Understanding the Landscape of HIV Subtypes in Southeast Asia
The Importance of Tracking HIV Genetic Diversity
Young researcher Mirna Widiyanti emphasizes the crucial need for continuous monitoring of HIV subtypes, including circulating recombinant forms (CRFs), within Indonesia. Mirna, affiliated with the Center for Public Health and Nutrition Research at the National Research and Innovation Agency (BRIN), stresses that ongoing research characterizing the genetic makeup of HIV is essential for mapping its transmission patterns and predicting future trends in the epidemic.
“These characteristics are useful for mapping the course of HIV transmission in the population and can predict the continuation of the HIV epidemic,” she stated.
Dominance of CRF01_AE in Indonesia
Research indicates that CRF01_AE, a subtype of HIV-1, is one of the predominantly circulating subtypes in Indonesia. Compared to other subtypes within the HIV type 1 strain, CRF01_AE, classified as a circulating recombinant form, has been found to progress faster to AIDS, based on in vitro studies.
Further highlighting its prevalence in Southeast Asia, “We have read several research results that show that HIV subtype B is mostly transmitted in the homosexual population and injecting drug users, while the CRF01 type is transmitted more in the heterosexual population,” Mirna revealed.
In contrast to the CRF subtypes, unique recombinant forms (URFs) have been identified in Africa but have not yet been detected in Indonesia.
Global Distribution of HIV Subtypes
HIV-1, the most widely distributed type of HIV globally, is categorized into four groups, with group M (major) encompassing subtypes A, B, C, D, F, G, H, J, and K.
Other subtypes
Several other subtypes, including subtype B and recombinant AG, have also been identified across Indonesia. Globally, HIV subtype B is prevalent in Australia, North America, parts of South America, and parts of Europe. In Southeast Asia, the CRF01_AE virus is commonly found in Thailand and Indonesia.
The Challenge of Reaching Global HIV Targets
According to UNAIDS data in 2023, an estimated 40 million people worldwide are likely to be infected with HIV this year. Southeast Asia accounts for 3.8 million cases, making it the region with the second highest number of HIV infections, trailing behind Africa with 25.7 million cases.
To eliminate HIV by 2030, UNAIDS has established the 95-95-95 strategy. This strategy aims to ensure that 95% of people living with HIV know their status, 95% of those diagnosed receive antiretroviral therapy (ART), and 95% of those on ART achieve viral suppression.
Data from Indonesia’s Ministry of Health shows that the estimated number of PLHIV will reach 515,455 in 2023. However, progress towards the 95-95-95 targets remains slow. As of April 15, 2024, only 67% of PLHIV know their status, 60% aware of their status are receiving ART, and only 34% of individuals on ART have achieved viral suppression.
Indonesian government remains committed to achieving these targets.
What are the potential implications of the finding that CRF01_AE, a prevalent subtype in Southeast Asia, may progress to AIDS more quickly than other subtypes?
## Understanding the Landscape of HIV Subtypes in Southeast Asia
**Interviewer:** Welcome to our show. Today, we’re talking about the importance of understanding the different subtypes of HIV circulating in Southeast Asia. Joining us is young researcher Mirna Widiyanti from the Center for Public Health and Nutrition Research at the National Research and Innovation Agency (BRIN) in Indonesia. Mirna, thanks for being here.
**Mirna Widiyanti:** Thank you for having me.
**Interviewer:** Mirna, can you tell us why it’s so important to track the genetic diversity of HIV, particularly in Southeast Asia?
**Mirna Widiyanti:** Absolutely. Southeast Asia has a high prevalence of HIV, and understanding the different subtypes circulating is critical for several reasons. [1](https://pubmed.ncbi.nlm.nih.gov/18219365/)
Firstly, different subtypes can have varying levels of virulence and transmissibility. This means some subtypes might progress to AIDS faster than others, requiring different treatment approaches.
Secondly, by tracking the genetic makeup of the virus, we can better understand how HIV is spreading within populations. Are certain subtypes more prevalent among specific demographics or geographic locations?
this information is essential for developing effective prevention and treatment strategies. Vaccines and antiretroviral drugs may need to be adapted based on the dominant subtypes circulating in a specific region.
**Interviewer:** And you mentioned Southeast Asia having a high prevalence of HIV.
What are some of the most common subtypes circulating in the region?
**Mirna Widiyanti:** One subtype that’s particularly prevalent in Southeast Asia, and especially Indonesia, is CRF01_AE. It’s a circulating recombinant form, meaning it’s a combination of different HIV subtypes. Research indicates that CRF01_AE might progress to AIDS more quickly compared to other subtypes. [1](https://pubmed.ncbi.nlm.nih.gov/18219365/)
**Interviewer:** That’s concerning. Are there other subtypes to be aware of?
**Mirna Widiyanti:** Yes, subtypes B and C are also present.
Interestingly, some studies suggest that subtype B is more commonly transmitted among men who have sex with men and injecting drug users, while CRF01_AE might be more prevalent in the general population. [1](https://pubmed.ncbi.nlm.nih.gov/18219365/)
**Interviewer:** This all highlights the need for continued research and surveillance. What are some of the ongoing efforts in Indonesia to track HIV subtypes?
**Mirna Widiyanti:** We at BRIN are actively involved in characterizing the genetic makeup of HIV circulating in Indonesia. We collect samples, analyze their genetic sequences, and share our findings with the global research community.
This collaborative effort is essential for developing a comprehensive understanding of the HIV epidemic in Southeast Asia and, ultimately, creating more effective prevention and treatment strategies.
**Interviewer:**
Thank you, Mirna, for shedding light on this important issue. Your work is crucial in the fight against HIV/AIDS.
