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Symptomatic cerebrospinal fluid (CSF) viral escape (sCVE) is reported in people with HIV, who are on ritonavir-boosted protease inhibitor (PI/r) containing antiretroviral therapy (ART). Management of sCVE includes performing genotypic HIV-1 resistance testing (GRT) on CSF and plasma HIV and changing ART accordingly. Neither GRT nor newer drugs (Dolutegravir and Darunavir/ritonavir) are routinely available in India. As a result, management of sCVE includes 2 modalities: a) ART intensification by adding drugs that reach therapeutic concentrations in CSF, like Zidovudine, to existing ART or b) Changing to a regimen containing newer boosted PI/r and integrase strand transfer inhibitor (INSTI) as per GRT or expert opinion. In this retrospective study, we report the outcomes of above 2 modalities in treatment of sCVE in Pune, India.Fifty-seven episodes of sCVE in 54 people with HIV taking PI/r-containing ART were identified. Clinical, demographic, laboratory and ART data were recorded. Forty-seven cases had follow-up data available after ART change including measurement of plasma and CSF viral load (VL).Of the 47 cases, 23 received zidovudine intensification (Group A, median VL: plasma- 290, CSF- 5200 copies/mL) and 24 received PI/INSTI intensification (Group B, median VL: plasma- 265, CSF-4750 copies/mL). CSF GRT was performed in 16 participants: 8 had triple class resistance. After ART change, complete resolution of neurologic symptoms occurred in most participants (Group A: 18, Group B: 17). In Group A, follow-up plasma and CSF VL were available for 21 participants, most of whom achieved virologic suppression (VL < 20 copies/mL) in plasma (17) and CSF (15). Four participants were shifted to the PI/INSTI intensification group due to virologic failure (plasma or CSF VL > 200 copies/mL). In Group B, follow-up plasma and CSF VL were available for 23 participants, most of whom also achieved virologic suppression in plasma (21) and CSF (18). Four deaths were noted, 2 of which were in individuals who interrupted ART.This is a unique sCVE cohort that was managed with 1 of 2 approaches based on treatment history and the availability of GRT. At least 75% of participants responded to either approach with virologic suppression and improvement in symptoms.

Background: India is a major contributor to the global burden of leprosy and tuberculosis (TB), which adversely affects the poorest tribal communities. Despite prioritisation by disease control programmes, programme performance for leprosy and TB in tribal communities continues to be a challenge. In addition to access to services and infrastructural limitations, socio-cultural concepts of illness causation and related help seeking (HS) rooted in distinct features of tribal culture need to be addressed to improve programme outcomes. Methods: A cultural epidemiological survey of leprosy and TB patients was carried out using a locally adapted, semi-structured explanatory model interviews. A total of 100 leprosy and 50 TB patients registered for treatment at government health facilities were selected randomly from tribal dominant blocks of the Thane district, Maharashtra state. The perceived causes (PCs) of leprosy and TB in patients were compared based on prominence categories. The relationship between PCs as predictors, and disease conditions and HS preferences as outcome variables were assessed using multivariate logistic regression. Results: In the multivariate logistic regression model with disease conditions as outcome variables, TB patients were significantly more likely to report PCs in the categories of ingestion; health, illness and injury; and traditional, cultural and supernatural. Tuberculosis patients more frequently first sought help from private facilities as compared to leprosy patients who preferred government health facilities. In a combined analysis of leprosy and TB patients employing multivariate logistic regression, it was found that patients who reported PCs in the environmental and contact-related categories were more likely to visit traditional rather than non-traditional practitioners. In another multivariate combined model, it was found that patients who reported PCs in the traditional, cultural and supernatural category were significantly more likely to visit private rather than public health facilities. Conclusion: Cultural concepts about illness causation and associated HS behaviours should be considered as priorities for action, which in turn would provide the necessary impetus to ensure that tribal patients seek help in a timely and appropriate manner, and could facilitate improvement in programme performance in general. [ABSTRACT FROM AUTHOR]

To assess the population-level impact of “Avahan,” the India AIDS Initiative of the Bill & Melinda Gates Foundation, between 2003 and 2008 in Karnataka state, India.Secondary data analysis using all consistent data collection sites from antenatal clinic (ANC) sentinel surveillance data from 2003 to 2008 in Karnataka.A multilevel logistic regression model considering individual- and district-level variables was developed to compare time trends in HIV prevalence among young ANC women (younger than 25 years of age) between Avahan (18) and non-Avahan (9) districts. District-level random effects were considered for the intercept and time. The impact was assessed using interaction terms between district type (Avahan vs. non-Avahan) and time. The number of cases averted was estimated, comparing predicted ANC HIV prevalence in the presence versus the absence of Avahan. Data from the National Family Health Survey Round 3 (2006) were used to extrapolate these numbers to the general population.HIV prevalence among young ANC women declined from 1.46% (2003) to 0.83% (2008). The HIV prevalence trend was significantly different between Avahan and non-Avahan districts (P = 0.046). Overall, 87,035 cases of HIV infection were estimated to have been averted in the Karnataka general population because of Avahan during the 2003-2008 period (range under varying assumptions: 55,160-150,784).Our results suggest that Avahan has had a significant impact on the HIV epidemic in the general population of Karnataka. These results suggest that targeted interventions similar to Avahan should be implemented and scaled up in all concentrated and mixed HIV epidemics. [ABSTRACT FROM AUTHOR]