The review traces the unfolding of HIV epidemic in North India. The first few cases were reported in 1989 in Indians returning from African countries like Uganda, Zambia and a trickle from USA. Subsequently the cases started pouring from coastal areas of Mumbai, Chennai and finally the virus spread all over through rail and road. In the North eastern region or the golden triangle, IV drug users formed a major group. Using a simple peptide ELISA, it was documented that the virus belonged to the NOF strain. This was much before clades were identified using molecular analysis. It appears that the HIV virus followed the drug (mandrax) route between Mumbai and South Africa. An alarming rise was observed among truck drivers fuelling HIV in Punjab villages who indulged in promiscuous behavior in road side making shift brothels near eating kiosks. Special customs in the state also flared the spread. During the early epidemic a very high prevalence was shown in blood transfused individuals (12.5%) which dropped to 2% -3% after aggressive measures taken by the NACO. While HIV positivity rates plateaued in some states by 2004, infection in Punjab continued to rise even after 2005. Kaposi sarcoma is almost unknown in Indian patients while TB and candida formed major co-infections. In one study, subtype V3 -V5 region chimeras of Indian clade C and clade B replicated freely in peripheral blood mononuclear cells (PBMC) and macrophages and showed higher HIV replication. Opt-out screening was started in an emergency setting in a tertiary care hospital. The positivity rate was 20/per thousand. Thus a large number of patients would have been missed if opt-out screening was not resorted to.
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