|Year : 2002 | Volume
| Issue : 1 | Page : 93-95
Routine HIV testing in urological patients: is it desirable ?
Vibhav Malviya, Gopi Kishore, Arif Hameed, US Dwivedi, AK Gulati, PB Singh
Departments of Urology and HIV Surveillance Centre, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221005, India
Departments of Urology and HIV Surveillance Centre, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221005
Source of Support: None, Conflict of Interest: None
| Abstract|| |
The incidence of HIV infection has increased tremendously over the last few years. National AIDS control organisation has estimated that about 3.5 million persons in the reproductive age group in India are harbouring HIV infection.
The positivity rate of HIV-tested persons has shown a rising trend with 0.8% in 1989, 1.4% in 1993 and 2.4% in 1998. In our study we found 19 HIV positive patients out of 776 patients before any urological procedure. HIV infection was found both in males and females and in almost all types of urological dirorders.
Routine HIV testing is usually not carried out at most centres and the medical fraternity is constantly exposed to the risk of HIV infection which can have wide-ranging implications in a health professional's life. We should all strive, for routine HIV testing before undertaking patients for any procedure.
Keywords: Urology Patients; HIV Testing
|How to cite this article:|
Malviya V, Kishore G, Hameed A, Dwivedi U S, Gulati A K, Singh P B. Routine HIV testing in urological patients: is it desirable ?. Indian J Urol 2002;19:93-5
|How to cite this URL:|
Malviya V, Kishore G, Hameed A, Dwivedi U S, Gulati A K, Singh P B. Routine HIV testing in urological patients: is it desirable ?. Indian J Urol [serial online] 2002 [cited 2020 Feb 19];19:93-5. Available from: http://www.indianjurol.com/text.asp?2002/19/1/93/20305
| Introduction|| |
Over the years the incidence of AIDS has been alarmingly increasing. The disease, which was confined to few groups and in certain pockets of the country, is being increasingly detected. Ignorance coupled with sexual promiscuity, and unhealthy practices in medical and other fields of life is leading to large number of HIV positive cases in the society.
The recent World Bank report (1990) stated that India tops in the number of AIDS cases in the world. National Aids Control Organization (NACO) has put the prevalence at 1 % of adult population, i.e.. a whopping 3.5 million persons in the reproductive age group in the country. In India, Maharastra has the highest prevalence rate of around 2%. It is followed closely by Andhra Pradesh, Tamil Nadu, Manipur, and Karnataka.
The Annual AIDS epidemic update figures are really startling. 16 thousand persons are affected daily and 5.8 million people in a year, that too in those between 15-24 years of age. Among these 3 million are men, 2.1 million are women and 0.59 million are children under the age of 15 years. In 1998, there were 2.5 million deaths due to AIDS. The most shocking aspect of this is that >20%, i.e., 0.51 million were children. Over the last year, the number of HIV patients has gone up by more than 10%. The main concern is that whereas in the world, the prevalence has reached a plateau, in most of the South Asian countries it is showing a rising trend.
At present in 10 African countries like Mozambique, Botswana, Tanzania, etc., the prevalence rate is equal to 10%. Recent studies have indicated that the life expectancy may fall from 67 years at present to 47 years by 2015 if the situation is not controlled.
A similar situation may erupt here in India, if we don't Give serious thought to this problem. Recent reports have suggested that India has the highest number of HIV infected people in the world, and the most worrying aspect of this is that 1/3 are between 10-24 years of age. The recent projections indicate that if this trend continues, by 2001, India will have 20 million HIV positive cases.
If we go into the official figures, till March 1998, there were 74.960 positive cases, out of which there were 5204 full-blown cases. In UP itself, there were 1495 HIV positive cases and, amongst them there were 230 full-blown cases. In eastern UP where our institute is situated, we noticed a gradually rising trend. The postivity rate was 0.8% in 1989. 1.4% in 1993 and went up to 2.4% in 1998. Higher prevalence in this area can be attributed to number of persons moving out to metropolitan cities like Mumbai, Calcutta, etc. for jobs. Seeing the higher prevalence as well as the medical fraternity being at great risk, we thought to study prevalence of HIV cases in patients suffering from urological diseases.
| Materials and Methods|| |
Earlier, in our department we used to subject only those patients for HIV testing who had h/o multiple unsafe contacts, were intravenous drug users or had h/o blood transfusions outside the institute. Seeing the high prevalence rate in this region, from February 1999 onwards we subjected all the patients undergoing any endoscopic or surgical intervention for HIV testing after informed consent at Institute surveillance centre. HIV status of the patient was not a deterrent for the planned management.
Till 31st Dec.1999, 776 patients were subject to HIV testing. Out of these 19 patients were found to be HIV positive - giving the disease prevalence at 2.5%. The table below shows the diseasewise distribution of the patients.[Table - 1]
From the table we can see that HIV positive cases could be found in all variety of diseases. But the major bulk was constituted by patients suffering from stricture urethra. There were 16 males and 3 females amongst the positive cases. In females, there was 1 case each of GUTB, ureteric calculus and VVF. Amongst the males, the bulk of the cases were constituted by stricture urethra cases. There were 10 cases of stricture urethra. Amongst these 10 cases, 6 patients had h/o multiple unsafe contacts, 3 patients were of traumatic stricture urethra and h/o blood transfusions carried out outside the institute. In 1 patient, we couldn't trace out the source of infection.
| Discussion|| |
In our institute during the year 1999, out of the 3787 patients who were tested for HIV, 126 patients were tested positive. This gave the prevalence of disease 3.3% whereas it was 10.4% in the suspected high-risk group, it was 0.6% in the antenatal cases. The male to female ratio was 1.8:1 at our institute whereas the national figure stands at 3.4:1. The high male to female ratio could be attributed to the fact that people from this place move off to metropolitan cities and on coming back, gift it to their spouses.
Inspite of increase in number of HIV positive cases coming to notice, why it is not being routinely carried out in most of the centres. Though there are centres which are carrying out these tests routinely in government set-up the reason cited for not doing routine HIV is the financial crunch, but much more important than this is the fact that people are still unaware of implications that it has. This lack of awareness coupled with lack of commitment is the basic hurdle in its implementation.
But the real issue which springs up off and on is the ethical issue. Subjecting the patients to routine testing is considered unethical. Presumptions given are that if patient is tested false positive then it leads to considerable mental trauma and social disrepute. But one important fact that has to be taken into consideration is that ELISA has high sensitivity, almost to the tune of 98-99%. Also the question of patient being in window period creeps up, but various studies have shown that this percentage of patient remains below 3-4%.
Everybody, right from government, NGOs, and people are concerned about the patients' mental status, but what about the treating doctors and paramedics. Injuries during procedures right from intravenous cannula insertion to peroperative injuries are common and doctors are constantly exposed to these. When the HIV status of the patient is not known, nobody really bothers to take care and precautions which ideally should have been taken in every case and this leads to high chances of contacting infection. Since routine screening is not done the guidelines profess to consider all patients as potential carriers until proved otherwise. But all will agree to this fact that in clinical practice this is not always possible for various reasons and more so in government set-ups.
Now if we look into a situation where a doctor discovers his/her positive status. The source of infection is not known and what happens when he/she discloses his/her positive status. His/her professional life is over, it is almost as good as committing a professional harakiri, becomes the butt of jokes amongst the colleagues that the condition is probably due to some good times which he had. If the doctor is married then it ultimately leads to marital discord. Is this what the doctor deserved for all his sincerity and hard work ?
A resident doctor had to go through all this when she contracted HIV infection from the patient. What compensation did she get ? In fact a big nothing. There are lots of legal hassles and loopholes. In order to prove infection from needle prick or injury during surgery, immediate blood testing to know current HIV status, then at 1 and 3 months to note for any infection and the head of the institute be informed along with the witness who was present at the time of injury. But is it really feasible to inform about every injury especially when the HIV status of the patient is not known. The government, according to a recent act, considers the doctor / paramedical personnel contacting HIV infection during work, as war disabled. But does it really suffice for the mental trauma, anguish and life of the doctor?
A recent Supreme Court judgment suspended the matrimonial rights of HIV-infected patients. This has been done to prevent the spread of disease. If measures are being taken to prevent the spread of this deadly disease, why this debate continues over routine screening? We all advise that prevention is better than cure then why not on this aspect. So will HIV status replace horoscope matching before marriage ?
Following precautions listed below are to be taken during surgery of HIV positive cases -
- Avoiding prick injuries;
- Use of protective glasses and boots;
- Use of double gloves;
- We use protective disposable non-absorbable gowns, mostly manufactured by a local company.
Practically it is not possible to take above precautions in every case particularly in government sector. In our study, out of 776 cases 19 were positive for HIV. If we know HIV status of patient, it is easier to take special measures to prevent infection. Our recommendation is, once patient is registered for treatment, it should be deemed as informed consent of patient to undergo HIV testing. This needs discussion at both GOs & NGOs for its implementation.
| References|| |
|1.||Unsafe injections in developing world : a review. L. Smonsen et al 782-800. Bulletin WHO. Vol. 77, No.10, 1999. |
|2.||Transmission of HBV, HCV and HIV through unsafe injections. A Kane et al 801-807. Bulletin WHO. Vol. 77. No. 10, 1999. |
|3.||Preventing mother to child transmission of HIV in Africa P. Piot & A. Cole-seck. Bulletin WHO, Vol.77, No.11, 869-670. |
|4.||Campbells Urology, 7 th Edition. |
|5.||Annual AIDS epidemic update: 1999. |
|6.||National AIDS Control Organization (NACO), update: 1999. 7. Articles published in Times of India. |
[Table - 1]
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