Background: The human immunodeficiency virus was first detected in young intravenous drug users in Manipur in 1989 and it quickly reached a high prevalence in this group. Diagnostic facilities are scarce and it is thus important to suspect the presence of the infection by its clinical features.
Methods: We did a cross-sectional survey for 13 months among residents of different detoxification centres of Imphal, Manipur, to study the sensitivity, specificity and positive predictive values of different signs and symptoms occurring at the early phase of the infection.
Results: Most of the young injectors in this survey were found to be in the early phases (stage I 43%; stage II 32%; stage III 15% and stage IV 9.9%) of the World Health Organization clinical staging of human immunodeficiency virus infection and disease. Herpes zoster, oral candidiasis, pruritic papular eruptions, jaundice and lymphadenopathy had positive predictive values of 100%, 100%, 93%, 93% and 88% respectively. Cryptosporidial diarrhoea and tuberculosis (pulmonary and extrapulmonary) were also encountered.
Conclusion: Intravenous drug users in Manipur who have human immunodeficiency virus infection suffer from different opportunistic infections which give rise to clinical features that are easily recognizable. It is important to be aware of these in areas which lack diagnostic facilities for confirming the infection.
PIP: A cross-sectional study conducted among intravenous drug users in India's Manipur State suggests that certain clinical signs and symptoms can be used to detect human immunodeficiency virus (HIV) in areas with scarce diagnostic resources. From May 1992 to April 1993, 154 intravenous drug users recruited from drug detoxification centers in the capital city of Imphal were monitored for clinical manifestations of disease. 131 subjects were HIV-positive, but examining clinicians were not given data on HIV status. All subjects had started injecting within the last seven years, so the majority were in the early phases of HIV. The distribution, by clinical stage, was as follows: I, 43%, II, 32%, III, 15%, and IV, 9.9%). Clinical features most frequently encountered included herpes zoster (27 men), oral thrush (7), pruritic papular eruptions (15), lymphadenopathy (33), and jaundice (14). The positive predictive values of these signs were 100%, 100%, 93%, 88%, and 93%, respectively. Similar studies in other areas are urged to provide information on the sensitivity and specificity of major signs for defining clinical cases of HIV infection.