Molecular epidemiology of HIV-1 in Jilin province, northeastern China: emergence of a new CRF07_BC transmission cluster and intersubtype recombinants.

OBJECTIVE: To investigate the HIV-1 molecular epidemiology among newly diagnosed HIV-1 infected persons living in the Jilin province of northeastern China. METHODS: Plasma samples from 189 newly diagnosed HIV-1 infected patients were collected between June 2010 and August 2011 from all nine cities of Jilin province. HIV-1 nucleotide sequences of gag P17-P24 and env C2-C4 gene regions were amplified using a multiplex RT-PCR method and sequenced. Phylogenetic and recombination analyses were used to determine the HIV-1 genotypes. RESULTS: Based on all sequences generated, the subtype/CFR distribution was as follows: CRF01_AE (58.1%), CRF07_BC (13.2%), subtype B' (13.2%), recombinant viruses (8.1%), subtype B (3.7%), CRF02_AG (2.9%), subtype C (0.7%). In addition to finding CRF01_AE strains from previously reported transmission clusters 1, 4 and 5, a new transmission cluster was described within the CRF07_BC radiation. Among 11 different recombinants identified, 10 contained portions of gene regions from the CRF01_AE lineage. CRF02_AG was found to form a transmission cluster of 4 in local Jilin residents. CONCLUSIONS: Our study presents a molecular epidemiologic investigation describing the complex structure of HIV-1 strains co-circulating in Jilin province. The results highlight the critical importance of continuous monitoring of HIV-infections, along with detailed socio-demographic data, in order to design appropriate prevention measures to limit the spread of new HIV infections.

Identification of a novel HIV-1 second-generation recombinant form (CRF01_AE/CRF07_BC) in Jilin, China.

We report here a novel HIV-1 second-generation recombinant form (CRF01_AE/CRF07_BC) isolated from an HIV-positive male subject infected through heterosexual contact in Jilin province in northeastern China. Phylogenic analysis shows that this novel second-generation recombinant (JL.RF09) was composed of two well-established circulating recombinant forms (CRF01_AE and CRF07_BC), with two recombinant breakpoints observed in the vpu/env and env gene regions, respectively. The CRF01_AE region of the recombinant was clustered together with a previously described subcluster 4a lineage of CRF01_AE, which is exclusively circulating among men who have sex with men (MSM) in northern China, indicating that the parental origin of the CRF01_AE region in JL.RF09 was from MSM in north China. The CRF07_BC regions of the recombinant are clustered within the CRF07_BC cluster but are distinct from other CRF07_BC references. The detailed origin of CRF07_BC in this recombinant is still not clear. The emergence of the novel HIV-1 recombinant indicates the ongoing generation of recombinants involving CRF01_AE and CRF07_BC, and may provide vital insights into our understanding of the dynamics and complexity of the HIV-1 epidemic in China.

Near full-length genome sequence of a novel HIV-1 recombinant form (CRF01_AE/B) detected among men who have sex with men in Jilin Province, China.

We report here a novel HIV-1 recombinant form (CRF01_AE/B) detected from a comprehensive HIV-1 molecular epidemiologic study among men who have sex with men (MSM) in Jilin province of northeastern China. The near full-length genome (NFLG) analyses showed that the novel HIV-1 recombinant isolate (JL.RF07) was composed of CRF01_AE cluster 5 (northeastern China origin) and subtype B (U.S. and European origin), with six recombinant breakpoints observed in the pol, vif, tat, rev, and env gene regions. To the best of our knowledge, this is the first detection of a novel HIV-1 recombinant form (CRF01_AE/B) in Jilin, which may indicate an active transmission network of HIV-1 infection among MSM in the region. Further studies of the molecular epidemiology of the HIV-1 epidemic among MSM in northeastern China are necessary to gain a fuller understanding of the transmission network and potential public health impact of HIV-1 among MSM in this region.

A pilot project for the effective delivery of HAART in rural China.

The purpose of this pilot study, conducted in rural Jilin Province in northeastern China, was to develop and test an infrastructure for the delivery of highly active antiretroviral therapy (HAART) that might be applicable to other such areas across the country. Earlier attempts to provide antiretroviral therapy in rural areas met with mixed success in large measure because of social stigma, a lack of adequate physician training, and problems with patient retention. In response to these problems, a highly integrated and family-centered approach was developed that placed emphasis on the primary care level for regimen delivery. Using this structure, a treatment naïve cohort of 22 male and 20 female (n = 42) volunteers with HIV/acquired immune deficiency syndrome (AIDS) was given government-provided HAART. After 12 months, all volunteers remained in the cohort, and there were significant changes in both CD4 levels and ability to return to work. Per patient cost for the 12-month study was Dollars 1,259.00, with Dollars 1,149 being spent on treatment and Dollars 110.00 on educational and administrative costs. This project demonstrated that HAART can be delivered successfully in resource-poor rural areas in China.