Rapid Communication: Emerging HIV Infections With Distinct... : JAIDS Journal of Acquired Immune Deficiency Syndromes (original) (raw)

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Rapid Communication: Emerging HIV Infections With Distinct Subtypes of HIV-1 Infection Among Injection Drug Users From Geographically Separate Locations in Guangxi Province, China

Yu, Xiao-Fang*; Chen, Jie†; Shao, Yiming‡; Beyrer, Chris§; Liu, Bindong*; Wang, Zhe*; Liu, Wei†; Yang, Jinye†; Liang, Shaoling†; Viscidi, Raphael P.∥; Gu, Jing∥; Gurri-Glass, Gregory*; Lai, Shenghan¶

*Department of Molecular Microbiology and Immunology, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland, U.S.A.; †Guangxi Health and Anti-Epidemic Center, Nanning, China; ‡Chinese Academy of Preventive Medicine, Beijing, China; §Department of Epidemiology, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland, U.S.A. ∥ Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.; and ¶Comprehensive Drug Research Center, University of Miami, Miami, Florida, U.S.A.

Address correspondence and reprint requests to Xiao-Fang Yu, Department of Molecular Microbiology and Immunology, Johns Hopkins University School of Hygiene and Public Health, 615 North Wolfe Street, Room E4012, Baltimore, MD 21205, U.S.A.; email:xfyu@ jhsph.edu.

Manuscript received February 16, 1999; accepted July 13, 1999.

Abstract

Summary:

Heroin users from Guangxi province, a southern province of China that borders Vietnam in the south and Yunnan province in China in the west, were studied for prevalence and risk factors for HIV-1 infection. Viral env sequences from HIV-1-positive individuals were also determined for subtypes of HIV-1. The overall HIV prevalence among 227 heroin users was 40%. Most had used drugs for ≤3 years. Sharing of injection equipment and unprotected sex were significantly associated with HIV-1 infection. Subtypes C and E HIV-1 were detected in infected heroin users and were sharply segregated in two geographic locations: only subtype C was found in a border city with Yunnan province, whereas only subtype E was found in a city bordering northern Vietnam. HIV-1 strains within each subtype were remarkably homogenous, with a mean intersubject DNA distance of 2.32% for subtype E and 1.13% for subtype C, respectively. Phylogenetic analysis of C2-V5 region of Guangxi subtype E env sequences revealed significant clustering with subtype E sequences from southern Vietnam and Cambodia. These results suggest that HIV-1 infection among heroin users in Guangxi represents two emerging epidemics initiated from distinct sources: one from Vietnam and another from Yunnan province. Factors associated with HIV-1 infection were not restricted to injection practices. Unprotected sexual behaviors are likely to increase the probability of HIV transmission beyond this high-risk population. Designing and implementing effective intervention strategies targeted toward both injection drug use and high risk sexual behavior are urgently needed to further reduce HIV-1 spread in China.