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ONGOING PROJECT
Nature: Multicentric and longitudinal
Principal Investigator: Dr. A.R Risbud (Scientist F)
Brief Description:
Avahan is the STI/HIV prevention project in India, funded by the Bill & Melinda Gates Foundation. Avahan’s STI strategy aims to reduce the prevalence of common curable STIs that facilitate HIV transmission, and to reinforce general STI and HIV prevention efforts. In coordination with peer-based outreach and community-led approaches, clinics supported by Avahan state lead partner (SLPs) provide an essential service package (ESP) for female sex workers (FSW) and men having sex with men (MSM) designed to detect and treat curable STIs and to reinforce condom use. The main clinical components of this essential service package (ESP) are syndromic case management, provision of regular check-ups and presumptive treatment for asymptomatic infections. The Clinic Operational Guidelines and Standards (COGS) COGS recommend that FSW and MSM with STI symptoms should be managed based on syndromic case management using the National AIDS Control Organization (NACO) guidelines. Presumptive treatment of asymptomatic infections at first visit and repeated if FSW and MSM has not come for STI screening for 6 months is intended to treat infections that are missed by other methods and is based on assumptions of high STI prevalence and frequent re-exposure. These protocols have been developed based on the limited data in India and experiences from other countries.
Objectives:
- To validate the essential service package for FSW and MSM; and
- 2. To monitor the STI prevalence and patterns within the cohort, the community of FSW, MSM and men attending STI clinics. More specifically, the study will:
- Measure the prevalence of symptomatic and asymptomatic STIs and common RTIs among FSW and MSM at the start of the intervention and 6 months later, and correlate with demographics, behavioral characteristics, clinical manifestations, and symptoms.
- Measure incidence of symptomatic and asymptomatic curable STIs in the cohort of FSW and MSM, and correlate with demographics, behavioral characteristics, clinical manifestations, and symptoms.
- Determine the patterns and etiologies of urethral discharge and genital ulcers among men consulting the STI clinics.
- Measure gonococcal susceptibility patterns in selected sites.
Current status:
Study population enrolment and follow up has been completed; demographics, behavioral characteristics, clinical manifestations and symptoms of study population were recorded. Baseline results were analysed. Determination of STI etiologies by using molecular diagnostic methods are being conducted presently.
2. Title:- Enteric pathogens in HIV infected individuals with diarrhea in Pune, India
Principal Investigator: Mrs. Sangeeta Kulkarni, Technical officer
Nature: Basic Science
Collaborators: Family Health International
Nature: Basic Science
Funding Agency: Intramural funding, NARI
Budget for the study: Rs.5,50000/-
Total Duration: Two years
Study Initiation: 2009
Brief summary:
HIV infected individuals are prone to develop a panorama of diseases during their lifetime. Among them diarrhea is a significant cause of morbidity and mortality observed. It occurs sometime during the illness in up to 60% of patients in industrialized nations and in up to 90% of patients in developing countries. Multiple infections including bacteria, viruses, fungi and parasites have been implicated as a cause of diarrheal illness in patients infected with HIV.
Studies in India have indicated that diarrhea is the third common clinical presentation in AIDS patients. Isospora belli and Cryptosporidium parvum are the two main causes of chronic diarrheal diseases in HIV infected individuals have been reported from north, south and east India. There are several other pathogenic organisms like Blastocystis hominis, Strongyloides stercoralis, Entamoeba histolytica, Giardia lamblia, enteropathogenic Escherichia coli, Enterocytozoon bineusi and campylobacter jejuni which can cause diarrhea in Indian patients with HIV but their prevalence is unknown. The etiology of diarrheal disease appears to vary in different geographic regions and there are many reports regarding varying frequency of enteric pathogens causing diarrhea from different parts of India. Hence there is a need to determine disease prevalence in a specific population so that it can provide guidelines for empirical treatment and necessary data for planning and evaluation of HIV/AIDS care. Very limited studies of this nature have been done in India. Hence, this investigation is designed to determine the prevalence of enteric pathogens (Bacterial, Parasites, Fungal and Viral) and their association with diarrhea & without diarrhea in HIV infected patients.
Current status:
This project is being done in collaboration with the Naidu Hospital, Pune. 340 participants have been enrolled in the project till date.
Principal Investigator: Dr. Arati Mane, Scientist B
Nature: Basic Science
Collaborators: Family Health International
Nature: Basic Science
Funding Agency: Intramural funding, NARI
Budget for the study: Rs.5,50000/-
Total Duration: Two years
Study Initiation: 2010
Brief summary:
Among the various opportunistic infections, respiratory diseases account for 70% of the AIDS defining illnesses and 90% of these are infectious in nature. Hence the knowledge of spectrum of pathogens in pulmonary infections is essential. There is still controversy surrounding the issue of managing immunosuppressed patients with pulmonary diseases. Sputum testing is the least invasive and the most commonly used method for detection of pulmonary pathogens. The fact that most of the HIV infected patients do not expectorate spontaneously makes use of this specimen difficult and also increases the chances of salivary contamination and missing out detection of certain microbes. It is also known that invasive procedures are not risk free in immunocompromised individuals because of their physical fragility and abnormal immune status and are more likely to present with adverse effects from diagnostic procedures than the immunocompetent. Currently studies in India mostly use sputum samples for diagnosis of pulmonary infections with the likelihood of missing out diagnosis of many pulmonary pathogens, thus proper sample has to be considered to determine the exact disease burden in a specific population which can provide guidelines for empirical treatment and necessary data for planning and evaluation of HIV/AIDS care. The role of non invasive technique like induced sputum as a diagnostic tool merits investigation.
Hence, this investigation is designed to determine the spectrum of pulmonary pathogens using induced sputum against the bronchoalveolar lavage fluid (BAL).
Current status:
This project is being done in collaboration with the Department of Chest and TB, Sassoon General Hospital, Pune. The project has been initiated and seven participants have been enrolled till date.
4. Title: Quinolone resistance mutations in Neisseria gonorrhoeae
Principal Investigator: Dr. AR Risbud, Scientist F
Ph D student: Mrs. Sangeeta Kulkarni, Technical officer
Nature: Basic Science
Funding Agency: Intramural funding, NARI
Total Duration: Two years
Study Initiation: 2009
Brief summary:
Gonorrhea remains one of the most common sexually transmitted diseases worldwide. Gonorrhea increases the risk of HIV infection and early treatment of gonorrhea is critically important. Gonococcal resistance to antimicrobial agents is an increasing problem in the treatment of gonorrhea. Antimicrobial resistance of Neisseria gonorrhoeae to penicillin and tetracycline is well known and has been increasing over the years. The emergence of resistant strains has led to the increased use of broad-spectrum cephalosporins and fluoroquinolones for the treatment of uncomplicated gonorrhea. However, during the past decade, quinolone –resistant Neisseria gonorrhoeae (QRNG) has been isolated in Asia, Europe, Australia, and North America, threatening the usefulness of quinolone antimicrobials for the treatment of gonorrhea. The treatment of gonorrhea has now become more complicated due to resistance to a variety of antimicrobial agents.
In India, penicillin, tetracycline and fluoroquinolone resistance has been reported. Fluoroquinolone resistance in Neisseria gonorrhoeae has been attributed to point mutations in the bacterial genes gyr A and ParC, which code for the target enzymes DNA gyrase and topoisomerase IV, respectively. Previous studies have suggested that gyr A mutations are required for quinolone resistance, which is evident by increased MICs and was clinically expressed as treatment failure. In India only one study has been carried out in Delhi reporting that double and triple mutations in gyr A alone or together in gyr A and par C could be responsible for such a high resistance of ciprofloxacin in Delhi. The objective of this work is to identify and characterize mutations in the gyr A and par C genes & comparing these mutations with the level of MICs of fluoroquinolone (Ciprofloxacin, Gatifloxacin, Ofloxacin, Enoxacin, Gatifloxacin and Lomefloxacin) resistance Neisseria gonorrhoeae strains in India
Current status:
Fifty four Neisseria gonorrhoeae clinical isolates were collected from patients attending sexually transmitted disease clinics [34-Delhi, 13-Pune, 5-Mumbai and 2-Nagpur] during 2006-2009. The minimum inhibitory concentration {MIC} of quinolones for these isolates was determined by agar dilution and E-test method. Mutation patterns of the gyr A and par C were analysed
Guid: Dr. AR Risbud, Scientist ‘F’
Co-Guid: Dr. SP Tripathy, Scientist ‘F’
Ph D student: Mr. Mycal Pereira
Category: Basic Science
Funding Agency: Intramural funding, NARI
Total Duration: Three years
Study Initiation: January 2010
Brief summary:
Tuberculosis (TB) is still a major public-health concern worldwide and main cause of death by a single infectious agent, namely Mycobacterium tuberculosis. Some recent developments, such as emergence of multidrug resistant (MDR) TB, resistance to at least rifampicin and isoniazid of first-line anti-TB drugs resulting from inadequate therapies and indiscriminate use of antibiotics and HIV/ AIDS pandemic has worsened the TB scenario. Treatment of MDR TB requires the use of more costly and more toxic second-line drugs and is associated with higher mortality rates than drug-sensitive TB, particularly in immunocompromised patients. A delay in the diagnosis of MDR TB associated with standard drug susceptibility testing (DST) methods is likely to contribute to the transmission of resistant isolates. Therefore, there is a great need for use of rapid methods for identification and drug susceptibility testing of M. tuberculosis isolates and hence the need to evaluate these methods for their sensitivity and accuracy in Indian settings prior to implementation.
Rapid detection and monitoring of anti-TB drug resistance pattern in TB patients in general and HIV Seropositive tuberculosis patients in particular, would provide important data, which may be crucial for the National Tuberculosis Control Programme. Multidrug resistant tuberculosis (MDR-TB) poses a formidable challenge to TB control due to its complex diagnostic and treatment challenges. Conventional methods for mycobacteriological culture and drug susceptibility testing (DST) are slow and cumbersome, requiring sequential procedures for isolation of mycobacteria from clinical specimens, identification and testing of susceptibility to anti-TB drugs. The objective of this work is to evaluate the sensitivity and accuracy of rapid anti-TB drug resistance detection methods; Microscopic Observation of Drug Susceptibility (MODS) and BACTEC MGIT 960 and detection of mutations associated with anti-TB drug resistance in Mycobacterium tuberculosis in Pune, India.
Current status:
The project has been initiated and a total of twenty five sputum samples have been processed under this study and the study is ongoing.
6. Title: Spectrum of diarrheal etiologies in HIV infected patients: a multicentre study
Principal Investigator: Dr. AR Risbud, Scientist ‘F’
Nature: Multicentric
Other sites: National AIDS Research Institute, Christian Medical College, Vellore, PGIMER, Chandigarh, School of Tropical Medicine, Kolkata
Funding Agency: ICMR
Total Duration: Two years
Study Initiation: Not yet initiated
Brief summary:
Diarrhea is one of the most common symptoms in HIV infected patients. 90% of AIDS patients in developing countries suffer from diarrhea and is a significant cause of morbidity and mortality. The etiological spectrum of pathogens causing diarrhea is broad. Regional variability of pathogens as well as changing trends in etiological agents causing diarrhea are reported. Studies on correlation of type of diarrheas with CD4 counts as well as impact of CD4 levels on isolation of pathogens are rare. The present study has the following objectives:
Objectives:
- To evaluate the etiological spectrum of diarrheas in HIV infected individuals in India
- To compare etiologies patterns in different geographic regions
- To correlate the spectrum of pathogens and type of diarrheas with CD4 count