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Bangladesh Journal of Medical Science Vol.10 No.1 Jan’11 

1. *MM Rahman, PhD (India), Postdoc. Virology (Taiwan); 
2. WK Ken, MSc Medical Microbiology (UKM); 
3. MR Norzuriza, BSc Technology Biomedical (UM); 
4. I Isahak, MD, MSc Medical Microbiology (UK); 
5. SS Azura, MD, MPath (Microbiology) (UKM); 
6. MN Tzar, MD, MPath (Microbiology) (UKM); 
Department of Medical Microbiology and Immunology, Medical Centre, Faculty of Medicine, University 
Kebangsaan Malaysia, Cheras-56000, Kuala Lumpur, Malaysia. 
*Corresponds to: Dr. MM Rahman, Department of Medical Microbiology and Immunology, University 
Kebangsaan Malaysia, Medical Centre, Cheras-56000, Kuala Lumpur, Malaysia. Email: 
mmr@ppukm.ukm.my, mostabau@yahoo.com. 

Original article 

Scenerio of HIV patients reported to  
University Kebangsaan Medical Centre during 2006-2009 

 
Rahman MM1, Ken WK2, Norzuriza MR3, Isahak I4, Azura SS5, Tzar MN6 

 
Abstract 

Objective: A study was undertaken to identify the HIV-positive cases from suspected 
patients reported to University Kebangsaan Malaysia Medical Centre (UKMMC) from 
January, 2006 to December; 2009. Methods: Cases were identified and confirmed by three 
established sero-diagnostic tests: Micro particulate Enzyme Immunoassay, Passive Particle 
Agglutination Test and Line Immunoassay. Results: A total of 256 HIV positive patients 
were identified and highlighted about their age, sex, ethnic origin and year wise 
distribution of cases. Frequency distribution of HIV-positive cases among different age 
groups indicated that, 144 (%) were aged between 21 to 40 years, 81 (%) were aged 41 to 
60, 19 (%) were aged above 60 and 12 (%) were in the age group of 0-20 years. It revealed 
that the highest number of HIV-positive patients was in the age group of 21-40 years. 
Among the 4 groups of people living in Malaysia, HIV infection was found more in 
Chinese community (101), followed by Malaya community (97), Other community (Sikhs, 
tribes, foreigners) living in Malaysia (30) and Indian community (28). A total of 179 male 
and 77 female were positive for HIV infection. Monthly records of case detection indicate 
more or less similar prevalence pattern throughout the study period. Conclusions: It 
reveals from the report that the Malysian patients are mostly infected at the adulthood 
unlike other countries where majority of infections occur in young age .A high percent of 
HIV infection in males  in the country indicates that they might played a vital role in 
carrying and disseminating infectiions to their female parterners. 
 
Keywords: HIV/AIDS, Sero-diagnosis, Socio-demographic profile, Malaysia. 

Introduction

Human immunodeficiency virus (HIV) is a 
member of the Retroviridae family causes 
acquired immunodeficiency syndrome 
(AIDS). The virus produces a condition in 
humans in which the immune system 
begins to fail, leading to life-threatening 
opportunistic infections. Infection with 
HIV occurs by the transfer of blood, 
semen, vaginal fluid, pre-ejaculate, or 
breast milk. Within these bodily fluids, 
HIV is present as both free virus particles 
and virus within infected immune cells. 

The four major routes of transmission are 
unsafe sex, contaminated needles, breast 
milk, and transmission from an infected 
mother to her baby at birth (perinatal 
transmission). Screening of blood products 
for HIV has largely eliminated 
transmission through blood transfusions or 
infected blood products in the developed 
world.1 
 
HIV infection in humans is considered 
pandemic by the World Health 



Scenario of HIV patients 

22 

Organization . From its discovery in 1981 
to 2006, AIDS killed more than 30 million 
people.2 
 
Each minute, five new persons get infected 
with HIV, and the virus kills young people, 
found in their productive period. About 3.3 
million people with HIV die annually. 
Sixty eight million people could die from 
2000 to 2020. In developed world, 58% of 
the new cases are drug addicts who share 
syringes, and 33% are infected through 
unprotected sexual contacts, but in 
undeveloped countries, it is mainly 
transmitted through unprotected sex and 
blood transfusions.28 million of the HIV 
infected people are found in Africa and 0.5 
million in Western Europe; 300,000 in 
Eastern Europe, 600,000 in Eastern Asia 
and Oceania; 2.6 million in America.3   
 
World Health Organization (WHO) 
released their annual figures for World 
AIDS Day in 2009. They said that at the 
end of 2008 there were 33.4 million people 
living with HIV. In 2008 there were 2.7 
million new infections and 2 million HIV-
related deaths. The vast majorities of HIV 
infected people, more than 30 million, live 
in low and middle-income countries; 
according to the World Health 
Organization.4 
 
Most untreated people infected with HIV 
eventually develop AIDS. These 
individuals mostly die from opportunistic 
infections or malignancies associated with 
the progressive failure of the immune 
system. HIV progresses to AIDS at a 
variable rate affected by viral, host, and 
environmental factors; most will progress 
to AIDS within 10 years of HIV infection: 
some will have progressed much sooner, 
and some will take much longer.Therefore 
,it is prerequisite to identify the virus at the 
early stage of infection so that proper 
antiretroviral therapy can be given to the 
patients5 
 

The present research article is aimed at to 
identify the samples collected from 
suspected HIV patients and highlighted the 
scenario of the patients: age, sex, and 
community and year wise distribution. 
 
Materials & Methods 

Specimen collection: Blood samples 
collected from the suspected patients 
during January 2006 to December, 2009 
reported to UKM medical Centre were 
immediately sent to the laboratory of the 
Department of Medical Microbiology & 
Immunology, Faculty of Medicine, 
National University Malaysia, Cheras-
56000, Kuala Lumpur, Malaysia. 
Ethics approval: It has been approved by 
the ethics committee of the medical faculty 
and hospital.  
Samples processing: All the samples were 
kept for sometime for clotting and sera 
were collected in vials after centrifugation 
and then used in the following test proper: 
 
Test 1: Micro particulate Enzyme 
Immunoassay (MEIA) 
The test was performed with the kits of 
Abbott Axsym system HIV ½ go 
REF3D41-22, B3D4A0, 36-63881/R3. The 
kits were provided with :Anti-
Biotin(Rabbit) Alkaline phosphatase,  
Conjugate in tris buffer, HIV-1 and HIV-2 
antigen coated microplates in tris buffer, 
Biotinylated HIV-1 and HIV-2 antigens in 
tris buffer, Specimen diluent in tris buffer 
and   Positive and Negative control of 
HIV-1 and HIV-2 antigens. 
 
The test was performed as per the method 
described by the manufacturer.6 The 
presence or absence of antibodies  toHIV-1 
and or HiV-2 in the samples is determined 
by comparing the rate of formation of 
fluorescent product to the cut off rate 
which is calculated by axsym HIV-1/2 
index calibration. The rate of formation of 
fluorescent product in the sample is grater 
than or equal to the cutoff rate, the sample 
is considered reactive for anti-HIV. 
 



MM Rahman, WK Ken, MR Norzuriza, I Isahak, SS Azura, MN Tzar 

23 

Test 2: Passive particle –Agglutination 
Test for detection of Antibodies to HIV-1 
and or HIV-2 
The test was performed as per the 
procedure described by SERODIA- HIV-
1/2. The kits contain sample diluent, HIV 
sensitized particle, HIV-1 sensitized 
particles, HIV-2 sensitized particles, 
unsensitized particles and positive control. 
Agglutinated particles spread out covering 
the bottom of the well uniformly 

considered positive. Specimens showed 
inconclusive results were retested. 
 
Test 3: INNO-LIA HIV 1/2 Score: Line 
immunoassay (LIA) 
The test was performed as per the 
procedure described in the Kits of 
INNOGENETICS (Biotechnology for 
healthcare): The test confirmed the 
presence of HIV1/2 in the specimens if 
found discrepancy of the above two tests.   
 

Figure-1: Month and year wise Scenario of HIV positive cases during January 2006-December 
2009  
 

 
Figure-2: Scenario of HIV positive cases in different age groups during January 2006-December 
2009  

12

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0‐20 21‐40 41‐60 >60

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MM Rahman, WK Ken, MR Norzuriza, I Isahak, SS Azura, MN Tzar 

24 

Results and Discussion 

During the period of January 2006 to 
December 2009 a total number of 256 
specimens were confirmed for HIV 
infection from the samples those were 
suspected to analyze for the purpose. 
 
It was observed from the scenario of HIV 
infections from monthly data of the 
laboratory that the prevalence of HIV 
infection starting from January 2006 to 
December 2009(Fig-1) going on in a same 
patterns with a little variation in different 
months. Therefore, HIV infection due to 
seasonal variation has little or no impact. It 
is observed from the figure that the 
prevalence of the infection tended to 
declined at the end of December, 2009.It 
might be due to creation of awareness 
among the people due to mass media 
propaganda for the fatal effect of HIV and 
AIDS. Due to paucity of published reports 
of seasonal effect on HIV infection our 
data generated in the present study could 
not be compared. 
 
Malaysian AIDS Council and AIDS 
foundation7 reported from the   
surveillance data on HIV and AIDS and 

mentioned that   a total 86,127 HIV 
infections were reported to the Ministry of 
Health, Malaysia up to June 2009.  
 
The council reported that in Malaysia, the 
first HIV case was reported in 1986. Since 
then, the number of cases continued to 
increase with the highest number recorded 
in 2002 at 6,978 - a notification rate of 
28.5 cases per 100,000 populations. There 
was a decrease in the number of HIV cases 
in the year 2003 where 6,756 cases were 
reported and that were less than the record 
of 2002. The number and rate of 
notification continued to decrease to 13.3 
cases per 100,000 populations (3,692 
cases) in 2008. The period between 
January and June 2009, a total of 1,497 
HIV cases were reported. The Ministry of 
Health forecasts that until the end of 2009, 
the estimated rate of HIV notification 
would be 10.0 cases per 100,000 
populations in Malaysia. 7 
 
The present study correlates with the above 
report, it reveals from the Fig-1 that at the 
end of December 2009 a declining trend of 
HIIV prevalence was observed. 

 

 
Figure-3: Scenario of HIV positive cases in different community during 2006-2009  

97 101

28 30

0

20

40

60

80

100

120

Malay C hinese Indian Others



Scenario of HIV patients 

25 

HIV positive samples were classified 
according to different age groups (Fig-2). 
It was observed from our results that out of 
256 patients’ samples those were proved to 
be positive for HIV infections 144 were 
aged between 21 to 40 years, 81 were aged 
41 to 60, 19 were aged above 60 and 12 
were in the age group of 0-20. It reveals 
(Fig-2) that the highest number of 
patients(144/256) showing HIV infection 
in the age group of 21-40.This scenario 
gives an idea about the vulnerable ages for 
the picking up of HIV infections in 

Malaysia. The present report agrees with 
the recently published report of global fact 
book.8 In the report it was observed that 
during 2009 and 2010 among the HIV and 
AIDS affected patients 50% were adult 
(aged 15-49).The adult prevalence rates of 
HIV and AIDS were 23.9% in Botswana, 
23.2% in Lesotho, 18.1% in South Africa, 
15.3% in Zimbabwe and 15.3% Namibia.  
Comparing the above reports high rate of 
HIV infections are recorded in adult 
population in Malaysia. 

 

 
Figure-4: Scenario of HIV positive cases in male and female during 2006-2009 
 
A report from International AIDS 
conference  held at Vienna July, 2010 
pointed out that in Thailand 22% of men 
were HIV-positive at baseline but were 
generally unaware of their infection. After 
three years of study, another 135 men had 
acquired HIV. In a 12-month period, the 
annual rate of HIV acquisition (incidence) 
was 5.9 per 100 person years. This did not 
vary between years 1, 2 or 3 of the study. 
The mean age at sero-conversion was 26.4, 
and the median was 26. “This means that 
50% of the men who became infected 
during follow-up were younger than 26 
years, and they observed a quite large 
number of cases where men got infected 
when they were 18 or 19 years of age. In 
the report men were found to be the most 
vulnerable to infection when they were 
younger – men who did not acquire HIV at 

a young age were less likely to acquire it 
when they are older. In the study they 
pointed out that prevalence relates to an 
infection acquired at any time in the past, 
so older men were more likely to have 
prevalent HIV. A man aged 30 or over was 
three times more likely to have prevalent 
HIV than a man aged 18 to 21.On the other 
hand, incidence refers only to newly 
acquired infections. A man aged 18 to 21 
was also almost three times more likely to 
have incident HIV than a man aged over 
309. 
 
HIV infections scenario in terns of 
community during 2006 to 2009 has been 
presented in Fig-3.It reveals from the 
results that among the 4 groups of people 
living in Malaysia HIV infection was 
found more in Chinese community (101), 



Scenario of HIV patients 

26 

next is Malaya community (97) next other 
community (foreigners) living in Malaysia 
and lowest the Indian community (28).The 
highest prevalence HIV infections in the 
Chinese community might me due to their 
adaptation with western life style. On the 
other hand, the Malay community is 
Muslims and most of them are practicing 
which prevents them to pick up HIV 
infections. However, the present report 
varied from the statistical data of Malaysia 
from 1986 to 2008 where Malaya 
community was the highest recorded HIV 
and AIDS sufferers.7 
 
Henry Bauer10 described HIV infection 
relating to community and race 
discrimination of HIV is unique, not only 
as an infection that discriminates by race; 
it’s unique as a sexually transmitted 
infection that discriminates by race. He 
mentioned that no other sexually 
transmitted infection has managed to be 
quarantined geographically and racially in 
this way. The evidence is simply 
overwhelming: from every tested social 
group, high-risk as well as low-risk; from 
every part of the world; for both sexes and 
at all ages—wherever “HIV” tests are 
reported separately by race in any given 
sample, the tendency to test “HIV”-
positive is paralleled by racial ancestry. 
 
In another report from USA on adults and 
adolescents those were diagnosed of 
HIV/AIDS in the 34 states with 
confidential name-based HIV infection 
reporting, 50% were black/African 
American, 29% were white, 18% were 
Hispanic/Latino, 1% each were Asian and 
American Indian/Alaska Native, and less 
than 1% were Native Hawaiian/other 
Pacific Islander.11 Reports on the racial 
affiliation of HIV infections are described 
above are inclusive; it depends on the 
sexual habit and awareness.   
 
It is observed from Fig 4, out of 256 
samples found positive during 2006 to 
2009, HIV positive infections were 179 

male and 77 female in different age groups. 
It is observed from the Fig 4 that male 
might have played a vital role for carrying 
HIV infection and disseminating it to the 
female partner. 
 
More than half of women who have HIV 
got the infection from sexual partners. A 
woman can be infected by contact with a 
man or contact with another woman. When 
a woman has sex with an infected man, she 
has a high risk of getting HIV if a condom 
is not used properly.12 
 
In Malaysia HIV infections occur mostly in 
intravenous drug users 7 and almost all 
drug users are male, this might be the 
reason of being higher prevalence of HIV 
infection in male than female. 
 
In our report though female are less 
infected by HIV, however, report of 
Michel Sidibé, Executive Director of 
UNAIDS11 mentioned that  AIDS ‘This 
epidemic unfortunately remains an 
epidemic of women.” He also mentioned 
that at the end of 2008 it was estimated that 
out of the 31.3 million adults worldwide 
living with HIV and AIDS, around half are 
women. It was mentioned   that 98 percent 
of these women live in developing 
countries The AIDS epidemic has had a 
unique impact on women, which has been 
exacerbated by their role within society 
and their biological vulnerability to HIV 
infection. In his report it was also pointed 
that generally women are at a greater risk 
of heterosexual transmission of HIV. 
Biologically women are twice more likely 
to become infected with HIV through 
unprotected heterosexual intercourse than 
men. In many countries women are less 
likely to be able to negotiate condom use 
and are more likely to be subjected to non-
consensual sex. 
 
In Malaysia HIV transmission occurred by 
intravenous drug users during 1986 to 2008 
were 58, 1358.7 It is the highest 
transmission source next to heterosexual 



MM Rahman, WK Ken, MR Norzuriza, I Isahak, SS Azura, MN Tzar 

27 

transmission. In a report from the 
government agency pointed out that 
Malaysia is poised to achieve the 
“Millennium Goal” set by the United 
Nations of stopping the spread of 
HIV/AIDS and reducing infant and mother 
mortality by the end of the decade. 
 
In a recent report Malaysia has recorded a 
significant drop in the number of HIV 
cases due to the government's 
implementation of various initiatives and 
awareness programmes14. 
 
In a report14 it is mentioned that Malaysia 
recorded a significant drop last year as 
3,080 cases per 100,000 population were 
recorded (10.8%) compared with 21.7% in 
2000 based on the Millennium 
Development Goals (MDG) report. The 
report  added that though the target of 
MDG was to reduce the number of new 
HIV cases to 11% per 100,000 population 
by 2015, Malaysia has been able to achieve 
that target six years ahead.The 
government, through government agencies 
and non governmental organisations had 
carried out 55 medium and long term HIV 
and AIDS awareness programmes over the 
past five years, she mentioned that   of 
2009, 87,710 HIV cases reported, in  
which, 74,316 were still alive, 15,317 or 
(17.5%) are AIDS cases while 13,394 
(15.3%) have died. Total number of 
infected cases were Malays topped the list 
with 62,953 cases, Chinese (12,887), 
Indians (6,929), Bumiputra Sarawak 

(2,200), Bumiputra Sabah (630), others 
(478), foreigners (1,298) and the of 535 
cases has yet to be determined.14 
 
The present paper highlighted the scenario 
of HIV positive patients reported to 
UKMMC based on laboratory detection of 
HIV. The detection was confirmed by three 
tests, if any discrepancies occurred in 1st     
and 2nd tests then 3rd test was performed 
to be reconfirmed. It reveals from the 
report that the Malaysian patients are 
mostly infected at the adulthood unlike 
other countries where majority of 
infections occur in young age that are 
carried to adulthood period. 
 
It is expected that recent awareness created 
by Malaysian government may help reduce 
the number of HIV and AIDS cases in the 
forthcoming years. 
 
Authors Contribution 

All the authors worked in a team to 
formulate, execute and finalized the 
research works. 
 
Ethical approval 

The Laboratory of the Department of 
Medical Microbiology & Immunology is 
an accredited laboratory for the diagnosis 
of diseases   from the samples received 
from the University Kebangsaan Malaysia 
Medical Centre, UKM, Malaysia. 
Therefore it does not need separate 
approval from Ethical committee. 

______________ 
 



Scenario of HIV patients 

28 

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