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  • Title: Infection with HIV-1 subtypes B and E in injecting drug users screened for enrollment into a prospective cohort in Bangkok, Thailand.
    Author: Kitayaporn D, Vanichseni S, Mastro TD, Raktham S, Vaniyapongs T, Des Jarlais DC, Wasi C, Young NL, Sujarita S, Heyward WL, Esparza J.
    Journal: J Acquir Immune Defic Syndr Hum Retrovirol; 1998 Nov 01; 19(3):289-95. PubMed ID: 9803972.
    Abstract:
    From May through August 1995, a cross-sectional survey was conducted among injecting drug users (IDUs) drawn from 15 drug treatment clinics in Bangkok and who were not known to be HIV-seropositive, to determine the prevalence of HIV-1 subtypes B and E and related risk behaviors, and to offer enrollment in a prospective cohort study. IDUs who voluntarily consented were interviewed, and blood specimens were tested for the presence of HIV antibodies. HIV-1-seropositive specimens were tested for subtypes B' (Thai B) and E by using V3 loop peptide enzyme immunoassays specific for these HIV-1 genetic subtypes. Of 1674 IDUs studied, the mean age was 31.2 years (interquartile range, 25-37 years), 94.8% were men, and 29.3% were HIV-1-seropositive. On multiple logistic regression analysis, HIV-1 seropositivity was associated with older age, not being married, less education, needle sharing, and incarceration. HIV-1 subtype B' accounted for 65% of prevalent infections and subtype E, 35%. Infection with subtype E was associated with younger age and did not seem to be associated with sexual risk behaviors, which were uncommon in general. Bangkok IDUs continue to be at high risk for HIV-1 infection related to needle sharing and incarceration. Although HIV-1 subtype B' accounts for most prevalent infections, subtype E seems to be more prevalent among younger IDUs, and most infections seem likely to result from parenteral transmission. In a 3-month period in 1995, voluntary HIV counseling and testing was offered to injecting drug users (IDUs) 20-50 years of age who attended any of the 15 drug treatment centers operated by the Bangkok (Thailand) Metropolitan Administration and were not known to be HIV-positive. The long-term purpose of this screening was to enroll a cohort in which to monitor HIV trends and obtain HIV-1 strains for genetic and phenotypic characterization. 1674 predominantly male IDUs (mean age, 31.2 years) were screened. 70.1% reported having been tested for HIV in the past 3 years. In the preceding 6 months, 77.9% had injected drugs at least once a day, 39.1% had used needles or syringes used by others, and 42.5% had shared needles. HIV-1 seroprevalence was 29.3%. In multiple logistic regression analysis, the following factors were significantly and independently associated with HIV-1 positivity: older age, unmarried status, less than 7 years of education, having shared needles or syringes, incarceration in the past 6 months, and drug injection during incarceration. A convenience sample of 205 of the 490 HIV-1-positive specimens was selected for serotyping through use of V3 loop peptide enzyme immunoassays. Of the 194 for which the HIV-1 subtype could be determined, 126 (64.9%) reacted to subtype B prime ("Thai B") and 68 (35.1%) reacted to subtype E. Subtype E was significantly more common among younger IDUs. 822 of the 1184 HIV-negative IDUs were interviewed and offered enrollment in the prospective cohort study; 678 (82.5%) agreed to participate. A phase III efficacy trial of an HIV-1 vaccine may be feasible in this cohort.
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