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  Table of Contents  
Year : 2014  |  Volume : 32  |  Issue : 2  |  Page : 110-111

South African HIV strains in India: Did clade C follow the mandrax route?

Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Submission25-Feb-2014
Date of Acceptance02-Mar-2014
Date of Web Publication2-Apr-2014

Correspondence Address:
Shobha Sehgal
Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0255-0857.129763

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How to cite this article:
Sehgal S. South African HIV strains in India: Did clade C follow the mandrax route? . Indian J Med Microbiol 2014;32:110-1

How to cite this URL:
Sehgal S. South African HIV strains in India: Did clade C follow the mandrax route? . Indian J Med Microbiol [serial online] 2014 [cited 2020 Jul 11];32:110-1. Available from:

During the evolution of human immunodeficiency virus (HIV) epidemic in India, heterosexual spread has characteristically been clustered around coastal areas of Maharashtra, Gujarat, Tamil Nadu and Andhra Pradesh. Subsequently the epidemic fanned out in rest of the country via rail and road. Ditreich et al.[1] first documented in 1993 that four patients from Mumbai and Pune had name of a peptide (NOF) strain prevalent in South Africa and concluded a rapid and recent spread of HIV and possibly by heterosexual transmission.

 ~ Further studies indicating NOF strain of HIV in India Top

Preliminary observations on genetic analysis of 13 isolates revealed that the principal neutralising determinant (PND) of the V 3 loop was closely related to the South African isolate. [2] Since serotyping can give reliable information about genotypic prevalence in the population, we used five synthetic peptides (NOF, EL 1 , MN, IIIB and IND) of African, North American, European and Indian origin. The Indian consensus was derived from the above isolates. Results indicated that 82% of patients harboured a strain closely related to the South African type of HIV-1 designated as HIV-1NOF, with a homology of 85-87%. [3] In the phylogenetic tree, these clustered together to constitute a subtype strikingly different from the North American/European, central African, Uganda/Rwanda and northern Thailand subtypes. Interestingly, the viruses of this subtype are characterised by an additional potential N-glycosylation site C-terminal to the CD4-binding domain. Subsequently several reports indicated that the predominant virus was clade C according to the Mayer's classification. [4],[5]

 ~ Clade C and recombinants Top

Recent studies by Neogi et al. [6] on 168 blood samples from 7 different states of India indicated that Indian HIV-1C epidemic originated around 40 years ago from a single or few genetically related African lineages, and since then largely evolved independently. They also stressed that the increase of recombinant strains, warranted a continued molecular surveillance for appropriate intervention strategies. For the first time, a high prevalence (10%) of unique recombinant forms (BC and A1C) was observed when all the three genes, that is, gag, pol and env were used (P<0.01). The most recent common ancestor (tMRCA) of Indian HIV-1C was estimated using the three viral genes, ranged from 1967 (gag) to 1974 (env). Pol gene analysis provided the most reliable estimate.

 ~ HIV cases in Punjab from African states Top

The very first trickle of cases in Punjab originated from Congo, Uganda, Zambia, etc., therefore it was puzzling that peptide analysis revealed predominantly the SA strain. Our manuscript submitted in 1996 with a bold title 'South African strains of HIV in India' got quickly dismissed by two prestigious journals because of lack of sequence data or perhaps lack of credibility of data originating from a developing country. In retrospect this jig saw puzzle seems to fall in place once we realized the close link between coastal areas particularly Mumbai and South Africa. This sea route was extensively being used for trade and also for drug trafficking.

Although, cocaine and opiates such as heroine were being transported illegally, the popularity of Mandrax both in India and South Africa is striking; the latter still being the largest market for Indian Mandrax [Figure 1].
Figure 1: The route of HIV from South Africa. Red arrows indicate the drug route to South Africa from India. The virus then travelled to and fro with in southern African states through land routes (black arrows and interrupted lines)

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 ~ India Emerged an Hub of International Drug Trafficking Top

Mandrax is a synthetic drug whose active ingredient is methaqualone. It was used as a sedative-hypnotic, which was first produced in the mid-1960s. It is highly addictive and was therefore banned in 1974. In early eighties, huge quantities of mandrax were seized in Mumbai. It is documented that several drug houses in India switched over from paracetamol production to mandrax production as the latter was more profitable. Mandrax seizure was linked to South Africa, which is reportedly the world's largest abuser of the drug as confirmed by the Narcotics Control Bureau. Surprisingly, it is still being illegally produced secretly in small pharmaceutical factories in Gujarat, Maharashtra and Rajasthan. It takes less than one rupee to manufacture one Mandrax tablet and when the consignment touches the African shores, the cost goes up to about $1. The price gets further escalated on reaching Europe. It is usually smuggled in cargo and one container has nearly 10 crore tablets. So even if one container escapes detection meant huge profits for the mandrax king. [7] During one of the raids, officials found a large unit with methaqualone powder and 2535 kg of mandrax. In 1993, 14,000 kg of mandrax were seized in Mumbai. Besides, drug lords had links in Peshawar, Karachi and Cape Town. Roul [8] reported massive shipments of illegal ephedrine and mandrax (June and September 2006) captured in Mumbai in a container packed with some $100 million worth of illicit psychoactive drugs including an estimated 4400 kg of mandrax. New Delhi, Mumbai along with India's Information Technology centre, Bangalore are the hubs of India's international drug trade. Tewari [9] indicated that mandrax use in India has increased by over 4200% between 2009 and 2012. [9]

Molly Charles, an expert on illegal substances working with the Tata Institute of Social Science in Mumbai, stated that even during the apartheid era, there was a smooth trade with South Africa through the years. For many years mandrax use was widespread among the Africans and Indian/Asians living in Africa.

It is possible that en route back, clade C travelled back to India as well as inside different countries of Africa including Zambia, Botswana Tanzania, etc. The entire eastern coast was vulnerable too.

Since South Africa was by far the world's leading consumer of the drug, the authorities in South Africa also swung into action and regularly dismantled laboratories manufacturing illicit drugs during 1992-1997 (Office of Drug Control, Africa ODC [10] ) At the end of September 2002, a total of 23 laboratories had been closed down in a similar fashion. There is evidence that the apartheid state promoted drug use as a form of chemical control ('pacification') and 'crowd control'. The drugs allegedly were ultimately sold on the streets. Thus a close link between SA and Indian coasts could explain the intriguing and predominant presence of clade C in India.

 ~ References Top

1.Dietrich U, Grez M, von Briesen H, Panhans B, Geissendörfer M, Kühnel H, et al. HIV-1 strains from India are highly divergent from prototypic African and US/European strains, but are linked to a South African isolate. AIDS 1993;7:23-7.  Back to cited text no. 1
2.Ahmed KM, Mujtaba S, Das R, Zafrullah M, Sehgal S, Jameel S. NeF sequence of primary HIV 1. Isolate from North India. Hum Retrovirus AIDS Res 1998;14:1491-3.  Back to cited text no. 2
3.Sehgal S, Pasricha N, Jameel S. Serotype analysis of Indian patients with HIV infection. Trop Med Int Health 1996;1:199-204.  Back to cited text no. 3
4.Lole KS, Bollinger RC, Paranjape RC, Gadkari D, Kulkarni SS, Novak NG, et al. Full-length human immunodeficiency virus type 1 genomes from subtype C-infected seroconverters in India, with evidence of inter-subtype recombination. J Virol 1999;73:152-60.  Back to cited text no. 4
5.Shankarappa R, Chatterjee R, Learn GH, Neogi D, Ding M, Roy P, et al. Human Immunodeficiency Virus Type 1 Env Sequences from Calcutta in Eastern India: Identification of Features That Distinguish Subtype C Sequences in India from Other Subtype C Sequences. J Virol 2001;75:10479-87.  Back to cited text no. 5
6.Neogi U, Bontell I, Shet A, De Costa A, Gupta S, Diwan V, et al. Molecular Epidemiology of HIV-1 Subtypes in India: Origin and Evolutionary History of the Predominant Subtype C. PLoS ONE 2012;7:e39819.  Back to cited text no. 6
7.Chakrabarti SK, Dawood Turns MandraxKing.CNN-IBN | Updated Apr 17, 2008 at 02:56am IST.  Back to cited text no. 7
8.Roul Animesh. World Politics Review (WPR) briefing, 27 Sept 2006.  Back to cited text no. 8
9.Tewari D. TNN Nov 25, 2013, 04.00AM IST  Back to cited text no. 9
10.Available from: [Last accessed on 2002 Oct 1] ODC Country Profile: South Africa. Page 1. 1. CONTEXT. 1.1 General Background Statistics.  Back to cited text no. 10


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