title: Socio-demographic and drug use factors associated with HIV-1 recombinants and dual infections in Northern Thai drug users: associations of risk with genetic complexity.
abstract: BACKGROUND
  Dual infection with diverse HIV strains can foster the emergence of recombinants. The resulting increase in viral genetic diversity is a major challenge for vaccine development HIV treatment. In this study we aim to investigate the socio demographic factors associated with an increasing level of genetic diversity among HIV strains in a population of drug-users in Northern Thailand.
  
  
  METHODS
  From 1999 through 2000, 2231 volunteers were enrolled in the Opiate-Users Research in Chiang Mai, Thailand. HIV subtype analysis was conducted among those HIV-1 seropositive (n=347) using a multi-region hybridization assay. Social and demographic variables were assessed using a structured questionnaire.
  
  
  RESULTS
  Overall, 336/347 (96.8%) of the samples could be typed. 81.8% were CRF01_AE, 3.9% were subtype B, 9.2% were recombinants (mostly between CRF01_AE and B) and 5.1% were dual infections. Dual infections were more frequent among those with a lower education level (AOR: 5.2; 95% CI 1.4-20.3), those who have initiated injecting in the last 3 years (AOR: 3.9; 95% CI 1.1-14.6), and those reporting frequent needle sharing in the last 3 months (AOR: 7.0; 95% CI 1.5-34.1). Both recombinant strains and dual infection were more frequent among those reporting frequent needle sharing in the last 3 months (AOR: 5.3; 95% CI 1.6-17.1).
  
  
  CONCLUSIONS
  To limit the expanding complexity of HIV-1 strains, early intervention should be aimed at reduction in needle sharing, especially among new intravenous drug users.
authors.affiliation: US Military HIV Research Program, Henry M Jackson Foundation, Rockville, MD 20850, USA. drkijak@gmail.com
authors.forename: G H
authors.initials: GH
authors.lastname: Kijak
authors.forename: C
authors.initials: C
authors.lastname: Beyrer
authors.forename: S
authors.initials: S
authors.lastname: Tovanabutra
authors.forename: T
authors.initials: T
authors.lastname: Sripaipan
authors.forename: V
authors.initials: V
authors.lastname: Suriyanon
authors.forename: N
authors.initials: N
authors.lastname: Moqueet
authors.forename: E
authors.initials: E
authors.lastname: Sanders-Buell
authors.forename: P
authors.initials: P
authors.lastname: Saokhieo
authors.forename: U
authors.initials: U
authors.lastname: Timpan
authors.forename: J
authors.initials: J
authors.lastname: Jittiwutikarn
authors.forename: M L
authors.initials: ML
authors.lastname: Robb
authors.forename: D L
authors.initials: DL
authors.lastname: Birx
authors.forename: D D
authors.initials: DD
authors.lastname: Celentano
authors.forename: F E
authors.initials: FE
authors.lastname: McCutchan
mesh_terms: D000293:Adolescent; D000328:Adult; D003710:Demography; D055030:Drug Users; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000235:genetics* / Q000276:immunology / Q000635:transmission; D006679:HIV Seropositivity / Q000150:complications* / Q000453:epidemiology / Q000235:genetics / Q000635:transmission; D015497:HIV-1 / Q000145:classification / Q000235:genetics* / Q000276:immunology / Q000302:isolation & purification; D006801:Humans; D008297:Male; D012307:Risk Factors; D012959:Socioeconomic Factors; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D019966:Substance-Related Disorders / Q000150:complications / Q000453:epidemiology; D013785:Thailand / Q000453:epidemiology; D055815:Young Adult