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Epidemiological Study of Syndromic Diagnosis Cases of HIV Positive Attending DVL OP in Government General Hospital Nizamabad

Poola Ramachandra Rao* and S Surya Narayana

Government Medical College & Hospital Nizamabad, India

*Corresponding Author:
Poola Ramachandra Rao
Assistant Professor in DVL
Government Medical College & Hospital
Nizamabad, Telangana, India
Tel: +91-0884 230087
E-mail: [email protected]

Received Date: October 09, 2015 Accepted Date: November 30, 2015 Published Date: December 08,2015

Citation: Ramachandra Rao P, Narayana SS (2015) Epidemiological Study of Syndromic Diagnosis Cases of HIV Positive Attending DVL OP in Government General Hospital Nizamabad. J Trop Dis 4:189. doi:10.4172/2329891X.1000189

Copyright: © 2015 Ramachandra Rao P, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Sexually transmitted diseases (STD) consist of different group of endemic diseases of varying clinical presentation, characterized epidemiologically as sexually transmitted infections. Sexually transmitted diseases in individuals have far reaching health, social and economic consequences. Sexually transmitted infections are very important because of their potential complication and interaction with HIV/AIDS. Recognition of HIV/STI cases has tremendous contribution for targeted intervention in the hospital. By evaluating the HIV/STI cases it will be a signal to know the affected groups and major determinants. In this Paper, the study was conducted to evaluate the clinical, epidemiological and laboratory characteristics of the sexually transmitted diseases (STD) found in the government general Hospital, Nizamabad in the year 2013.

Keywords

HIV; HIV Transmission; Epidemiology; Diagnosis of HIV; Diagnosis of different diseases with HIV

Introduction

Sexually transmitted diseases (STD) consist of a group of endemic diseases of varying clinical presentation, characterized epidemiologically as sexually transmitted infections. Sexually transmitted diseases in different individuals with different age group may leads to Scabies, Genital Scabies, Lower abdominal Pain (LAP), Vagilo Cervical Discharge (VCD), Urethral Discharge (UD), Genital Ulcer Disease (GUD) - Genital Ulcer Disease Herpetic (GUDH) and Genital Ulcer Disease Non-Herpetic (GUDNH). HIV from sexual intercourse, the latter generally occurring within the context of sexual abuse. The objective of the present study is to evaluate the epidemiological, clinical and laboratory characteristics of different age groups with HIV Positive [1,2].

Human Immunodeficiency Virus (HIV)

The human immunodeficiency virus (HIV) is the cause of one of the most destructive human pandemics in recorded history. Acquired immune deficiency syndrome (AIDS) is a set of symptoms that occur in the final stage of an infection caused by the human immunodeficiency virus (HIV). AIDS occurs when the virus has destroyed the immune system, leaving the patient highly susceptible to other life threatening infections. People who are infected with HIV are referred to as being ‘HIV positive’, but they do not necessarily have any symptoms of disease. With the advent of new drug regimens it is now hoped that many HIV positive people may never reach the AIDS stage. HIV is an RNA virus known as a retrovirus. The HIV virion has a central core containing two identical RNA genomes and enzymes such as reverse transcriptase, protease and integrase. There is a protein capsid covered by a lipid bilayer envelope which contains glycoprotein spikes. There are two major strains of HIV. HIV-1 causes the majority of the infections worldwide and is more easily transmitted than the other strain HIV-2 [3-5].

Retrovirus

When cells make proteins they use their DNA as a template to make another nucleic acid called RNA. This process is called transcription. The information on the RNA is then used to assemble the sequence of polypeptides that make up a particular protein. This process is called translation.

Reverse transcription

Retroviruses are capable of carrying out transcription in reverse. They contain an enzyme called reverse transcriptase which transcribes the viral RNA into DNA. This DNA can then be inserted into the genome of the host cell, where it stays for the lifetime of the cell. The cell synthesizes viral RNA and proteins, allowing the virus to multiply inside the host cell.

HIV Transmission

The three main routes for HIV transmission are:

• Contaminated blood (for example between injecting drug users)

• Sex: vaginal, anal (and very rarely, oral)

• From mother to child (either in pregnancy, during birth or via breast milk)

• Worldwide, approximately 60% of new HIV infections are contracted through sex between men and women. The other cases are usually due to:

• Babies who acquire the virus from their mothers (10%).

• Drug users sharing used needles (10%).

• Sex between men (5-10%).

In the early stages of the epidemic, some transmission occurred in health care settings, for example via infected blood for transfusion. This is now rare due to better screening and increased awareness.

Epidemiology

Identifying and understanding the risk factors associated with HIV acquisition and transmission, and the development and progression of AIDS in men, women, and adolescents are critical aspects in the fight against this disease. Using the epidemiological methods, scientists are able to address key scientific questions by studying and comparing the effects of HIV in different human populations. Scientific findings gathered from these epidemiological studies help to provide insight on how to prevent the spread of HIV and also improve the quality of life for those already infected [6-8]. The types of scientific investigation through epidemiological research include:

• Identifying the proportion of the population affected by HIV and the rate at which new infections are occurring.

• Describing the changing manifestations of the clinical and laboratory course of HIV infection, the changing frequency with which various complications occur, and the impact of therapy on HIV-related survival and clinical outcomes.

• Investigating the clinical course of HIV infection among people with other co-morbidities to better understand the natural and treated history of the disease in those with other chronic conditions.

• Studying the biological, clinical, and epidemiological characteristics of people who are at high risk for HIV infection but do not become infected and those who are long-term non-Progresso.

• The cause of GUD can be related to a number of factors, such as geographical area where sexual intercourse has taken place; socioeconomic factors; gender of sexual partners; number of partners; HIV status and local prevalence; drug use; commercial sex; and circumcision.

• GUD constitutes at most 5% of visits to physicians for a possible STI.

• About 70 to 80% of genital ulcers are due to HSV-1 or HSV-2.

• Genital ulcers in sexually active persons can be associated with two or more pathogens.

• Women and men with GUD are at increased risk of acquiring and transmitting HIV.

• Chancroid has been sporadically associated with focal urban epidemics, particularly among cocaine users. Sex workers are the usual reservoir.

• Co-infection with HIV and hepatitis C virus are seen at a high rate. HIV infection increases the transmission of STI genital ulcers, and the reverse is also true.

• Scabies is caused by infection with Sarcoptesscabiei var Hominis (a mite parasitic to the horny layer of human skin). Major symptoms of this infection are skin lesions and itching arising from allergic reactions to the body, excretion and so forth of the parasite [9,10].

Materials and Methods

Syndromic Diagnosis of Signs and symptoms of HIV were included in the study. An epidemiological study with a descriptive, exploratory approach was conducted by reviewing patients’ charts and notification records, verifying the clinical, epidemiological and laboratory characteristics of sexually transmitted diseases in individuals and the patients’ characteristics, including data on gender, age, race and place of birth. Etiological and syndromic diagnosis of HIV on 500 cases. Laboratory tests can help keep tabs on patient’s health. Some of these tests will be done soon after patients are HIV positive [11-15]. Then depending on their immune status, whether they are on medication or not, and a variety of other factors, their provider will set up a schedule for them. Whether Patients have other diseases that are associated with HIV (tests for certain infections) [16,17].

The most common tests:

1) CD4 count: Immune system functioning condition

2) HIV viral load: Rapidly HIV is replicating, or multiplying,

3) Resistance test: Body functioning (tests on kidneys, liver, Cholesterol and blood cells)

4) Complete blood count

5) Blood chemistry tests

6) Fasting lipid profile

7) Tuberculosis test

8) STD screening

9) Hepatitis A, B, and C [18,19]

Physical Examination

A. Genital Regions:

1) Number of ulcers and pain:

• Solitary and painless: chancre

• Solitary and painful: trauma, Ca, TB, Behcet’s disease

• Multiple and painful: primary herpes, chancroid, Behcet’s disease.

• Multiple andpainless : secondary syphilis, recurrent herpes

2) Base of ulcer: indurated :

• Chancre, Ca

• Lymph nodes

B. Extra-Genital Regions:

They may give important clues to the diagnosis. E.g. palms and soles secondary syphilis, lips - fixed drug eruption, finger-webs – scabies [20,21].

Laboratory Tests

1) Dark-ground examination spirochetes – for primary and secondary syphilis

2) Serological tests -e.g. V.D.R.L., F.T.A., herpes simplex antibodies

3) Viral study

4) Biopsy - diagnostic in cancroids, Ca

5) Screening for other S.T.D.S

Management

A. General management:

1) Saline dressing,

2) Analgesics,

3) Treatment of secondary infections

B. Specific treatment - depends on the etiological agents:

1) Genital herpes:

• Antivrialagents: e.g. Acyclovir, Famciclovir, Valaciclovir

• Counseling : male – depression is common; female – delivery screening for Ca cervix

2) Chancre and secondary syphilis:

• Penicillin: Procaine penicillin 1.2 mega UIMI × 10 days, Benzathine penicillin 2.4 mega UIMI weekly × 3 wks

• Tetracycline: Tetracycline 500 mg quid × 2 wks, Doxycycline100 mg bd × 2 weeks

• Erythromycin 500 mg qid × 2 weeks

3) Chancroid:

• Multidose: Erythromycin500 mg qid × 2 weeks, Cotrimoxazole 500 mg bd × 2 weeks, Ciprofloxacin 500 mgbd × 3 days

• Single dose: Spectinomycin 2G IMI, Ofloxacin 400 mg, Ceftriaxone 250 mg IMI

Results

The epidemiological Study of Syndromic Diagnosis of HIV Positive was conducted on 500 cases in the year 2013 in Government General Hospital, Nizamabad. Based on the symptoms, signs, 475Patients had HIV and also effected with different diseases in different cases [22,23].

Diseases effected to the percentage of Patients: (Tables 1-7)

1) 22% were effected with Scabies

2) 11% were effected with Genital Scabies

3) 20% were effected with GUDNH

4) 12% were effected with GUDH

5) 10% were effected with VCD

6) 10% were effected with UD

7) 10% were effected with LAP

S.No. Sex Age HIV VDRL Diagnosis
1 Male 45 Positive Negative Scabies
2 Female 30 Negative Negative Scabies
3 Female 35 Negative Negative Scabies
4 Female 28 Negative Negative Scabies
5 Female 38 Negative Negative Scabies
6 Male 55 Negative Negative Scabies
7 Female 50 Positive Negative Scabies
8 Female 32 Positive Negative Scabies
9 Male 50 Negative Negative Scabies
10 Female 25 Positive Negative Scabies
11 Male 37 Positive Negative Scabies
12 Male 32 Positive Negative Scabies

Table 1: The patients were effected with Scabies.

S. No. Sex Age HIV VDRL Diagnosis
1 Male 45 Positive Negative G S
2 Female 30 Negative Negative G S
3 Female 35 Positive Negative G S
4 Female 28 Positive Negative G S
5 Female 38 Negative Negative G S
6 Male 55 Positive Negative G S
7 Female 50 Negative Negative G S
8 Female 32 Positive Negative G S
9 Male 50 Positive Negative G S
10 Female 35 Positive Negative G S

Table 2: The patients were effected with Genital Scabies.

S. No. Sex Age HIV VDRL Diagnosis
1 Male 28 Positive Negative GUD- NH
2 Female 38 Negative Negative GUD -NH
3 Female 26 Negative Negative GUD -NH
4 Female 25 Negative Negative GUD - NH
5 Female 30 Negative Negative GUD - NH
6 Male 35 Negative Negative GUD - NH
7 Female 38 Positive Negative GUD - NH
8 Female 28 Positive Negative GUD - NH
9 Male 32 Positive Negative GUD - NH
10 Female 35 Positive Negative GUD - NH

Table 3: The patients were effected with Genital Ulcer Disease Non-Herpetic (GUDNH).

S. No. Sex Age HIV VDRL Diagnosis
1 Male 32 Positive Negative GUD - H
2 Male  35 Negative Negative GUD - H
3 Male 35 Positive Negative GUD - H
4 Male 38 Positive Negative GUD - H
5 Female 28 Negative Negative GUD - H
6 Male 28 Negative Negative GUD - H
7 Female 38 Positive Negative GUD - H
8 Female 26 Positive Negative GUD - H
9 Female 25 Positive Negative GUD - H
10 Female 30 Positive Negative GUD - H

Table 4: The patients were effected with Genital Ulcer Disease Herpetic (GUDH).

S. No. Sex Age HIV VDRL Diagnosis
1 Female 30 Negative Negative VCD
2 Female 32 Negative Negative VCD
3 Female 58 Positive Negative VCD
4 Female 45 Positive Negative VCD
5 Female 40 Positive Negative VCD
6 Female 28 Positive Negative VCD
7 Female 26 Positive Negative VCD
8 Female 38 Positive Negative VCD
9 Female 26 Positive Negative VCD
10 Female 35 Positive Negative VCD

Table 5: The patients were effected with Vagilo Cervical Discharge (VCD)

S. No. Sex Age HIV VDRL Diagnosis
1 Male 35 Positive Negative UD
2 Male 60 Positive Negative UD
3 Male 48 Positive Negative UD
4 Male 29 Positive Negative UD
5 Male 35 Positive Negative UD
6 Male 48 Positive Negative UD
7 Male 60 Positive Negative UD
8 Male 40 Positive Negative UD
9 Male 55 Positive Negative UD
10 Male 30 Positive Negative UD

Table 6: The patients were effected with Urethral Discharge (UD)

S.No. Sex Age HIV VDRL Diagnosis
1 Female 35 Positive Negative LAP
2 Female 25 Positive Negative LAP
3 Female 45 Positive Negative LAP
4 Female 40 Positive Negative LAP
5 Female 28 Positive Negative LAP
6 Female 26 Positive Negative LAP
7 Female 38 Positive Negative LAP
8 Female 26 Positive Negative LAP
9 Female 35 Positive Negative LAP
10 Female 32 Positive Negative LAP

Table 7: The patients were effected with Lower abdominal Pain (LAP).

Based on the symptoms, signs, laboratory investigations and diagnostic techniques, the Cases which are Diagnosed, Tabulated below and also graphically represented [24,25] (Charts 1-7).

tropical-diseases-community-Scabies

Chart 1: Effected with Scabies.

tropical-diseases-community-Genital

Chart 2: Effected with Genital Scabies (GS).

tropical-diseases-community-Ulcer

Chart 3: Effected with Genital Ulcer Disease Non-Herpetic (GUDNH)

tropical-diseases-community-Herpetic

Chart 4: Effected with Genital Ulcer Disease Herpetic (GUDH).

tropical-diseases-community-Cervical

Chart 5: Effected with Vagilo Cervical Discharge (VCD).

tropical-diseases-community-Urethral

Chart 6: Effected with Urethral Discharge (UD).

tropical-diseases-community-abdominal

Chart 7: Effected with Lower abdominal Pain (LAP).

Discussion

This study was conducted to determine the prevalence and determinants of HIV among Diagnosis of effective cases like who had HIV and also they suffered with Scabies, Genital Scabies, Lower abdominal Pain (LAP), Vagilo Cervical Discharge (VCD), Urethral Discharge (UD), Genital Ulcer Disease (GUD) - Genital Ulcer Disease Herpetic (GUDH) and Genital Ulcer Disease Non-Herpetic (GUDNH) diseases in different age groups and different individuals [26,27]. The total numbers of cases are 500, in which 95% are affected with HIV and also other diseases and cases were attended by the Government General Hospital, Nizamabad [28].

Conclusion

Diagnosis of HIV/STI cases in earlier Stage is important. By evaluating the 500 HIV/STI cases, 95% are affected with HIV and also other diseases. In this Paper, the study was conducted to diagnose the clinical, epidemiological characteristics of the sexually transmitted diseases (STD) and tested through labs, Patients were suffered with HIV and also they suffered with Scabies, Genital Scabies, Lower abdominal Pain (LAP), Vagilo Cervical Discharge (VCD), Urethral Discharge (UD), Genital Ulcer Disease (GUD) - Genital Ulcer Disease Herpetic (GUDH) and Genital Ulcer Disease Non-Herpetic (GUDNH) diseases in the government general Hospital, Nizamabad in 2013.Furthermore, public health intervention on consistent condom use and partner notification and referral should be given due emphasis targeted to the most at risk population.

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  1. Adrienne Mong
    Posted on Jul 19 2016 at 5:44 pm
    HIV is not the death sentence it once was. It is now a life sentence - without the possibility of parole with the HAART meds being a lifetime commitment and with being a responsible sex partner and taking appropriate precautions to prevent the transmission of infection. This study is really a new approach to evaluate the epidemiological,clinical and laboratory characteristics of different age groups with HIV Positive and clearly focus on the epidemiological studies help to provide insight on how to prevent the spread of HIV and also improve the quality of life for those already infected.
 

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