Opium dependence was indigenous to countries in the Golden Triangle area in south-east Asia (SA). Heroin epidemics developed in most SA countries in the 1960s and early 1970s and remained a significant problem particularly in Myanmar, Thailand and Malaysia until now. In contrast, the island countries in SA seemed quite free from opiate abuse. Intravenous injection (IV) of drugs appeared after the heroin epidemic and currently prevails in countries with a significant opiate abuse problem. IV of opium was particularly common in the highly urbanized cities in Vietnam. Most SA countries started HIV seroscreening in IV drug users (IVDU) around the middle of the 1980s. Rapid epidemic spread of HIV infection was observed in 1988-89 in Thailand and Myanmar. The Highest prevalence of more than 80% was reported from a study of IVDUs in Yangon, Myanmar, followed by Thailand at about 40%. Although HIV infected IVDUs were identified at the same time in Malaysia and later in Singapore and the Philippines, there was no evidence of such a rapid and severe epidemic.
Opium has been produced and consumed since the nineteenth century in the areas of Asia currently referred to as the Golden Crescent and the Golden Triangle. In the 1970s and 1980s, most countries from Afghanistan to Japan experienced a heroin epidemic of varying degrees of severity. Opium and heroin abuse appeared to be more severe in countries and areas where those drugs were produced, an exception being Hong Kong, which has had a large population of heroin abusers for more than two decades. Drug injecting was far more common in countries of the Golden Triangle than in those of the Golden Crescent. In Myanmar and Thailand, for example, up to 90 per cent of chronic heroin abusers practised intravenous injection, which appeared to spread to heroin abusers in nearby territories such as the State of Manipur in India. Yunnan province in China, as well as Malaysia and Viet Nam. Amphetamine abuse was more frequent in Japan and the Republic of Korea for a number of years, while illicit production and consumption in the Philippines have recently shown significant increases. The injection of amphetamines was common only in the Republic of Korea. The prevalence of injecting among institutionalized methamphetamine abusers was reported at about 90 per cent. Most countries in Asia first reported cases of infection with the human immunodeficiency virus (HIV) in the mid-1980s. An extremely rapid spead of the epidemic and high prevalence, at rates of from 30 to 90 per cent, of HIV infection among the sample of intravenous heroin abusers were observed in a few countries with a high prevalence of intravenous injecting, such as India (in the State of Manipur), Myanmar and Thailand. The rest had either few reported cases or none at all, even though needle-sharing was found to be common. Great caution should be exercised in interpreting prevalence because of vast differences in methods of assessment. Given the vulnerability of intravenous drug abusers to rapid transmission of HIV infection, the prevention of drug injecting is of paramount importance in arresting the spread of the epidemic. Efforts to contain drug abuse, though difficult, are a principal means of achieving that end.
Human immunodeficiency virus (HIV) has spread widely among injecting drug users (IDUs) in countries to the north and west of the 'Golden Triangle' region of South-East Asia; it is likely to have spread southwards to Malaysia as well. In order to assess HIV seroprevalence among IDUs in north-east Malaysia and describe risk factors for HIV infection in this population, we performed a cross-sectional seroepidemiological study among 210 IDUs recruited at the detoxification ward of the General Hospital in the capital city of the north-eastern Malaysian state, Kelantan. Subjects were sequential entrants to the detoxification ward, interviewed about HIV risk behaviour, and tested for antibody to HIV and to syphilis. Nearly a third (62/210, 30%) of these IDUs were HIV seropositive. Three-quarters (159/210) had travelled to Thailand in the preceding 5 years, of whom 32% (51/159) were HIV seropositive; this was associated with injecting in Thailand, but not with sexual contact there. Of those who had not left Malaysia in the preceding 5 years, 26% (11/43) were HIV seropositive, a rate not significantly different from those who had travelled. Travel within Malaysia was common (144/210, 69%) among IDUs interviewed, as was unsafe injecting and unsafe sexual behaviour (20% had shared injecting equipment and 21% had had unprotected intercourse) in other states. In every locale, rates of unsafe injecting behaviour were high (55% sharing in last month), even among those who knew they were HIV infected, and rates of condom usage were low (93% of 160 sexually active IDUs had never used a condom). Syphilis was not associated with HIV infection, but with contact with Thai prostitutes.(ABSTRACT TRUNCATED AT 250 WORDS)
The hepatitis delta virus (HDV) is an RNA containing virus that requires hepatitis B virus (HBV) to supply the envelope proteins. HDV only infect man in the presence of HBV, either as a coinfection or as superinfection in HBV carriers. In the presence of hepatitis B infection, the HDV may cause more severe liver damage than that caused by the hepatitis B virus alone. HDV infection was studied in 44 HBsAg positive serum samples collected from male intravenous drug users sent for screening to the Blood Services Centre (BSC), Hospital Kuala Lumpur (HKL) between 1990 and 1992. The majority (39) were in the 20 to 39 age group. The youngest was 19 years old and the oldest was 61 years old. There were 25 Malays, 13 Chinese, five Indians and one Albanian. Anti hepatitis delta antibody (Anti-HDV) was detected in 15 out of 44 (34%) of the drug addicts. These results shows an increased in delta infection in HBsAg positive intravenous drug addicts compared to the surveillance results in 1985 when no delta antibodies were detected, and the 1986 and 1989 surveillance which showed 17.8% and 20% delta antibody positivity respectively.
A study was conducted to determine the feasibility of establishing a sentinel human immunodeficiency virus (HIV) surveillance system involving patients with sexually transmitted diseases attending private clinics and a government sexually transmitted disease clinic in Kuala Lumpur, Malaysia. Information on risk behaviours for HIV infection were also collected. A total of 84 female and 91 male patients were interviewed and tested for HIV infection; 41.7% of the women reported working as prostitutes, other occupations included masseuses, hairdressers, waitresses, salesgirls, receptionists, factory workers, and others. The most common diagnosis was gonorrhoea. Other diagnoses included non-specific genital infection, pelvic inflammatory disease, genital herpes and syphilis. 58.3% of the women had a hundred or more sex partners during the previous month; 99% had 6 or more sex partners. Only 4.8% of female patients had their male partners using condoms most of the time, 11.9% hardly used condoms at all. Of the males, 93.3% were heterosexual, while 6.7% were bisexuals, 41.1% had between 6-20 different partners in the previous year. 78.0% of them had prostitutes as their sex partners most of the time. 41.8% had experiences in Thailand and the Philippines. 73.6% never used condoms, while 19.8% only used condoms rarely. Although all patients were tested negative for HIV antibodies, lot quality assurance sampling methods indicate that the upper limits of prevalences for females and males were 3.5% and 3.3% respectively, at a 5% type I error. The study has shown that it is feasible to carry out a sentinel surveillance programme among STD patients and provided useful baseline data for future comparisons.(ABSTRACT TRUNCATED AT 250 WORDS)
The spread of HIV infection into Malaysia is estimated to have occurred in the early 1980's. The first case of AIDS was reported here in 1986. As of March 31, 1994, the numbers have increased to 8049 HIV positive individuals detected in the country. The risk behaviours among those tested positive were intravenous drug use in 77.2%, sexual transmission in 4.5%, while the remainder are still under investigation. Pediatric AIDS constitutes 0.2% of positives. The high prevalence among intravenous drug users (IVDU) is likely to be due to mandatory testing for HIV upon entry to rehabilitation centres. The trend of HIV infection in this country seems to be highest amongst the intravenous drug users. The increasing number of HIV infected prostitutes and heterosexuals in our population is worrying. Since 1986, a total of 104 HIV positive individuals have been treated at the University Hospital, Kuala Lumpur, Malaysia. Of these, 25 have died and of those still alive, 5 have symptomatic disease. The most common AIDS-defining illness is Pneumocystis carinii pneumonia. Education programmes have been developed targeting the various high risk groups and the general population.
HIV spread in South and South-East Asia is most alarming, and genetic variability of HIV-1 is an important consideration in vaccine development. In this study, we examined the third variable (V3) region of env gene of HIV-1 variants prevalent in Thailand, Malaysia, India, and the Philippines. By phylogenetic tree analyses, an HIV-1 variant from an injecting drug user (IDU) in Thailand belonged to subtype B, and HIV-1 variants from 2 IDUs in Malaysia were classified into 2 subtypes, B and E. One HIV-1 variant from a male homosexual in the Philippines belonged to subtype B. Out of 8 HIV-1 variants from sexually transmitted disease patients in India, 7 belonged to subtype C, and one to subtype A. Although the total number of individuals examined in this study was limited, 4 HIV-1 subtypes were found in South and South-East Asia and large international movements of HIV-1-infected individuals in this region could induce global dissemination of these HIV-1 variants.
One hundred and seventy-one drug-dependent females in a drug rehabilitation centre were studied to estimate the prevalence of HIV infection among them. Twenty-four (14%) were positive on the Western Blot test. The presence of HIV infection was significantly correlated with syphilis (p < 0.03) and age (p < 0.001); 83% of those who were HIV positive were intravenous drug users. The need for harm reduction programmes to prevent spread of HIV infection among injecting drug users is stressed.
The incidence of new HIV infections in Asia and the Pacific will soon pass that in Africa and is projected to increase into the next century. The AIDS epidemic arising from these infections will have enormous consequences for the health and socioeconomic development of a region encompassing more than half the world's population.
Between 1987 to 1995, a total of 334 patients infected with HIV were treated at the Hospital Kuala Lumpur. There were 159 Malays, 108 Chinese, 64 Indians, and 3 from other ethnic groups. Three hundred and twenty-one (96.1%) of these individuals were males and 262 (65.9%) were between the ages of 26-45 years. Intravenous drug users made up 77% (256) of the attributable risk behaviour from the group although many of them also had added risk behaviours like heterosexual activity with multiple partners (50 patients), tattoos (7 patients), homosexual practice (4 patients) and previous transfusions (3 patients). The others acquired their infection through heterosexual promiscuity (59 patients), homo/bisexual activity (7 patients), previous transfusion (5 patients) and tattoos (1 patient). Sixty-six patients (all males) had since progressed to full blown AIDS and 10 have died. The two commonest AIDS-defining events were tuberculosis infection and Pneumocystic carinii pneumonia occurring in 37 (56%) and 15 (22.7%) of patients respectively. Forty-one patients with AIDS presented for the first time with their AIDS-defining infections. The mean CD4 count of the patients when they progressed to AIDS was 130/mm3. The mean time for progression from "known" seropositivity to AIDS was 2.42 years. These results suggest that Malaysians infected with HIV are not coming forward for treatment until they are in the advanced stage of the disease.
The method of backcalculation estimates past HIV infection rates from available AIDS incidence data and an estimate of the incubation period. The method is used on the Malaysian data to model the AIDS epidemic because it makes use of the Malaysian AIDS incidence data which is fairly reliable and is more reflective of the trend of the epidemic as compared to the HIV infection rate recorded. An application is made on the monthly AIDS incidence data in Malaysia from January 1995 until August 1996 released by the Ministry of Health, Malaysia using the backcalculation program from Bacchetti et al and the incubation period distribution from Brookmeyer to generate the current HIV infection rate for Malaysia (until August 1996).
Regular blood transfusions for patients with thalassemia have improved their overall survival although these transfusions carry a definite risk of the transmission of certain viruses. Infection with hepatitis B virus (HBV), hepatitis C virus (HCV), cytomegalovirus (CMV) and human immunodeficiency virus (HIV) leads to complications which contribute to the morbidity and mortality of patients with thalassemia. We analyzed the blood samples taken from 85 transfusion dependent thalassemics receiving treatment at the day care center in Hospital Universiti Kebangsaan Malaysia and found that the seroprevalence rates for HBV, HCV and CMV were 2.4%, 22.4% and 91.8% respectively. None of the patients tested positive for HIV. Those positive for HBV and HCV will require further tests and treatment if chronic hepatitis is confirmed.