CRF01_AE subtype is associated with X4 tropism and fast HIV progression in Chinese patients infected through sexual transmission

Li, Yijiaa,*; Han, Yanga,*; Xie, Jinga; Gu, Lijunb,c; Li, Wenjuand; Wang, Huanlinga; Lv, Weia; Song, Xiaojinga; Li, Yanlinga; Routy, Jean-Pierree; Ishida, Takaomib,c; Iwamoto, Aikichib,c; Li, Taishenga; on behalf of CACT0810 group

doi: 10.1097/QAD.0000000000000125
Clinical Science

Background: The molecular epidemiology of the HIV-1 CRF01_AE subtype as a risk factor for fast HIV-1 progression remains poorly understood.

Methods: We analyzed HIV-1 tropism by utilizing samples from 201 treatment-naive patients in our multicenter cohort (12 research centers in different provinces of China). Tropism was determined by V3 loop sequencing. Data from 235 treatment-naive patients infected sexually (including aforementioned 201 patients) in this cohort with date of estimated seroconversion (EDS) were retrospectively evaluated. Median time from EDS to AIDS was analyzed by Kaplan–Meier curves. Hazard ratios were determined by Cox proportional model.

Results: CRF01_AE subtype was predominant (46.0%), especially in the MSM group. Further analysis revealed that the proportion of X4 tropism was higher in the CRF01_AE subtype (45.5%) than in others (C/CRF07_BC/CRF08_BC, 4.3%; B, 6.1%; P <0.001). CRF01_AE subtype was associated with faster progression from EDS to AIDS (4.8 vs. 6.4 years, P = 0.018) compared with non-CRF01_AE subtypes. In a multivariate model, the adjusted hazard ratio (aHR) of CRF01_AE was 1.42 (95% confidence interval, CI 0.99–2.03, P = 0.057), independent of HIV-1 viral load; it was also associated with fast progression to advanced immunodeficiency (aHR, 1.81, 95% CI 1.03–3.18, P = 0.038).

Conclusion: CRF01_AE, a predominant HIV-1 subtype in Chinese HIV-1 sexually infected patients, tends to be associated with fast progression to AIDS and advanced immunodeficiency, which might be ascribed to high proportion of X4 tropism. Further investigation of these risk factors may have significant implications to clinical practice and policy-making.

Author Information

aDepartment of Infectious Diseases, Peking Union Medical College Hospital, Beijing, China

bResearch Center for Asian Infectious Diseases, the Institute of Medical Science, the University of Tokyo, Tokyo, Japan

cJapan-China Joint Laboratory of Molecular Immunology and Molecular Microbiology, Institute of Microbiology, Chinese Academy of Sciences

dBeijing Youan Hospital, Capital Medical University, Beijing, China

eDivision of Hematology and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada.

*Yijia Li and Yang Han contributed equally to the writing of the study.

Correspondence to Taisheng Li, Department of Infectious Diseases, Peking Union Medical College Hospital, Shuafuyuan 1#, Beijing 100730, China. Tel: +86 10 69155048; fax: +86 10 69155046; e-mail:

Received 6 July, 2013

Revised 23 October, 2013

Accepted 23 October, 2013

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (

Copyright © 2014 Wolters Kluwer Health, Inc.