LAHORE: A recent scientific investigation has provided sufficient evidence that the transmission of HIV infection among a cluster of dialysis patients in Multan originated from within a healthcare setting, raising serious concerns about infection control practices and administrative oversight.

The study was mainly conducted by three researchers -- Syed Faisal Mahmood, Hasnain Javed, and Ayesha Shahbaz --- with institutional involvement from the Aga Khan University, the Punjab AIDS Control Programme and department of biomedical sciences, Nazarbayev University School of Medicine, Kazakhstan.

The researchers found that all cases were closely inter-linked, indicating a single-source outbreak, rather than unrelated community transmission.

They believe that the timing of the infections — traced between 2023 and 2024 — aligns with the period when these patients were receiving treatment at a dialysis unit in Multan.

The findings place scrutiny on Nishtar Hospital Hospital, Multan, a major public sector facility, where a kidney failure patient had reportedly died, while 30 others contracted Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDs) infections during dialysis treatment in November 2024.

As per earlier reports, a majority of the affected patients had no history of conventional high-risk factors, such as intravenous drug use. Instead, a striking number of patients were also infected with Hepatitis C, a pattern often associated with unsafe medical practices, including lapses in sterilisation, reuse of equipment, or improper handling of blood products.

The healthcare experts noted that dialysis units required strict adherence to infection prevention protocols due to repeated blood exposure and shared clinical environments.

They pointed out that any breach, even minor, can result in rapid transmission among vulnerable patients.

According to the research study, the above-mentioned scam was not the first one in Pakistan as the previous outbreaks in Sindh and Punjab have similarly been linked to failures in infection control.

Questions were raised about regulatory oversight, internal audits and whether early warning signs were overlooked.

The report underscores a broader systemic concern: when preventable infections occur within hospitals, the issue extends beyond clinical error to institutional accountability.

Giving a background perspective, it states that the number of HIV cases has been increasing significantly, attributing to risk factors, such as use of drug injections, sexual transmission, etc.

However, transmission through hemodialysis units was not well documented, as per the report.

“The HIV epidemic in Pakistan is complex and understudied. Since the first report of an HIV case in 1987, the number of HIV cases had proportionally increased to about 210,000, including people of all ages, in 2021”, the report reveals.

It says that HIV is highly prevalent in three high-risk groups -- people who inject drugs (PWID), transgender sex workers (also known as Hijra sex workers (HSW)), and men who have sex with men (MSM). The HIV prevalence in these groups is around 38–40 percent, 11pc and 7.5pc, respectively, the study mentions.

The researchers lament that awareness regarding HIV status has been extremely low, as only 36,000 of an estimated 0.16 million people living with HIV (PLWH) know that they were infected.

Furthermore, it points out that treatment coverage in Pakistan has also been very low and only 58,622 individuals were receiving HIV treatment.

“In Pakistan, there have been eight documented HIV outbreaks in the past two decades, including the 2019 outbreak in Sindh province, where more than 900 individuals, mostly children, had been identified as HIV positive, making this outbreak the largest among children

in the world,” reveals the study. However, it says, transmission through hemodialysis units was not well documented.

In 2024, the outbreak of HIV cases in Multan, set alarm bells ringing for the local health authorities, due to reports linking it to a major public hospital in south Punjab.

The report states that a committee subsequently formed to investigate this alarming development confirmed an HIV outbreak in the hospital’s nephrology unit.

To assess whether this was a point-source outbreak or an overall increase in HIV incidence in the population, a collaborative molecular investigation was launched to perform phylogenetic analysis on the HIV sequences obtained from the patients involved in the outbreak.

“This cross-sectional study presents the findings of the molecular analysis conducted on the HIV outbreak in Multan. We have reported the molecular epidemiological investigation of the outbreak,” say the researchers.

The outbreak occurred between October and December 2024 at the dialysis unit in the tertiary care hospital of Multan.

About the methods, the report states, 25 hemodialysis patients identified during the outbreak were enrolled.

Blood samples, transferred to Aga Khan University, Karachi, at 4 C, were subjected to DNA extraction and polymerase chain reaction (PCR) amplification.

“Findings provide biologically plausible evidence of a point-source HIV outbreak linked to lapses in infection prevention and control practices at the hemodialysis unit,” concludes the report.

Published in Dawn, April 4th, 2026