eighty percent of the HCV positive and 55% of the anti-HBc (total) positive

personnel

had more than four needle-stick injuries per year in the last five years,

while 75% HBsAg-reactive personnel had received one to three needle-stick

injuries per year. This study indicates a need for continued efforts to

minimize the risk of blood-borne infection by enhancing the compliance of

operation room personnel with HBV vaccination and adherence to infection

control measures.

Publication Types:

Clinical trial

Multicenter study

PMID: 9522291, UI: 98182760

HCV

-------

JPMA J Pak Med Assoc 1999 Aug;49(8):198-201

Demographic aspects of hepatitis C in northern Pakistan.

Tariq WU, Hussain AB, Karamat KA, Ghani E, Hussain T, Hussain S

Armed Forces Institute of Pathology Rawalpindi, Military Hospital,

Rawalpindi.

OBJECTIVE: To find out the prevalence of hepatitis C in various, age, sex

and ethnic groups in Pakistan. SETTING: Specimens obtained from

military/civil hospitals

and General Practitioners of Rawalpindi Islamabad, region and other areas of

Northern Pakistan, in vicinity. SUBJECTS: Serum of 1710 patients of

hepatitis C, diagnosed at Armed Forces Institute of Pathology (AFIP),

Rawalpindi between 1st July 1996 and Dec 31, 1997, tested for Anti HCV by

3rd generation Murex . Required information was collected on a proforma

filled for each patient. RESULTS AND CONCLUSION: The majority of the cases

were between

30-60 years of age. There was male preponderance.

The infection was more common in Urdu speaking fraction of the patients as

compared with others.

PMID: 10641504, UI: 20106258

J Clin Microbiol 1999 Jun;37(6):2061-3

Detection of antibodies to hepatitis C virus in dried blood spot samples

from mothers and their offspring in Lahore, Pakistan.

SP, Khan HI, Cubitt WD

Virology Department, Camelia Botnar Laboratories, Great Ormond Street

Hospital for Children, London WC1N 3JH, United Kingdom.

simon.parker@...

Dried blood spot samples from mothers and their offspring attending the

obstetric and pediatric departments of two hospitals in Lahore, Pakistan,

were tested for antibodies to hepatitis C virus (HCV). The seroprevalence of

HCV in the women was 6.7%

(95% confidence interval [CI], 4.3 to 9.1), and that in the

children was 1.3%

(95% CI, 0.34 to 2.26). Four anti-HCV immunoglobulin G (IgG)-positive

children had mothers that were anti-HCV IgG negative, which suggested that

their infection was community acquired.

PMID: 10325381, UI: 99262[824

J Gastroenterol Hepatol 1997 Nov;12(11):758-61

Hepatitis C virus (HCV) genotypes and chronic liver disease in Pakistan.

Shah HA, Jafri W, Malik I, Prescott L, Simmonds P

Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.

Hepatitis C virus (HCV) is classified into different types depending on

nucleotide sequence variability. Detailed information on the distribution of

various HCV genotypes in some geographical areas is available but little is

known about Pakistan. In this study, a 5' non-coding region (NCR)-based

restriction fragment length polymorphism (RFLP) genotyping assay was used to

investigate the genotype distribution in a large series of HCV-infected

patients in Karachi, Pakistan. Serum samples from 74 hepatitis B surface

antigen (HBsAg)-negative patients with a clinical diagnosis of chronic liver

disease (60 patients) and hepatocellular carcinoma (HCC) (14 patients) were

assayed for anti-HCV antibody by second generation enzyme immunoassay and 48

were confirmed anti-HCV-positive (33 males, 15 females). Other causes of

chronic liver disease (e.g. haemochromatosis, 's disease and

immune-mediated injury) were ruled out. Liver biopsy was done in 27/48

anti-HCV-positive patients and in all HCC patients. Genotypes were

determined for 45/48 anti-HCV-positive study patients; 39/45 (87%) were type

3; four (9%) were type 1; one was type 2; and one was type 5. Past blood

transfusion was the main identifiable risk factor found in 10 patients, all

type 3. Seven of the 14 HCC patients were anti-HCV positive, (six were type

3). Most patients with hepatitis C presented with established cirrhosis and

complications of portal hypertension and liver failure. In conclusion: (i)

genotype 3 is the most common

isolate in HCV-associated chronic liver disease in Pakistan; (ii) a

significant proportion of HBsAg-negative cirrhotics are non-B, non-C in

aetiology; and (iii) half of the patients with HCC have serological evidence

of HCV infection.

PMID: 9430043, UI: 98091878

Southeast Asian J Trop Med Public Health 1996 Dec;27(4):703-6

Epidemiology of blood-borne viruses: a study of healthy blood donors in

Southern Pakistan.

Kakepoto GN, Bhally HS, Khaliq G, Kayani N, Burney IA, Siddiqui T, Khurshid

M

Department of Pathology, The Aga Khan University Hospital, Karachi,

Pakistan. gnkake@...

There are only a few published reports regarding the prevalence of hepatitis

B virus, hepatitis C virus and human immunodeficiency virus in Pakistani

blood donors. The true extent of the prevalence of these viral infections in

healthy adults in unclear. We examined blood donors attending the Aga Khan

University Hospital and blood donation camps in the cities of Karachi and

Hyderabad, Pakistan for the presence of hepatitis B surface antigen (HBsAg),

antibodies to hepatitis C virus (anti-HCV) and human immunodeficiency virus

(anti-HIV). Relationship of anti HCV to the surrogate marker alanine

aminotransferase (ALT) was also examined. Prevalence of HBsAg was found to

be 2.28% (1,173/51,257),

anti HCV was 1.18%

(198/16,705) and that of anti HIV to be 0.02% (10/51,257). Higher rate of

prevalence of HBsAg and anti HCV was observed in the younger age group of 21

to 30 years. Male to female ratio for HBsAg was 2.5:1 and for anti HCV 1:1.

Seropositivity for HBsAg was significantly greater than anti HCV (p <

0.0001). No clear relationship was found between high ALT (>55 U/l) and anti

HCV positivity. Further examination of seropositive samples for HIV revealed

only one donor to be positive by Western blot also. Prevalence of hepatitis

B and C in the adult blood donor population in

Southern Pakistan is higher than western countries but

is similar to regional countries.

This study also suggested that high ALT is not a useful surrogate marker for

hepatitis C virus. Prevalence of HIV in this donor population is very low

and is comparable to the western countries.

PMID: 9253870, UI: 97395883

JPMA J Pak Med Assoc 1995 Oct;45(10):269-71

Prevalence of antibody to hepatitis C virus in Pakistani thalassaemics by

particle agglutination test utilizing C 200 and C 22-3 viral antigen coated

particles.

Bhatti FA, Amin M, Saleem M

Department of Pathology, AFIT and AFIP, Rawalpindi.

Exposure to hepatitis C virus (HCV) and its effect on ALT levels was studied

in 35 transfusion dependent cases of thalassaemia major. Twenty-one (60%)

cases were anti HCV positive and also showed raised Alanine Transaminase

(ALT) levels. Of 14 anti HCV negative, Hepatitis B Surface Antigen (HBs Ag)

negative seven showed raised ALT levels, indicating the chances of acute

viraemia. Thus there is an

urgent need to start anti HCV screening on all blood donations.

PMID: 8714623, UI: 96287890

HDV

-------

NL

HEV

-------

Proc Natl Acad Sci U S A 1992 Jan 15;89(2):559-63

Characterization of a prototype strain of hepatitis E virus.

Tsarev SA, Emerson SU, Reyes GR, Tsareva TS, Legters LJ, Malik IA, Iqbal M,

Purcell RH

Hepatitis Viruses Section, National Institute of Allergy and Infectious

Diseases, National Institutes of Health, Bethesda, MD 20892.

A strain of hepatitis E virus (SAR-55) implicated in an epidemic of

enterically transmitted non-A, non-B hepatitis, now called hepatitis E, was

characterized extensively. Six cynomolgus monkeys (Macaca fascicularis) were

infected with a strain of hepatitis E virus from Pakistan. Reverse

transcription-polymerase chain reaction was used to determine the pattern of

virus shedding in feces, bile, and serum relative to hepatitis and induction

of specific antibodies. Virtually the entire genome of SAR-55 (7195

nucleotides) was sequenced. Comparison of the sequence of SAR-55 with that

of a Burmese strain revealed a high level of homology except for one region

encoding 100 amino acids of a putative nonstructural polyprotein.

Identification of

this region as hypervariable

was obtained by partial sequencing of a third isolate of hepatitis E virus

from Kirgizia.

PMID: 1731327, UI: 92115700

Am J Trop Med Hyg 1988 May;38(3):628-32

Epidemic non-A non-B hepatitis in urban Karachi, Pakistan.

Smego RA Jr, Khaliq AA

Department of Medicine, Aga Khan University Medical College, Karachi,

Pakistan.

An outbreak of icteric non-A non-B (NANB) hepatitis occurred in a

residential community of urban Karachi, Pakistan, from August 1986 through

October 1986. Of the 114 cases reported from this community during the 1986

calendar year, a clustering of 85 cases was seen during the above period.

Twenty-seven percent of 226 households and 9% of 1,250 individuals were

affected. Five persons were hospitalized and 1 death occurred in a young

pregnant woman. Cases occurred predominantly in the less than or equal to

29-year-old age group (

72%

), with a male:female ratio of 1.8:1. Thirty-four cases occurred singly

within households, while in 28 households multiple cases were seen. Analysis

of the epidemic curve and intervals of onset of multiple cases within

households suggested prolonged common source exposure rather than secondary

person-to-person transmission. No single water source was implicated but a

contaminated municipal supply was presumed. Information collected from

several other communities and from a university hepatitis reference

laboratory suggested that the outbreak was part of a larger urban epidemic

of NANB hepatitis. Based upon this investigation and data from recently

published reports, it is concluded that NANB hepatitis is endemic in

Pakistan.

PMID: 3152784, UI: 90365113

Am J Trop Med Hyg 1998 Jun;58(6):731-6

Seroprevalence of hepatitis E virus among United Nations Mission in Haiti

(UNMIH) peacekeepers, 1995.

Gambel JM, Drabick JJ, Seriwatana J, Innis BL

Division of Preventive Medicine, Walter Army Institute of Research,

Washington, District of Columbia 20307-5100, USA.

Information about the prevalence of hepatitis E virus (HEV) infection is

sparse in many countries. Following the identification of four cases of

acute HEV infection among Bangladeshi soldiers, a serologic survey was

conducted to determine the prevalence of HEV infection among other

peacekeepers from the United Nations Mission in Haiti (UNMIH) and Haitian

civilians. Of the 981 participants in the survey, 876 were soldiers from

eight UNMIH-participating countries representing Asia, Africa, and the

Americas, and 105 were Haitian civilians. The prevalence of HEV infection by

country (from highest to lowest) included

Pakistan (62%),

India (37%), Nepal (37%), Bangladesh (27%), Djibouti (13%), Honduras (6%),

Guatemala (5%), Haiti (3%), and the United States (2%). More than 90% of

those surveyed from Guatemala, Haiti, and Honduras, where prevalence data

has been scarce, appeared susceptible to HEV infection. Future multinational

missions like the UNMIH might also present unique opportunities to study

health threats of widespread interest.

PMID: 9660454, UI: 98321891

Trop Med Int Health 1997 Sep;2(9):885-91

Emerging viral pathogens in long-term expatriates (I): Hepatitis E virus.

Janisch T, Preiser W, Berger A, Mikulicz U, Thoma B, Hampl H, Doerr HW

Institut fur Medizinische Virologie, Zentrum der Hygiene, Klinikum der J. W.

Goethe-Universitat, furt am Main, Germany.

Hepatitis E virus (HEV) is one of the so-called 'emerging' viral pathogens,

whose role is increasingly being recognized. To estimate the risk of HEV

infection during long-term stays in HEV-endemic countries, 500 serum samples

obtained from development aid workers and their family members who had spent

on average 9 years in HEV-endemic regions were tested for antibodies against

HEV by ELISA and Immunoblot.

We found seroprevalence rates of 5-6% with no significant differences

related to gender or area of upbringing (raised in an HEV-endemic vs.

nonendemic region). Seroprevalence rates did not increase with increasing

number of stays or number of expatriate years. None of 77 children and

adolescents tested was positive for anti-HEV. The

Indian subcontinent showed the highest seropositive rate with 10%.

In subjects returning from West and Central Africa, East Africa, South-east

Asia and Latin America seroprevalence rates were around 7%.

We found a comparatively low seroprevalence rate of 2.1% for the Arab

countries and the Middle East.

Our results show that there definitely is a risk for long-term expatriates

to acquire HEV infection; however, in most of our cases infection seems to

have been non- or oligo-symptomatic.

PMID: 9315047, UI: 97460665

HGV

-------

Virus Res 1999 Nov;64(2):151-60

A new variant of GB virus C/hepatitis G virus (GBV-C/HGV) from South Africa.

Sathar MA, Soni PN, Pegoraro R, Simmonds P, DB, Dhillon AP, Dusheiko

GM

Department of Medicine, University of Natal/King VIII Hospital, South

Africa. sathar@...

Phylogenetic analysis of the 5' non-coding region (5'NCR) sequences has

demonstrated that GB virus C/hepatitis G virus (GBV-C/HGV) can be separated

into three major groups that correlate with the geographic origin of the

isolate. Sequence analysis of the 5'NCR of 54 GBV-C/HGV isolates from 31

blood donors, 11 haemodialysis patients and 12 patients with chronic liver

disease suggests the presence of a new variant of GBV-C/HGV in the province

of KwaZulu Natal, South Africa. Eleven isolates grouped as group 1 variants

(bootstrap support, 90%) found predominantly in West and Central Africa, a

further six isolates grouped as group 2 variants (bootstrap support, 58%)

found in Europe and North America; five of which grouped as 2a (bootstrap

support, 91%) and one as

2b (bootstrap support, 87%), the latter also includes isolates from Japan,

East Africa and Pakistan.

Although the remaining 37 GBV-C/HGV isolates were more closely related to

group 1 variants (bootstrap support, 90%), they formed a cluster, which was

distinct from all other known GBV-C/HGV sequences. None of the South African

isolates grouped with group 3 variants described from Southeast Asia. Three

variants of GBV-C/HGV exist in KwaZulu Natal: groups 1, 2 and a new variant,

which is distinct from other African isolates.

PMID: 10518711, UI: 99449837

J Gen Virol 1997 Jul;78 ( Pt 7):1533-42

Discrimination of hepatitis G virus/GBV-C geographical variants by analysis

of the 5' non-coding region.

DB, Cuceanu N, son F, Jarvis LM, Mokili JL, Hamid S, Ludlam CA,

Simmonds P

Department of Medical Microbiology, University of Edinburgh, Medical School,

UK. .B.@...

We have investigated the ability of different subgenomic fragments to

reproduce the phylogenetic relationships observed between six complete

genome sequences of GBV-C/hepatitis G virus (HGV). While similar

relationships were observed following analysis of part of the 5' non-coding

region (5'NCR), for the coding region they were not accurately reproduced

for some large fragments or for the majority of fragments of 300 or 600

nucleotides. Analysis of 5'NCR sequences from a large number of isolates,

including

newly obtained sequences from Pakistan

, Zaire and Scotland, produced separate groupings of Asian, African and

European/North American variants. These groupings are associated with

specific polymorphisms in the 5'NCR, many of which were covariant and

consistent with a proposed secondary structure for this region. The

relatively low level of amino acid sequence variation observed between these

geographically and phylogenetically defined groups of variants suggests that

they are unlikely to display significant biological differences.

PMID: 9225026, UI: 97368412

TTV

------

NL

HIV/AIDS

------------

Int J STD AIDS 1999 May;10(5):300-4

Seroprevalence of HIV, HBV, and syphilis and associated risk behaviours in

male transvestites (Hijras) in Karachi, Pakistan.

Baqi S, Shah SA, Baig MA, Mujeeb SA, Memon A

Department of Medicine, Ziauddin University Hospital, Clifton, Karachi,

Pakistan.

In Pakistan, male sex workers are predominantly transvestites and

transsexuals known as Hijras. In 1998 in Karachi, Pakistan, we studied the

seroprevalence of HIV, HBsAg and syphilis and associated risk factors in

Hijras. Study subjects were verbally administered a structured questionnaire

that determined risk behaviours for sexually transmitted and blood-borne

diseases and knowledge of AIDS/STDs. After pre-test counselling, verbal

consent was taken for serological testing. The results were provided on a

one-on-one post-test counselling session. Three hundred male transvestites

were approached; all agreed to answer the questionnaire, 208 consented to

blood testing. Of 300, 81% acknowledged commercial sex with men. Of 208,

prevalence of syphilis was 37%; HBsAg 3.4%;

HIV 0%.

The prevalence of HIV and hepatitis B virus (HBV) is low in transvestite sex

workers but that of syphilis is high. Intervention programmes implemented at

this stage can have an impact on HIV and STD prevention. PMID: 10361918, UI:

99288764