Re: Trends in HIV-1 in young adults in south India. The Lancet article

[Guest guest]

[Moderators note: The Lancet 2006; 368:113 is carrying a series of

correspondence on the article " Kumar R, Jha P, Arora P, et alfor

the International Studies of HIV/AIDS (ISHA) Investigators. Trends

in HIV-1 in young adults in south India from 2000 to 2004: a

prevalence study. Lancet 2006; 367: 1164-1172 " . The following

correspondence is an example of the responses. I am sorry, I can't

access all the correspondences. If any of you have access to pdf

version of those correspondences, and willing to share a copy it

will be apprecired.

In the original study the most southern state of India Kerala is

excluded and western Indian state of Maharashtra is added as

Southern State. However, the most hilarious research interpretation

I have ever read is the authors argument that `south' is defined by

epidemiological (historic prevalence of more than 1•5% and

heterosexual transmission) criteria….Only an epidemiologist could

come out with comparing apple and orange and justify it on

epidemiological criteria.!]

_________________________

HIV-1 prevalence in young adults in south India

The Lancet 2006; 368:113. DOI:10.1016/S0140-6736(06)68991-5

Soman (a) and Aju Mathew (

The article by Rajesh Kumar and colleagues (April 8, p 1164)1 begins

with misrepresentations. Although the title speaks of trends in HIV-

1 in young adults of south India, the southern state of Kerala was

omitted from the analysis. Paradoxically, Maharashtra, always

represented as a western Indian state, was included. We do not

understand the logic behind redefining the regional geography of

India.

The omission of Kerala is significant because Kerala stands out as a

low-prevalence state. Its inclusion would have slightly reduced the

initial prevalence and attenuated the slope of the decline. The

deliberate inclusion of Maharashtra serves the purpose of increasing

the credibility of the conclusion in the paper. We also note that

the three states in north India—Mizoram, Nagaland, and Manipur—

excluded by the authors are high-prevalence states that do not fit

into the pattern in north India. The title would have done more

justice to the article if " south India " had been replaced

by " selected states of India " .

An examination of the crude prevalence of HIV-1 in antenatal

clinics2 indicates no consistent trend in the south Indian states

(figure). It is quite clear that the steady decline in the

prevalence of HIV-1 among young pregnant women is mainly driven by

prevalence in Tamil Nadu, followed by Maharashtra (see Kumar and

colleagues' reference 1 and webfigure 1). The significant decline of

HIV-1 prevalence in Tamil Nadu seems to counteract the apparent lack

of trend in other south Indian states. If Kerala was included and

Maharashtra excluded (figure), one would conclude that the decline

in HIV-1 prevalence in south India is a Tamil Nadu phenomenon.

[sorry, the image- Figure. Crude HIV-1 prevalence in women attending

antenatal clinics in 2000–04 is removed. Moderator]

The aggregate analysis suggesting that the rate of infection in

south India is declining among young women is likely to generate an

air of optimism leading to complacency. The need of the hour is to

establish more antenatal clinics in every Indian state and generate

reliable state-level estimates of HIV-1 prevalence. Until that time,

broad generalisations based on deliberate selection of states seem

premature.

We declare that we have no conflict of interest.

References

1. Kumar R, Jha P, Arora P, et al for the International Studies of

HIV/AIDS (ISHA) Investigators. Trends in HIV-1 in young adults in

south India from 2000 to 2004: a prevalence study. Lancet 2006; 367:

1164-1172.

2. National AIDS Council Organization (NACO). In: Annual report

2002–2003, 2003–2004. New Delhi: Ministry of Health and Family

Welfare, 2004: 1-95.

Affiliations

a. Health Action by People, Trivandrum 695 011, Kerala, India

b. 29 Kairali Street, Ashoka Road, Kalloor, Cochin, Kerala, India

http://www.thelancet.com/journals/lancet/article/PIIS0140673606689915

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