Bloodborne HIV: Don't Get Stuck!

Only 0.2% of adults are HIV-positive in India; many infections are from injection drug use (IDU) and anal sex among men (MSM). Over the years, government of India (and in one case, experts from Denmark) have investigated at least four reports of unexpected HIV infections to identify outbreaks from healthcare. Government has ignored many other unexpected infections.

Investigations that found HIV outbreaks from healthcare (from earliest to latest)

1989: Investigation of HIV in professional plasma donors, Mumbai: In early 1989, public health authorities learned that many of the blood products produced in India were HIV-positive. Acting on this information, doctors in Mumbai, India, in 1989 tested 200 professional plasma donors who sold their blood plasma to organizations that produced blood products. Of these 200 donors, 86% (~172) were HIV-positive. Donors sold plasma an average of 3.5 times per week, and 90% had been doing so for 5 years.[1]

1989: Investigation of HIV in professional plasma donors, Pune: Acting on information  that many of the blood products made in India were HIV-positive, the National Institute of Virology in early 1989 tested sera from 129 clients of a commercial plasma collection center in Pune. Ninety-seven of 129 tested HIV-positive. “It appears that they became infected…most probably via a common source at any one of the commercial establishments where they sold their plasma.”[2]

1997: Investigation at a Mumbai orphanage: In January 1997, a child in a Mumbai orphanage tested HIV-positive. Danish families had arranged to adopt some children from the orphanage. A team from Denmark helped with an investigation. Tests found seven other children at the orphanage to be HIV-positive. All had previously tested HIV-negative. All had been treated at a nursing home in October 1986, during which five had received intravenous antibiotics and routine immunizations. The investigation did not test anyone except the orphans treated at the nursing home.[3]

2018: Investigation of an outbreak in patients receiving healthcare in Unnao, Uttar Pradesh: In July 2017, 12 persons from an area of Unnao District tested HIV-positive; many reported injections from a local unlicensed and  untrained provider. The Chief Medical Superintendent of the District Hospital alerted to Chief Medical Officer of the District, who did nothing. In November 2017 another 13 residents tested HIV-positive. Seeing this unusual number of infections, the district organized a 2-member team to investigate, and arranged HIV testing camps in Bangarmau on January 24, 25, and 27. At the camps, tests on 566 persons found 33 (5.8%) with HIV.[4] Over subsequent weeks, as many as 75 have been reported in the news through 12 February 2018. As reported on 10 February, Government of India responded to news of the outbreak by sending a 3-member team from the National AIDS Control Organization to Unnao to investigate.[5,6,7] As of October 2018, I have found no report from this investigation.

Unexplained infections recognized but not investigated

Aside from the outbreaks discussed in the above paragraphs, doctors throughout  India have from time to time reported unexplained infections in persons with no sexual or mother-to-child risks. For example, in during 1995-2003, doctors at the All India Institute of Medical Sciences in New Delhi diagnosed 109 children aged 3 weeks to 15 years with HIV. For 21 children (19%) infections were suspected to have come from blood transfusions. For another 7 children (6.4%) with HIV-negative mothers, no risk was identified. There was no subsequent investigation to find if other children had been infected or to determine how they were infected.[8]

References

1. Bhimani GV, Gilada IS. HIV prevalence in people with no fixed abode: a study of blood donorship patterns & risk determinants. 8th International Conference on AIDS, Amsterdam, 19-24 July 1992. Abstract MoC 0093.

2. Banerjee K, Rodriguez J, Israel Z, et al. Outbreak of HIV seropositivity among commerical plasma donors in Pune, India [letter]. Lancet 1989; 2: 166. Referenced at:  https://www.ncbi.nlm.nih.gov/pubmed/?term=banerjee+rodrigues+israel+kulkarni.

3. Christiansen CB, Nielsen C, Machucca R. Cluster of HIV-1 infection among children in Indian Hospital in Bombay. Department of Virology, Statens Serum Institute, Copenhagen, Denmark. Report to World Health Organization, September 1998. Unpublished

4. Quack held for infecting scores with HIV. India Post, 13 February 2018. Available at: http://www.indiapost.com/quack-held-for-infecting-scores-with-hiv/ (accessed 13 February 2018).

5. Unnao chief medical officer alerted in July about quack who caused HIV infections: Indian Express. Scroll-in 11 February 2018. Available at: https://scroll.in/latest/868274/unnao-chief-medical-officer-alerted-in-july-about-quack-who-caused-hiv-infections-indian-express (accessed 12 February 2018).

6. Williams H. Fake doctor infects 75 Indian patients with HIV. World Report Now, 10 February 2018. Available at: https://www.worldreportnow.com/fake-doctor/6754/ (accessed 12 February 2018).

7. Uttar Pradesh: Centre rusks 3-member team to HIV-hit Bangarmau. DNA, 10 February 2018. Available at: http://www.dnaindia.com/india/report-uttar-pradesh-centre-rushes-3-member-naco-team-to-hiv-hit-bangarmau-2583385 (accessed 12 February 2018).

8. Lodha R, Upadhyay A, Kapoor V, et al. Clinical profile and natural history of children with HIV infection. Ind J Pediatr 2006; 73: 201-204. Abstract available at: http://www.ncbi.nlm.nih.gov/pubmed/16567911 (accessed 13 January 2012).