Abstract
HIV subtypes convey important epidemiological information and possibly influence the rate of disease progression. In this study, HIV disease progression in patients infected with CRF01_AE, CRF07_BC, and subtype B was compared in the largest HIV molecular epidemiology study ever done in China. A national data set of HIV pol sequences was assembled by pooling sequences from public databases and the Beijing HIV laboratory network. Logistic regression was used to assess factors associated with the risk of AIDS at diagnosis ([AIDSAD], defined as a CD4 count < 200 cells/µL) in patients with HIV subtype B, CRF01_AE, and CRF07_BC. Of the 20,663 sequences, 9,156 (44.3%) were CRF01_AE. CRF07_BC was responsible for 28.3% of infections, followed by B (13.9%). In multivariable analysis, the risk of AIDSAD differed significantly according to HIV subtype (OR for CRF07_BC vs. B: 0.46, 95% CI 0.39─0.53), age (OR for ≥ 65 years vs. < 18 years: 4.3 95% CI 1.81─11.8), and transmission risk groups (OR for men who have sex with men vs. heterosexuals: 0.67 95% CI 0.6─0.75). These findings suggest that HIV diversity in China is constantly evolving and gaining in complexity. CRF07_BC is less pathogenic than subtype B, while CRF01_AE is as pathogenic as B.
Highlights
During the first two decades of the epidemic (1985–2005), most HIV cases were concentrated in the injection drug users (IDU [44.2%]) and former blood donors (29.6%), but since 2006, there has been a clear expansion in the number of the HIV cases in heterosexuals and men who have sex with men (MSM)
HIV disease progression was compared between patients infected with subtype B, CRF01_AE, and CRF07_BC in the largest HIV molecular epidemiology study ever conducted in China
The risk of AIDSAD was significantly associated with sex, age, transmission risk group, and HIV subtype. After adjustment for these factors in the multivariable analysis, patients infected with CRF07_BC had only less than half of the risk of AIDSAD than those infected with subtype B
Summary
Fifth Medical Center of PLA General Hospital of China, No.[100]. Western 4th Ring Middle Road, Fengtai District, Beijing, China. 7Institute for HIV/AIDS and STD Prevention and Control, Tianjin CDC, No 6 Huayue Road, Hedong District, Tianjin, China. 8Institute for HIV/AIDS and STD Prevention and Control, Hebei CDC, No 97 Huaian East Road, Shijiazhuang, Hebei, China. 9Institute for HIV/AIDS and STD Prevention and Control, Shanxi CDC, No 8 Xiaonanguan, Shuangta West Street, Yingze District, Taiyuan, Shanxi, China. 10Institute for HIV/AIDS and STD Prevention and Control, Inner Mongolia CDC, No 50 Erdos Street, Hohhot, Inner Mongolia, China. 11Institute for HIV/AIDS and STD Prevention and Control, Jilin CDC, No 3145 Jingyang Road Changchun, Jilin, China. 12Institute for HIV/AIDS and STD Prevention and Control, Shanghai CDC, No 1380 Zhongshan West Road, Shanghai, China. 13Institute for HIV/AIDS and STD Prevention and Control, Anhui CDC, No 12560 Fanhua Road, Economic and Technological Development Zone, Hefei, Anhui, China. 14Institute for HIV/AIDS and STD Prevention and Control, Fujian CDC, No 76 Jintai Road, Gulou District, Fuzhou, Fujian, China. 15Institute for HIV/AIDS and STD Prevention and Control, Jiangxi CDC, No 555 Beijing East Road, Nanchang, Jiangxi, China. 16Institute for HIV/AIDS and STD Prevention and Control, Shandong CDC, No 16992 Jingshi Road, Jinan, Shandong, China. 17Institute for HIV/AIDS and STD Prevention and Control, Hunan CDC, No 450 Furong Middle Road, 1st Section, Changsha, Hunan, China. 18Institute for HIV/AIDS and STD Prevention and Control, Guangdong CDC, No 160 Qunxian Road, Dashi Street, Panyu District, Guangzhou, Guangdong, China. 19Institute for HIV/AIDS and STD Prevention and Control, Guangxi CDC, No 18 Jinzhou Road Nanning, Guangxi, China. 20Institute for HIV/AIDS and STD Prevention and Control, Chongqing CDC, No 8 Yangtze 2nd Road, Yuzhong District, Chongqing, China. 21Institute for HIV/AIDS and STD Prevention and Control, Sichuan CDC, No 6 Middle School Road, Chengdu, Sichuan, China. 22Institute for HIV/AIDS and STD Prevention and Control, Gansu CDC, No 310 Donggang West Road, Lanzhou, Gansu, China. 23Beijing Red Cross Blood Center, No 37 North 3rd Ring Middle Road, Haidian District, Beijing, China. 24These authors contributed : Hui Xing, Yiming Shao and Hongyan Lu *email: xingh@. China has a slowly increasing HIV epidemic, with 64,170, 71,204, and 63,154 new cases in 2018, 2019, and 2020, respectively, and 818,360 individuals living with HIV at the end of 2 0201. One of the fascinating findings concerning the HIV subtype in China is the belief that CRF01_AE progresses faster than C RF07_BC10–14. These studies were limited by small sample sizes and failed to adjust for important confounding factors. HIV disease progression was compared between patients infected with subtype B, CRF01_AE, and CRF07_BC in the largest HIV molecular epidemiology study ever conducted in China
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