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The rapidly expanding CRF01_AE epidemic in China is driven by multiple lineages of HIV-1 viruses introduced in the 1990s

Feng, Yia,*; He, Xianga,*; Hsi, Jenny H.a; Li, Fana; Li, Xingguanga; Wang, Quanb; Ruan, Yuhuaa; Xing, Huia; Lam, Tommy Tsan-Yukc; Pybus, Oliver G.c; Takebe, Yutakaa,d; Shao, Yiminga

doi: 10.1097/QAD.0b013e328360db2d
Epidemiology and Social

Objectives: We sought to comprehensively analyze the origin, transmission patterns and sub-epidemic clusters of the HIV-1 CRF01_AE strains in China.

Methods: Available HIV-1 CRF01_AE samples indentified in national molecular epidemiologic surveys were used to generate near full-length genome (NFLG) sequences. The new and globally available CRF01_AE NFLG sequences were subjected to phylogenetic and Bayesian molecular clock analyses, and combined with epidemiologic data to elucidate the history of CRF01_AE transmission in China.

Results: We generated 75 new CRF01_AE NFLG sequences from various risk populations covering all major CRF01_AE epidemic regions in China. Seven distinct phylogenetic clusters of CRF01_AE were identified. Clusters 1, 2 and 3 were prevalent among heterosexuals and IDUs in southern and southwestern provinces. Clusters 4 and 5 were found primarily among MSM in major northern cities. Clusters 6 and 7 were only detected among heterosexuals in two southeast and southwest provinces. Molecular clock analysis indicated that all CRF01_AE clusters were introduced from Southeast Asia in the 1990s, coinciding with the peak of Thailand's HIV epidemic and the initiation of China's free overseas travel policy for their citizens, which started with Thailand as the first destination country.

Conclusion: China's HIV-1 epidemic of sexual transmissions, was initiated by multilineages of CRF01_AE strains, in contrast to the mono-lineage epidemic of B′ strain in former plasma donors and IDUs. Our study underscores the difficulty in controlling HIV-1 sexual transmission compared with parenteral transmission.

aState Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing

bTEDA School of Biological Sciences and Biotechnology, Nankai University, Tianjin, China

cDepartment of Zoology, University of Oxford, Oxford, UK

dAIDS Research Center, National Institute of Infectious Diseases, Tokyo, Japan.

*Yi Feng and Xiang He contributed equally to the writing of this work.

Correspondence to Dr Yiming Shao, Division of Research on Virology and Immunology, National Center for AIDS/STD Control and Prevention, China CDC, Beijing 102206, China. Tel: +86 10 5890 0981; e-mail:

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Received November 27, 2012

Accepted March 4, 2013

© 2013 Lippincott Williams & Wilkins, Inc.