ICMR BULLETIN VOL. 26-No.-12-DECEMBER-1996.pdf

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ISSN 0377-4910

December, 1996
POINT IN HIV/AIDS RESEARCH : VISION OF HOPE
Perhaps for the first time since the start of the HIV
pandemic the results of biomedical research in HIV/
AIDS are providing rays of cautious hope through the
dark clouds of despair and helplessness. The new knowl­
edge are the windows of opportunity for developing
effective therapy and prevention strategies.

In any disease control programme, more so for HIV/
AIDS, an element of hope is essential. Without hope
people with HIV will have no jreason to face up to the
dramatically changed circumstances of their lives. They
would have no cause to believe that elegant advances
made in biomedical science can contribute to building
a world in which AIDS would no longer be a threat to
the health and survival of millions. It is only within the
climate of hope—not one of fear and anxiety, that the
threat of HIV/AIDS epidemic can be confronted and
overcome.

Unfolding of the Epidemic
By the end of 1995, a total of 1.3 million cumulative
AIDS cases had been reported from 193 countries to the
WHO. After allowing for under diagnosis, delays and
under-reporting, and based on estimated number of HIV
infections, there are 6 million cumulative AIDS cases
world-wide- Currently 20.1 million adults are estimated
to be alive and infected with HIV or have AIDS. There
are at present 3 men infected for every 2 women.

Globally nearly 10,000 new infections occur each day.
Of the total prevalent infections, the majority remain
concentrated in eastern, central and southern Africa. But
the epidemic is evolving with spread of infection from
urban to rural areas as well as to West and South Africa,
India arid South-East Asia and to a lesser extent (with
proportional shifts to heterosexual infections) in North
America, western Europe and Latin America. WHO
currently projects that there will be 26 million persons
infected with HIV by the year , 2000, representing a
cumulative total of over 40 million infections; more than
90 per cent will be in developing countries. The pro­
jected cumulative total of AIDS cases will be close to
10 million’.
The economic and demographic consequences of the
spread of HIV/AIDS are inexorable and awesome. The
challenge is to act speedily and effectively to limit the
further spread of the epidemic and to minimize its impact
by harnessing the results of rapid progress in biomedical
research on HIV/AIDS that has taken place over the last
15 years.

Turning Point in HIV/AIDS Research

Though there are many areas of biomedical research
which hold promise/hope for the future, there are some
which have immediate relevance and application. Discussed here are four such areas. Taken together, they

Division of Publication & I nf o r ma t i o n, I C M R, N ew Delhi - 110 029
This issue commemorates the World AIDS Day (December 1, 1996)

could be described as the turning point of HIV/AIDS
research. They have generated hope in our struggle
against HIV. These are (i) a clearer understanding of
biology of HIV and host response, (ii) availability of
several new and promising drugs, (iii) strategies to reduce
perinatal transmission of HIV, and (iv) successful in­
terventions for behavioural change.

Estimated Global Burden (in million) of HIV/ .

North America
Latin America & Caribbean
Western Europe
North Africa, Middle East
Sub-Saharan Africa
Eastern Europe & Central Asia
East Asia & Pacific
South and South-East Asia
Australasia

0.79
1.47
0.47
0.21
12.90
0.03
0.03
4.77
0.01

Total

*
20.08

* including persons living with AIDS
Source : Mertens & Low-Beer, 1996

It is now known’that the composite lifespan of plasma
virus and virus-producing cells is remarkably short
(tl/2 = 2.0 ± 0.9 days). This holds true for patients with
CD4+ lymphocyte counts ranging from 18 to 355 cells/
mm2. Extrapolating from changes in blood it could be
shown that between 108 and 109 virions are being
cleared every day, equivalent to about 30 per cent of the
total. As the levels of blood-borne viraemia show only
gradual changes over many months, the daily rates of
virus destruction and production have been taken to be
roughly equal, that is HIV production must be around
108-109 per day2. That the mean half-life of virus
producing cells is around 2 days, indicates that turnover
of the actively infected cells is both rapid and continu­
ous. It could also be inferred that nearly all of plasma
virus must come from recently infected cells.
Several of the more potent combinations of anti­
retroviral drugs are capable of inducing such a dramatic?
fall in viral replication that the virus may no longer be
detectable in plasma with the currently available tech­
niques. Though studies of the relationship between
changes in viral RNA in plasma and changes in levels
in fixed lymphoid tissue are fragmentary, those that have
been completed suggest that viral RNA levels in plasma

Biology of HIV and Host Response

Situation of HIV/AIDS in India

Dynamics of HIV replication

The replication of HIV in the human body controls
the natural history and pathogenesis of HIV infection.
It multiplies mainly in the lymph nodes, spleen, gutassociated lymphoid cells, and macrophages. Despite the
obvious importance of clearer understanding of viral
replication relatively little quantitative information was
available regarding the kinetics of virus-production and
clearance. This quantification has now become possible
because of availability of retroviral agents with suffi­
cient potency to abrogate HIV-1 replication and sen­
sitive polymerase chain reaction (PCR) based methods
to quantify the virus. These assays are able to pick up
HIV RNA throughout the course of the disease of all
patients, regardless of the clinical stage.
By using drug inhibitors of HIV-1 (protease and/or
reverse transcriptase inhibitors) that block de novo
infection of cells, the rate of elimination of plasma virus
has been determined. From serial measurements of the
subsequent changes in plasma viraemia (and CD4 lym­
phocyte counts) it has also been possible to infer kinetic
information about pre-treatment steady state.

122

AIDS cases in India
Total no of AIDS cases

Male

Female

2284
(76.2)

712
(23.8)

Probable source of infection in India
Hetrosexual promiscuous
2205(73.6)
Blood transfusion
209(7.0)
Blood product infusion
23(0.8)
Homosexual contact
23(0.8)
Spouse of AIDS patients/
37(1.2)
seropositives
Intravenous drug addicts
239(8.0)
Others
260(8.6)

Total

|

2996

Figures in parentheses are the percentages
Source : NACO, Period of report upto 31st October, 1996
is an indirect reflection of the number of productively
infected cells in the body as a whole, and that most viral
replication occurs in extra-vascular fixed lymphoid tis­
sues. It is this viral replication in lymphoid tissues rather

than circulating virus per se that is mechanistically
linked to the progressive immunologic depletion that
characterizes the illness3,4.
Surveillance Data for HIV Infection in India
Details of seropositive individuals

Group

Seropositive

Hetrosexually promiscuous
Homosexuals
Blood donors
Dialysis patients
Antenatal mothers
Recipients of blood/blood
products
Suspected ARC/AIDS cases
Intravenous drug users
Others

.18350(38.2)
181(0.4)
3939(8.2)
241(0.5)
435(0.9)
822(1.7)
8409(17.5)
2375(4.9)
13281(27.7)

As an estimated 108 to 109 virions are produced
daily, it is very likely that HIV-1 replication continues
in lymphoid tissues though at a significantly lower rate.
Even at these lower replication rates it would be expected
that viral variants with reduced susceptibility to anti­
retroviral drugs will evolve over time. An asymptomatic
individual can harbour at least 106 mutants of HIV, and
for an AIDS patient the figure is more than JO8, among
which one may find drug-resistant mutations. Thus, even
in the absence of any selective pressure, a sub population
of viral variants that is resistant to anti-retroviral drugs
evolves. The prevalence of such mutants in the popu­
lation of virus prior to the initiation of anti-retroviral
therapy is dependent on the number of prior rounds of
viral replication, the mutation rate, and the selective
advantage possessed "by wild-type virus over variants
that have incorporated mutations confering drug resis­
tance. Recent studies have shown that there is almost
complete replacement of wild-type virus by drug-resis­
tant variants in plasma within 14-28 days2.

Seropositivity rate 16.5 per thousand

Turnover of CD4 cells
Figures in parentheses are the percentages
Source : NACO, Period of report upto 31st October, 1996
The rate of virus replication stabilizes after primary
infection at a particular level or ‘set point’ in each
individual. This level appears to be 102 to 106 HIV
RNA copies/ml of plasma and remains relatively stable
in asymptomatic patients over months and possibly years.
The ‘set-point' is strongly associated with rate of disease
progression and time to death, with a continuum of
increased risk with increased plasma HIV RNA levels5.
These results coupled with the demonstration that
"e level of plasma viraemia at 6 months to one year
following primary infection is an accurate predictor of
the rate of disease progression leave little doubt of the
importance of virus replication to the pathogenesis of
HIV diseases.

Measurements of viral burden may now form the
basis for decisions concerning initiation and modifica­
tion of anti-retroviral therapeutic regimens, and this will
be of practical consequence. HIV RNA levels appear to
be more predictive of progression than CD4+ counts
particularly in asymptomatic individuals with cell counts
higher than 0.35 x 109/l. In addition to the usefulness
in assessing prognosis and guiding the initiation of
therapy, HFV RNA levels are of potential value in
assessing response to therapy.

The concomitant recovery of CD4 cells following
drug treatment has also been studied. If it is assumed
that dynamics of blood lymphocytes reflect events

Projection and Estimation (in million) fo^ 2000

Cumulative number of HIV infected
Persons infected with HIV
Cumulative number of AIDS
cases
*
(adults)
Children <5 years infected through
mother
HIV related death (adults)
Children <10 years orphaned as a
result of AIDS related death

40
26
>10
5
>8
5-10

New cases/year

Africa
Asia

Prevalent HIV infections in India
AIDS cases in India

0.7
0.5

5
>1

Source: Mertens & Low-Beer, 1996; Quinn, 1996

throughout the body, and that the blood lymphocyte pool
is about 2 per cent of the total population, the overall
mean CD4+ lymphocyte turnover is about 2xl09 cells/
123

day. The number of CD4 lymphocyte destroyed and
replenished each day is of the order of 109 , which is
strikingly close to estimates of total number of HIV-1
RNA expressing lymphocytes in the body as determined
by using in situ PCR and hybridization methods6.

levels may also provide a reliable correlate of protection
in monkeys treated with experimental vaccines. The
identification of HIV-suppressive chemokines may open
new perspectives for the development of effective thera­
peutic approaches to AIDS.

This rapid and on-going recruitment of CD4+ cells
into a short-lived virus expressing pool probably ex­
plains the abrupt increase in CD4+ lymphocyte numbers
that is observed immediately following initiation ofpotent
anti-retroviral therapy.

HIV co-factor: It is known that HIV enters cells by
docking onto a receptor protein known as CD4. By itself
CD4 is not sufficient for HIV infectivity, some unknown
‘co-factor’ found only in human ceils is also required.
Researchers have reported the discovery of a membrane
protein called ‘fusin’ which together with CD4 permits
cells to fuse with HIV’s surface—a key step in the
infection process8.

The CD4 lymphocyte depletion in advanced
HIV-1 infection has been likened to a sink containing
a low water level, with the tap and drain both open
equally wide. As the regenerative capacity of the immune
system is not infinite, it is not difficult to see why the
sink eventually empties. It is tflso evident that the
primary strategy to reverse immuno-deficiency should
be to target virally mediated destruction, rather than to
emphasize lymphocyte reconstitution6.

Other developments
Two other significant breakthroughs, though they
do not qualify to have immediate application, deserve
mention. These are the identification of HIV suppressive
factors and co-factors.
HIV suppressive factors: The CD8+ lymphocytes
are believed to be involved in the control of HIV-1
infection in vivo, by cytotoxic mechanisms and/or by
release of HIV suppressive factors. The levels of pro­
duction of these factors correlate with the stage of disease
and show a progressive decline in parallel with the
decline of the immune system. For several years, many
groups tried to identify these elusive CD8+ suppressive
factors.

The chemokines RANTES, MIP-la and MIP-ip
have now been identified as the major suppressive fac­
tors produced by CD8+ T cells7. A combination of
monoclonals antibodies to these chemokines could block
the activity of CD8+ suppressive factors. It has been
shown that these 3 chemokines are the major HIVsuppressive factors secreted by .CD8+ cells.

Clinical studies on the production ofRANTES, MIPla and MIP-lp in vivo will be .critical to define their
role in the natural history of HIV infection, especially
whether high levels of these chemokines are associated
with delayed progression of HIV disease. Chemokines
124

Interpreted in the light of the earlier findings,
chemokines could be suppressing HIV infection by
blocking the fusin receptor directly or by sending signals
that make cells produce fewer receptors. If-so, then
together the two sets of findings might help to explain
why a small percentage of people have been able to resist
HIV’s ability to destroy the immune system even after
being infected with HIV for a decade. They may have
higher levels of these chemokines, fewer fusin like
receptors or both8.
This discovery could help clear up several puzzles
about HIV, including how it destroys cells and why it
appears not to harm some infected people. The work
could also lead to an animal model; by stitching the fusin
gene into a small animal such as rabbit, it would be
possible to develop a relatively inexpensive laboratory
model for testing AIDS vaccine and study exactly how
HIV destroys the immune system. And it also raises
the prospect of new therapies that, by blocking binding
_to fusin would limit HIV's ability to infect cells8.

Thus, clear messages for management of HIV/AIDS
emerge from improved understanding of the biology of
HIV and the host response. Given that the virus is
replicating 24 hours a day and from day-one, anti viral
treatment is called for at all stages of the disease. Any
means to reduce viral spread will ultimately be benefi­
cial. Treatment strategies, if they are to have a dramatic
clinical impact, must therefore be initiated as early as
possible in the course of infection, perhaps even during
sero-conversion.
The demonstration that there is complete replace­
ment of wild-type virus by drug resistant virus in plasma
within 14-28 days is a striking example of the capacity
of the virus to evolve in response to selection pressure.

Against this background, monotherapy cannot succeed.
Only a combination of drugs has the potential to outwit
the virus.

decreased the frequency and severity of opportunistic
infections in advanced cases of infection. However,
AZT failed to show much benefit when given to HIV
infected people who had not yet developed symptoms.
The recovery of the CD44- count, even in symptom­
This
happened, because HIV mutants that were resistant
atic infection, implies that immune reconstitution may
to AZT mushroomed. Other nucleoside analogues such
be possible as long as replication of the virus can be
as didansine (ddl), zalcitabine (ddC), stavudine (d4T)
held in check.
and lamivudine (3TC)
have the same draw­
Novel Therapies for
Shape of HIV/AIDS Epidemic • in Indra
back and this has lim­
HIV/AIDS £
ited their use. It had
Early studies on
* India is experiencing a rapid and extensive spread of HIV.
become evident that
pathogenesis and the
This is particularly worrysome since India has more people
monotherapy with
ability to better quan­
than the continents of Africa, Australia and Latin America
these drugs would not
combined.
tify plasma HIV load
have a long lasting
have established the
* There are estimated 2 jto 5 million people infected with
effect.
dynamic nature of
HIV, and 50,000 to 1,00,000 cases of AIDS may have
HIV infection. Also
already occurred.
Several clini­
established has been
cal
trials
using com­
* The epidemic is fueled by both married and unmarried men
the fact that an aggres­
bination
of two
visiting sex workers.
sive therapy instituted
nucleoside analogues
* The most rapid spread of HIV has occurred in Bombay (read
early in infection is
have shown promis­
Mumbai) and the State of Tamil Nadu. In Bombay HIV
not only desirable but
ing results. The suc­
prevalence has reached 50% in sex workers, 36% in STD
also essential.
cess
of US AIDS
patients and 2.5% in-women attending antenatal clinics.
Clinical
Trial Group
The presentations
* Certain regions, such as eastern India (Calcutta area) and
175 study, Europeanmade at the III
northern India (New Delhi region) still show a lower
Australian
trial-Delta
prevalence
of
HIV
(1-2%)
among
sex
workers.
Conference
on
and
other
studies
have
Retroviruses and Op­
* Contrary to traditional belief, sexually transmitted diseases
shown
that
combina
­
portunistic Infections,
and sex with multiple partners are common in the country,
tion
therapy
had
sus
­
Washington and the
both in urban and rural areas. An estimated 3-4% of some
tained clinical ben­
rural population have a STD,
XI International Con­
efits and plasma HIV
ference on AIDS,
* Injecting drug use is a problem in Manipur, which is in
RNA and CD4+
Vancouver, earlier
the North-East region, where 55% of drug users are HIV
counts
improved. The
this year have sparked
infected.
nucleoside analogue
enthusiasm in devel­
* HIV is rapidly spreading to rural areas through migrant
combinations with the
oping drug regimens
workers and truck drivers. Surveys show that 5-10% of
most demonstrated
for the prevention and
some truck drivers in the country are infected with HIV.
clinical benefits in­
treatment of HIV/
* An estimated 1-2 million cases of TB occur in India every
clude zidovudine/
AIDS.
year. In Bombay 10% of patients presenting with TB are
didanosine
and
HIV + ve. Tuberculosis is the presenting ailment of AIDS
Till recently only
zidovudine/zalcitain over 60% of AIDS cases.
one family of drugs
bine.
(nucleoside.
ana­
Source: AIDS Analysis Asia 2(5): 11, 1996
logues) had shown to
There are lim­
be promising after extensive clinical trials. Zidovudine
ited data on other combinations of nucleoside analogues
(AZT) was the first of such drugs that was developed.
that do not contain zidovudine. Thus, combinations of
It worked by interfering with an enzyme—reverse tran­
nucleoside analogues compared to zidovudine alone have
scriptase (RT), which is essential for HIV replication.
been shown to have clinical benefits in terms of pro­
The drug prevented successful transcription of viral
longed survival and fewer AIDS defining events, when
DNA into viral RNA. AZT increased survival and
given to asymptomatic individuals with relatively early
125

stage disease. These results have demonstrated that an
intervention regimen used in patients with early stage
HIV disease could actually be clinically beneficial9.
At Vancouver, experiences' with non-nucleoside
reverse transcriptase inhibitor used in combination with
nucleoside analogues have rekindled hope. These nonnucleoside drugs are similar to nucleoside analogues in
that they change the function of reverse transcriptase but
unlike the nucleoside drugs they do not have to be
activated by cellular enzymes, but disarm reverse tran­
scriptase by binding directly to it. However, like nucleo­
side analogues, there is quick development of resistance
against them.

These appear to act synergistically with drugs like
AZT, and because they affect RT by a different mecha­
nism, fear of cross-resistance is not much. They have
strong anti-retroviral activity but patients develop resis­
tance within weeks. Nevirapine, loviride, and delavirdine
are some of the non-nucleoside reverse transcriptase
inhibitors which are undergoing additional safety and
efficacy studies.
t

In an international study comparing a combination
of nevirapine, AZT'and ddl with a two drug'regimen
of AZT and ddl, and a third treatment group receiving
nevirapine and AZT, patients in all the 3 treatment arms
experienced a reduction in plasma RNA of 90 per cent
or more within a few days. But those taking triple drug
regimen experienced a 96.8 per cent viral load reduction
that persisted for a year. About 35 per cent of patients
taking nevirapine and AZT achieved undetectable levels
of virus in blood, but the effect gradually waned off.
About 30 per cent taking AZT and ddl sustained un­
detectable viral loads for a full year. However, 80 per
cent in the triple-drug arm reached undetectable levels,
about three-fourth of them maintained the effect. Similar
results have also been obtained in preliminary studies
in paediatric patients10.
Despite the drawback of quick development of
resistance associated with non-nucleosides, their
potency combined with rapid absorption make them ideal
candidates for situations that call for short term therapy.
They have the potential of playing a role as a “morning
after” pill for preventing infection following unprotected
sex. They also qualify for use in post-exposure pro­
phylaxis at the work place.

126

In Washington and later at Vancouver, researchers
presented findings of clinical trials with another class
of drugs that act by blocking the activity of a protease
enzyme needed for AIDS virus replication. In combina­
tion with other anti-HIV drugs, these protease inhibitors
have helped to decrease the viral load substantially
among patients, as compared to those receiving other
anti-HIV drugs.
Interim results of a study using indinavir (protease
inhibitor), alone or in combination with other nucleoside
analogue(s) indicated that after 24 weeks, the viral RNA
had plunged about 200-fold and was undetected in 86
per cent of patients who received indinavir, AZT and
3TC. Forty per cent of the patients receiving indinavir
alone had undetectable virus levels. While the virus was
detected in all who were taking AZT and 3TC.

In a large trial in patients with very advanced HIV f/;
disease the addition of ritonavir to an existing regimen
(including no current therapy) reduced progression to
AIDS, and morbidity by almost 50 per cent11. Even in
a population with severe HIV infection (CD4 counts
between 50 and 250 cells/mm3), it has been possible to
reduce circulating HIV to undetectable levels with a
combination regimen of ritonavir, ddC and AZT. This
reduction could, be maintained for over a year. The
results also suggested that the development of resistance
is certainly minimal when reduction in viral load is
high12. Combination of zidovudine, lamivudine and
indinavir resulted in a greater than 90 per cent reduction
in HIV RNA levels to fewer than 500 HIV RNA copies/
ml at 6 months.13 However, as yet, there are very few
data from long-term (more than 52 weeks) and large
(more than 250 patients) controlled clinical trials of any
protease inhibitors.
4|
The usexjf this new class of drugs in combination
with the first generation nucleosides and non-nucleoside
reverse transcriptase inhibitors hold promise for a level
of control of established HIV disease that has so far
eluded patients. Use of these regimens in primary HIV
infection holds promise for interfering with the estab­
lishment of chronic persistent infection and dramatically
altering the subsequent course of HIV disease.10 Seen
in the light of the findings of other studies which showed
that individuals who had less HIV in their bodies fibred
better than those with higher viral loads, it promises to
reshape the way clinicians manage HIV infected per­
sons14.

Preventing Perinatal HIV Infection
It is estimated that by the beginning of this year over
1.5 million children have been infected with HIV-1
through mother-to-child transmission. By the turn of
the century it is feared that as many as 5 million children
under the age of 5 years will be infected through their
mother1.

As HIV infection among women spreads more widely,
perinatal transmission likewise would continue to in­
crease in areas where heterosexual transmission is most
common. Transmission rates have varied from 13
to 52 per cent.
There are several factors associated with transmis­
sion of HIV from mother-to-child (Table). Of the inter­
ventions available to prevent this transmission the use
of zidovudine has been shown to be most promising15
The other interventions are non-nucleoside RT inhibi­
tors, immunoprophylaxis, vaginal disinfection, alterna­
tives to breast feeding, caesarian section and vitamin A
supplementation.

Table. Selected factors associated with mother-to-child
transmission of HIV-1.
Proved or possible (relationship not fully determined)

•
•
•
•
•
•
•
•
•

Maternal immune deficiency
Chorioamnionitis
Breast feeding
Vaginal delivery
Low maternal serum vitamin A concentration
Instrumentation during labour and/or delivery
(episiotomy, forceps, etc)
Premature rupture of membranes
Prematurity
Prolonged labour

Controversial
• Maternal immune response against HIV
• Viral strain characteristics
The results of AIDS Clinical Trial Group (ACTG)
Protocol 076 are considered as a turning point in
strategies for preventing perinatal HIV transmission. In
1994 it was demonstrated that zidovudine administered
to a group of HIV infected women (with CD4+ cJI count
above 0.2x109/l) during pregnancy and labour and to
their new boms reduced the risk of perinatal HIV trans­
mission by two-thirds (from 24.9% to 7.8%). The

zidovudine regimen consisted of antipartum zidovudine
(100 mg orally five times daily) plus intrapartum
zidovudine (2 mg/kg intravenously for 1 hour followed
by 1 mg/kg/h until delivery) plus zidovudine for new/
bom (2 mg/kg orally every 6 h for 6 weeks) beginning
8-12 h after birth16

The observation that the risk of transmission of
HIV-1 from mother to infant increases when the foetal
membranes rupture more than 4 h before delivery, may
lead to precautions as simple as not intentionally rup­
turing the membranes in the hope of inducing or accel­
erating labour. Though this suggests that every effort
should be made to shorten the time between rupture of
membranes and delivery, thk does not mean using in­
terventions that could increase morbidity for the mother
or child17

A lower incidence of mother-to-infant transmission
has also been attributed to the mode of delivery. In
several retrospective reports, caesarean section has been<
said to lower the risk of transmission. An observational
study of over 1200 mother-child pairs by the European
Collaborative Study showed, after controlling for poten­
tial confounders, that caesarean section halved the rate
of mother-to-child transmission of HIV18. Nevertheless
the risk of morbidity and mortality to both mother and
child with caesarean section precludes the use of this
method as a sole alternative in preventing mother-tochild HIV transmission especially in developing coun­
tries.
Similarly the advantages of breast feeding outweigh
the risk of transmission of HIV. ’ The role of other
potential interventions is still under evaluation. A ran­
domized trial of routine delivery vs caesarean section
is underway in Europe.

The breakthrough provided by the use of zidovudine
has offered the hope of controlling the HIV epidemic
in children. In countries where zidovudine is available
and affordable, these results have drawn attention to the
importance of expanding prenatal HIV testing and of
improving the care of the infected women during preg­
nancy. For countries where the cost of this regimen is
prohibitive, trials of modified timing and doses of
zidovudine are needed to find the most efficient method
of reducing perinatal transmission. The more potent and
shorter acting preparations against retroviruses now
becoming available, such as non-nucleoside reverse tran-

Two major types of HIV in humans have been characterized HIV type 1 and type 2. Presence
of both have been reported from India. HIV-1 isolates can be classified into eight subtypes, based
on env sequences. These subtypes designated A through H, constitute the major group named M.
In addition, a ninth subtype I has been described recently. Divergent strain of HIV-1 outside group
M have been reported and are provisionally categorized as group O. Within O group, isolates-may
differ from each other. HIV-2 has also been phylogenetically classified into subtypes, though the number
of sequenced isolates are limited.

There have been very few investigations of HIV-1 strain variation in India. Available data indicates
that subtype C is most predominant in India. Subtypes A,B and E also co-exist1. Genetic subtyping
studies have .revealed that majority of the C subtype were homologies to C3 genotype while remaining
(34%) were closest to C2 genotype. Greater degree of divergence observed within C2 genotype
as compared to C3 indicates earlier introduction of C2 in India. The C3 genotype may be a recent
mutational variant of subtype C unique to India2.
There appears to be a relationship between the subtypes and mode of transmission. Though HIV
*E and C have been reported to spread predominantly through heterosexual transmission and HIV B
transmission occurs amongst homosexuals and intravenous drug users, recent reports indicate that
this relationship is not very rigid.

Development and evaluation of diagnostic tests for HIV have been based primarily on subtype
B strains of North America & Europe. Sensitivity of these tests in detecting GpM subtypes other
than subtype B is a source of concern.
As with diagnostic tests for HIV-1 most vaccine candidates are based on subtype B. It is known
that vaccine efficacy is subtype specific. Hence evaluation of these candidate vaccines in areas where
other subtypes predominate or where multiple subtypes are circulating, like in India will pose
considerable challenges.
1. Bollinger, R.C., Tripathy, S.P. and Quinn, T.C. The human immunodeficiency virus epidemic in India. Current
magnitude and future projection. Medicine 74: 97, 1996

2. Gadkari. D.A. Moore, D., Sheppard, H., Mehendale, S., Kulkarni, S. and Bollinger, R. Viral subtype analysis
of HIV-1 infected patients from Pune, India. XI International Conference on AIDS, July 9-12, 1996; Vancouver,
Canada. Abstract TuA 374.

available strategies as these are tested for safety and
efficacy in pregnancy.

Successful Interventions for Behavioural Change
Since the start of the HIV epidemic, scientific
knowledge about AIDS and HIV has continuously ex­
panded and evolved. However, one thing has remained
unchanged. The only means to prevent HIV is by
behaviour change. Essentially all new HIV infections
associated with risk behaviour can be prevented if people
can be helped to make changes in sexual and drug use
practices that create risk for contracting HIV. Although
the two behaviours that confer risk—having unprotected
sex with a potentially infected partner and needle sharing
by injecting drug users (IUDs)—are very easy to specify,
128

these are also behaviours which are difficult for many
people to change.
f)

Several success stories in slowing down the spread
of HIV provide encouragement and hope for wider use
of these strategies to create an enabling environment
which will facilitate and support behaviour change.
Development of programmes with an integrated ap­
proach to inducing behavioural change, promoting
condom use and controlling STDs may reduce the in­
fectivity of HIV transmitters and the susceptibility of
HIV-exposed persons. In Kinshasa, Zaire, it has been
shown that intensive STD diagnosis and treatment
coupled with a condom distribution programme for
female sex workers successfully decreased the incidence
and prevalence of STDs including HIV. infection. A

community-based syndromic approach to the treatment
this public health intervention in quickly reducing the
of symptomatic STDs led to a 42 per cent decrease in
very high rates of HIV infection in a general population
HIV incidence compared with control villages in Mwanza,
of heterosexual adolescents and young men within a few
Tanzania. Needle exchange programmes have helped
years after their first sexual activity is unprecedented.
stabilize and in some instances reduce HIV incidence
One reason for the success of the 100 per cent condom
among IDUs in Australia and Europe. Similarly the steep
programme was that it concentrated on a limited goal,
decline in HI V incidence among homosexual men through
the use of condoms in commercial sex. The programme
educational efforts
used sanctions and
aimed at changing
threats of sanctions
Candles of Hope
sexual behaviour has
against sex establish­
been very encouragments where condoms
A
programme
for
care
of
HIV/AIDS
should
offer
a
vision
ing”.
were not used in every
of:
encounter. Violations
In the South-East
- hope th'at they can live normal, healthy lives for several
were detected by ask­
region of Asia, preven­
years after being infected with HIV
ing men who came to
tion strategies, (ap­
government clinics
- hope that they will receive a decent standard of health
proaches and interven­
care, without discrimination.
with STDs other than
tions)
adopted by
HIV where they had
- hope that they will receive the understanding and
countries so far, are
contacted their infec­
support of their families, friends and other members
now showing the im­
tion. The programme
of the community.
pact. The ‘ 100 per cent
worked as.it did not
- hope that they can maintain or recover their sense of
condom
*
use
reduce the income of
self-worth
and
seif
confidence.
programme in Thai­
the brothel owners
- hope that they can make a meaningful, positive con­
land has received
and the commercial
tribution to society as a whole.
world-wide attention.
sex workers21.
Started in 1991, the
strategy of 100 per cent Source: Candles of Hope: The AIDS Programme of the Thai Red
The Sonagachi
Cross Society, Actionaids, British Council, UNDP, 1994
condom use for men
project in Calcutta is
has been promoted,all over the country to ensure condom
another success story, and qualifies to be a model for
utilization in the commercial sex setting. The availabil­
successful peer education programme among sex work­
ity of condoms and well publicized messages on HIV
ers. The project also includes provision of health care,
transmission have resulted in a decrease of 80 per cent
literacy programme and schooling for children of sex
in STD rate in Thailand from 1989 to 1994. .From 1991
workers. An external evaluation ofthe Sonagachi project
to 1995, the men’s reported use of condoms during the
revealed that the level of syphilis in the community is
most recent sexual contacts with sex workers increased
showing a downward trend, from 28 per cent at base­
from 61 to 92.5 per cent. In 1995 15.2 per cent of men
line (1992) to 25 per cent at first follow up (1993) survey
had a history of a sexually transmitted disease as com­
to 13 per cent in second follow up (1994) survey. The
pared with 42.2 per cent in 199120.
condom use by clients has increased from 2 per cent in
1992 to 85 per cent in 1994 (personal communication
The success of the 100 per cent condom campaign
HPO, ODA, New Delhi, 1996).
suggests that environmental interventions may be more
effective public health strategies in preventing HIV
The interventions among injecting drug users includ­
infection in developing countries than strategies that rely
ing needle exchange programme, are being implemented
solely on health education targeted at the behaviour of
successfully in Nepal. In Myanmar, the IDUs- have
the individuals. The campaign in northern Thailand
begun to personalize the risk as a result of IEC
provided condoms to every establishment where sex was
programme. The peer education activities seem to have
sold and encouraged and enforced their use, as well as
contributed to a decline in HIV infection among IDUs
educated people to reduce the sexual behaviour that
from nearly 75 per cent in 1993 to 50 per cent as of
late 199522.
could place them at high risk. The dramatic success of

129

The National AIDS Control Organization (NACO),
India in collaboration with an international donor agency
is supporting five Non-governmental Organisations
(NGOs) in Assam, Manipur and Nagaland in conducting
out-reach interventions with injecting drug users. The
NGOs have also linked up with NACO, WHO and the
Govt of Manipur to develop a model project on homeor community-based care of persons with AIDS23.

A number of NGOs have responded very positively
to the HIV epidemic in India. Many of them have played
a major role in raising awareness and have helped to
remove the veil of secrecy and hypocrisy surrounding
sexual attitudes and behaviour. The experience of some
ofthese organizations demonstrate the potential of NGOs
to respond in a constructive way to the multi-faceted
challenges and problems posec( by the HIV epidemic.
In a recent publication, pioneering work of some of
such organizations has been documented24. They have
shown success in at least three fronts.
• They have shown how to reach and support
sections of the population such as women in
prostitution and injecting drug users..

• They have illustrated how community-based or­
ganizations such as women’s groups can help
economically and socially disadvantaged people
gain greater control over their lives and so protect
their health and well being.
• They have shown that NGOs working in such
diverse fields as legal aid, rural development and
women’s health have a common interest in HIV
epidemic.
Not only have the NGOs broadened the front
against HIV/AIDS, but they have shown how HIV/
AIDS programmes can promote development by en­
abling the poor and disadvantaged to gain some control
of at least some important aspect of their lives.

Conclusions
It has been 15 years since AIDS was first recognized
and given a name. It has taken these many years of
struggle, to discover and learn about the virus and the
disease caused by it, and methods to control it. Recent
studies on the dynamics of HIV-1 replication have en­
hanced our understanding of disease pathogenesis. It is
now clear that even during the period of clinical latency
there is continuous high-level viral replication, CD4
cells infection, cell death, and new CD4 lymphocyte

130

production. The magnitude of viral and CD4 cell turn­
over is phenomenal—on an average 108 - 109 virions and
approximately the same number of CD4 are produced
and destroyed each day. This suggests that sensitive
measurement of viral load may be useful in identifying
those individuals in whom the disease will rapidly
progress, and those in whom the disease will progress
slowly. This has re-defined the aim of the therapy. The
debate over whether to treat early or late in the course
of diseases has become insignificant when viral load
is used as a marker.
There is a reasonably good chance that of all modes
of transmission mother-to-child transmission may soon
become the most amenable to effective preventive inter­
vention. Trials have opened new opportunities and raised
hopes. A group of useful anti-retroviral drugs' are on the
horizon. The good news is that a whole range of new
drugs would become available for use singly or in
combination for those infected with HIV. The downside
of the good news is the cost. They would be ‘breath
takingly’ expensive. There are strategies for behavioural
changes with proven track record, waiting to be adapted
to local needs for control of HIV. These and many other
developments in research ring in an era of hope.

Until now the world has shown solidarity against
HIV/AIDS. The ‘haves’ and ‘have-nots’ have stood
together. Hand in hand, shoulder to shoulder. United by
common fear, despair and hopelessness. It may soon
change for the ‘haves’. HIV may become like any other
chronic disease—more or less manageable, but at a cost.
For the ‘have-nots’ HIV may continue to be killer No. 1.
Take for example the simple concept of using a drug
to prevent HIV transmission from mother to her new
bom. Implementing an effective programme based on
this intervention may require several steps, many of
which may not be feasible in less developed countries.
Institutional procedures need to be established, doctors
and other staff must be trained about HIV counselling
and testing and about utilizing zidovudine therapy for
HIV-infected women and their children. For this inter­
vention to be useful it requires that all pregnant women
have access to antenatal care, and they are offered HIV
counselling and voluntary testing. Further, those found
HIV positive are offered zidovudine and also access to
other important medical, social and psychological ser­
vices needed. To facilitate informed decision making
appropriate educational material may also need to be
prepared and provided.

For countries like India, which have sparse resources
for even the most basic public health measures, major
limitations in care, little or no option for anti-retroviral
treatment, inefficient methods of public education, in­
ability to utilize the results of research may widen the
gap between the ‘haves’ and the ‘have-nots’.

MIP-la, and MIP-lp as the major HIV-suppressive factors
produced by CD8+ T cells. Science 270: 1811, 1995.
8.

Feng,Y., Broder, C.C., Kennedy, P.E. and Berger, E.A.
HTV-1 entry co-factor: Functional cDNA cloning of a seventransmemberane, G protein-coupled receptor. Science 272:
872, 1996.

9.

Carpenter, C.C.J.,Fischi, M.A., Hammer, S.M, Hirsch, M.S.,
Jacobsen, D.M., Katzenstein, D.A. Montaner, J.S.G., Richman,
D.D., Saag, M.S., Schooley, R.T., Thompson, *M. A., Vella,
S., Yeni, P.G. and Volberding, P.A. Antiretroviral therapy for
HIV infection in 1996. Recommendations of an International
Panel. JAMA 276: 146,. 1996.

10.

New HIV drugs cast in supportive roles (Medical News and
Perspective). JAMA 276: 585, 1996.

11.

Cameron, B., Heath-Chiozzi, M., Kravcik, S., Mills, R.,
Potthoff, A., Henry, D. and Leonard, J. Prolongation -of life
and prevention of AIDS in advanced HIV immunodeficiency
with retonavir. In: Programme and Abstracts of the 3rd
Conference on Retroviruses and Opportunistic Infections:
January 28-February 1,1996, Washington DC. Abstract L86a.

12.

Emergence of a New Approach in HIV Disease Management.
Satellite Symposium Abstract Book. XI International Confer­
ence on AIDS, Vancouver. July 7-12, 1996.

13.

Gulick, R., Mellors, J., Havlir, D., Eron, J., Gonzalez, C.,
McMahon, D., Richman, D., Valentine, F., Jones, L., Meibohn,
A., Chlou, R., Deutsch, P., Emini, E. and Chodakewit, Z.
Potent and sustained antiretroviral activity of indinavir (ID V)
in combination with zidovudine (ZDV) and lamivudine (3TC).
In ’. Programme and Abstracts of the 3rd Conference on
Retroviruses and Opportunistic Infections. January 28-February 1, 1996, Washington DC. Abstract LB7.

14.

Cohen, J. Results of new AIDS drugs bring cautious optimism.
Science 271: 755, 1996.

15.

Van de Perre, P. and Meda Niolas. Interventions to reduce
mother to child transmission of HIV, AIDS 9 (Suppl A): S59,
1995.

16.

Connor, E.M., Sperling, R.S.,Gelber, R. Kiselev, P., Scott,
G.» O’sullivan, M.J., Vandyke, R., Bey, M., Sheaver, W.,
Jacobson, R.L., Jimenez, E., O'neill, E., Bazin, B., Delfraissy,
J.F., Culnane, M., Coombs, R., Elkins, M., Moye, J., Stratton,
P. and Balsley, J. Reduction of maternal-infant transmission
of human immuno-deficiency virus type 1 with zidovudine
treatment. N Engl J Med 331: 1173, 1994.

17.

Landesman, S.H., Kalish, L.A., Bums, D.N., Minkoff, H.,
Fox, H.E., Zorrilla, C., Garcia, P., Fowler, M.G., Mofenson,
L. and Tuomala, R. Obstetrical factors and the transmission
of human immuno-deficiency virus type 1 from mother to
child. N Engl J Med 334: 1617, 1996.

18.

Ho, D.D., Neumann, A.U., Perelson, A.S., Chen,W., Leonard,
J.M. and Markowitz, M. Rapid turnover of plasma virions and
CD4 lymphocytes in HIV-1 infection. Nature 373: 123,1995

The European Collaborative Study. Caesarean section and risk
of vertical transmission of HIV-1. Lancet 343: 1464, 1994.

19.

Quinn, T.C. Global burden of the HIV pandemic. Lancet: 348:
99, 1996.’

Cocchi, F., DeVico, A.L., Garzino-Demo, A., Arya, S.K.,
Gallo, R.C. and Lusso, P. Identification of RANTES^

20.

Nelson, K.E., Celentano, D.D., Eiumtrakol, S., Hoover, D.R.,
Beyrer, C., Suprasert, S.5 and Kuntolbutra, S. Changes in

Then, is the hope limited to the 9 per cent (1.29
million) people with HIV/AIDS living in the developed
world?
In their wake, these advances have brought chal­
lenges to the national and international community to
ensure that the gains of research reach the people who
need them most. The people of the world need to reach
out to each other. There should be no ‘them’ and ‘us’,
if this pandemic is to be overcome. It is time to dem­
onstrate that our capacity for compassion matches our
capacity for scientific progress. We should continue to
be all together in this voyage of hope. A journey through
the dark side of the pandemic. A journey of change. A
change for the better. A hope that stigma, fear, and
despair are replaced by optimism, equity and compas­
sion. A hope that tomorrow may not be just more of
yesterday.

References
1.

Mertens, T.E. and Low-Beer, D. HIV and AIDS: Where is the
epidemic going? Bull WHO 74: 12], 1996.

2.

Wei, X., Ghosh, S.K., Taylor, M.E., Johnson, V.A., Emini,
E.A., Deutsch, P., Lifson, J.D., Bonhoeffer, S., Nowak, M.A.,
Hahn, B.H., Saag, M.S. and Show, G.M. Viral dynamics in
human immunodeficiency virus type 1 infection. Nature 373:
117, 1995.

3.

Lafeuillade, A., Poggi, C., Profizi, N., Tamalet, C. and
Thiebaut, C. Similar kinetics of HTV-1 replication in lymphoid
organs and plasma. In: Programme and Abstracts of the 3rd
Conference on Retroviruses and Opportunistic Infections.
January 28-February 1, 1996; Washington DC. Abstract 255.

4.

Emini, E.A. Protease inhibitors. In: Programme and Abstracts
of the 3rd Conference on Retroviruses and Opportunistic
Infections. January 28-February 1, 1996; Washington DC.
Abstract LI.

5.

6.

7.

Mellors, J. W., Rinaldo Jr. C.R., Gupta, P., White, R.M., Todd,
J.A. and Kingsley, L.A. Prognosis in HIV-1 infection pre­
dicted by the quantity of virus in plasma. Science 272: 1167,
1996.

131

sexual behaviour and a decline in HIV infection among young
men in Thailand. N Engl J Med 335: 297, 1996.

23.

National AIDS Control Programme, India. Country scenario,
1995.

21.

Rojanapilhayakorn, W. and Hanenberg, R. The 100% condom
programme in Thailand. AIDS 10: 1, 1996.

24.

Sheedhar, J. and Colaco, A. Broadening the front. NGOs
responses to HIV and AIDS in India. Action AID, British
Council, UNDP. 1996.

22.

Progress Towards Prevention and Control ofAIDS in SouthEast Asia. Report of the Eleventh Meeting of National AIDS
Programme Managers, Jakarta, 22-24 November, 1995. WHO
SEARO, New Delhi, 1996.

This write-up has been contributed by Dr. Lalit Kant, Deputy
Director-General, and Dr. Q.B. Saxena, Asstt. DirectorGeneral, Indian Council of Medical Research, New Delhi.

ICMR NEWS
The following meetings of various technical committees/
groups of the Council were held:

Meetings of the Scientific Advisory Groups (SAGs)/
Scientific Advisory Committees (SACs):
SAC of the Centre for Advanced
Pharmacological' Research on
Selected Traditional Remedies,
Lucknow

October 28, 1996
(at Lucknow)

SAG of the Division of Reproduclive- Health and Nutrition

November 5-6, 1996
(at New Delhi)

SAC of the Centre for Advanced
Research on Standardization,
Quality Control and Formulation
of Selected Traditional Remedies/
Natural Products, Jammu

November 15, 1996
(at Jammu)

Meetings of the Toxicology Review Panel/Project Advi­
sory Committees (PACs)/ held at New Delhi:

Toxicology Review Panel of the
Division of Reproductive Health
and Nutrition

November 7, 1996

PAC on Management of Glaucoma November 15, 1996
Participation of ICMR Scientists in Scientific Events:
Dr. U. Sengupta, Director, Central J ALMA Institute of
Leprosy, Agra, participated in the autumn.meeting of the
project entitled Peptides for Early Detection and Vaccination
Against Tuberculosis and Leprosy at London (November 47, 1996).

Dr. G.V. Satyavati, Director-General, ICMR, partici­
pated in the X meeting of the Directors of Medical Research
Councils or Analogous Bodies and Concerned Research
Foci in the Relevant Ministries at Bandung, Indonesia
(October 21-25, 1996).

132

Dr. C.P. Puri, Dy. Director, Institute for Research in
Reproduction (IRR), Mumbai, participated in the meeting of
the Regional Advisory Panel of the WHO for Asia and the
Pacific at Vanuca Island, Fiji (October 24-27, 1996).
Dr. Z.M. Patel, Officer-in-Charge, ICMR Genetic
Research Centre, Mumbai, participated in the-VI World
Congress on Ultrasound in Obstetrics and Gynaecology at
Rotterdam (October 27-31, 1996).

Dr. Kamala Krishnaswamy, Dy. Director (Senior
Grade), National Institute of Nutrition, Hyderabad, partici­
pated in the VH Expert Panel meeting of the Diet and Cancer
Project at Washington D.C. (November 6-8, 1996).
Dr. U.M. Donde, Dy. Director, IRR, Mumbai, partici­
pated in the National Conference of the Vietnamese Asso­
ciation ofClinical Biochemists at Ho Chi Minh city (Novem­
ber 13-15, 1996).
Dr. G.B. Nair, Asstt. Director, National Institute of
Cholera and Enteric Diseases, Calcutta, participated in the
XXXII Joint Conference of the US-Japan Medical
Programme at Nagasaki (November 14-16, 1996).
Dr. Kalyan Banerjee, Director, National Institute of
Virology, Pune; Dr. K.N. Panicker, Dy. Director, Vector
Control Research Centre, Pondicherry; and Dr. G.B. Nair,
Participated in the XIV International Congress for Tropical
Medicine and Malaria at Nagasaki (November 17-22,
1996).
Dr. VP. Sharma, Director, Malaria Research Centre,
Delhi, participated in the IV Neem Awareness Workshop on
How to Grow and Use Neem at Mbita, Kenya (November
17-19, 1996).
Dr. M.A. Khan, Senior Research Officer, Institute of
Cytology and Preventive Oncology, New Delhi, participated
in the V Western Pacific Congress on Chemotherapy and
Infectious Diseases at Singapore (December 1-4, 1996).

ICMR AIDED SYMPOSIA/SEMINARS/WORKSHOPS/COURSES/CONFERENCES
Sym pos i u m/Scm i n a r/Wor ks hop/
Coursc/Confcrcncc

Date & .Place

Contact Address

XX National Conference of the Indian Society for Surg­
ery of Hand.

December 7-8, 1996;
(at Agra)

Dr. S. Husain, Organising Secretary, Department
of Plastic and Reconstructive Surgery, Central
Jalma Institute for Leprosy, Agra-282001.

Guha Research Conference.

December 23-26, 1996;
(at Darjeeling)

Prof N.C. Mandal, Convenor of the Conference,
Bose Institute, Calcutta-700054.

Symposium on Frontiers in Biology and Biotechnology.

January 6-8, 1997;
(at Vellore)

Dr. Arma Oomen, Organising Secretary of the
Symposium, Department of Neurological Scien­
ces, Christian Medical College, Vellore-632004.

XX All India Cell Biology Conference and Symposium
on Recent Trends in Cell Biology.

January 13-15, 1997;
(at Mumbai)

Dr. R.A. Bhisey, Organising Secretary of the
Conference, Cancer Research Institute, Mum­
bai-400012.

Symposia on (i) AIDS and Cancer Victims: Quality of
Life, Psychosocial Interventions and Issues Related to
Caregivers; and (ii) Divorce: A Grief Process.

January 23-24, 1997;
(at Mani pal)

Dr. K.B. Kumar, Department of Psychiatry, Kasturba Hospital, Manipal-576119.

INDIAN COUNCIL OF MEDICAL RESEARCH
The following areas have been identified as thrust areas for research in the field of HIV/AIDS and
its associations with sexually transmitted diseases and tuberculosis:

(i)

Basic research like culture, identification and characterization of various isolates of HIV.

(ii)

Prevalence of other communicable diseases and opportunistic infections in subjects with HIV/
AIDS.

(iii)

Studies of HIV/AIDS and tuberculosis and chemotherapeutic trials.

(iv)

Exploration of new drugs specifically anti-retroviral in Allopathy and traditional systems like
Homeopathy, Ayurveda, Siddha, etc.

(v)

Studies on the.effectiveness of AZT in:
(a) asymptomatic HIV positive cases.

(b) persons with accidental needle prick injury while handling HIV positive cases as a measure
of preventive AIDS therapy.
(vi)

Epidemiological research using more advanced techniques like mathematical modelling, clinical
research and drug development, studies related to the vaccine development, diagnostics,
surveillance and forecasting.

(vii)

Behavioural research related to the prevention/control of HIV/AIDS.

(viii) Development of indigenous kits for diagnosis of HIV.

(ix)

To generate prevalence/incidence data on STDs in individuals practicing high risk behaviours
in urban/rural areas.

133

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Price (Rs.)

Nutritive Value of Indian Foods (1985), by C. Gopalan, B.V. Ramasastri and
S.C. Balasubramaniam, Revised and Updated (1989), by B.S. Narasinga Rao, K.C. Pant
and Y.G. Deosthale (Reprinted 1995)

23.00

Growth & Physical Development of Indian Infants and Children (1972, Reprinted 1989)
(>
Studies on Weaning & Supplementary Foods (1974, Reprinted 1996)

10.00
15.00

Studies on Pre-School Children (1974, Reprinted 1984)

6.00

A Manual of Nutrition (Second Edition 1974, Reprinted 1995)

6.00

Low Cost Nutritious Supplements ^Second Edition 1975, Reprinted 1994)

4.00

Menus for Low Cost Balanced Diets and School Lunch Programmes Suitable for
North India (Second Edition 1977, Reprinted 1994)

4.50

Some Common Indian Recipes and their Nutritive Value (Fourth Edition 1977,
Reprinted 1995) by Swaran Pasricha & L.M. Rebello

10.00

Nutrition for Mother & Child (Third Edition 1978, Reprinted 1994) by P.S.
Venkatachalam & L.M. Rebello

9.00

Japanese Encephalitis in India (Revised Edition 1980)

5.00

Some Therapeutic Diets (Fourth Edition 1988, Reprinted 1995) by Swaran Pasricha

4.50

Nutrient Requirements & Recommended Dietary Allowances for Indians (1990, Reprinted 1995^ 16.00
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9.00

Diet & Diabetes (Second Edition 1993) by T.C. Raghuram, Swaran Pasricha & R.D. Sharma

18.00

Dietary Tips for the Elderly (1992) by Swaran Pasricha & B.V.S. Thimmayamma

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134

A TRIBUTE
TO
DR. VIJAY DHANDA

(1938-1996)

Dr. Vijay Dhanda, Director, Vector Control Research Centre, Pondicherry and one of the foremost
Medical Entomologists and Zoologists of the country, passed away on 21st August 1996 at the age
of 58 years.

Dr. Dhanda was bom at Izatnagar, Uttar Pradesh, on 26 January 1938 and had his school and college^
education at Mukteshwar and Nainital respectively. He obtained his Masters and Doctorate degree in
Zoology from Lucknow University in 1958 and 1963 respectively and a Diploma in Applied Parasitology
and Entomology from the London School of Hygiene and Tropical Medicine, London in 1966.

He joined the National Institute of Virology (NIV) at Pune, then called the Virus Research Centre
of the ICMR in 1962 as a Senior Research Fellow and subsequently rose to the position of Director
Grade Scientist in 1984. He was appointed as the Director, Vector Control Research Centre (VCRC),
Pondicherry in October'1990 and led the research activities of the Institute till his death.
During his active research career, Dr. Dhanda made commendable contributions in various aspects
of Medical Zoology particularly in taxonomy of ticks, arthropod tissue culture and parasitology. His
research has resulted in better understanding of the natural history of viral and parasitic diseases as
well as their vectors and has been directed towards the disease control.
He has published over 130 research papers in prestigious Indian and International journals.

Dr. Dhanda had actively participated in numerous national and international scientific conferences
and meetings and had been a member of numerous scientific oiganisations. He was awarded Dr. M.O.T.
Iyengar award of the ICMR . in 1984 for his contributions in Medical Entomology.

Dr. Dhanda was not only an excellent scientist, but also a fine human being. He was soft spoken,
suave and well read. He will be remembered with profound respect and affection by all at NIV, Pune
and VCRC. Pondicherry for his honesty, sincerity and conviction to scientific research.

Dr. H.R. Bhat

&
Dr. K. Banerjee
National Institute of Virology, Pune

135

ICMR BULLETIN INDEX
VOL. 26, 1996

Month

No­

Main Feature

January

Highlights of Research at the Tuberculosis Research
Centre, Madras

1

Neuritic Leprosy

13

Highlights of Tribal Research under Indian Council
of Medical Research

21

Health Care for the Elderly

33

Control of Iodine Deficiency through Safe Use of Iodised Salt

41

Highlights of Research on Diarrhoeal Diseases under the
Indian Council of Medical Research

49

Studies on Noise Pollution

61

Prospects of Using Monomolecular Surface Films in Mosquito
Control

77

Research in Infertility

97

ICMR Completes 85 Years: PM Launches the Concluding
Ceremoney and Gives Away ICMR Awards

109

Turning Point in HIV/AIDS Research Vision of Hope

121

February

March-April
May
June
July
August

September

October
November

December

editorial BOARD
Dr. G.V. Satyavati

...

Chairperson

Dr. Badri N. Saxena

...

Member

Dr. Bela Shah

...

Member

Dr. N. Medappa

...

Editor

Printed and Published by Shri J.N. Mathur for the Indian-Council of Medical Research, New Delhi
at the ICMR Offset Press, New Delhi-110029

R.N. 21813/71

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