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AIDS visits with its deadly new companion

BYLINE: By Kalpana Jain - The Times of India News Service

NEW DELHI: With doctors and researchers yet to come to grips with TB-HIV co-infections, another deadly synthesis of the AIDS virus has begun to emerge: HIV is combining with kala-azar - a potentially fatal disease affecting the immune system - to pose a major challenge in certain parts of India and the world.

First detected in southern Europe, the deadly combination is now appearing in kala-azar endemic areas in the country. A large number of such cases have already been seen in Bihar, one of the worst-affected areas.

This is causing serious concern as rapid urbanisation and widespread economic migration are seen to be leading to an increase in the incidence of kala-azar. Kala-azar cases are now reported from Bihar, Gujarat, Uttar Pradesh, Madhya Pradesh, Himachal Pradesh and also Jammu and Kashmir.

A person with kala-azar develops high fever with headache. If not treated in time, the disease results in death. ``We need to watch it carefully and intensify efforts against both HIV and kala-azar,'' says national research professor, Dr V Ramalingaswami. Union minister for water resources, C P Thakur, who worked as a physician in Bihar, said at a recent meeting that "of late a large number of people infected with HIV were seen with kala-azar, making the treatment difficult."

Kala-azar, which spreads through the bite of the sandfly, was almost eradicated with intense insecticide spraying during the 1950s. However, during a resurgence in the '70s, it was responsible for a large number of deaths. The Indian Council of Medical Research says 2 to 2.5 lakh people contracted kala-azar from 1977 to 1994, the last year for which reliable data exists. The recent increase is also due to an overlapping of HIV-kala-azar cases.

Explaining the co-infection, Dr Ramalingaswami says kala-azar affects the immune system. In such patients, therefore, any exposure to HIV would be deadly: the AIDS virus, would take immediate hold.

The reverse would also be true: HIV patients would acquire kala-azar easily. In fact, in endemic areas, kala-azar infections are known to get re-activated with HIV. "We expected the rise in these co-infections," says Ramalingaswami. "But we were surprised when we did not see it for quite sometime. Of late the trend is being observed, not just in India, but in other parts of the world as well."

The ICMR feels that the kala-azar-HIV co-infection can be considered an ``emerging disease''. Already in parts of southern Europe, 25 to 70 per cent of adult kala-azar cases are related to HIV infection and 1.5 to 9.5 per cent of AIDS cases suffer from newly acquired or reactivated kala-azar.

  • * Kala-azar patients more likely to develop AIDS than other HIV-infected persons
  • * HIV-infected persons more likely to contract kala-Azar
  • * Treatment for co-infection very difficult

The important point is that kala azar is preventable by use of vector control. "An ounce of prevention is worth a pound of cure." is very applicable in the case of kala azar, which is a deadly disease that is preventable by regularly conducted vector control. DDT works for this purpose.

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