Bridge Consultants Foundation

In Pakistan, the genetic diversity of human immunodeficiency virus type 1 (HIV-1) is becoming increasingly complex, compared to the early years of the epidemic that started after the detection of the first cases of HIV-1 in 1987 in Karachi. Based on the available molecular studies, two dominant HIV-1 clades, sub-subtype A1 and CRF02_AG, have been found to co-circulate with other clades, namely B, C, D, G, CRF01_AE, CRF35_A1D, and CRF56_cpx, in various urban areas of Pakistan. Several novel recombinant forms have also been detected. This first report of CRF152_DG highlights the complex nature of the HIV epidemic in Pakistan and emphasizes the importance of continual molecular surveillance (ideally based on whole-genome sequences) of HIV.

Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting reproductive-aged women, characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology. The main objective of the study is to find the effects of a ketogenic diet in overweight women with polycystic ovary syndrome. This prospective interventional study was conducted in a private hospital in Karachi, Pakistan, from June 2023 to Dec 2023. Data was collected from 320 females who were suffering from PCOS. Participants were randomized into two groups: the intervention group (n = 160) received a ketogenic diet, while the control group (n = 160) followed a standard hypocaloric diet. Randomization was performed using computer-generated random numbers to ensure allocation concealment and minimize selection bias. Upon enrollment, participants underwent baseline evaluations to establish their demographic characteristics, medical history, and anthropometric measurements, including weight, BMI, and waist circumference. Data were collected from 320 female patients. In the ketogenic diet (KD) group, participants had a mean age of 28.1±4.2 years and a mean BMI of 30.01±2.3 kg/m2. Their waist circumference averaged 90.1±5.0cm, with a fasting glucose level of 110±10 mg/dL and a DHEAS level of 350±50 μg/dL. In the ketogenic diet (KD) group, participants experienced a mean reduction in body weight of 8.5±2.3kg, a decrease in BMI of 3.2±1.1Kg/m2, and a reduction in waist circumference of 10±4cm. Conversely, the control group exhibited a mean decrease in body weight of 2.5±1.5kg, a reduction in BMI of 1.0±0.8kg/m2, and a decrease in waist circumference of 3±2cm. It is concluded that the ketogenic diet may offer metabolic and reproductive benefits for overweight women with polycystic ovary syndrome. The improvements observed in metabolic parameters and menstrual regularity support the potential role of KD as a therapeutic intervention in PCOS management.

To assess the prevalence and associated risk factors of syphilis among antenatal clinic attendees by a multi-center cross-sectional study in Karachi, Pakistan. We administered a structured questionnaire and obtained a blood sample for syphilis serology (rapid plasma reagin test with Treponema pallidum hemagglutination assay confirmation) from all women giving informed consent over six weeks in 2007. Prevalence was calculated at 95% confidence intervals. Multivariate analysis was adapted to assess risk factors. There were seven (0.9%) confirmed cases of syphilis (95% CI: 0.4, 1.8) in a sample size of 800 women recruited from three urban sites (-1% refusal rate). Women who lived in an area where male drug use is prevalent had 1.5% higher prevalence rates than women from the other two sites 0.5%. We documented higher-than-expected syphilis seroprevalence rates in a low risk population of antenatal clinic attendees in Pakistan. Bridge populations for syphilis may include drug users, who are usually married, and Hijras or their clients. In accordance with our results, the national policy for syphilis control in Pakistan should be modified to include universal syphilis screening in antenatal clinics with subsequent partner notification.

Pakistan is experiencing a growing HIV epidemic. Antiretroviral drugs (ARV) have been smuggled into the country and available without prescription since the early 1990s, but are now provided free of cost by the government. We assessed the prevalence of HIV-1, drug resistance, and subtype distributions. Blood specimens were collected from HIV-1-infected participants registered in Sindh Province on dry blood spot (DBS) cards in 2008. Pol, protease, and partial reverse transcriptase regions were sequenced after reverse transcriptase PCR (RT-PCR). HIV-1 subtype was assigned by phylogenetic analysis. Primary drug resistance was analyzed by the Calibrated Population Resistance (CPR) tool using the Stanford Surveillance Drug Resistance Mutation (SDRM) major mutation list. Out of 100 blood samples collected, 42 were suitable for testing. Out of 42, 11 were ARV-receiving and 31 ARV-naive patients. Among them, 24 were injection drug users (IDUs), four immigrants, two hijras (male transvestites), two men who have sex with men (MSM), four prisoners, one female sex workers, two spouses of HIV-infected persons, and four from the general population. ARV resistance among naive patients was 2/31 (6.5%) and 36.4% (4/11) among ARV-experienced patients making an overall resistance of 14.2%. HIV-1 subtype A1 was the predominant subtype found in 35/42 (83.3%) followed by CRF35_AD and C, 6.5% each. Subtype D and G were found in one (2.4%) each. A significant proportion of Pakistani HIV patients has ARV drug resistance. Physicians treating patients should consider the magnitude of drug resistance while selecting regimens, and address drug adherence aggressively.