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GUEST EDITORIAL
Year : 1988  |  Volume : 36  |  Issue : 4  |  Page : 150

Acquired immune deficiency syndrome, an Indian perspective


Dept. of Virology, Christian Medical College Hospital, Vellore. Tamil Nadu - 632 004, India

Correspondence Address:
T Jacob John
Dept. of Virology, Christian Medical College Hospital, Vellore. Tamil Nadu - 632 004
India
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Source of Support: None, Conflict of Interest: None


PMID: 3253208

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How to cite this article:
John T J. Acquired immune deficiency syndrome, an Indian perspective. Indian J Ophthalmol 1988;36:150

How to cite this URL:
John T J. Acquired immune deficiency syndrome, an Indian perspective. Indian J Ophthalmol [serial online] 1988 [cited 2020 Feb 27];36:150. Available from: http://www.ijo.in/text.asp?1988/36/4/150/26123

"My lovers and my friends stand aloof from my sore;

and my kinsmen stand after off

My heart panteth, my strength faileth me; as for the light of mine eyes, it is also gone from me"

(Psalm 38)

An excellent review of the prevalence of ocular lesions in AIDS, and their aetiology, diagnosis and manage­ment, appears in this issue (1). AIDS is caused by the recently-discovered human immunodeficiency virus (HIV). Evidence of the presence and transmission of HIV in India was found in February, 1986 (2, 3). In order to assess the extent of its spread in India, to identify risk-groups, and to monitor time-trends in its progression, 40 surveillance centres have been estab­lished in the country (4). These centres collect or recieve blood specimens from prostitutes, patients attending clinics for sexually tramsmitted diseases, homosexuals, drug addicts, patients suspected to have AIDS or pre-AIDS, blood donors, foreign students prior to registration in Indian Universities, and those who wish to get their blood tested. All sera are tested in these centres by the enzyme-linked immunosorbent assay (ELISA) using commercially available kits that are supplied through the Indian Council of Medical Research (ICMR). Four surveillance centres also act as Reference centres, where ELISA screening-positive amples are tested by western blot method in order to definitively diagnose the presence of HIV antibody.

The presence of HIV-specific antibody is diagnostic of a virus-carrier state. Virus carriers may be healthy, but they can transmit infection to others through sexual intercourse or through blood-borne routes such as transfusion or sharing of needles/syringes. After an incubation period of many months to several years, the virus carrier develops severe combined (celluar and humoral) immune deficiency and succumbs to infections or malignancy.

There is no cure for AIDS or for HIV infection. An antiviral drug, azidothymidine, retards the progression of immune deficiency to an extent; but it is expensive, toxic and ineffective in preventing death due to AIDS.

There is no vaccine yet against HIV; knowing the biology of HIV and the properties of other antiviral vaccines, I do not believe that a vaccine can offer complete protection. However, infection can easily be prevented by avoiding sex with infected individuals, sharing of needles, and transfusion with blood from infected donors.

The ICMR has recorded 370 HIV infected individuals in India after screening 118,229 persons upto June 15, 1988 (4). In the next 4 months, 43,487 more sera have been tested and 162 infected persons have been detected; thus a total of 532 infected persons have been identified. Assuming that less than 1 per cent of all infected persons are detected through the 40 surveillance centres, there may be over 50,000 virus carriers already in our country.

Even though our hospital does not accept paid blood donors, and only patients' relatives or volunteers are accepted, we have instituted routine screening of all donor blood prior to transfusion (5). To date we have tested 10,580 donors and found 18 to be positive for HIV infection, for a rate of 1.7 per 1000. If this rate is applied to the adult population of India within the age range of our donors (estimated at 300 million), there may be 500,000 virus carriers in India. It is reasonable to believe that the real number is between 50,000 and 500,000.

The first case of AIDS due to HIV transmission within India (via blood transfusion) was recorded in 1987 (4). In 1988 two prostitutes developed AIDS; they had presumably been infected in India (4). I am aware of 2 more cases of AIDS due to indigenous virus transmission. In addition to these 5, several Indians have developed AIDS as a result of infection acquired while living in North America, Europe or Africa (4, 6, 7).

Obviously, HIV infection will become more prevalent and AIDS more common in the coming years. Since all body fluids are potentially infectious, all health-care personnel must introduce stricter codes of disinfection, sterilization, hand-washing and personal habits, than ever before. Each speciality, be it ophthalmology, gynaecology, dentistry or surgery - must consider these issues deeply and evolve policies for its safe practice. Such care is essential not only for the personal protection of medical personnel, but also for preventing iatrogenic spread of infection to those who trust themselves in our care, and believe that we know and do the very best.




 

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