1990-2015 年全球和地区 HIV-1 重组体的流行病学：系统评价和全球调查。

Global and regional epidemiology of HIV-1 recombinants in 1990-2015: a systematic review and global survey.

机构信息

Nuffield Department of Population Health, University of Oxford, Oxford, UK; Nuffield Department of Women's & Reproductive Health, Women's Centre, John Radcliffe Hospital, University of Oxford, Oxford, UK.

Nuffield Department of Women's & Reproductive Health, Women's Centre, John Radcliffe Hospital, University of Oxford, Oxford, UK.

出版信息

Lancet HIV. 2020 Nov;7(11):e772-e781. doi: 10.1016/S2352-3018(20)30252-6.

DOI:10.1016/S2352-3018(20)30252-6

PMID:33128904

Abstract

BACKGROUND

Global HIV-1 genetic diversity and evolution form a major challenge to treatment and prevention efforts. An increasing number of distinct HIV-1 recombinants have been identified worldwide, but their contribution to the global epidemic is unknown. We aimed to estimate the global and regional distribution of HIV-1 recombinant forms during 1990-2015.

METHODS

We assembled a global HIV-1 molecular epidemiology database through a systematic literature review and a global survey. We searched the PubMed, Embase (Ovid), CINAHL (Ebscohost), and Global Health (Ovid) databases for HIV-1 subtyping studies published from Jan 1, 1990, to Dec 31, 2015. Unpublished original HIV-1 subtyping data were collected through a survey among experts in the field who were members of the WHO-UNAIDS Network for HIV Isolation and Characterisation. We included prevalence studies with HIV-1 subtyping data collected during 1990-2015. Countries were grouped into 14 regions and analyses were done for four time periods (1990-99, 2000-04, 2005-09, and 2010-15). The distribution of circulating recombinant forms (CRFs) and unique recombinant forms (URFs) in individual countries was weighted according to the UNAIDS estimates of the number of people living with HIV in each country to generate regional and global estimates of numbers and proportions of HIV-1 recombinants in each time period. The systematic review is registered with PROSPERO, CRD42017067164.

FINDINGS

Our global data collection yielded an HIV-1 molecular epidemiology database of 383 519 samples from 116 countries in 1990-2015. We found that the proportion of recombinants increased over time, both globally and in most regions, reaching 22·8% (7 978 517 of 34 921 639) of global HIV-1 infections in 2010-15. Both the proportion and the number of distinct CRFs detected increased over time to 16·7% and 57 CRFs in 2010-15. The global and regional distribution of HIV-1 recombinants was diverse and evolved over time, and we found large regional variation in the numbers (0-44 CRFs), types (58 distinct CRFs), and proportions (0-80·5%) of HIV-1 recombinants. Globally, CRF02_AG was the most prevalent recombinant, accounting for 33·9% (2 701 364 of 7 978 517) of all recombinant infections in 2010-15. URFs accounted for 26·7% (2 131 450 of 7 978 517), CRF01_AE for 23·0% (1 838 433), and other CRFs for 16·4% (1 307 270) of all recombinant infections in 2010-15. Although other CRFs accounted for small proportions of infections globally (<1% each), they were prominent in regional epidemics, including in east and southeast Asia, west and central Africa, Middle East and north Africa, and eastern Europe and central Asia. In addition, in 2010-15, central Africa (21·3% [243 041 of 1 143 531]), west Africa (15·5% [838 476 of 5 419 010]), east Africa (12·6% [591 140 of 4 704 986]), and Latin America (9·6% [153 069 of 1 586 605]) had high proportions of URFs.

INTERPRETATION

HIV-1 recombinants are increasingly prominent in global and regional HIV epidemics, which has important implications for the development of an HIV vaccine and the design of diagnostic, resistance, and viral load assays. Continued and improved surveillance of the global molecular epidemiology of HIV is crucial.

FUNDING

None.

摘要

背景

全球 HIV-1 遗传多样性和进化对治疗和预防工作构成了重大挑战。全世界已经确定了越来越多不同的 HIV-1 重组体，但它们对全球流行的贡献尚不清楚。我们旨在估计 1990-2015 年期间 HIV-1 重组形式的全球和区域分布。

方法

我们通过系统文献回顾和全球调查建立了一个全球 HIV-1 分子流行病学数据库。我们在 1990 年 1 月 1 日至 2015 年 12 月 31 日期间从 PubMed、Embase（Ovid）、CINAHL（Ebscohost）和 Global Health（Ovid）数据库中搜索了 HIV-1 亚型研究的文献。我们通过调查领域的专家收集了未发表的 HIV-1 亚型原始数据，这些专家是世界卫生组织/艾滋病规划署 HIV 分离和特征描述网络的成员。我们纳入了 1990-2015 年期间进行 HIV-1 亚型研究的数据的流行率研究。将各国分为 14 个区域，并对四个时间段（1990-99 年、2000-04 年、2005-09 年和 2010-15 年）进行分析。根据 UNAIDS 对每个国家 HIV 感染者人数的估计，对循环重组形式（CRFs）和独特重组形式（URFs）在各国的分布进行加权，以生成每个时间段每个国家 HIV-1 重组体的数量和比例的区域和全球估计值。该系统评价在 PROSPERO 注册，注册号为 CRD42017067164。

结果

我们的全球数据收集产生了一个包含 1990-2015 年来自 116 个国家的 383519 份样本的 HIV-1 分子流行病学数据库。我们发现，全球和大多数地区的重组体比例随着时间的推移而增加，到 2010-15 年，全球 HIV-1 感染的重组体比例达到 22.8%（7978517 例中的 34921639 例）。随着时间的推移，检测到的独特 CRFs 的比例和数量也有所增加，到 2010-15 年达到 16.7%和 57 种 CRFs。HIV-1 重组体的全球和区域分布多样化，且随着时间的推移不断演变，我们发现不同地区 HIV-1 重组体的数量（0-44 种 CRFs）、类型（58 种独特的 CRFs）和比例（0-80.5%）存在较大差异。在全球范围内，CRF02_AG 是最常见的重组体，占 2010-15 年所有重组感染的 33.9%（7978517 例中的 2701364 例）。URFs 占 26.7%（7978517 例中的 2131450 例），CRF01_AE 占 23.0%（1838433 例），其他 CRFs 占 2010-15 年所有重组感染的 16.4%（1307270 例）。尽管其他 CRFs 在全球范围内的感染比例较小（每种均低于 1%），但它们在一些区域流行中较为突出，包括东亚和东南亚、西非和中非、中东和北非以及东欧和中亚。此外，在 2010-15 年期间，中非（21.3%[1143531 例中的 243041 例]）、西非（15.5%[5419010 例中的 838476 例]）、东非（12.6%[4704986 例中的 591140 例]）和拉丁美洲（9.6%[1586605 例中的 153069 例]）的 URFs 比例较高。