Unfolding of HIV Epidemic and Spectrum of AIDS in North India


The review traces the unfolding of HIV epidemic in North India. The first few cases were reported in 1989 in Indians returning from African countries like Uganda, Zambia and a trickle from USA. Subsequently the cases started pouring from coastal areas of Mumbai, Chennai and finally the virus spread all over through rail and road. In the North eastern region or the golden triangle, IV drug users formed a major group. Using a simple peptide ELISA, it was documented that the virus belonged to the NOF strain. This was much before clades were identified using molecular analysis. It appears that the HIV virus followed the drug (mandrax) route between Mumbai and South Africa. An alarming rise was observed among truck drivers fuelling HIV in Punjab villages who indulged in promiscuous behavior in road side making shift brothels near eating kiosks. Special customs in the state also flared the spread. During the early epidemic a very high prevalence was shown in blood transfused individuals (12.5%) which dropped to 2% -3% after aggressive measures taken by the NACO. While HIV positivity rates plateaued in some states by 2004, infection in Punjab continued to rise even after 2005. Kaposi sarcoma is almost unknown in Indian patients while TB and candida formed major co-infections. In one study, subtype V3 -V5 region chimeras of Indian clade C and clade B replicated freely in peripheral blood mononuclear cells (PBMC) and macrophages and showed higher HIV replication. Opt-out screening was started in an emergency setting in a tertiary care hospital. The positivity rate was 20/per thousand. Thus a large number of patients would have been missed if opt-out screening was not resorted to.

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Sehgal, S. (2014) Unfolding of HIV Epidemic and Spectrum of AIDS in North India. World Journal of AIDS, 4, 52-61. doi: 10.4236/wja.2014.41007.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Bureau of Hygiene & Tropical Diseases (1986) AIDS Newsletter.
[2] Ghosh, T.K. (1986) AIDS: A Serious Challenge to Public Health. Journal of the Indian, 1, 29-30.
[3] Simoes, A.F., Babu, G., John, T.J. Nirmala, S. and Solomon, S. (1987) Evidence for HTLV-III Infection in Prostitutes in Tamil Nadu (India). Indian Journal of Medical Research, 85, 335-338.
[4] Sehgal, S., Arora, S.K, Rajwanshi, A and Deodhar, S.D. (1988) AIDS in India. II. Asian Pacific Journal of Allergy and Immunology, 6, 39-42.
[5] Sehgal, S. (1992) Comparative evaluation of HIV infected foreign students and Indian with AIDS in Chandigarh, India. Asian Pacific Journal of Allergy and Immunology, 10, 141-143.
[6] Sehgal, S. (1995) HIV Epidemic in Punjab. Indian Journal of Medical Research, 101, 47-49.
[7] Sehgal, S. (1998) Time Trends of HIV Epidemic in Punjab: A Decade of Observation. Bulletin of the World Health Organization, 76, 509-513.
[8] Prasada Rao, J.V.R., Ganguly, N.K., Mehendale, S.M. and Bollinger, R. (2004) India’s Response to HIV Epidemic. The Lancet, 364, 9442-9444.
[9] Krishnan, J. (2003) The Rights of the New Untouchables: A Constitutional Analysis of HIV Jurisprudence in India. Human Rights Quarterly, 25, 791-781.
[10] Singh, B., Bedi, Y.P., Singh, S. and Sehgal, S. (1994) AIDS Awareness among Truck Drivers in Punjab. Annals of the National Academy of Medical Sciences (India), 30, 129-132.
[11] NACO (2005) UNGASS India Report: Progress Report on the Declaration of Commitment on HIV/AIDS’ITCT.
[12] Pal, S.C., Sarkar, S., Naik, T.N., Singh, P.K., Toshi, S.I., Shiv, L. and Tripathy, S.P. (1990) Explosive Increase of HIV Infection in North East States of India; Manipur and Nagaland. Bulletin of the Center for AIDS Research and Control, 3, 2-6.
[13] History of the HIV Epidemic and the Country’s Response. http://www.avert.org/aidsindia.htm
[14] www//nedan.in. nedan_ trafnaids_ north_east 070402 (2006) Trafficking and HIV/AIDS, North East Report.
[15] Www//Norwegian Refugee Council (2013) Advocacy > Climate Change > Global Estimates. Internal Displacement Group.
[16] Kakar, D.N. and Kakar, S.N. (2001) Combating AIDS in the 21st century Issues and Challenges. Sterling Publishers Private Limited, 32.
[17] Prasanna, K. (2013) The National AIDS Control Programme (1, 2, 3)
[18] HIV/AIDS September (2001) AtalBihari Vajpayee, Speech at the Meeting with Chief Ministers of High Prevalence States on the Issue of Control and Prevention of HIV/AIDS, New Delhi.
[19] www/UNAIDS.org/knowledgecenter (2006) Report on the Global AIDS Epidemic.
[20] UNAIDS (2007) Press Release: 2.5 Million People in India Living with HIV According to New Estimates.
[21] UNAIDS (2010) UNAIDS Report on the Global AIDS Epidemic.
[22] HIV Estimations (2012) Report Released. Press Information Bureau, Government of India Ministry of Health and Family Welfare, 40.
[23] Sivaram S. (2002) Integrating Income Generation and AIDS Prevention Efforts: Lessons from Working with Devadasi Women in Rural Karnataka, India.
[24] NACO (2008) Annual Report NACO 2008-09.
[25] UNGASS (2010) India—Country Progress Report.
[26] UNODC (2007) Feature—Drug Users Raise Risk of HIV in India's heartland.
[27] UNGASS (2010) India—Country Progress Report.
[28] NACO (2005) UNGASS India Report: Progress Report on the Declaration of Commitment on HIV/AIDS.
[29] WHO/UNAIDS/UNICEF (2011) Global HIV/AIDS Response: Epidemic Update and Health Sector Progress towards Universal Access 2011.
[30] Jameel, S., Zafarullah, M., Ahmed, M., Kapoor, G.S. and Sehgal, S. (1995) A Genetic Analysis of HIV-1 from Punjab, India Reveals the Presence of Multiple Variants. AIDS, 9, 685-690.
[31] Sehgal, S., Pasricha, N. and Jameel, S. (1996) Serotype Analysis of Indian Patients with HIV Infection. Tropical Medicine & International Health, 1, 199-204.
[32] Ahmed, K.M., Mujtaba, S., Das, R., Zafrullah, M., Sehgal, S. and Jameel, S. (1998) NeF Sequence of Primary HIV 1. Isolate from North India. Human Retrovirus & AIDS Research, 14, 1491-1493.
[33] Lole, K., Bollinger, R.C., Paranjape, R.C., Gadkari, D., Kulkarni, S.S., Novak, N.G., et al. (1999) Full-Length Human Immunodeficiency Virus Type 1 Genomes from Subtype C-Infected Seroconverters in India, with Evidence of Inter-subtype Recombination. Journal of Virology, 73, 152-160.
[34] Chakrabarti Sumon, K. (2008) CNN IBN: Dawood turns Mandrax King Updated Apr 17, at 02:56 am IST.
[35] Animesh, R. (2006) Briefing India an Emerging Hub of International Drug Trafficking. Society for the Study of Peace and Conflict at New Delhi.
[36] (2008) Office of Drug and Crime Report (ODC Report) from South Africa. 25-20.
[37] Solomon, S. (2003) YRG CARE. Integrated Preventive Care and Support Services, Horizon and International HIV/AIDS Alliance.
[38] Singh, S., Jat, K.R., Suri, D., Arora, S.K., Minz, R. and Sehgal, S. (2009) Clinical Profile of 516 Children Overview of HIV and AIDS in India. Retrieved from Affected by HIV in a Tertiary Care Center in Northern India: 14 Years of Experience. Transactions of the Royal Society of Tropical Medicine and Hygiene, 103, 627-633.
[39] Merchant, R.H. and Lala, M.M. (2011) Principles of Perinatal and Pediatric HIV/AIDS. JP Brothers, New Delhi.
[40] Sehgal, S., Varma, S., Rajwanshi, A., Sood, A., Dash, R.J., Singh, K., et al. (1997) Incidence of Tuberculosis in AIDS Patients in Punjab: A Retrospective Study. In: Aggarwal, O.P., Sharmam, A.K. and Indrayan, A., Eds., HIV & AIDS Research in India, NACO, Ministry of Health, New Delhi, 602-604.
[41] Sud, A., Sehgal, S., Sharma, M., Varma, S., Kumar, B. and Varma, S. (2000) Spectrum of Secondary Infections Associated with HIV Infection in North India. Annals of the National Academy of Medical Sciences (India), 35, 151-158.
[42] Mujtaba, S., Varma, S. and Sehgal, S. (2003) Cytomegalovirus Co-Infection in Patients with HIV/AIDS in North India. Indian Journal of Medical Research, 117, 99-103.
[43] Sehgal, S., Mujtaba, S., Sud, A., Datta, U. and Vinayak, V.K. (2002) Cellular and Serological Markers of Disease Activity in Indian Patients with HIV/AIDS. Methods in Cell Science, 24, 107-114.
[44] Pasricha, N., Datta, U., Chawla, Y., Singh, S., Arora, S.K., Sud, A., Minz, R.W., Saikia, B., Singh, H., James, I. and Sehgal, S. (2006) Immune Responses in Patients with HIV Infection after Vaccination with Recombinant Hepatitis B Virus Vaccine. BMC Infectious Diseases, 6, 65.
[45] Sundaravaradan, V., Das, S.R., Ramakrishnan, R., Sehgal, S., Gopalan, S., Ahmad, N. and Jameel, S. (2007) Role of HIV-1 Subtype C Envelope V3 to V5 Regions in Viral Entry, Co-Receptor Utilization and Replication Efficiency in Primary T-Lymphocytes and Monocyte-Derived Macrophages. Virology Journal, 4, 126.
[46] Minz, R.W., Singh, S., Varma, S., Mathuria, S.N., Aggrawal, R. and Sehgal, S. (2010) Relevance of Opt-Out Screening for HIV in Emergency and Pre-Surgery Patients in a Tertiary Care Center in Northern India: A Pilot Study. Indian Journal of Pathology & Microbiology, 53, 287-289.
[47] Jefferys, R. and McEnery, R. (2013) A Toddler Stole the Show: Report of a Child Functionally Cured of HIV Stirred Up the Typically Staid Proceedings of the Conference on Retroviruses and Opportunistic Infections. IAVI Report, 17, 4-8.

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