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Introduction: The HIV epidemic continues to expand in Central Asia, bridging from injecting drug users to the general population, largely through heterosexual transmission. This study describes medical students' attitudes and behaviours regarding HIV and sexual practices in response to recently introduced HIV curriculum., Methodology: Medical students in Almaty, Kazakhstan, were invited to participate in a cross-sectional survey between April and November, 2013. The survey assessed participant's risk behaviours (e.g., injecting drug use, condom use), concerns related to HIV infection risk (e.g., medical care exposures, personal behaviours), and ability to identify HIV-positive individuals without asking their status. Bivariate analyses (Chi-square test or Fisher's exact test) and multivariate analysis (log-binomial regression) were conducted., Results: Of 647 medical students, the majority were female (82.2%) and single (92.8%) with a median age of 21-22 years. Sexual activity was reported by 176 (27.2%); males were substantially more likely to report sexual activity (74.8% males vs. 16.9% females, p <.0001). The majority of sexually active medical students (65.6% and 68.3% males and females, respectively) believe they can determine if their partner is HIV-positive without asking or seeking a laboratory test. This proportion is much higher (92.6%) among married or cohabitating women. No association between perceived ability to ascertain HIV status and condom use was identified., Conclusions: The medical students in our study had a relatively naïve perception of HIV risk, and their knowledge of risk did not translate to appropriate precautionary behaviours. Much work remains if the epidemic in Central Asia is to be contained., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2017 Zhamilya Sakenovna Nugmanova, Gulzhakhan Mazhitovna Akhmetova, Gulnara Sayabekovna Kurmangalieva, Natalia Grigorievna Kovtunenko, Gulmira Rakhatovna Kalzhanbaeva, Malika Kamalovna Abdumananova, Louise-Anne McNutt.)

Introduction: Human immunodeficiency virus (HIV) is associated with inflammation. An association between vitamin D deficiency and inflammation also exists. Our study attempts to examine whether there may be a relationship between vitamin D and HIV viral load (HIV RNA) by: 1) characterizing the distribution of 25-hydroxyvitamin D (25-OHD), and 2) determining if 25-OHD is independently associated with HIV RNA., Methodology: A cross-sectional study among HIV-infected adults was conducted. Demographics, clinical / social / HIV characteristics and data on antiretroviral therapy were collected by questionnaire, medical records and laboratory testing. All patients provided blood samples. Bivariate and multivariate analyses were conducted to quantify the relationship between vitamin D and HIV RNA., Results: Among the 564 patients, the median (interquartile range, IQR) 25-OHD value was 24.42 (16.22 - 34.10) ng/mL. The mean (standard deviation, SD) log-HIV RNA was 3.51 (1.11) copies/mL. There were 304 patients (53.9%) with an undetectable HIV RNA (< 500 copies/mL). In the bivariate analyses, no differences were observed between patients with and without an undetectable HIV RNA in mean (SD) 25-OHD, 25-OHD insufficiency (< 30 ng/mL), or 25-OHD deciles. In the log-binomial regression analyses, there was no association between 25-OHD and an undetectable HIV RNA (prevalence ratio: 1.00, 95% confidence interval: 0.99 - 1.01, p = 0.67)., Conclusions: No relationship was observed between 25-OHD and HIV RNA among HIV-infected patients in Kazakhstan.

To determine the HIV-1 genetic diversity in Kazakhstan, 85 blood samples from HIV-seropositive donors were collected between 2001 and 2003. The study population consisted of 91.8% injecting drug users (IDUs); the remainder was infected sexually or iatrogenically. A genomic region that included part of the polymerase gene was sequenced for all 85 samples, and from these, 6 samples were randomly selected for nearly full genome sequencing. Subtype A was the most common genetic form (94.1%), followed by CRF02&#95;AG (4.7%) and subtype C (1.2%). All subtype A sequences clustered closely with samples from countries of the former Soviet Union (FSU). From these sequences, 47 (58.8%) presented the secondary protease inhibitor mutation V77I that has been linked to a genetic lineage in the FSU epidemic. In addition, most had the other 2 mutations that characterize the "V77I haplotype." All 6 nearly full-length sequences were subtype A and clustered with other FSU strains. The CRF02&#95;AG strains from this population clustered with strains from Uzbekistan, reflecting the spread of the CRF02&#95;AG epidemic in Central Asia. The HIV epidemic in Kazakhstan is predominantly in IDUs and is indigenous to the geographic region, and most of the strains are genetically similar to those circulating in the FSU and other parts of Central Asia.

Kazakhstan experienced the start of the HIV-1 outbreak among intravenous drug users (IDUs) in 1997. To characterize genetically HIV-1 strains circulating in this country, peripheral blood mononuclear cells (PBMCs) DNA samples (1999-2002) derived from HIV-infected IDUs and their sexual partners in Pavlodar (n = 19), Shymkent (n = 6), and Qaraghandy (n = 18) regions were analyzed by the gag/env heteroduplex mobility assay (HMA). The 366-bp proviral env gene fragments encoding the gp120 C2-V3 region obtained from 16 individuals were sequenced. The results of HMA revealed that all 43 HIV-1 strains studied belonged to gag/env subtype A. The nucleotide sequence analysis showed a marked genetic homogeneity with the mean genetic distance being 3.63 +/- 2.39 (range 0.00-12.13). The mean genetic distance between each sequence within the Kazakhstan set and the East-European IDU subtype A consensus was 2.94 +/- 1.92 (range 0.79-8.48). The data presented thus confirm the spreading of the same IDU subtype A virus in the former Soviet Union.