HIV transmission through medical injections and parenteral exposures

[Guest guest]

Evidence for HIV transmission through medical injections and other

parenteral exposures in India (except blood transfusions and injection drug use)

Gisselquist, PhD; email: david_gisselquist@...

Mariette Correa, PhD; email: mariettec@...

Indiaÿs National AIDS Control Organization attributes 2.6% of HIV

infections to transfusions and 2.2% to injection drug use (IDU), and

makes no estimates for other parenteral exposures. Blood exposures have been

common during medical injections, tattooing, shaving, and other health care and

cosmetic procedures. We searched Medline and unpublished studies for evidence to

assess the scale of HIV transmission through parenteral exposures in India. We

summarize three types of evidence.

Results

First, five studies report parenteral exposures as risks for prevalent and/or

incident HIV. Among adults in the general population in Bagalkot, a 2003 study

reports a non-significant adjusted odds ratio (OR) of 1.59 for prevalent HIV

associated with any compared to no injection ever as an adult; the adjusted

population attributable fraction (PAF) is 36%.

A 1993-2000 study among persons recruited at sexually transmitted

disease (STD) clinics in Pune reported rate ratios of 1.3 (P = 0.07) and 2.4 (P

= 0.007) for incident HIV associated with injections and with tattooing,

respectively, during 3-month follow-up periods. The PAFs of incident HIV

associated with injections and tattooing are 9.4% and 3.5%, respectively.

A study among outpatients at health camps in Andhra Pradesh reported

that prevalent HIV was significantly associated with receipt of 10 or

more injections in the past year. Among IDUs in Chennai, the adjusted OR for

prevalent HIV associated with having a tattoo was 2.4. A study among blood

donors in New Delhi reported crude ORs of 14 and 17 for prevalent HIV associated

with donating more than once per month and with donating at more than one blood

bank, respectively.

Second, summary information from nine studies attributes HIV infections in

almost 200 adults and 26 children to medical or other unknown exposure (except

transfusion of blood or blood products). For example, 5 infants in a Mumbai

orphanage seroconverted during 1996-97 after intravenous antibiotic treatment

and routine immunization.

Third, studies among female sex workers (FSW) and STD patients show high

prevalence of infection with hepatitis B and C viruses (HBV, HCV), frequent

parenteral exposures, and a trend for HIV coinfection with HBC and HCV. This

evidence suggests that FSW and STD patients may be contracting not only HBV and

HCV but also HIV through parenteral exposures.

From available evidence, as summarized in this paper, there is little

chance that parenteral exposures (setting aside blood transfusions and IDU)

account for less than 10% of HIV infections in India, and they very likely

account for much more.

However, the evidence base to understand HIV epidemiology in India is weak.

Priority locations for further research on parenteral risks for HIV infection

are southern and north-eastern districts with high HIV prevalence.

Attention to blood exposures among FSW and STD patients could lead to

more effective programs to prevent non-sexual HIV acquisition among and

transmission from these groups. HIV prevention programs could be more effective

if suspected nosocomial infections were investigated to obtain better

information about the scale and specific risks for nosocomial HIV

infection.

For further discussion and/or the complete paper contact or

Mariette.

Mariette

E-mail: <mariettec@...>