ReviewOverview of HIV molecular epidemiology among people who inject drugs in Europe and Asia
Introduction
In 1981, unexpected cases of Kaposi sarcoma and Pneumocystis carinii (now known as jirovecii) pneumonia were diagnosed among young men who have sex with men (MSM) (Centers for Disease Control, 1981a, Centers for Disease Control, 1981b, Gottlieb et al., 1981). The United States (US) Centers for Disease Control and Prevention (CDC) carried out detailed investigations and soon defined the acquired immune deficiency syndrome (AIDS) hinting also at a viral etiology of the new disease (Centers for Disease Control, 1982a, Centers for Disease Control, 1982b). Human immunodeficiency virus (HIV), which causes AIDS, was eventually discovered in 1983 (Barré-Sinoussi et al., 1983, Gallo et al., 1984), but the scientific community soon realized that HIV had been spreading globally before the initial recognition of AIDS in the US. As a matter of fact, a stored sample collected in 1959 in Belgian Congo (now Democratic Republic of the Congo) tested positive for HIV (Nahmias et al., 1986, Zhu et al., 1998) and molecular investigations have shown that HIV was the result of cross-species transmissions from different primates that had taken place long before the first diagnoses (Gao et al., 1999, Keele et al., 2006, Sharp and Hahn, 2011, Van Heuverswyn et al., 2006). The most recent ancestor of the pandemic strain was probably circulating in human populations in Central Africa early in the 20th century (Faria et al., 2014, Korber et al., 2000, Worobey et al., 2008).
The toll of HIV has been high with millions of HIV infections and HIV-related deaths since the early 1980s (Faria et al., 2014, Sharp and Hahn, 2011). However, considerable progress has occurred over the years, which transformed HIV from a lethal disease to a chronic condition. Combinations of potent antiretroviral drugs (antiretroviral treatment—ART) in simplified regimens have significantly reduced morbidity and mortality, and people infected today can anticipate an almost normal life expectancy (Mills et al., 2011, Nsanzimana et al., 2015, Samji et al., 2013, The Antiretroviral Cohort Collaboration, 2008). Following intensified efforts by the World Health Organization (WHO) and the United Nations Joint Programme on HIV/AIDS (UNAIDS), around 17 million people worldwide were on ART in 2015 (UNAIDS, 2015, UNAIDS, 2016). In addition, treatment as prevention (TasP) (Cohen et al., 2011a) and pre-exposure prophylaxis (PrEP) (Grant et al., 2010, McCormack et al., 2015, Molina et al., 2015) are promising prevention approaches added to the existing arsenal of effective tools (Giannou et al., 2015) and UNAIDS has thus set an ambitious goal to end the HIV epidemic, as a public health threat, by 2030 (UNAIDS, 2015).
The first important element of a comprehensive strategy to contain HIV transmission and reach UNAIDS targets is public health authorities and other groups in each locale to understand their epidemic (WHO, 2015). Epidemiological input from HIV/AIDS reporting systems, biological surveillance, and behavioral surveys is necessary to get a deep understanding of local epidemics that could then help design, implement, and evaluate appropriate prevention measures (WHO and UNAIDS, 2013). In this context, molecular studies become invaluable as they shed light on parameters that traditional epidemiological techniques fail to capture.
This review summarizes evidence on circulating HIV-1 subtypes in people who inject drugs (PWID) in Europe and Asia. This geographical area includes countries with past or recent PWID-related outbreaks (Nikolopoulos et al., 2015a); countries with mega-epidemics in PWID such as Ukraine, Russia, China, and Malaysia (Wolfe et al., 2010); and hotspots of ongoing recombination processes (Lau and Wong, 2013).
Section snippets
Molecular epidemiology
HIV-1 and HIV-2 comprise two distinct types of HIV. HIV-2 is classified in groups (A to G) and one recombinant (HIV2_CRF01_AB), and is more closely related to Simian immunodeficiency viruses (SIV) isolated from sooty mangabeys (Clavel et al., 1986, Gao et al., 1992, Ibe et al., 2010, Sharp and Hahn, 2011). HIV-2 is mostly concentrated in West Africa although it has been detected in other geographical settings, especially in those with historical and political ties to West Africa (
HIV transmission and epidemiology among PWID
An HIV infectee can pass the virus onto susceptible individuals usually through unprotected sexual intercourse, by sharing of injecting equipment, and vertically such as from infected mothers to children during pregnancy, at delivery, and through breastfeeding (Cohen et al., 2011b). The estimated risk of infection following needle/syringe sharing with an HIV-positive individual is 0.63% and comes fourth after blood transfusion (92.5%), perinatal transmission (22.6%), and receptive anal
PWID in Former Soviet Union (FSU) states and molecular epidemiology of HIV
The collapse of Former Soviet Union was followed by economic instability, newly established networks of drug trafficking, high unemployment rates, serious destruction of norms and values, intergenerational gaps, and youth alienation, which, in turn, contributed to increased rates of injecting drug use and a huge HIV epidemic among PWID (Friedman et al., 2009, Rhodes and Simic, 2005, Strathdee et al., 2006; United Nations Office on Drugs and Crime (UNODC), 2014). Heterosexual transmission of HIV
Molecular epidemiology of HIV among PWID in Western and Central Europe
Subtype B travelled from the US to Europe infecting initially MSM, and then PWID and other key populations (Glauser and Francioli, 1984, Kuiken et al., 2000, Thomson and Najera, 2007). PWID in Europe became infected either from local epidemics among MSM (Casado et al., 2000, Kuiken et al., 2000, Thomson and Najera, 2007) or from a variant circulating among PWID in North America (Lukashov et al., 1996, Thomson and Najera, 2007).
Between 70% and 85% of newly diagnosed infections in Western and
Molecular epidemiology of HIV among PWID in Asia
Injecting drug use has been fueling the HIV epidemic in many parts of this region, which includes the two primary opium-producing areas in the world: the Golden Crescent defined by peripheries of mountains in Afghanistan, Iran, and Pakistan, and the Golden Triangle than spans Myanmar (Burma), Laos, Vietnam, and Thailand. The major HIV strains that circulate in South and Southeast Asia are subtypes B and C, and CRF01_AE (Lau et al., 2007). Genetic complexity, however, has increased over time as
Conclusion
Injecting drug use is a risky practice associated with increased likelihood of HIV acquisition. Over the last 30 years, millions of PWID became infected with an estimated overall mortality almost 3 times higher among HIV-positive than among HIV-negative drug injectors (Mathers et al., 2013). In addition, PWID serve as bridges of HIV transmission into other groups including the general population. For instance, nowadays in New York, a city that suffered a huge epidemic among PWID in the 1980s and
Conflict of interest
The authors declare that they have no conflict of interest.
Acknowledgments
Funding
GKN acknowledges support from US National Institute on Drug Abuse (grant: DP1 DA034989).
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