title: A new circulating recombinant form, CRF15_01B, reinforces the linkage between IDU and heterosexual epidemics in Thailand.
abstract: HIV-1 subtype B and CRF01_AE have been in circulation in Thailand and Southeast Asia for more than a decade. Initially separated by risk group, the two strains are increasingly intermixed, and two recombinant strains of essentially reciprocal structure have been recently reported. Here we identify additional CRF_01B recombinants and provide the evidence that HIV-1 strains now pass freely between the two high-risk populations. HIV isolates that showed discordance between CRF01_AE and subtype B in multi-region genotyping assays were selected for the study. They were drawn from 3 different cohorts in Thailand representing different risk behaviors and demographic characteristics: a drug user cohort in the north, a family planning clinic attendee cohort in the southeast, and a cohort study of the mucosal virology and immunology of HIV-1 infection in Thailand. The DNA from these isolates was PCR amplified to recover the full HIV-1 genome and subjected to sequencing and phylogenetic analysis. We establish that one particular CRF_01B recombinant, with the external envelope of subtype B and the rest of the genome from CRF01_AE, is circulating widely in Thailand. Termed CRF15_01B (also referred to as CRF15), the strain was primarily heterosexually transmitted, although injecting drug use (IDU) also played a role. In aggregate data from the studies, CRF15 constituted 1.7% of all HIV-1 infections (95% confidence interval 0.5-4.4%) and was dispersed widely in the country. The previously separate heterosexual and IDU epidemics have apparently been bridged by a new CRF. The entry of CRF15 into the mainstream of the epidemic signals new complexity in the long stable molecular picture in Thailand. These recombinants must be considered in ongoing or projected efficacy evaluations of HIV-1 vaccines and antiviral therapies.
authors.affiliation: Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand. stovanabutra@hivresearch.org
authors.forename: Sodsai
authors.initials: S
authors.lastname: Tovanabutra
authors.forename: Veerachai
authors.initials: V
authors.lastname: Watanaveeradej
authors.forename: Kwanjai
authors.initials: K
authors.lastname: Viputtikul
authors.forename: Mark
authors.initials: M
authors.lastname: De Souza
authors.forename: Myat Htoo
authors.initials: MH
authors.lastname: Razak
authors.forename: Vinai
authors.initials: V
authors.lastname: Suriyanon
authors.forename: Jaroon
authors.initials: J
authors.lastname: Jittiwutikarn
authors.forename: Somchai
authors.initials: S
authors.lastname: Sriplienchan
authors.forename: Sorachai
authors.initials: S
authors.lastname: Nitayaphan
authors.forename: Michael W
authors.initials: MW
authors.lastname: Benenson
authors.forename: Narongrid
authors.initials: N
authors.lastname: Sirisopana
authors.forename: Philip O
authors.initials: PO
authors.lastname: Renzullo
authors.forename: Arthur E
authors.initials: AE
authors.lastname: Brown
authors.forename: Merlin L
authors.initials: ML
authors.lastname: Robb
authors.forename: Chris
authors.initials: C
authors.lastname: Beyrer
authors.forename: David D
authors.initials: DD
authors.lastname: Celentano
authors.forename: John G
authors.initials: JG
authors.lastname: McNeil
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Birx
authors.forename: Jean K
authors.initials: JK
authors.lastname: Carr
authors.forename: Francine E
authors.initials: FE
authors.lastname: McCutchan
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004279:DNA, Viral / Q000235:genetics; D004196:Disease Outbreaks; D005260:Female; D016679:Genome, Viral; D015658:HIV Infections / Q000453:epidemiology / Q000635:transmission* / Q000821:virology; D015497:HIV-1 / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification; D020010:Heterosexuality; D006801:Humans; D008297:Male; D008969:Molecular Sequence Data; D010802:Phylogeny; D016133:Polymerase Chain Reaction; D016865:Reassortant Viruses / Q000235:genetics / Q000302:isolation & purification*; D012307:Risk Factors; D012689:Sequence Homology, Nucleic Acid; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D013785:Thailand / Q000453:epidemiology
chemical_list: D004279:DNA, Viral