Yuqi Zhang

HIV-1 Genetic Diversity and Transmitted Drug Resistance Among Recently Infected Individuals at Men Who Have Sex with Men Sentinel Surveillance Points in Hebei Province, China.

For this study, 50 HIV-1 plasma samples of recently infected men who have sex with men (MSM) were amplified and sequenced. Multiple subtypes were identified by phylogenetic analyses of HIV-1 gag, env, and pol gene regions, including CRF01_AE (56.0%), CRF07_BC (30.0%), subtype B (12.0%), and unique recombinant forms (URFs, 6.0%). CRF01_AE was the most frequent genotype in the epidemic. Three recombination patterns of URFs were identified: 01BC, 01B, and 01C. The rate of HIV-1 transmitted drug resistance (TDR) mutation (M46L) was 2.08% (1/48). URFs and TDR first identified in this study suggest that HIV-1 prevalence is more and more complicated, and HIV-1 drug-resistant strains have begun to spread among at risk populations in Hebei. Our findings can provide vital information for an efficient surveillance system and strategic HIV prevention and control measures in China by revealing the evolutionary status and HIV-1 TDR of HIV-1 strains among recently infected MSM in Hebei Province.

Recombinant Patterns of Nine Novel HIV-1 Recombinant Strains Identified in Hebei Province, China.

We found cluster 1 and cluster 2 that were identified as two potential circulating recombinant forms (CRFs) by analyzing the recombinant breakpoints and phylogenetic tree. Three sequences composed of CRF01_AE, subtype C, and potential subtype B (N/A) in cluster 1 had nearly identical recombinant breakpoints, and four sequences composed of CRF01_AE and subtype B in cluster 2 possessed identical breakpoints. Demographic characteristics indicated that there were no epidemiological linkages among three subjects in cluster 1 and four subjects in cluster 2, respectively. Likewise, two unique recombinant forms (URFs) were found in this study: one URF was composed of subtype C and subtype B, and subtype B was inserted into a backbone of subtype C; another URF was composed of subtype C, subtype B, CRF01_AE, and subtype A2. It was inferred that the potential novel CRFs and URFs have spread into general populations, suggesting that the series research of novel recombinant strains will be a priority for our researches in the future.

HIV-1 molecular epidemiology among newly diagnosed HIV-1 individuals in Hebei, a low HIV prevalence province in China

New human immunodeficiency virus type 1 (HIV-1) diagnoses are increasing rapidly in Hebei. The aim of this study presents the most extensive HIV-1 molecular epidemiology investigation in Hebei province in China thus far. We have carried out the most extensive systematic cross-sectional study based on newly diagnosed HIV-1 positive individuals in 2013, and characterized the molecular epidemiology of HIV-1 based on full length gag-partial pol gene sequences in the whole of Hebei. Nine HIV-1 genotypes based on full length gag-partial pol gene sequence were identified among 610 newly diagnosed naïve individuals. The four main genotypes were circulating recombinant form (CRF)01_AE (53.4%), CRF07_BC (23.4%), subtype B (15.9%), and unique recombinant forms URFs (4.9%). Within 1 year, three new genotypes (subtype A1, CRF55_01B, CRF65_cpx), unknown before in Hebei, were first found among men who have sex with men (MSM). All nine genotypes were identified in the sexually contracted HIV-1 population. Among 30 URFs, six recombinant patterns were revealed, including CRF01_AE/BC (40.0%), CRF01_AE/B (23.3%), B/C (16.7%), CRF01_AE/C (13.3%), CRF01_AE/B/A2 (3.3%) and CRF01_AE/BC/A2 (3.3%), plus two potential CRFs. This study elucidated the complicated characteristics of HIV-1 molecular epidemiology in a low HIV-1 prevalence northern province of China and revealed the high level of HIV-1 genetic diversity. All nine HIV-1 genotypes circulating in Hebei have spread out of their initial risk groups into the general population through sexual contact, especially through MSM. This highlights the urgency of HIV prevention and control in China.

Twenty-seven year surveillance of blood transfusion recipients infected with HIV-1 in Hebei Province, China

We conducted an investigation of blood management in which blood transfusion recipients underwent molecular biological analysis, to trace the possible source of HIV infection. Epidemiological investigation was carried out among HIV-infected individuals. Blood transfusion recipients infected with HIV were tracked for the date of transfusion, reason for transfusion, hospital where transfusion was received, source of blood, components of transfusion, number of transfusions, and transfusion volume. A total of 285 blood transfusion recipients infected with HIV-1 were detected in Hebei over the study period, with 42.81% (122/285) detected through clinical diagnostic testing. These cases showed a concentrated distribution in southern Hebei, with local outbreak characteristics. A census of the population in Shahe County, which had a high concentration of cases, revealed that recipients of blood transfusions had an HIV infection rate of 15.54% (92/592). Post-transfusion infection frequently occurred among blood transfusion recipients at township medical institutions, with a peak in 1995. Owing to late detection of HIV infection among blood transfusion recipients, the rates of spousal transmission and mother-to-child transmission reached 20.87% and 28.05%, respectively. Around 1995, community medical institutions did not screen for HIV antibodies among paid blood donors, which was an important cause of the outbreak of HIV-1 infection among blood transfusion recipients. Our findings indicate that cases of blood transfusion-related infection decreased rapidly with gradual improvement in the HIV screening system for blood donors that began in 1995, particularly after full implementation of HIV nucleic acid testing of volunteer blood donors was begun in 2015.

Epidemic Trend of HIV-1 Drug-ResistantMutations Isolated From HIV-InfectedPatients in Hebei, China from 2008 to 2013

Background: Widespread use of anti-HIV therapies has led to the global development of drug-resistant HIV strains. In China, our current knowledge of HIV- 1 strain variation, emerging epidemiological trends and viral genetics underlying drug resistance is limited. Method: Between 2008 and 2013, HIV-1 strains from 569 HIV-seropositive and AIDS patients undergoing antiviral treatment in Hebei province (China) were genotyped. ART-virological failure (viral load ≥ 1000 copies/ml) and HIV-1 mutations for these strains were analyzed, as were variations in mutation trends during this period. Results: ART-virological failure in HIV-infected patients decreased significantly between 2008 and 2013 (60.9% vs. 35.0%, p<0.05), and showed a significant decreasing trend (p<0.05). When all HIV-seropositive patients undergoing antiviral treatment were included in this analysis, however, differences or trends observed were not significant. Six mutations were detected in the HIV-1 protease coding region. Only one (A71V/T) showed a significant difference in prevalence during this period (p<0.05). Sixty-one mutations were found in the HIV-1 reverse transcriptase coding region, including 34 related to nucleoside reverse transcriptase inhibitor treatment and 27 related to non-nucleoside reverse transcriptase inhibitor treatment. Thirteen mutations (V75I, T215Y, M41L, L210W, T69D, D67DG, V118I, V75I/T, F77L, T215F, Q151M; NNRTI-related: V108I, M230L) exhibited significant decreasing trends between 2010 and 2013, and two mutations (K238T, V90I) showed significant increasing trends (p<0.05). Conclusion: Continuous monitoring of drug resistance is essential for the design of optimal regimens and improvement of therapeutic outcomes.