Abstract
BackgroundCRF55_01B is a newly identified HIV-1 circulating recombinant form originated from MSM in China. However, its impact on the disease progression and transmission risk has not been investigated. This study aimed to determine the impact of CRF55_01B infection on viral dynamics and immunological status so as to provide scientific evidence for further control and prevention effort on CRF55_01B. Linear mixed effect models were applied to evaluate CD4 cell count decline and viral load increase by subtype.ResultsOf the 3418 blood samples, 1446 (42.3%) were CRF07_BC, 1169 (34.2%) CRF01_AE, 467 (13.7%) CRF55_01B, 249 (7.3%) type B, and 87 (2.5%) other subtypes (CRF_08BC, CRF_01B, C). CRF55_01B had become the third predominant strain since 2012 in Shenzhen, China. CRF55_01B-infected MSM showed lower median of CD4 count than CRF07_BC-infected MSM (349.5 [IQR, 250.2–474.8] vs. 370.0 [IQR, 278.0–501.0], P < 0.05). CRF55_01B infection was associated with slower loss of CD4 count than CRF01_AE (13.6 vs. 23.3 [cells/µl]¹/²/year, P < 0.05)among MSM with initial CD4 count of 200–350 cells/µl. On the other hand, those infected with CRF55_01B showed higher median plasma HIV RNA load (5.4 [IQR, 5.0–5.9]) than both CRF01_AE (5.3 [IQR, 4.8–5.7], P < 0.05) and CRF07_BC (5.0 log10 [IQR, 4.5–5.5], P < 0.001) at the initiation of antiretroviral therapy. Furthermore, the annual increasing rate of viral load for CRF55_01B infection was significantly higher than that of CRF07_BC (2.0 vs. 0.7 log10 copies/ml/year, P < 0.01).ConclusionsThe relatively lower CD4 count and faster increase of plasma HIV RNA load of CRF55_01B-infected MSM without antiretroviral therapy suggest that CRF55_01B may lead to longer asymptomatic phase and higher risk of HIV transmission. Strengthened surveillance, tailored prevention strategies and interventions, and in-depth research focusing on CRF55_01B are urgently needed to forestall potential epidemic.
Highlights
HIV has very high genetic variability and diversity
Demographic characteristics From 2005 to 2015, blood samples were collected from 3418 men who have sex with men (MSM) at diagnosis of HIV infection in Shenzhen, with genotype distribution as follows: 1446 (42.3%) CRF07_BC, 1169 (34.2%) CRF01_AE, 467 (13.7%) CRF55_01B, 249 (7.3%) subtype B, and 87 (2.5%) other subtypes (CRF_08BC, CRF_01B, C, and others) (Fig. 1B)
CD4 T‐cell count and plasma HIV RNA load Among the 1792 MSM who were infected with the three main subtypes, CRF55_01B-infected MSM showed a significantly lower median CD4 count than CRF07_BCinfected MSM at diagnosis of HIV infection (349.5 [interquartile range (IQR), 250.2–474.8] vs. 370.0 [IQR, 278.0–501.0], P < 0.05), as
Summary
HIV has very high genetic variability and diversity. To date, two main types, nine subtypes, 89 HIV circulating recombinant forms (CRFs) and multiple unique recombinant forms (URFs) had been recognized worldwide [1]. Wei et al Retrovirology (2021) 18:22 increasing trend of HIV prevalence among men who have sex with men (MSM) in China in the past decade [3], the three predominant genotypes co-circulated and rapidly mixed, leading to inevitable generation of new CRFs. Previous studies implied that CRFs accounted for more than 90% of all HIV-1 infection in China, and new CRFs played an increasing role in the nationwide or regional HIV pandemic [4, 5]. Existing literature indicated that the prevalence of HIV-1 CRF01_AE and subtype B in Shenzhen had gradually decreased from 50% and 37.5% to 32.3% and 5.7% from 2006 to 2012, respectively. CRF55_01B is a newly identified HIV-1 circulating recombinant form originated from MSM in China. Linear mixed effect models were applied to evaluate CD4 cell count decline and viral load increase by subtype
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