Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2012 | Month : May | Volume : 6 | Issue : 4 | Page : 623 - 626 Full Version

Prevalence of the Human Immunodeficiency Virus, the Hepatitis B Virus and the Hepatitis C Virus among the Patients at a Tertiary Health Care Centre: A Five Year Study

Published: May 1, 2012 | DOI:
Ronald Roche, Shriyan Amrita, Leslie, Ranjana Nayak

1. Prof & H.O.D. Microbiology. 2. Assistant Prof., Microbiology. 3. Lecturer, Microbiology. 4. Quality Manager. INSTITUTION TO WHICH STUDY IS ATTRIBUTED TO: AJ Institute of Medical Sciences, Dept. of Microbiology, Kuntikan , NH-17 Mangalore 575004 Karnataka, India.

Correspondence Address :
Institute of Medical Sciences,
Dept. of Microbiology,
Kuntikan, NH-17
Mangalore, Karnataka, India - 575004.
Phone: 9986252598


Background: Infection with the Human Immunodeficiency Virus (HIV), the Hepatitis B Virus (HBV) and the Hepatitis C Virus (HCV) is a global health problem. Epidemiological studies worldwide show wide variations in the prevalence patterns of the HIV, Hepatitis B and the Hepatitis C Virus infections. Globally, a total of 39.5 million were living with HIV in 2006, of which approximately 5.7 million were from India. Early detection can contribute substantially to the timely diagnosis of the patients with acute illnesses and to an early treatment and hence, it can limit the transmission of the infection.

Aim: To provide a baseline data on the prevalence of HIV, Hepatitis B and Hepatitis C among the patients who were referred to our hospital over a period of 5 years (2006-2010). This study was planned to evaluate the prevalence of the HIV coinfection with the Hepatitis B and C viruses among the patients who were admitted to and were attending the hospital.

Materials and Methods: This was a retrospective study which was carried out among the patients who were attending the AJ Hospital Kuntikana Mangalore, over a period of five years (January 2006 – December 2010). The sera of the patients were initially tested for the presence of anti-HIV antibodies as per the National Aids Control Organisation (NACO) guidelines and they were tested for HBsAg (Hepatitis B surface antigen) and the anti-HCV antibody by an Enzyme linked Immuno-sorbent Assay (ELISA) test.

Results: Out of 24,576 samples or sera which were studied, 608 (2.5%) were sero-positive cases. These included 318 with antibodies to HIV, 285 with antibodies to the Hepatitis B surface antigen and 5 with antibodies to the Hepatitis C Virus. Among the positive cases, a majority were of the age group of 21 to 40 years, with a male preponderance. The anti-HCV positivity showed a significant downward trend during the study period.

Conclusion: The overall prevalence of the positivity for these three markers among the patients who attended the AJ Hospital in this study was comparatively lower than that which was reported by other studies from India. The lower incidence of the HCV positivity which was found in this study was probably due to the lack of awareness about the co-infection with HBV and this was not screened for. Our study demonstrated low HIV / HCV/HBV co-infection rates.


Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV), Co-infection, Prevalence

India has the highest HIV/AIDS prevalence in the world, with an estimated 5.7 million people living with HIV/AIDS according to the UNAIDS (1). India now has the third largest number of individuals with HIV/AIDS after south Africa and Nigeria (2). Co-infection of HIV with the hepatitis B and the hepatitis C viruses is a common event due to the similar routes of transmission (3). In India the estimated number of children who are living with HIV/AIDS is 202,000 as per the UNAIDS. However, half of these children die undiagnosed before their 2nd birthday. The predominant mode of transmission of HIV in children is vertical i.e., it is acquired through the intrauterine or intra-partum routes or through breast feeding from an HIV infected mother. The WHO program of “3” by “5” whereby 3 million people would be given antiretroviral therapy (ART), of which 10 to 15% would be children, by the year 2005. However, very few children in India had access to ART till the year 2005 and thus, even though children represented about 4% of the total population with HIV/ AIDS, they accounted for almost 18% of the deaths in 2005 (4). The national HIV prevalence is 0.8% and there are certain areas such as Maharashtra, Andhra Pradesh, Tamil Nadu, Karnataka, Manipur and Nagaland that account for over 80% of all the reported AIDS cases in the country (5). The vertical transmission of HBV in India is considered to be infrequent. HBV vaccination in an expanded program of immunization is essential to reduce the HBV carrier frequency and the disease burden (6). In India, approximately 1.8% to 2.5% of the population is presently infected by HCV and about 20 million people are already infected with HCV (7). Routine surveillance and screening of the blood strengthening the services for the treatment of sexually transmitted diseases, thus preventing the mother to child transmission of the blood borne pathogens. This proposal has been put forward by the National AIDS Control Organization (NACO) guidelines [7,8]. The National AIDS Control Program is the most visible vertical health program in India because of much global attention and the fear of a rapidly growing HIV epidemic. Recently, the Center for Disease Control (CDC) has revisedthe guidelines for HIV testing and it has introduced expanded screening in the health care setting with streamlined procedures for the pre-test information and the consent of the patients (9). There are very few studies which are available regarding the prevalence of HIV, HBV and HCV among the patients in the coastal area of Karnataka. Hence, a surveillance study was undertaken at our centre.

Material and Methods

This was a retrospective study which was carried out among the patients who were attending the AJ Hospital, Kuntikana, Mangalore, India, over a period of five years (January 2006– December 2010). Patients with a clinical history and signs and symptoms which were suggestive of an immuno-compromised condition and those patients who were admitted to the hospital for surgery were also screened after getting a written consent from them as per the NACO guidelines. All the sera were initially tested for the anti-HIV antibody, HBsAg and the anti- HCV antibody by the Enzyme linked Immuno-sorbent Assay (ELISA) test (manufactured by J.Mitra Diagnostics, Microlisa-HIV ELISA, Eliscan HIV 1st, 2nd and 3rd generation ELISA kit, J.Mitra Diagnostics Hepalisa-HBsAg ELISA, Microlisa-HBsAg ELISA-HBsAg 3rd generation ELISA kit. J.Mitra Diagnostics Microlisa-HCV ELISA and the Eliscan HCV 3rd generation ELISA kit). This was a qualitative assay, with each micro-well being coated with the recombinant HIV antigen, the HBV antibody and the HCV antigen respectively. The positive sera were confirmed by a repeat ELISA. The validity of the ELISA tests was assessed by means of acceptance criteria which were laid down by the manufacturer for the absorbance of the reagent blank as well as for the mean absorbance of the positive and negative controls which were present with the test kits. The cut off value for reporting the positive results was calculated as per the manufacturer’s directions. Known positive and negative controls were used as the external controls.


Out of the 24,576 patients who were studied, there were 608 (2.5%) sero-positive cases. These included 318 (1.24 %) with HIV, 285 (1.56 %) with the Hepatitis B surface antigen and 5 (0.2 %) with the Hepatitis C Virus. Among the positive cases, a majority were of the age group of 21 to 40 years, with a male preponderance. The anti-HCV positivity showed a significant downward trend during the study period. There was an increase in the prevalence among the male population as compared to that in females, as shown in [Table/Fig-1, 2 and 3]. and a majority of them belonged to the age group of 21-40 years, as shown in [Table/Fig-4, 5 and 6]. Many factors favour mixed infections, which include a high degree of epidemiological similarity between the HIV and the hepatitis viruses. They have similar routes of transmission, similar risk factors such as a high risk sexual behaviour and a higher prevalence than other sexuallytransmitted diseases. Studies on the prevalence of the hepatitis viruses in patients with HIV have shown the HIV and the HBV/ HCV co-infection rate to be 12%–15%. However, studies from India have shown that this varies with the geographical region. Rates of 9%–30% for HBV and 2%–8% for HCV have been reported [10 -12]. Our study demonstrated a low HIV/HCV/HBV co-infection rate of (0.2%). Five among the 603 seropositive cases were positive for both HIV and HBsAg. Due to a similarity in the risk factors and the routes of transmission, public awareness and education would go a long way in curbing the prevalence of these infections. Thus, the disease duration and the use of the anti-viral therapy could not be estimated. This may be due to the fact that the patients who were attending the hospital were probably from a better socioeconomic background.


Stringent measures need to be undertaken on urgent basis, which include the dissemination of information, strict screening of the blood and inclusion of the antibody to the hepatitis B core antigen and other sensitive markers to the screening protocol. Having acquired the knowledge about the importance of such a co-infection, it is essential that all the patients who are infected with HIV be screened for the HBV and the HCV co-infection. Seropositive patients visit the healthcare centre, but they are not tested for the infection with HIV, Hepatitis B and Hepatitis C, until late in the course of their disease. Hence, they are deprived the benefit of the antiviral therapy and this has been documented in several studies [13-17]. In a study which was carried out among the tribal population of central India, the HBV carriage rate was found to be 3.4% among the STI patients as against 2.9% in the general population. The HCV prevalence was 3.9% in the STI patients and it was 4.6% in the general population. No HIV infection was found in the study population. Our study population showed a prevalence of 1.24 % with HIV, the Hepatitis B surface antigen was detected among 1.56 % patients and 0.2 % showed a prevalence of with the Hepatitis C Virus.


To conclude, the overall prevalence of the positivity for the infectious disease markers among the patients in this study was similar to that which was reported by other studies from India, except for the lower incidence of the HCV positivity which was found in this study as compared to that in other studies [15,16]. Although HBV showed decreasing trends, it cannot be relied upon because the patients were screened only for HIV and HBsAg initially. The implications of the HBV or HCV co-infection in the HIV patients are of great importance in India too, as an increasing number of patients are diagnosed to be having HIV disease (18). The knowledge of this co-infection in patients with HIV is vital, as they will live longer on the antiretroviral treatment and they will also need to be managed for their co-infection with HBV or HCV (19). In addition, the derangement of the liver functions as a result of the therapy (Antiretroviral therapy or the treatment for opportunistic infections) may also complicate the situation (20). Our study demonstrated low HIV /HCV/HBV co-infection rates as compared to those in other studies from India [15,17]. The sero-prevalence rates of HIV among males and females from the general population were 4.3% and 2% (21). The HBV co-infection was detected in 2.61% of the patients at a hospital at Delhi, which was partly attributable to the low incidence of intravenous drug use and infrequent transfusion-related infections (22). This study was in concordance with our data of a low prevalence of a 0.2% HBV co-infection among the HIV patients in this part of the country, which was due to better socio-economic conditions and health education (23).


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