HIV-1 molecular epidemiology evidence and transmission patterns in the Middle East and North Africa
- Ghina Mumtaz1,
- Nahla Hilmi2,
- Francisca Ayodeji Akala2,
- Iris Semini3,
- Gabriele Riedner4,
- David Wilson5,
- Laith J Abu-Raddad1,6,7
- 1Infectious Disease Epidemiology Group, Weill Cornell Medical College – Qatar, Cornell University, Qatar Foundation, Education City, Doha, Qatar
- 2Human Development Sector, Middle East and North Africa Region, World Bank, Washington, DC, USA
- 3Joint United Nations Programme on HIV/AIDS Regional Support Team, Middle East and North Africa, Cairo, Egypt
- 4Regional Office of the Eastern Mediterranean, World Health Organization, Cairo, Egypt
- 5Global HIV/AIDS Program, World Bank, Washington, DC, USA
- 6Department of Public Health, Weill Cornell Medical College, Cornell University, New York, New York, USA
- 7Vaccine and Infectious Disease Institute, Fred Hutchinson Cancer Research Center, Seattle, Washington, DC, USA
- Correspondence to Dr Laith J Abu-Raddad, Infectious Disease Epidemiology Group, Weill Cornell Medical College – Qatar, Qatar Foundation, Education City, P.O. Box 24144, Doha, Qatar;
Contributors LJA conceived and led the design and conduct of this study; co-led the literature reviews and collection, analysis and interpretation of the data; and contributed to the drafting of the manuscript. GM led the drafting of the manuscript and co-led the literature reviews and collection, analysis and interpretation of the data. NH contributed to the literature reviews and assisted in the general conduct of the research. FAA, IS, GR and DW contributed to the interpretation of the results, contributed to the drafting of the manuscript, and provided data at the regional and country level. All authors were involved in the finalisation of the manuscript and approved the final version.
- Accepted 24 August 2010
- Published Online First 29 October 2010
The distribution of HIV-1 subtypes in a population tracks the spread and evolution of the epidemic. This study is a systematic review of all available evidence on HIV-1 molecular epidemiology and subtype distribution in the Middle East and North Africa. Sources of data included Medline and various institutional documents and databases. In several countries, a diverse distribution of HIV-1 subtypes was observed principally reflecting travel-related exogenous exposures. A trend for a dominant HIV-1 subtype was observed in a few other settings and was often linked to HIV transmission within specific high-risk groups such as subtype A and CRF35_AD among injecting drug users and subtype C among commercial sex networks. Multiple exogenous introductions of HIV-1 variants seemed common to all countries, as observed from the high diversity in subtypes, or the high genetic divergence among any specific subtype even if predominant. In several countries though, epidemic-type clustering of specific subtypes suggests established or nascent HIV epidemics among classic core risk groups for HIV infection. HIV prevention efforts in MENA must be prioritized for these high-risk groups.
Funding The MENA HIV/AIDS Epidemiology Synthesis Project was funded through a joint partnership of the World Bank, the MENA Regional Support Team of the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the Eastern Mediterranean Regional Office (EMRO) of the WHO. LJA and GM are also grateful for the Qatar National Research Fund for supporting this work (NPRP 08-068-3-024).
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.