The rapidly expanding CRF01AE epidemic in China is driven by multiple lineages of HIV-1 viruses introduced in the 1990s

OBJECTIVES: We sought to comprehensively analyze the origin, transmission patterns and sub-epidemic clusters of the HIV-1 CRF01AE strains in China. METHODS: Available HIV-1 CRF01AE samples indentified in national molecular epidemiologic surveys were used to generate near full-length genome (NFLG) sequences. The new and globally available CRF01AE NFLG sequences were subjected to phylogenetic and Bayesian molecular clock analyses, and combined with epidemiologic data to elucidate the history of CRF01AE transmission in China. RESULTS: We generated 75 new CRF01AE NFLG sequences from various risk populations covering all major CRF01AE epidemic regions in China. Seven distinct phylogenetic clusters of CRF01AE were identified. Clusters 1, 2 and 3 were prevalent among heterosexuals and IDUs in southern and southwestern provinces. Clusters 4 and 5 were found primarily among MSM in major northern cities. Clusters 6 and 7 were only detected among heterosexuals in two southeast and southwest provinces. Molecular clock analysis indicated that all CRF01AE clusters were introduced from Southeast Asia in the 1990s, coinciding with the peak of Thailand's HIV epidemic and the initiation of China's free overseas travel policy for their citizens, which started with Thailand as the first destination country. CONCLUSION: China's HIV-1 epidemic of sexual transmissions, was initiated by multilineages of CRF01AE strains, in contrast to the mono-lineage epidemic of B' strain in former plasma donors and IDUs. Our study underscores the difficulty in controlling HIV-1 sexual transmission compared with parenteral transmission.