|Year : 2006 | Volume
| Issue : 4 | Page : 170-171
Chemoprophylaxis in sexually transmitted HIV/AIDS lung diseases
Professor & Head Superintendent, Govt. General & Chest Hospital, Hyderabad., India
Professor & Head Superintendent, Govt. General & Chest Hospital, Hyderabad.
Source of Support: None, Conflict of Interest: None
Clinical trial registration None
|How to cite this article:|
Venu K. Chemoprophylaxis in sexually transmitted HIV/AIDS lung diseases. Lung India 2006;23:170-1
To day HIV/AIDS is the greatest threat to the health of the community  WHO estimates the annual number of new cases of tuberculosis will increase to 10 million by 2000 and deaths attributable to tuberculosis will increase from 2.5 million to 3.5 million by the end of millennium  . The advent of HIV infection has a substantial impact on the incidence of Tuberculosis, particularly in developing countries  . Tuberculosis was unknown in economically developed world. In 1991, about 3673 cases were reported in New York City, representing an increase of 143% over the incidence in 1980  . Tuberculosis account for 60% of opportunistic infections  . Tuberculosis is the cause for high morbidity and mortality in HIV seropositive patients. Mortality of tuberculosis is about 10% in HIV seronegative patients and increased to 30% in HIV seropositive patients  . The incidence of many other infections like pneumocystis carinii pneumonia, fungal infections, and non infectious conditions like Kaposi's sarcoma, leukemia, lymphomas and lung cancer are increased in HIV seropositive patients (scar carcinoma from Tuberculosis, lymphomas, leukemia and kaposi's sarcoma). Lung Cancers are increased in HIV patients with smoking  . HIV is a Human T-cell Lymphotrophic Virus (HTLV-3) and it has close similarities with other lymphotrophic viruses. This could be the cause for increased incidence of lymphomas in HIV seropositive patients. Natural history of Human Papilloma Virus (HPV) is altered and risk of cervical cancer is increased in HIV seropositive patients particularly in smokers  , which in turn causes metastasis of the lung.
WHO estimated 42 million HIV seropositive cases globally and 90% of the infections are in the developing countries  . In India alone there are about 5.1 million estimated cases according to National Aids Control Organization (NACO)  . About 4 lakhs cases of HIV/AIDS are documented in the State of Andhra Pradesh  .
This disease was earlier confined to only select groups like homosexuals, commercial sex workers and drugs addicts. This has crossed into the general population and hence there is a danger of pandemic. It is time for us to react quickly to the situation and prevent the transmission of this disease which is the main predisposing cause for lung infections. This has become more complicated because of non availability of the vaccine, no cure and a complex socio biological phenomena involved in the transmission of HIV infection.
The disease is transmitted by sexual contact in 85.6%, through maternal child transmission in 2.7%, through blood products in 2.5%, through intravenous drug abusing in 2.2% and in 6.7% cases route of infection is not identified  .
There are effective measures for the prevention of maternal child transmission of HIV infection. The prevention of parentaral to child transmission programme, which has shown that, prevention to child transmission is possible by the administration of long term, short term Zidovudine or Nevirapine 200mg single dose in combination with other interventional strategies can reduce the transmission to less than 2% from around (15-40%)  .
In drug addicts HIV/AIDS can be effectively intercepted by the education, providing free sterile needles, needle cutters, counseling, deaddiction process and Anti Retro Viral Therapy. Reduction of sexually transmitted diseases is highly important because it is the major route of infection, which will have greater impact than the interventions of other routes and this is the most complex one because of psycho socio biological behaviour of human beings. The lessons learned from Chiang Mai sex workers study  and West Bengal sex workers study shown that treatment of STD's produced significant reduction. Use of condom cannot be underestimated in the prevention of transmission of HIV/AIDS  .
Lessons have been learned from "Velugu Rekha programme" which is a medical education strategy for the common man's benefit in which clinician is available on his mobile for answering the questions and providing helpline, condom rupture is frequently complained. Condom failure situations to be helped by considering post exposure prophylaxis of Anti Retro Viral Therapy for four weeks as per National Aids Control Organization guidelines. In 11 cases of post exposure, with above said therapy in our hospital did not develop HIV in 4 years follow up. Anti Retroviral Therapy with quick three drugs and once monthly follow up of patients for 3 months is suggested. Scheme of post exposure prophylaxis strategy for patients in risk situations such as condom rupture during contact with HIV positive subjects is presented. Such a strategy if found successful on further studies will be of immense help in the prevention of high burden disease and reduction in morbidity and mortality of lung infections and malignancies.
| Acknowledgement|| |
I sincerely thank: Dr. K. Subhakar, Asst. Professor, Govt. Genl. & Chest Hospital, Dr. P. Ajay, Senior Resident, Dr. M. Madhusudana Reddy, Post Graduate, Govt. Genl. & Chest Hospital and Mr. Ratnakar, computer operator and other seniors.
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