Abstract
Bangladesh has an overall low HIV prevalence of <0.1% in the general population and <1% among key affected populations, but it is one of few Asian countries that has yet to reverse the epidemic. In order to do this, it is important to understand the transmission dynamics in this country. The aim of this study was to investigate the phylogenetic relationships of HIV-1 subtype C strains from Bangladesh and related strains from other countries, and thereby clarify when and from where subtype C was introduced in the country and how it subsequently spread within Bangladesh. The phylogenetic analysis included 118 Bangladeshi gag sequences and 128 sequences from other countries and was performed using the BEAST package. Our analysis revealed that the vast majority of Bangladeshi sequences (97/118, 82%) fall into a large regional cluster of samples from Bangladesh, India, China and Myanmar, which dates back to the early 1960’s. Following its establishment in the region, this strain has entered Bangladesh multiple times from around 1975 and onwards, but extensive in-country transmission could only be detected among drug users and not through sexual transmission. In addition, there have been multiple (at least ten) introductions of subtype C to Bangladesh from outside this region, but no extensive spread could be detected for any of these. Since many HIV-infections remain undetected while asymptomatic, the true extent of the transmission of each strain remains unknown, especially among hard to reach groups such as clients of sex workers and returning migrants with families.
Highlights
Bangladesh is a low-prevalence country for HIV with an estimated overall prevalence of less than 0.1%
The prevalence in most of the key affected populations, such as female sex workers (FSW), men who have sex with men (MSM) and hijra/transgendered population (TG) remains below 1%, but the highest concentration of cases is found among people who inject drugs (PWID) in Dhaka, where the latest reported prevalence figure is 5.3% [1]
The aim of this study was to investigate the phylogenetic relationship between HIV-1 subtype C strains from Bangladesh and related strains from other countries, and thereby elucidate when and from where subtype C was introduced in the country and how it has subsequently spread within Bangladesh
Summary
Bangladesh is a low-prevalence country for HIV with an estimated overall prevalence of less than 0.1%. The HIV-epidemics of several other countries in South and South-East Asia started off in PWIDs and spread via needle sharing and unprotected sex to sex workers and thereafter to the general population [3]. Intervention efforts in Bangladesh, including extensive needle-syringe exchange programs, are estimated to have reduced infections among PWIDs by as much as 90% [4] and contributed to decreased transmission to other populations. Going abroad to work is not a risk factor per se and the individual risk of contracting HIV remains low, this large group of people contributes to a continuous inflow of new HIV-infections to Bangladesh. The aim of this study was to investigate the phylogenetic relationship between HIV-1 subtype C strains from Bangladesh and related strains from other countries, and thereby elucidate when and from where subtype C was introduced in the country and how it has subsequently spread within Bangladesh
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