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Globally there are 40 million people living with human immunodeficiency virus (HIV)/ acquired immunodeficiency syndrome (AIDS). According to latest estimates based on National Family Health Survey (NFHS), released by National AIDS Control Organization (NACO), the National adult HIV prevalence in India is approximately 0.36% which corresponds to an estimated 2 to 3.1 million people living with HIV in the country. The new lower estimates are due to difference in surveillance method and do not mean a sharp decline in the epidemic. HIV prevalence has begun to decline in Tamil Nadu and other southern states with high HIV burden. There has been feminization of epidemic with an estimated 38.4% of infected adults being female. Eighty-six percent of the Indian population is unaware of their HIV status with only 57% population being aware of the preventive methods. There are more than 4000 integrated counseling and testing centers (ICTCs) in the country. About 80,000 patients are accessing free antiretroviral treatment (ART) in 127 centers. PPTCT program has been scaled up in the county with Nevirapine as the regimen of choice. It has an efficacy rate of 48% in prevention of HIV transmission in the mother baby pair; there are chances of increased drug-resistance to ART in mothers who were treated with prophylactic single-dose Nevirapine. These patients face a lot of stigma and discrimination. A 2006 study found that 25% of people living with HIV in India had been refused medical treatment on the basis of their HIV-positive status.

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Cutaneous manifestations of human immunodeficiency virus (HIV) infection or acquired Immunodeficiency syndrome (AIDS) can occur throughout all stages of infection. The dermatological complications of HIV and AIDS may be distressing to the patient and difficult for the dermatologist to diagnose and manage. The aim of this study was to examine the pattern of noninfectious cutaneous manifestations and their relationship with stage of HIV infection. Two hundred HIV-positive/AIDS cases attending Skin-STD clinic, Govt. Medical College, Vadodara, were thoroughly examined to find cutaneous manifestations. Skin, scalp and nails were thoroughly examined. One hundred twenty out of 200 cases had noninfectious cutaneous manifestations like pruritic papular eruption in 43 cases (35.8%), pigmentary changes in 10 cases (8.3%), seborrheic dermatitis in 5 cases (4.2%) and psoriasis in 4 cases (3.3%). Such presentations were more frequently observed in symptomatic/AIDS cases. Adverse drug reactions (ADRs) were observed in 15 cases. These include 6 out of 30 cases on antiretroviral therapy (ART) and 9 cases on other medications. Pemphigus vulgaris and acanthosis nigricans (AN) were seen as co-presentation, each in 1 case of AIDS. HIV-related cutaneous manifestations are very common and, if studied properly, can serve as diagnostic and prognostic markers. They may reflect involvement of internal organs. Many of the infectious and noninfectious manifestations respond well to antiretroviral therapy, which may not be feasible in resource-restricted setup.

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A 56-year-old male patient who had history of sexual exposure 28 years back was referred by the Department of General Medicine as he was not responding to treatment for spastic paraplegia and was venereal disease research laboratory (VDRL) reactive. The patient had characteristic clinical features of tabes dorsalis except Charcot's arthropathy, dribbling incontinence and visceral crises. Serum VDRL was 1:32 and cerebrospinal fluid (CSF) VDRL was 1:4. CSF analysis showed increased lymphocytes and protein. Though tabes dorsalis is a rarity now compared to the pre-antibiotic era, one may come across few cases presenting with variable manifestations, more so in the era of human immunodeficiency virus infection. Therefore, awareness of the florid manifestations of tabes dorsalis is necessary for early diagnosis and proper treatment of this disabling condition.

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Lichen sclerosus is an uncommon disease of unknown etiology in which small white areas on the skin may be associated with an atrophic, potentially scarring condition of the perineum. A 45-year-old male patient presented with porcelain white atrophic plaques over shaft and glans penis, along with complaint of intense pruritus, painful penile erection and burning micturition. Presumptive diagnosis of lichen sclerosus was kept. Histopathological examination confirmed the diagnosis.

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The study aims to find out the knowledge and understanding of acquired immunodeficiency syndrome (AIDS) in 1,200 randomly selected women in the age group of 15-45 years, of 16 villages belonging to Villupuram Health Unit District, Tamil Nadu, India, using a two-stage sampling design. Data collection was done in the period from August to November 2001, using both qualitative and quantitative methods. In all, 28% of the women had not heard of AIDS at all. More than one-third of the women who had heard of AIDS considered AIDS as a serious illness; and among them, 72% ranked AIDS as the number one killer disease. The main findings showed that the rural women's knowledge was poor in areas like cause, symptoms and prevention. Level of literacy of the women was significantly associated with their knowledge of HIV/AIDS ( P <0.05), showing that literates had better knowledge than illiterates. Also, there were misconceptions and false beliefs about cause and spread of the infection, which were found to be more prevalent among illiterates. Television was found to be the major source of knowledge on AIDS among both literates and illiterates. This study suggests a need for innovative, group-based repeated education on AIDS, particularly for rural women, in order to impart better knowledge and understanding on AIDS.

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Sexually transmitted infections (STIs) are becoming a major public health problem in India. The study was undertaken to identify different STIs/ human immunodeficiency virus (HIV) in female sex workers, their co-relation with socio-demographic and behavioral factors; and also to provide treatments for symptoms. The mean age at presentation was 27.5 years for female sex workers (FSWs), and majority (64.5%) of FSWs were below 35 years. A higher proportion (75%) of the women were living with their husbands. About 88.5% of sex workers had less than two partners per day, and only 2.5% of sex workers had more than five partners per day. Forty percent received a monthly income of less than Rs. 1,000, while 6% received more than Rs. 5,000 per month. In half (49.4%) of the women, vaginal discharge was the major complaint, followed by genital ulcer, pain during intercourse, burning micturition and lower abdominal pain. HIV and VDRL reactivity were observed in 3.2% and 3.73% of subjects respectively.

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Trends of sexually transmitted diseases (STD) vary from place to place depending on various epidemiological factors prevailing in that respective geographic area. To understand the pattern and trends of STDs, a study was conducted at the STD Dept., Govt. General Hospital, Kakinada, for a period of 6 years, i.e., from Jan. 2000 to Dec. 2005, which was further divided into two spells of 3 years each to understand the behavior of STDs. During the entire study period, a total of 12,071 patients were enrolled. All the patients were thoroughly examined and investigated. On analysis, it was found that 5,004 patients attended in the 1 ^st spell and 7,067 in the 2 ^nd spell. Majority of them were male, married and in the third decade of their life. At the same time, the number of female patients attending STD clinic increased significantly in the 2 ^nd spell. All the diseases were broadly categorized into four groups, viz., bacterial, viral, protozoal, parasitic and fungal (PPF) and miscellaneous. The trend of STDs was changing from bacterial to viral diseases during the period of 6 years, with a definite decline of bacterial STDs. Among the viral diseases, HIV stood first in both the spells. In the PPF group, majority of the cases were contributed by fungal diseases. Unlike other studies, miscellaneous diseases included in this study dominated the picture and significantly influenced the percentage of incidence of individual diseases, which made it uncomparable with other studies. Similar continuous ongoing studies at every level are essential to understand the pattern and behavior of STDs, which may influence the already existing strategies and interventions for control of STDs.

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Stavudine (d4T) and zidovudine (AZT) belong to nucleoside reverse transcriptase inhibitor (NRTI) group of drugs and they are the core drugs with lamivudine (3TC) as the first-line therapy. d4T is reported to cause a number of long-term metabolic and morphologic adverse drug reactions (ADR). In this study, the incidence and pattern of ADR due to d4T and AZT were compared. Ninety cases on antiretroviral treatment (ART) were studied prospectively over a period of 2 years. Forty-two cases were on AZT-based regimen, and 48 cases were on d4T-based regimen. In all cases, baseline investigations, serum lipid profile and lactate levels (if required) were carried out. Cases were evaluated monthly, and investigations were repeated quarterly for any ADR. Out of the 42 cases on AZT-based regimen, 21 had ADR; while 23 out of the 48 cases on d4T had ADR. Anemia (42.8%) and nail hyperpigmentation (30.9%) were the commonest ADR due to AZT. Peripheral neuropathy (PN) (39.6%) was the commonest ADR with d4T, followed by lipodystrophy (LD) (22.9%). Change of therapy was required in 1 case on AZT with severe anemia and in 5 cases on d4T with LD, PN or lactic acidemia. The severe ADR with d4T needed a change of regimen to AZT in 5 cases. Moreover, d4T requires monitoring for long-term metabolic changes, which may lead to morphologic disfigurement which are particularly distressing to females. As the cost of both the regimens is now almost equal, preference should be given to AZT-based regimen.

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A 25-year-old married woman presented with swelling of vulva with oozing of watery fluid from vulval skin surface for the past 8 years. She also complained of swelling in the inguinal region (occasionally painful) on both sides for the past 8 years. Local genital examination revealed diffuse indurated swelling of the labia majora with overlying skin studded with papulo-vesicles and oozing of milky fluid. Nontender, firm, matted lymph nodes involving both horizontal and vertical groups of inguinal lymph nodes were found bilaterally. Histopathology of the lesion was consistent with lymphangiectasia. Fine needle aspiration cytology from the right inguinal lymph node showed caseating epitheliod cell granulomas with calcification consistent with tuberculosis. Acid-fast bacilli and parasites were not seen. Hemogram was normal except for raised erythrocyte sedimentation rate (35 mm in the first hour). Mantoux test was highly reactive (15 × 15 mm). A final diagnosis of lymphangiectasia of the vulva secondary to tubercular lymphadenitis was made. The patient was started on anti-tubercular drug therapy. There was a partial recovery in the genital lesions.

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Serum iron was estimated in 105 human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients, 20 HIV-negative sexually transmitted disease (STD) patients and 25 voluntary healthy controls. Twenty-two clinical AIDS patients, 8 immunological AIDS patients, 2 HIV seropositive and 8 non-HIV STD controls had serum iron <60 mg/dl (Hb: <10 gm). Two clinical AIDS patients and two non-HIV STD controls showed serum iron level >161 µg/dl (Hb: 12-14 gm). Anemia was prevalent in AIDS cases, and the study of survival period may be unfolded in follow-up. Bone marrow biopsy could not be performed to identify the suppression of hemopoiesis in 4 patients, who showed >161 mg/dl of serum iron. Study of iron supplementation and long-term follow-up are necessary to unfold the risks and benefits of iron supplementation in HIV/AIDS patients.

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Cryptococcus neoformans infection is one of the acquired immunodeficiency syndrome (AIDS)-defining conditions. It can be readily identified by its characteristic capsulated morphology by negative staining. We report a case of chronic meningitis produced by pseudohyphal forms of Cryptococcus neoformans in an AIDS patient who responded to amphotericin B.

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A case of human immunodeficiency virus-positive patient having tuberculosis and oral thrush with diarrhea was investigated for gastrointestinal pathogens. The stool specimen of the patient, whose CD ₄ count was 162/cuµl, revealed as many as four microbes including fertilized eggs of Ascaris lumbricoides , larvae of Strongyloides stercoralis , cysts of Cryptosporidium parvum and Salmonella typhimurium . A comprehensive stool examination for different pathogens in acquired immunodeficiency syndrome patients with diarrhea is recommended.

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