Abstract
In the last two decades, ‘concentrated epidemics’ of human immunodeficiency virus (HIV) have established in several high risk groups in Pakistan, including Injecting Drug Users (IDUs) and among men who have sex with men (MSM). To explore the transmission patterns of HIV infection in these major high-risk groups of Pakistan, 76 HIV samples were analyzed from MSM, their female spouses and children, along with 26 samples from a previously studied cohort of IDUs. Phylogenetic analysis of HIV gag gene sequences obtained from these samples indicated a substantial degree of intermixing between the IDU and MSM populations, suggesting a bridging of HIV infection from IDUs, via MSM, to the MSM spouses and children. HIV epidemic in Pakistan is now spreading to the female spouses and offspring of bisexual MSM. HIV control and awareness programs must be refocused to include IDUs, MSM, as well as bisexual MSM, and their spouses and children.
Highlights
Since the earlier reports of human immunodeficiency virus (HIV) epidemics amongst Injecting Drug Users (IDUs) communities [1,2], in the last two decades, ‘concentrated epidemics’ have established in several high risk groups in Pakistan, including men who have sex with men (MSM) [3,4,5]
Final trees were visualized and annotated with FigTree v.1.2.2 [http://tree.bio.ed.ac.uk/software/figtree/]. Alignment of these samples with reference sequences obtained from Los Alamos HIV database revealed that 53 (69.73%) samples were HIV-1 subtype A, 13 (17.10%) samples clustered with HIV circulating recombinant form (CRF)_AE, 2 (2.63%) samples grouped with HIV-1 subtype G and 8 (10.52%) assembled with HIV-1 CRF_AG
Results we present here show that HIV epidemic in the Pakistani MSM community is represented by HIV subtypes A and G, and by CRFs AE and AG
Summary
Since the earlier reports of HIV epidemics amongst IDU communities [1,2], in the last two decades, ‘concentrated epidemics’ have established in several high risk groups in Pakistan, including MSM [3,4,5]. Communities of IDUs and MSM are known to interact through overlapping risk behaviors (needlesharing, sexual contact, etc.), which may facilitate spillover of HIV infection from IDUs into MSM, or vice versa. Such bridging phenomena have been observed in Eastern Europe, Russian Federation and Central Asia where HIV epidemics once concentrated among IDUs are increasingly characterized by significant transmission into MSM, and subsequently, general population [6,7]. Since MSM in Pakistan exhibit multiple high risk behaviors that overlap with those of IDUs, we hypothesized that MSM may act as ‘bridge’ for introducing the HIV infection into the general population from the IDU community, where ‘bridging’ is defined as transmission of HIV from high-risk core groups to non-core groups [6]. We show evidence that from the MSM community, the HIV epidemic is spreading into the spouses and children of bisexual MSM, seeding the epidemic into non high-risk populations
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
