13 October 2008

Drug-resistant HIV in China

Drug-resistant HIV strains are turning up in parts of China as the virus stretches beyond high-risk groups and gains a stronger foothold in the general population, researchers say.

Drug-resistant HIV strains are turning up in parts of China as the virus stretches beyond high-risk groups and gains a stronger foothold in the general population, a leading Chinese Aids researcher said.

Chen Zhiwei, director of the Aids Institute in Hong Kong, described the trends as "alarming" and warned that Chinese Aids patients could get in trouble because there were very few HIV drugs available in China.

"All these drug-resistant mutations are in China now, they are emerging in Chinese patients. The major worry is whether the drug-resistant virus (strains) will spread," Chen said. "We are studying whether that is happening, but that will be the case if you don't provide proper treatment.

"If drug resistant virus (strains) spread in China, we don't have enough selection of (drugs) that are made available," Chen said, adding that researchers had urged China to import more varieties of HIV drugs.

China has only seven of the more than 20 different HIV drugs on the market, which means patients have limited options once they develop resistance to certain drugs.

Poor patient knowledge means bad drug adherence
Although HIV infection is incurable, cocktails of the drugs can control the virus. But drug adherence is bad in China's rural regions due to poor patient knowledge, inaccessible healthcare and a lack of health workers to explain to patients the importance of staying on drug regimens.

Chen's warning comes after he and his colleagues published an article in Nature last week, detailing how HIV infections were rising sharply among women and gay and bisexual men in China.

There were some 700 000 HIV/Aids cases in China as of October 2007, up 8% from 2006. Some 38% of cases were attributed to heterosexual contact, more than triple the 11% in 2005 - when the bulk of infections were occurring among injecting drug users and through blood transmissions.

Cases among gay and bisexual men jumped to 3.3% in 2007 from 0.4% in 2005 nationally.

In a separate study of south-western Yunnan province - a region notorious for HIV infections among drug users - the scientists found that women now make up 35% of those infected, up from 7.1% before 1996.

Travelling prostitutes pose problem
"The virus is moving into the general population. Signs are prevalent among women and vertical transmission (from mother to foetus)," he said.

"We have to find a way to stop this or the change will be like South Africa. If there is no good prevention, transmissions will suddenly explode," said the scientist. Chen said the porous southern Chinese border was a concern.

An HIV strain circulating in Yunnan is also found in Thailand and Myanmar, which could be partly explained by Chinese women working as prostitutes in Indochina, he said. "They travel to and from Indochina. They work in Thailand, then they bring the virus back," he said.

Travellers crossing the southern border may be responsible. "Last year, we randomly tested travellers and found 30 people from Myanmar, Laos and Vietnam who were HIV positive. We try to test the bridging population and see what's going on," Chen said. – (Reuters Health, October 2008)

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Experts call for new HIV strategy


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Dr Sindisiwe van Zyl qualified at the University of Pretoria in 2005. She is a patients' rights activist and loves using social media to teach about HIV. She is in private practice in Johannesburg.

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