Expanding Epidemics of HIV-1 in States of the Former Soviet Union
J L Sanchez*1, J K Carr2, R Graham3, W B Sateren1, and E T Latta4
1US Military HIV Res. Prgm., Walter Reed Army Inst. of Res., Rockville, MD, USA; 2Henry M. Jackson Fndn. for the Advancement of Military Med., Rockville, MD, USA; 3US Naval Med. Res. Unit No. 3 (NAMRU-3), Cairo, Egypt; and 4Armed Forces Med. Intelligence Ctr., Defense Intelligence Agency, Fort Detrick, MD, USA
Background: During the past 5 to 10 years the number of
cases of HIV/AIDS reported from the independent states of the Former Soviet
Union (FSU) has dramatically increased, and appears to be primarily related to
a sharp increase in intravenous drug use (IDU) practices and, secondarily, to
subsequent spread among heterosexually active IDU, especially in states such as
Ukraine and the Russian Federation.
Methods: We examined the published literature and
conducted genotyping studies among HIV-positive patients in 5 states of the FSU
and Georgia). Genotyping was accomplished by sequencing the reverse
transcriptase and protease (RT/pro) gene regions of HIV-1 strains collected
during the years from 2000 to 2003.
Results: The highest HIV/AIDS population prevalence
rates have been reported from Estonia,
the Russian Federation,
where rates as high as 1 to 1.5 per thousand have been reported. In the Russian
Federation, for example, it is estimated that there exist between 1.5 million
and 2 million infected individuals (more than 2% of the population) and that more
than 80% of new cases occur in persons <30 years of age. Approximately
100,000 new annual cases are reported now from the Russian Federation compared to only
5000 to 10,000 per year in the late 1990s. Core IDU constitute a key bridge to
the general heterosexual population in the FSU, especially to young females.
From our genotyping studies performed on 207 HIV-1 strains from the region,
subtype A was found to predominate and was found to be similar to the already
described subtype A strains found among IDU networks (IDU-A) in the region. The
virus genetic composition seems to be unique, mostly restricted to drug
networks in the FSU, and seems to be rapidly expanding among IDU and heterosexual
populations in the region. Relative ignorance regarding HIV preventive
measures, lack of formal HIV/AIDS control policies and associated increases in
high-risk sexual behavior have led to the establishment of this IDU-A epidemic.
Conclusions: Immediate action is required by public health
authorities in the FSU in order to stem the rise of this, the most rapidly expanding,
HIV epidemic in the world.
Keywords: genotypes; epidemiology; drugs