Collaborating with colleagues from the Institute of Life Sciences in Jiangsu, the Second People’s Hospital of the Yunnan Center for Disease Control and Prevention, and the Yunnan Kunming Blood Center, Drs. PANG Wei and ZHENG Yongtang of the Kunming Institute of Zoology (KIZ, CAS) undertook an in-depth study on the rising entanglement of the drug trade and HIV-1 epidemic along the Golden Triangle.
The border between Myanmar and China is quickly becoming the largest conduit for the trafficking of illicit drugs into Asia, in large part because Myanmar is a global leader in the production of opium poppies, second only to Afghanistan. Unfortunately, Myanmar is also a leader in HIV infections: nearly a fifth of all female sex workers and a third of intravenous drug users (IDUs) tested HIV+ in 2008.
The border towns between Myanmar and China are even harder hit, as HIV and other co-infections like Hepatitis C are strongly associated with drug trafficking routes and drug users. Along the northern border of Myanmar in Kachin state, HIV infections among IDUs range from 77-93%. Southwestern China is not immune to these trends. In the border city of Dehong, Yunnan province HIV infection rates among IDUs were 42-75%. To complicate matters, a growing number of new HIV variants have begun circulating between infected populations.
HIV-1 infections can be grouped by several subtypes. In Asia, the most popular variants include subtypes B and CRF_AE, which originated in Thailand, and subtype C, from India. Throughout the 1980s and 90s, subtypes B and C spread along drug-trade routes from Xinjiang and Southeast Asia into Yunnan, but were largely confined to drug using populations. Among IDUs, these two HIV variants mixed, forming what became known as CRF_BC. CRF_AE meanwhile was transmitted mainly through heterosexual contact throughout Thailand and spread upwards in to China and the rest of Asia.
In less than two decades, the situation in northern Myanmar was greatly different than in the rest of Asia. PANG and ZHENG found that very few cases were of these typical variants. Instead, over 85% of HIV infections were new intersubtype recombinants that were not only different from one another, but from any previously documented. The strong appearance of these new infections suggests that along the Chinese-Myanmar border, traditional segregation between the sex trade and drug trade are breaking down, allowing all three subtypes to mix and form all new variants.
While Myanmar increasingly links China and Yunnan to the rest of Southeast Asia in trade and tourism, it is also central to the dispersion and growth of HIV-1, acting a foundry for new mutations of the virus. Though the implications of this are serious, there is one upside—the border between China and Myanmar is an ideal laboratory to study the evolution and dispersion of HIV-1and will substantially allow researchers to gather data and contribute to devising new ways of controlling the HIV/AIDS Pandemic.
The full paper, “Extensive and complex HIV-1 recombination between B’, C, and CRF01_AE among IDUs in south-east Asia” can be found in the June 2012 issue of the journal AIDS 26: 1121-1129or online at http://journals.lww.com/aidsonline/Abstract/2012/06010/Extensive_and_complex_HIV_1_recombination_between.8.aspx. This work was supported in part by grants from the Key Scientific and Technological program of China, National Basic Research Program of China, the Natural Science Foundation of China, the Chinese Academy of Sciences, and the Scientific and Technological Program of Yunnan Province.
