Abstract
Men who have sex with men (MSM) have recently accounted for an alarmingly increasing proportion of HIV-1 transmission in China. In order to investigate the immune status as a result of CRF01_AE infection and CXCR4 co-receptor usage in a young Shanghai-based HIV-1-infected MSM population in Shanghai, 364 HIV-1-infected MSM with average age of 22.7 years old, newly diagnosed between Jan 2009 and Jul 2013 were analyzed for CD4+T cell count, subtyping using phylogenetic analysis, and viral co-receptor tropism using Geno2pheno and webPSSM in combination. A total of 276 individuals were identified as recently infected. Subtype assignment were as follows: 176 (63.8%) CRF01_AE, 77 (27.9%) CRF07_BC, and 23 (8.3%) subtype B. Besides, 24 second-generation recombinant strains were identified. A lower CD4+T cell count at baseline survey was observed among CRF01_AE strain-infected individuals, compared to those who were infected with CRF07_BC (P<0.01). The frequency of baseline CD4+T cell count <200 was higher and the frequency of CD4 T counts >500 lower in CRF01_AE infection than CRF07_BC infection. It is worth noting that 32.4%–40.9% of CRF01_AE strain-infected individuals were predicted to carry CXCR4-tropic viruses whereas none of CRF07_BC and subtype B were found to be as CXCR4-tropic viruses (P<0.001). As could be expected CXCR4 tropism was associated with lower CD4 T counts. This study revealed that CRF01_AE strains with high frequency of CXCR4 tropism are prevailing in the young MSM population in China and could potentially cause a severe loss of CD4+T cell count and rapid disease progression. A regular surveillance of HIV-1 subtypes, CD4+T cell count and viral co-receptor usage would be greatly beneficial for effectively monitoring disease progression, improvement of antiretroviral therapy strategy and prompt intervention of transmission.
Highlights
Men who have sex with men (MSM) have become the most vulnerable risk group to HIV-1 infection in China
By the end of 2011, the estimated number of people living with HIV (PLHIV) in China stood at 780,000 [1]
A meta-analysis of twelve relevant studies revealed that the suboverall HIV-1 incidence estimates were 3.5% and 6.7% among MSM in China for cohort and cross-sectional studies, respectively [2]
Summary
Men who have sex with men (MSM) have become the most vulnerable risk group to HIV-1 infection in China. Compared with the estimated 2.5% in 2006, 13.7% in 2011, homosexual transmission has become a very significant mode of transmission for new HIV infections in China [1]. A meta-analysis of twelve relevant studies revealed that the suboverall HIV-1 incidence estimates were 3.5% (95% CI: 1.7%– 5.3%) and 6.7% (95% CI: 4.8%–8.6%) among MSM in China for cohort and cross-sectional studies, respectively [2]. A cross-sectional survey among 47,231 MSM from 61 cities in China conducted from February 2008 to September 2009 indicated that the overall prevalence of HIV infection was 4.9% [4]
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