Better Syringe Designs Could Nearly Eradicate Global Annual HIV Infections from Syringe Sharing Within Eight Years
January 16, 2013 - RESEARCH TRIANGLE PARK, N.C. - Switching the type of syringe used by people who inject drugs could help curb HIV transmission in countries with injection-driven epidemics within eight years, according to a new article by researchers at RTI International and Futures Institute.
The commentary , published in the January issue of International Journal of Drug Policy (IJDP), summarizes existing evidence regarding how low dead-space syringes can help reduce HIV transmission and estimates potential impacts on HIV transmission among people who inject drugs.
According to the authors, when a plunger on a syringe is fully depressed, all syringes retain fluid in what has been termed "dead space." In high dead-space syringes, a 1000 times more blood is retained in the syringe after washing than in low dead-space syringes.
This suggests that if a person who injects drugs shares a high dead-space syringe with an HIV-positive injecting partner, they are more likely to be exposed to HIV than if he or she shared a low dead-space syringe.
Perhaps an even more important factor is that, before modern medicine and vaccinations, infectious diseases such as smallpox killed large numbers of people. People with compromised immune systems may have succumbed first, preventing the immunodeficiency virus from spreading.
If HIV crossed the species barrier many times, it is possible that selection favored protective genetic variants in the affected populations. Roca and his co-investigators looked for evidence of this selection in the Biaka genomes.
The Biaka are a human community that inhabits forests in the range of the chimpanzee subspecies believed to be the source of the current HIV pandemic. The researchers compared Biaka genomes with the genomes of four other African populations who live outside the chimpanzee's range.
Biaka genotypes were available through the Human Genome Diversity Project, which collected biological samples from 52 different population groups across the world. The project genotyped these diverse human communities for single nucleotide polymorphisms (SNPs, pronounced "snips"), or genomic variation, at around 650,000 locations across the genome.
Previous research that used cell lines made in the 1980s from individuals who had AIDS or were believed to be at risk for it had identified 26 genomic locations as being involved in resistance to HIV. Kai Zhao, a graduate student working in Roca's laboratory, examined these locations.
Zhao ran all 10 possible pairwise comparisons for the five human populations and looked for selection signatures. Specifically, selection for a genetic trait tends to reduce diversity in the surrounding genomic region within the affected population, increasing the differences between populations.
The researchers looked at the genomic regions that contain genes known to have a protective effect against HIV to see if there was any overlap with the selection signatures. Eight of the comparisons found overlap. Seven involved the Biaka.
They identified four genes in these overlaps that code for proteins affecting either the ability of HIV to infect the host cell or the disease progression. The researchers also found that for several genes, SNPs associated with protection against HIV-1 were common among the Biaka.
Roca cautions that these results should not be considered definitive. It is not possible to rule out false positives.
"You may detect a signature of selection, but it doesn't necessarily mean that selection has caused it. It's just a good sign that selection may have occurred," he said. Also, the signature of selection may span several genes, of which only one is actually protective against HIV-1.
However, he said that the results are intriguing and indicate that this line of research is worth pursuing.
"If additional studies confirm that these genes have undergone selection and that human populations in the region have some genetic resistance to HIV-1, one could try to find additional genes in the population that may also be protective against HIV but have not yet been identified," he said.
"The mechanism by which these genes work could be determined," he continued. "It could open up a new line of research for fighting retroviruses."
According to the authors, when a plunger on a syringe is fully depressed, all syringes retain fluid in what has been termed "dead space." In high dead-space syringes, a 1000 times more blood is retained in the syringe after washing than in low dead-space syringes.