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CORRESPONDENCE SECTION
Year : 2002  |  Volume : 19  |  Issue : 1  |  Page : 93-95
 

Routine HIV testing in urological patients: is it desirable ?


Departments of Urology and HIV Surveillance Centre, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221005, India

Correspondence Address:
Vibhav Malviya
Departments of Urology and HIV Surveillance Centre, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221005
India
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Source of Support: None, Conflict of Interest: None


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   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 2019 Oct 14];19:93-5. Available from: http://www.indianjurol.com/text.asp?2002/19/1/93/20305



   Introduction Top


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 Top


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.

Observation:

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 Top


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 -

  1. Avoiding prick injuries;
  2. Use of protective glasses and boots;
  3. Use of double gloves;
  4. 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.[6]

 
   References Top

1.Unsafe injections in developing world : a review. L. Smonsen et al 782-800. Bulletin WHO. Vol. 77, No.10, 1999.  Back to cited text no. 1    
2.Transmission of HBV, HCV and HIV through unsafe injections. A Kane et al 801-807. Bulletin WHO. Vol. 77. No. 10, 1999.  Back to cited text no. 2    
3.Preventing mother to child transmission of HIV in Africa P. Piot & A. Cole-seck. Bulletin WHO, Vol.77, No.11, 869-670.   Back to cited text no. 3    
4.Campbells Urology, 7 th Edition.  Back to cited text no. 4    
5.Annual AIDS epidemic update: 1999.  Back to cited text no. 5    
6.National AIDS Control Organization (NACO), update: 1999. 7. Articles published in Times of India.  Back to cited text no. 6    



 
 
    Tables

  [Table - 1]

This article has been cited by
1 Prevalence of HIV seropositivity among surgical patients in a tertiary care hospital
Bhattacharya, S. and Chakrabarty, B. and Kundu, P.K. and Maji, A. and Ghosal, S.R. and Dey, K.K.
Journal of the Indian Medical Association. 2012; 109(12): 896-898
[Pubmed]



 

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    Abstract
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