According to World Health Organization estimates, India will have the greatest number of human immunodeficiency virus (HIV)-infected individuals of any country by the end of this decade (1, 6). High rates of sexually transmitted diseases, rapidly increasing seroprevalence in female commercial sex workers, and inadequate facilities for HIV testing, counseling, and prevention are the major contributing factors in the recent explosive increases in the numbers of HIV infections (5, 6, 24, 29). While antiretroviral drugs have reduced mortality from AIDS in developed nations, their effect will be negligible elsewhere due to their cost. For most communicable diseases, vaccines offer the most cost-effective control strategy. It is likely that development of a vaccine for HIV will require knowledge of the viral variants being transmitted in the target population. Despite India’s impending predominance in the worldwide pandemic, little is known of the genetic diversity of HIV-1 in India.

The HIV-1 sequence database is growing exponentially, but the distribution of submitted sequences is not representative of the worldwide picture. Subtype C has been reported in nearly every region affected by HIV-1 (11, 23, 28) and predominates in India, and it also causes 74% of infections in southern Africa and 96% of infections in northern Africa (11, 18, 32). Given the combined population of India and the other regions affected, subtype C is likely to be the most commonly transmitted HIV-1 subtype worldwide. In contrast, 7% of the available HIV-1 sequence data is from subtype C-infected individuals (37), and of the 46 completely sequenced HIV-1 genomes (excluding multiple derivatives of HIV-1LAI), only two are of subtype C, one from a 1992 Brazilian sample and the other from a 1986 Ethiopian sample (37). In November 1997, an analysis of cross-clade epitope variation (9) excluded the C clade from evaluation of p24gag epitopes because of a lack of sequence data, whereas there was sufficient data to analyze subtypes A, B, D, F, G, and H (no HIV-1 harboring a subtype E gag gene has been found). Further sequence data from subtype C is needed, but the past approach of generating data from small subgenomic amplicons is no longer sufficient.

Recent developments have made full-genome characterization of HIV-1 isolates both important and feasible. First, the recognition of intersubtype recombination in a significant proportion of HIV-1 sequences (44, 45) has led to detection of mosaic genomes in many regions of the world affected by multiple subtypes (14, 17, 31). Subtypes A, B, and C in India have been reported (4, 22, 30, 31, 59), but mosaic HIV-1 there has not been reported. The existence of such recombinants makes characterization of variants by analyzing subgenomic segments incomplete. Second, immune responses to vaccines based on single genes such as env have been limited (13), and attention is being shifted toward multivalent vaccines that incorporate other gene products. Third, interactions among discontinuous regions of the genome, such as between the long terminal repeat (LTR) and pol (26), can be detected only when such regions can be analyzed from the same template.

In an effort to characterize subtype C virus genomes being transmitted currently in India, viral isolates were obtained from individuals with seroincident infections in India. Three of the isolates (collected in 1994 and 1995) were known to be non-syncytium inducing (NSI) and therefore resembled viruses transmitted through unprotected sexual contact, which account for 75 to 85% of new infections (2, 15, 61). These isolates were cloned, and nearly full-length genomic sequences were determined. Detailed sequence analysis was performed, as was an analysis of variation in characterized cytotoxic T lymphocyte (CTL) epitopes.

https://jvi.asm.org/content/jvi/73/1/152.full.pdf

Full-Length Human Immunodeficiency Virus Type 1 Genomes from Subtype C-Infected Seroconverters in India, with Evidence of Intersubtype Recombination

BACKGROUND Mortality from coronary heart disease in the United States has decreased substantially in recent decades. We conducted a study to determine how much of this decrease could be explained by the use of medical and surgical treatments as opposed to changes in cardiovascular risk factors. METHODS We applied a previously validated statistical model, IMPACT, to data on the use and effectiveness of specific cardiac treatments and on changes in risk factors between 1980 and 2000 among U.S. adults 25 to 84 years old. The difference between the observed and expected number of deaths from coronary heart disease in 2000 was distributed among the treatments and risk factors included in the analyses. RESULTS From 1980 through 2000, the age-adjusted death rate for coronary heart disease fell from 542.9 to 266.8 deaths per 100,000 population among men and from 263.3 to 134.4 deaths per 100,000 population among women, resulting in 341,745 fewer deaths from coronary heart disease in 2000. Approximately 47% of this decrease was attributed to treatments, including secondary preventive therapies after myocardial infarction or revascularization (11%), initial treatments for acute myocardial infarction or unstable angina (10%), treatments for heart failure (9%), revascularization for chronic angina (5%), and other therapies (12%). Approximately 44% was attributed to changes in risk factors, including reductions in total cholesterol (24%), systolic blood pressure (20%), smoking prevalence (12%), and physical inactivity (5%), although these reductions were partially offset by increases in the body-mass index and the prevalence of diabetes, which accounted for an increased number of deaths (8% and 10%, respectively). CONCLUSIONS Approximately half the decline in U.S. deaths from coronary heart disease from 1980 through 2000 may be attributable to reductions in major risk factors and approximately half to evidence-based medical therapies.

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Explaining the Decrease in U.S. Deaths from Coronary Disease, 1980–2000

The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries.

Self-care is advocated as a method of improving outcomes from heart failure (HF), the final common pathway for several prevalent illnesses, including hypertension and coronary artery disease. HF is widespread in aging populations across the world.1 The burden of HF is manifested in poor quality of life (QOL)2,3 and early mortality.4 In addition, there are >3 million ambulatory care and emergency department visits5 and well over 1 million hospitalizations for HF in the United States annually,6 which contributes to the exorbitant costs associated with HF. Much of this healthcare utilization is thought to be preventable if patients engage in consistent self-care.7,8

This scientific statement seeks to highlight concepts and evidence important to the understanding and promotion of self-care in persons with HF. Specifically, the document describes what is known about (1) the self-care behaviors required of HF patients, (2) factors that make self-care challenging for patients, (3) interventions that promote self-care, and (4) the effect of self-care on HF outcomes. The review ends with evidence-based recommendations for clinicians and direction for future research.

Self-care is defined as a naturalistic decision-making process that patients use in the choice of behaviors that maintain physiological stability (symptom monitoring and treatment adherence) and the response to symptoms when they occur.9 The term naturalistic decision making is used to describe how people make decisions in real-world settings. Naturalistic decision makers focus on process rather than outcomes, make decisions based on the situation, let the context influence their decision-making processes, and base practical decisions on the information available at the moment.10

In HF, self-care maintenance requires following the advice of providers to take medications, eat a low-sodium diet, exercise, engage in preventive behaviors, and actively monitor themselves for signs and symptoms. Self-care management refers to decision making in …

State of the science: Promoting self-care in persons with heart failure: A scientific statement from the american heart association

Following a peak in deaths from coronary heart disease (CHD) in about 1968, age-adjusted rates have declined by half. Two factors may have made critical contributions: a substantial decrease in prevalence of major cardiovascular risk factors such as smoking, high cholesterol, and high blood pressure; and major breakthroughs in evidence-based treatments including coronary bypass graft surgery, coronary angioplasty, thrombolytic therapy, and stents. The investigators used a validated statistical model, IMPACT, in an attempt to identify those factors chiefly responsible for the impressive decline in CHD mortality. Data were available for U.S. adults 25 to 84 years of age covering the years 1980-2000. Between 1980 and 2000, the age-adjusted death rate for CHD fell from 543 to 267 deaths per 100,000 population among men, and from 263 to 134 per 100,000 population among women. The result was 341,745 fewer CHD deaths in 2000. The U.S. IMPACT model explained approximately 90% of the decline in CHD deaths. • About 47% of the decline in deaths from CHD was ascribed to treatments, including secondary preventive therapy following acute myocardial infarction (AMI) or revascularization (11%), initial treatments for AMI or unstable angina (10%), treatments for heart failure (9%), revascularization for chronic angina (5%), and other treatments (12%). • Approximately 44% of the decline in CHD deaths was attributed to changes in risk factors, including reductions in total cholesterol of 0.34 mmol/L; systolic blood pressure of 5.1 mm Hg; the prevalence of smoking by 11.7%; and physical inactivity by 5%. These reductions were, however, partly offset by increases in body mass index and the prevalence of diabetes. These effects accounted, respectively, for increases of 8% and 10% in CHD mortality. The proportional contributions of specific treatments and risk factor changes to the overall reduction in deaths from CHD in the year 2000 were relatively consistent. The contribution of treatments for AMI remained consistently smaller than that of secondary prevention or treatments for heart failure, regardless of whether best, minimum, or maximum estimates were compared. These findings suggest the need for comprehensive strategies to treat and prevent CHD. Efforts will be needed to maximize the coverage of effective treatments and to actively promote population-based prevention through reducing risk factors.

Explaining the decrease in U.S. deaths from coronary disease, 1980-2000

http://psych415.class.uic.edu/Readings/Benson,%20Intercessory%20prayer%20&%20CHD,%20AmHrtJr,%202006.pdf

Study of the Therapeutic Effects of Intercessory Prayer (STEP) in cardiac bypass patients: a multicenter randomized trial of uncertainty and certainty of receiving intercessory prayer.

Outpatient adherence to beta-blocker therapy after acute myocardial infarction

https://www.onlinejacc.org/content/accj/43/11/2036.full.pdf

Outpatient utilization of angiotensin-converting enzyme inhibitors among heart failure patients after hospital discharge

By the turn of the century 20-50 million adults are projected to be HIV positive in Asia, and India will have the largest burden of newly infected patients in a single country. To determine the present status of the epidemic, a systematic review of available data in India has been carried out. Regional differences in reported HIV seroprevalence were found, with high levels in western, northeastern, and southern India and lower levels in northern, central, and eastern India. While differences in the temporal introduction of HIV may be partly responsible, the more likely explanation is incomplete data and reporting. In the past 4 years HIV has rapidly increased among commercial sex workers and patients coming to sexually transmitted diseases clinics in western (Bombay) and southern (Madras and Vellore) India. Assessing HIV seroprevalence in the general population is difficult because of limited data, especially from rural areas, where 60% of Indians reside. Heterosexual contact with commercial sex workers is the major reported risk factor, except in eastern India, where intravenous drug use is common. The impact of transfusions or contaminated needles is uncertain, but between 25 and 75% of blood donations are not screened for HIV, and 15% of infected patients had received transfusions. By October 1993, 494 cases of AIDS had been reported, but this number grossly underestimates the real situation since HIV is often unrecognized. Tuberculosis is the major HIV-associated infection. In its efforts to control HIV, India needs to institute a standardized surveillance system to provide data needed to design and implement appropriate interventions.

A review of human immunodeficiency virus infection in India

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Manoj Jain

Papers

Study of the Therapeutic Effects of Intercessory Prayer (STEP) in cardiac bypass patients: a multicenter randomized trial of uncertainty and certainty of receiving intercessory prayer.

Outpatient adherence to beta-blocker therapy after acute myocardial infarction

Outpatient utilization of angiotensin-converting enzyme inhibitors among heart failure patients after hospital discharge

A review of human immunodeficiency virus infection in India

A Case of Scrub Typhus Probably Acquired in Africa