Neogi Ujjwal, Häggblom Amanda, Santacatterina Michele, Bratt Göran, Gisslén Magnus, Albert Jan, Sonnerborg Anders
Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, County Council of Gävleborg, Gävle, Sweden.
PLoS One. 2014 Jun 12;9(6):e99390. doi: 10.1371/journal.pone.0099390. eCollection 2014.
HIV-1 subtype B (HIV-1B) still dominates in resource-rich countries but increased migration contributes to changes in the global subtype distribution. Also, spread of non-B subtypes within such countries occurs. The trend of the subtype distribution from the beginning of the epidemic in the country has earlier not been reported in detail. Thus the primary objective of this study is to describe the temporal trend of the subtype distribution from the beginning of the HIV-1 epidemic in Sweden over three decades.
HIV-1 pol sequences from patients (n = 3967) diagnosed in Sweden 1983-2012, corresponding to >40% of patients ever diagnosed, were re-subtyped using several automated bioinformatics tools. The temporal trends of subtypes and recombinants during three decades were described by a multinomial logistic regression model.
All eleven group M HIV-1 subtypes and sub-subtypes (78%), 17 circulating recombinant forms (CRFs) (19%) and 32 unique recombinants forms (URF) (3%) were identified. When all patients were analysed, there was an increase of newly diagnosed HIV-1C (RR, 95%CI: 1.10, 1.06-1.14), recombinants (1.20, 1.17-1.24) and other pure subtypes (1.11, 1.07-1.16) over time compared to HIV-1B. The same pattern was found when all patients infected in Sweden (n = 1165) were analysed. Also, for MSM patients infected in Sweden (n = 921), recombinant forms and other pure subtypes increased.
Sweden exhibits one of the most diverse subtype epidemics outside Africa. The increase of non-B subtypes is due to migration and to a spread among heterosexually infected patients and MSM within the country. This viral heterogeneity may become a hotspot for development of more diverse and complex recombinant forms if the epidemics converge.
HIV-1 B亚型（HIV-1B）在资源丰富的国家仍占主导地位，但移民增加导致全球亚型分布发生变化。此外，此类国家内非B亚型也在传播。该国自疫情开始以来亚型分布的趋势此前尚未详细报道。因此，本研究的主要目的是描述瑞典自HIV-1疫情开始三十多年来亚型分布的时间趋势。
使用多种自动化生物信息学工具对1983年至2012年在瑞典诊断出的患者（n = 3967）的HIV-1 pol序列进行重新分型，这些序列对应超过40%的确诊患者。通过多项逻辑回归模型描述三十年来亚型和重组体的时间趋势。
共鉴定出所有11种M组HIV-1亚型和亚亚型（78%）、17种流行重组形式（CRF）（19%）和32种独特重组形式（URF）（3%）。对所有患者进行分析时，与HIV-1B相比，新诊断出的HIV-1C（相对风险，95%置信区间：1.10，1.06 - 1.14）、重组体（1.20，1.17 - 1.24）和其他纯亚型（1.11，1.07 - 1.16）随时间增加。对所有在瑞典感染的患者（n = 1165）进行分析时也发现了相同模式。此外，对于在瑞典感染的男男性行为者（MSM）患者（n = 921），重组形式和其他纯亚型增加。
瑞典呈现出非洲以外最多样化的亚型流行情况之一。非B亚型的增加归因于移民以及在该国异性传播感染患者和男男性行为者中的传播。如果疫情汇聚，这种病毒异质性可能成为更多样化和复杂重组形式发展的热点。
