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Official websites use. Share sensitive information only on official, secure websites. HIV strains continuously evolve, tend to recombine and new circulating variants are being discovered. Novel strains complicate efforts to develop a vaccine against HIV and may exhibit higher transmission efficiency and virulence, and elevated resistance to antiretroviral agents. In this context, molecular epidemiology becomes invaluable as it captures trends in HIV evolution rates that shape epidemiological pictures across several geographical areas. The latter was first identified in Afghanistan. In , unexpected cases of Kaposi sarcoma and Pneumocystis carinii now known as jirovecii pneumonia were diagnosed among young men who have sex with men MSM Centers for Disease Control, a , b ; Gottlieb et al. The most recent ancestor of the pandemic strain was probably circulating in human populations in Central Africa early in the 20 th century Faria et al. However, considerable progress has occurred over the years, which transformed HIV from a lethal disease to a chronic condition. Combinations of potent antiretroviral drugs antiretroviral treatment - ART in simplified regimens have significantly reduced morbidity and mortality, and people infected today can anticipate an almost normal life expectancy Mills et al. In addition, treatment as prevention TasP Cohen et al. In this context, molecular studies become invaluable as they shed light on parameters that traditional epidemiological techniques fail to capture. This geographical area includes countries with past or recent PWID-related outbreaks Nikolopoulos et al. HIV-2 is mostly concentrated in West Africa although it has been detected in other geographical settings, especially in those with historical and political ties to West Africa Campbell-Yesufu and Gandhi, ; Soriano et al. HIV-1 is the pandemic type and consists of 4 groups, M, N, O and P, each of which represent independent cross-species transmission events of SIV from chimpanzees Pan troglodytes troglodytes and gorillas D'arc et al. Group N has been identified in very few cases accounting for approximately 0. Group P was discovered in and has been detected insofar in only two persons D'arc et al. Around , Group M transitioned epidemiologically to a faster growth rate outpacing regional population growth and managed to spread globally Faria et al. Geographical patterns are not stable and may change over time. Although a biological effect on the different and changing estimates of subtypes prevalence is uncertain, previous research has found, for instance, that subtype A viruses had higher rates of heterosexual transmission and lower rates of disease progression than subtype D viruses in the Rakai district of Uganda Kiwanuka et al. Changes in the distribution of HIV subtypes over time is certainly a complex and multifactorial phenomenon, and includes founder effects, population growth and mixing, migration and interconnectivity between geographical settings Hemelaar et al. It should be noted that recent reviews suggest an even higher prevalence for subtype B and much lower for subtype C Lau and Wong, An HIV infectee can pass the virus onto susceptible individuals usually through unprotected sexual intercourse, by sharing of injecting equipment, and vertically such as from infected mothers to children during pregnancy, at delivery, and through breastfeeding Cohen et al. A systematic review has calculated that approximately 16 million people worldwide inject drugs. Of these, 4 million are in East and Southeast Asia, 3. It is estimated that Around 3 million 0. PWID may also suffer from mental illness, co-infection with hepatitis B or C and tuberculosis is common, and they are at increased risk of experiencing drug overdose, violence, and incarceration Kamarulzaman and Altice, Although not corroborated by some studies Wood et al. The collapse of Former Soviet Union was followed by economic instability, newly-established networks of drug trafficking, high unemployment rates, serious destruction of norms and values, intergenerational gaps, and youth alienation, which, in turn, contributed to increased rates of injecting drug use and a huge HIV epidemic among PWID Friedman et al. It is estimated that around 1. In the gray region, subtype B predominates. Between the late s and early s, HIV diagnoses in FSU were rather limited, primarily representing sexually-acquired infections mostly abroad and nosocomial outbreaks affecting children in southern Russia, and were characterized by substantial molecular diversity circulating strains included subtypes A-D, F, G, H, and some recombinants Bobkov et al. Migratory waves between the FSU states and other countries, and increasing rates of heterosexually-acquired HIV infection have produced some changes in the molecular epidemiological patterns of FSU countries. It should be mentioned that A1 has been spreading in some Central and Western European countries through sexual or injecting networks Lai et al. B FSU IDU-B is a common variant in the region Bobkova, but failed to spread widely outside of Ukraine creating mainly localized epidemics in Nikolayev, an important transportation junction of Ukraine where the strain was first identified Nabatov et al. Spain and Portugal experienced an enormous HIV spread among PWID in the s and their epidemics are characterized by substantial viral diversity and distinct molecular properties compared to other European countries Carvalho et al. Before , HIV-1 infections among drug injectors in Greece were rather sporadic and not phylogenetically clustered indicating limited networks of transmission in this group Paraskevis et al. The two recombinants had not been identified in samples collected before and phylodynamic analyses estimated the start of their transmission clusters in Paraskevis et al. Outbreak subtypes A and B originated in Greece; the B cluster begun earlier than the others, probably in Paraskevis et al. The Romanian epidemic has been dominated by subtype F1, being a unique case in Europe Stanojevic et al. It is estimated that one F1 cluster started earlier than the others Paraskevis et al. Contrary to the Greek and Romanian cases, previous outbreaks in Western and Central European settings were primarily caused by a single circulating clade although other strains could co-circulate as well Paraskevis et al. Injecting drug use has been fueling the HIV epidemic in many parts of this region, which includes the two primary opium-producing areas in the world: the Golden Crescent defined by peripheries of mountains in Afghanistan, Iran and Pakistan, and the Golden Triangle than spans Myanmar Burma , Laos, Vietnam, and Thailand. Genetic complexity, however, has increased over time as multiple recombination events took place Figure 2. Note: Deep purple highlights countries that include hotspots of genetic recombination between HIV-1 strains. Similarly to Thailand, Malaysia has been experiencing molecular shifts over the years. Subtype C is currently a minor clade with a prevalence at 1. The province of Yunnan that is located in the Southwest part of China and shares borders with Vietnam, Laos, and Burma Myanmar , has played an important role in HIV spread in China and serves as a hotspot of genetic mixing due to its closeness to the Golden Triangle and the heroin trafficking routes Beyrer et al. Subtype B', that soon became the predominant B clade in China Graf et al. Travel, trade and intermarriage across the Myanmar-China borders are common. This finding suggests that events of genetic mixture in Dehong and Northern Myanmar are, to some degree, independent. Beyond drug injectors who cross the borders and become infected probably by multiple co-circulating strains, other factors may contribute to high levels of genetic heterogeneity in the region. For instance, Burmese long-distance truck drivers who drive between Mandalay, Myanmar and Ruili, China, are engaged in unprotected sex with occasional, multiple partners or sex workers, and some of them also inject drugs Zhou et al. These drivers may serve as a bridge of bidirectional transmission between heterosexuals and PWID on both sides of the borders Zhou et al. Cross-border transmissions between Northern Vietnam and the Guangxi province of China have been reported Kato et al. India hosts more than 2. Injecting drug use is a risky practice associated with increased likelihood of HIV acquisition. However, on the other hand, comprehensive prevention approaches have been developed including scaling-up HIV testing, distribution of clean injection equipment, and increased access to substitution programs and ART that can significantly reduce infection rates in PWID Abdul-Quader et al. Molecular epidemiology has revealed underlying patterns of HIV spread that traditional epidemiological methods are inherently unable to capture. For example, we know that starting in Odessa, Ukraine, a major seaport of the Black sea, a particular variant, subtype A1, spread at impressively rapid rates among PWID and to almost every part of the former Soviet Union. This finding indicated the role of population movement in HIV spread, which should be taken into account when public health interventions are designed and implemented. As a matter of fact, in Greece, successful efforts to contain the epidemic Hatzakis et al. This is a major issue of public health concern as novel strains may further complicate the process of vaccine development, increase transmission and disease progression rates or change patterns of resistance to antiretrovirals Abecasis et al. In addition, molecular epidemiology has shown that HIV spreads in many parts of this region following routes of illicit drugs trafficking, which clearly shows that it might be hard to control HIV unless appropriate measures are taken to limit drug markets and trafficking. Taken all findings together, it seems that routine systems of collecting, analyzing and interpreting molecular information are urgently needed if we do want to understand better and deeper HIV diversity and its public health implications. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. As a library, NLM provides access to scientific literature. Infect Genet Evol. Published in final edited form as: Infect Genet Evol. Find articles by Georgios K Nikolopoulos. Find articles by Evangelia-Georgia Kostaki. Find articles by Dimitrios Paraskevis. Issue date Dec. PMC Copyright notice. The publisher's version of this article is available at Infect Genet Evol. Open in a new tab. Conflict of Interest. The authors declare that they have no conflict of interest. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.
Overview of HIV molecular epidemiology among People who Inject Drugs in Europe and Asia
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Both the male and female pathological gamblers were and continue to be actively involved in various forms of gambling. A greater proportion of males had engaged in almost all specific types of gambling, although differences between males and females were not all statistically significant. Males and females were very similar in terms of their patterns of drug and alcohol use and the substances they used when gambling. Males and females shared some reasons but also had separate reasons as to why they used heroin when they gambled. Males especially may participate in a variety of criminal and hustling activities to have the money to be able to gamble or to pay gambling debts. The implications of this research are discussed. This is a preview of subscription content, log in via an institution to check access. Rent this article via DeepDyve. Institutional subscriptions. Abbott, D. Google Scholar. Anglin, M. Treatment of Drug Abuse. Wilson eds. Drugs and crime pp. Chicago: University of Chicago. Ball, J. The effectiveness of methadone maintenance treatment New York: Springer-Verlag. Blaszczynski, A. Crime, antisocial personality, and pathological gambling Journal of Gambling Behavior 5 , — Brown, R. Pathological gambling and associated patterns of crime: Comparisons with alcohol and other drug addictions Journal of Gambling Behavior 3 , 98— Bruce, A. Male and female betting behavior: New perspectives. Journal of Gambling Studies 10 , — Custer, R. When luck runs out New York: Facts on File. Elia, C. The incidence of pathological gambling among Native Americans treated for alcohol dependence The International Journal of the Addictions 28 , — Griffiths, M. An exploratory study of gambling cross addictions Journal of Gambling Studies 10 , — Hubbard, R. Johnson, B. Johnson, E. The Rotter I-E Scale as a predictor of relapse in a population of compulsive gamblers. Psychological Reports 70 , — Lesieur, H. Gambling, pathological gambling, and crime. In Thomas Galski ed The handbook of pathological gambling Chapter 5, pp. When Lady Luck loses: Women and compulsive gambling. Pathological gambling among multiple substance abusers in a therapeutic community British Journal of Addiction 83 , — Problematic gambling and problematic drug use: Their interactions. Alcoholism, drug abuse and gambling Alcoholism: Clinical and Experimental Research 10 , 33— Maddux, J. Methadone dose and urine morphine Journal of Substance Abuse Treatment 8 , — Mark, M. A feminist critique of problem gambling research British Journal of Addiction 87 , — Martinez-Pina, A. The Catalonia survey: Personality and intelligence structure in a sample of compulsive gamblers. Journal of Gambling Studies 7 , — McAleavy, T. More women among problem gamblers The Bergen Record September 10, p. Meyer, G. Ramirez, L. Patterns of substance abuse in pathological gamblers undergoing treatment Addictive Behaviors 8 , — Roehrich, L. Opiate dependence, gambling, and HIV risk behavior in a low income population. Rosenthal, R. Pathological gambling Psychiatric Annals 22 , 72— Simpson, D. Addiction careers: Etiology, treatment, and twelve year followup Journal of Drug Issues 16 , — Spunt, B. Gambling among methadone patients International Journal of the Addictions 30 , — Steinberg, M. Cocaine abuse and pathological gambling American Journal on Addictions 1 , — Download references. National Development and Research Institutes, Inc. You can also search for this author in PubMed Google Scholar. Points of view or opinions in this report do not necessarily represent the official opinions or policies of the United States Government, National Development and Research Institutes, Inc. The authors wish to thank Leila Cahill and Michelle Silverman for their assistance with this research. Reprints and permissions. Pathological gamblers in methadone treatment: A comparison between men and women. J Gambling Stud 12 , — Download citation. Issue Date : December Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Home Journal of Gambling Studies Article Pathological gamblers in methadone treatment: A comparison between men and women Articles Published: December Volume 12 , pages —, Cite this article. Journal of Gambling Studies Aims and scope Submit manuscript. Access this article Log in via an institution. References Abbott, D. Google Scholar Anglin, M. Google Scholar Ball, J. Google Scholar Blaszczynski, A. Google Scholar Brown, R. Google Scholar Bruce, A. Google Scholar Custer, R. Google Scholar Elia, C. Google Scholar Griffiths, M. Google Scholar Hubbard, R. Google Scholar Johnson, B. Google Scholar Johnson, E. Google Scholar Lesieur, H. Google Scholar Maddux, J. Google Scholar Mark, M. Google Scholar Martinez-Pina, A. Google Scholar McAleavy, T. Google Scholar Ramirez, L. Google Scholar Roehrich, L. Google Scholar Simpson, D. Google Scholar Spunt, B. Google Scholar Steinberg, M. Google Scholar Download references. View author publications. Rights and permissions Reprints and permissions. About this article Cite this article Spunt, B. Copy to clipboard. Search Search by keyword or author Search. Navigation Find a journal Publish with us Track your research.
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Pathological gamblers in methadone treatment: A comparison between men and women
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