Objective: To determine HIV-1 and HCV prevalence and correlates and HIV-1 subtypes among injecting drug users (IDUs) in Tajikistan, a frontline heroin trafficking state of Central Asia bordering Afghanistan and the poorest former Soviet republic.

Methods:  In 2004, 491 active adult IDUs were recruited through street outreach in Dushanbe, Tajikistan’s capital. Risk factors for HIV and HCV were assessed through an interview administered survey.  HIV-1 status was determined with rapid testing and confirmed with ELISA. HCV testing was conducted using BIOELISA HCV kit; syphilis with VDRL and TPHA. HIV-1 subtyping was done on a subset with full-length sequencing.  Logistic regression was used to identify correlates of HIV and HCV infection.

Results:  Overall prevalence of HIV, HCV and syphilis was 12.1%, 61.3% and 15.7% respectively.  Independent correlates of HIV infection in multivariate analyses included Tajik nationality (OR 7.06), and daily injection of narcotics (OR 3.22).  Independent correlates of HCV infection were Tajik nationality (OR 1.91); history of arrest (OR 2.37); living/working outside Tajikistan in the last ten years (OR 2.43); and daily injection of narcotics (OR 3.26); protective effects for HCV were being female (OR 0.53); and always using sterile needles (OR 0.47).  Among 20 HIV positive IDU with specimens available for typing, 10 had subtype A of HIV-1, 9 had CRF02_AG, and one an A-CRF02_AG recombinant.

Conclusions:  Epidemics of HIV, HCV, syphilis and drug use are underway in Dushanbe and have distinctive molecular features, including predominance of HIV-1 West African variants.  Targeted prevention programs offering both needle exchange programs and drug treatment (with methadone, buprenorphine or other currently unavailable therapies) are urgently called for to prevent further spread of HIV and HCV in Tajikistan.  Afghanistan was the world’s largest exporter of opiates including heroin in 2004 and is having regional health implications.