Abstract
Beijing is a national and international hub potentially containing a broad diversity of HIV variants. Previous studies on molecular epidemiology of HIV in Beijing pooled together samples from residents and non-residents. Pooling residents and non-residents has potentially introduced bias and undermined a good assessment and the intervention among the autochthonous population. Here, we aimed to define HIV subtype diversity and investigate the TDR in Beijing residents exclusively. We analyzed the demographic, clinical, and virological data collected between 2001 and 2016 from residents in Beijing. A population-based sequencing of the HIV pol gene was carried out using plasma specimens. Phylogenetic analysis was performed in order to classify sequences into their corresponding subtypes using an automated subtyping tool, the Context-Based Modeling for Expeditious Typing (COMET). Furthermore, the drug resistance mutations were determined using the World Health Organization list for surveillance of TDR mutations. Data on TDR were available for 92% of 2,315 individuals with HIV infection, of whom 7.1% were women. The bioinformatic analysis of HIV strains from this study revealed that a combined 17 subtypes were circulating in Beijing, China between 2001 and 2016. The most common ones were CRF01_AE, CRF07_BC, and subtype B in Beijing during this period. The overall prevalence of TDR was 4.5% (95% confidence intervals[CI]: 3.6%-5.4%), with a declining trend over the period of spanning 2001 through 2016. In-depth class-specific analysis revealed that the prevalence of TDR for the nucleoside reverse-transcriptase inhibitors (NRTIs) was 1.0% (95% CI: 0.6-1.5), 0.9% (95% CI:0.6-1.4) for non-NRTIs and 2.8% (95% CI:2.1-3.5) for protease inhibitors. The prevalence of TDR was lower in individuals infected with the CRF07_BC HIV strain than those infected with CRF01_AE. Our data showed that the HIV epidemic in Beijing displayed a high genetic heterogeneity and a low and declining prevalence of TDR. In sharp contrast to Europe and North America, the declining trend of TDR between 2001 through 2016 was noticed while there was a widespread distribution of antiretroviral treatment in Beijing, China.
Highlights
HIV epidemic in Beijing, the capital of the largest developing country, has remained stable over the last 5 years
The bioinformatic analysis of HIV strains from this study revealed that a combined 17 subtypes were circulating in Beijing, China between 2001 and 2016
Our data showed that the HIV epidemic in Beijing displayed a high genetic heterogeneity and a low and declining prevalence of TDR
Summary
HIV epidemic in Beijing, the capital of the largest developing country, has remained stable over the last 5 years. By Oct 31, 2016, the Beijing HIV epidemiology database cumulatively recorded 21,886 HIV-positive individuals since the identification of the first case of AIDS in 1985 in China Most of these cases are among the so called, the floating population known as people without the Beijing Hukou identification (74.2%) and men who have sex with men (MSM, [66.0%]). There has been a general concern that the prevalence of transmitted drug resistance (TDR) could increase in parallel with the increasing availability of antiretroviral treatment (ART) Such increase of TDR could negatively compromise the effectiveness of ART distribution program [3]. Previous epidemiological studies documented a relatively high genetic diversity and prevalence of TDR of HIV in Beijing[6,7,8,9] Data in those studies were collected from both the non-resident floating population and the Beijing residents (people with Beijing Hukou). We aimed to characterize the trend of the HIV subtype diversity and the prevalence of TDR in Beijing residents from 2001 to 2016
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