Reconstructing the AIDS epidemic among injection drug users in Brazil <span class="so-article-trans-title" dir="auto"> Translated title: Reconstruindo a epidemia de AIDS entre usuários de drogas injetáveis brasileiros </span>

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Abstract

The HIV/AIDS epidemic among injection drug users (IDUs) in Brazil has been unique in terms of temporal and geographical contrasts. This analysis explores these contrasts through the use of multilevel modeling. Standardized AIDS incidence rates among IDUs for Brazilian municipalities (1986-2000) were used as the dependent variable, with a set of social indicators as independent variables (covariates). In some States of the North/Northeast, the epidemic among IDUs has been incipient. The São Paulo epidemic extended to reach a network of municipalities, most of which located far from the capital. More recently, on a smaller scale, a similar extension has been observed in the southernmost States of the country. Both "number of physicians per inhabitant" and "standard distance to the State capital" were found to be associated with AIDS incidence. AIDS cases among IDUs appeared to cluster in wealthier, more developed municipalities. The relative weight of such extensive dissemination in key, heavily populated States prevails in the Brazilian IDU epidemic, defining a central-western-southeastern strip of wealthier middle-sized municipalities and more recently a southern strip of municipalities deeply affected by the epidemic in this population.

Translated abstract

A epidemia de HIV/AIDS entre usuários de drogas injetáveis (UDIs) apresenta, no Brasil, contrastes temporais e geográficos. Esta análise explora tais complexidades, com o emprego de modelagem multinível. As taxas padronizadas de incidência de AIDS em UDIs para os municípios brasileiros (período 1986-2000) foram consideradas como variável-dependente, e um conjunto de indicadores sociais como covariáveis. Em alguns Estados do Norte e Nordeste, a epidemia é incipiente entre UDIs, enquanto a epidemia paulista atinge uma rede de municípios, a maioria deles distantes da capital. Mais recentemente, e em menor escala, disseminação análoga foi observada nos Estados mais meridionais. As covariáveis "número de médicos por habitante" e "distância-padrão da capital do respectivo estado" se mostraram associadas à variável-dependente. Os casos de AIDS entre UDIs parecem se concentrar em municípios mais ricos e bem equipados. O peso relativo dessa disseminação extensa em Estados-chave, populosos, prevalece sobre o conjunto da epidemia brasileira, definindo uma faixa que se estende do Centro-oeste ao Sudeste, com municípios mais ricos, de médio porte, e, mais recentemente, uma faixa sul de municípios substancialmente afetados pela epidemia entre UDIs.

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Global overview of injecting drug use and HIV infection among injecting drug users.

, Gerry V Stimson, Matthew Hickman … (2004)

To provide global estimates of the prevalence of injecting drug use (IDU) and HIV prevalence among IDU, in particular to provide estimates for developing and transitional countries. Collation and review of existing estimates of IDU prevalence and HIV prevalence from published and unpublished documents for the period 1998-2003. The strength of evidence for the information was assessed based on the source and type of study. Estimates of IDU prevalence were available for 130 countries. The number of IDU worldwide was estimated as approximately 13.2 million. Over ten million (78%) live in developing and transitional countries (Eastern Europe and Central Asia, 3.1 million; South and South-east Asia, 3.3 million; East-Asia and Pacific, 2.3 million). Estimates of HIV prevalence were available for 78 countries. HIV prevalence among IDU of over 20% was reported for at least one site in 25 countries and territories: Belarus, Estonia, Kazakhstan, Russia, Ukraine, Italy, Netherlands, Portugal, Serbia and Montenegro, Spain, Libya, India, Indonesia, Malaysia, Myanmar, Nepal, Thailand, Viet Nam, China, Argentina, Brazil, Uruguay, Puerto Rico, USA and Canada. These findings update previous assessments of the number of countries with IDU and HIV-infected IDU, and the previous quantitative global estimates of the prevalence of IDU. However, gaps remain in the information and the strength of the evidence often was weak.

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A recent outbreak of human immunodeficiency virus type 1 infection in southern China was initiated by two highly homogeneous, geographically separated strains, circulating recombinant form AE and a novel BC recombinant.

Justina Liu, Wei Chen, Thomas McCutchan … (2000)

New outbreaks of human immunodeficiency virus type 1 (HIV-1) among injecting drug users (IDUs) are spreading in China along heroin trafficking routes. Recently, two separate HIV-1 epidemics among IDUs were reported in Guangxi, Southern China, where partial sequencing of the env gene showed subtype C and circulating recombinant form (CRF) AE. We evaluated five virtually full-length HIV-1 genome sequences from IDUs in Guangxi to determine the genetic diversity and the presence of intersubtype recombinants. Sequence analysis showed two geographically separated, highly homogeneous HIV-1 strains. B/C intersubtype recombinants were found in three IDUs from Baise City, in a mountainous region near the Yunnan-Guangxi border. These were mostly subtype C, with portions of the capsid and reverse transcriptase (RT) genes from subtype B. The subtype B portion of the capsid was located in the N-terminal domain, which has been shown to influence virus core maturation, virus infectivity, and binding to cyclophilin A, whereas the subtype B portion of RT was located in the palm subdomain, which is the active site of the enzyme. These BC recombinants differed from a BC recombinant found in Xinjiang Province in northwestern China. CRF AE strains were found in IDUs from Nanning, the capital of Guangxi, and in IDUs from Pingxiang City near the China-Vietnam border. The AE and BC recombinants were both remarkable for their low interpatient diversity, less than 1% for the full genome. Rapid spread of HIV-1 among IDUs may foster the emergence of highly homogeneous strains, including novel recombinants in regions with multiple subtypes.