Trends in adult chlamydia and gonorrhoea prevalence, incidence and urethral discharge case reporting in Mongolia from 1995 to 2016 – estimates using the Spectrum-STI model

Objective: To estimate Mongolia’s prevalence and incidence trends of gonorrhoea and chlamydia in women and men 15–49 years old to inform control of STIs and HIV, a national health sector priority. Methods: We applied the Spectrum-STI estimation model, fitting data from two national population surveys (2001 and 2008) and from routine gonorrhoea screening of pregnant women in antenatal care (1997 to 2016) adjusted for diagnostic test performance, male/female differences and missing high-risk populations. Prevalence and incidence estimates were then used to assess completeness of national case reporting. Results: Gonorrhoea prevalence was estimated at 3.3% (95% confidence interval, 1.6–3.9%) in women and 2.9% (1.6–4.1%) in men in 2016; chlamydia prevalence levels were 19.5% (17.3–21.9%) and 15.6% (10.0–21.2%), respectively. Corresponding new incident cases in women and men in 2016 totalled 60 334 (36 147 to 121 933) and 76 893 (35 639 to 254 913) for gonorrhoea and 131 306 (84 232 to 254 316) and 148 162 (71 885 to 462 588) for chlamydia. Gonorrhoea and chlamydia prevalence declined by an estimated 33% and 11%, respectively from 2001 to 2016. Comparing numbers of symptomatic and treated cases estimated by Spectrum with gonorrhoea case reports suggests that 15% of symptomatic treated gonorrhoea cases were reported in 2016; only a minority of chlamydia episodes were reported as male urethral discharge cases. Discussion: Gonorrhoea and chlamydia prevalence are estimated to have declined in Mongolia during the early 2000s, possibly associated with syndromic management in primary care facilities and improving treatment coverage since 2001 and scale up of HIV/STI prevention interventions since 2003. However, prevalence remains high with most gonorrhoea and chlamydia cases not treated or recorded in the public health system.

Identification of a current hot spot of HIV type 1 transmission in Mongolia by molecular epidemiological analysis.

We investigated the current molecular epidemiological status of HIV-1 in Mongolia, a country with very low incidence of HIV-1 though with rapid expansion in recent years. HIV-1 pol (1065 nt) and env (447 nt) genes were sequenced to construct phylogenetic trees. The evolutionary rates, molecular clock phylogenies, and other evolutionary parameters were estimated from heterochronous genomic sequences of HIV-1 subtype B by the Bayesian Markov chain Monte Carlo method. We obtained 41 sera from 56 reported HIV-1-positive cases as of May 2009. The main route of infection was men who have sex with men (MSM). Dominant subtypes were subtype B in 32 cases (78%) followed by subtype CRF02_AG (9.8%). The phylogenetic analysis of the pol gene identified two clusters in subtype B sequences. Cluster 1 consisted of 21 cases including MSM and other routes of infection, and cluster 2 consisted of eight MSM cases. The tree analyses demonstrated very short branch lengths in cluster 1, suggesting a surprisingly active expansion of HIV-1 transmission during a short period with the same ancestor virus. Evolutionary analysis indicated that the outbreak started around the early 2000s. This study identified a current hot spot of HIV-1 transmission and potential seed of the epidemic in Mongolia. Comprehensive preventive measures targeting this group are urgently needed.

Allele and genotype frequencies of cytochrome P450 2B6 gene in a Mongolian population.

CYP2B6 plays an important role in metabolizing various drugs in common clinical use. Increasing interest in CYP2B6 genetic polymorphism was stimulated by revelations of a specific CYP2B6 genotype significantly affecting the metabolism of efavirenz, an anti-HIV type-1 agent. The present study determined the CYP2B6 haplotype in 100 healthy unrelated Mongolian volunteers by analyzing the genotypes of nine single nucleotide polymorphism (SNP) positions (-82T>C, 64C>T, 499C>T, 516G>T, 777C>A, 785A>G, 983T>C, 1375A>G, and 1459C>T) in the CYP2B6 gene. The CYP2B6 *1 allele was the most frequent in the Mongolian population tested at 64.5%, higher than the equivalent frequency in African-Americans and Ghanaians. The second most frequent allele was CYP2B6 *6 (21.0%), although this allele was less frequent than that in Ghanaians. Only one CYP2B6 *5 allele was identified in our Mongolian subjects (0.5%), although it is the third most frequent allele in white and African-American populations. These CYP2B6 genotypes revealed seven slow efavirenz metabolizers in 100 Mongolians, which is significantly fewer than the same group among Ghanaians. Overall, the Mongolian CYP2B6 allele distribution was comparable with that in Japanese, Koreans, and Han Chinese. This is the first report of CYP2B6 genotype frequency in a Mongolian population, and it could provide clinically useful information on drug metabolism in this population group.