Should the “New” Russian HIV Strain Cause Concern?

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There has been a lot of play in the press recently about a “new and more virulent strain of HIV” (Daily Mail, Oct. 17) that appears to be spreading quickly in parts of Russia and Central Asia.

According to the epidemiological reports, this new recombinant form of HIV-1 — called 02_AG/A — is spreading at a faster rate than the dominant subtype, HIV-1 A. Moreover, the prevalence rate in some parts of Siberia have spiked by as much as 700% in the past five years, with nearly one out of every 180 persons infected.

Of these, 50% can be attributed to 02_AG/A.

What’s causing the most concern among global health officials is the fact that Eastern Europe and Central Asia are the two areas in the world where HIV infections are actively increasing.

The question is whether this “new” HIV strain is the cause of the increase. Is it as virulent as some are claiming, or are there other factors playing a key role (e.g., social, behavioral)?

Looking at the epidemic up-close, injection drug users and their sexual partners still remain the major drivers for the epidemic in the majority of Russian regions. A steady drug trade from Central Asia through the western borders of Russia — combined with increases in migratory labor and international travel — have likely contributed to the genetic diversity in the regional HIV pool.  Over time, this gave rise a recombinant form of HIV that appears to be more “fit” than other forms of HIV, allowing it to predominate.

But does this, in and of itself, mean that 02_AG/A is a “meaner, scarier” version of HIV, able to infect more easily than other HIV strains?

In truth, the fact that it has spread so quickly, taking a leading position in some regions, does warrant concern. One study conducted by the New York University School of Medicine suggests that 02_AG/A is able to replicate nearly 1.5 times faster than parental subtype A. Simply put, the replication rate may allow the virus to “build traction” more quickly in an effected host, far in advance of an immune response.

But what all of this doesn’t suggest is that 02-AG/A is any more or less deadly than other forms of HIV. In fact, a four-year study by the University of Montepelier in France showed that the 02_AG strain (which predominates in Cameroon and West-Central Africa) does not differ from other forms of HIV in the region, either in terms of survival, disease progression, or CD4 cell decline.

However, none of this can downplay the fact that, unless Russian health authorities act now, the spread of 02_AG/A may thwart any effort to stave the alarming HIV infection rates in the region… or the spread the virus to other regions and continents.

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