A new circulating recombinant form, CRF15_01B, reinforces the linkage between IDU and heterosexual epidemics in Thailand.
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.
Tovanabutra
Sodsai
S
Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand. stovanabutra@hivresearch.org
Watanaveeradej
Veerachai
V
Viputtikul
Kwanjai
K
De Souza
Mark
M
Razak
Myat Htoo
MH
Suriyanon
Vinai
V
Jittiwutikarn
Jaroon
J
Sriplienchan
Somchai
S
Nitayaphan
Sorachai
S
Benenson
Michael W
MW
Sirisopana
Narongrid
N
Renzullo
Philip O
PO
Brown
Arthur E
AE
Robb
Merlin L
ML
Beyrer
Chris
C
Celentano
David D
DD
McNeil
John G
JG
Birx
Deborah L
DL
Carr
Jean K
JK
McCutchan
Francine E
FE
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
D004279:DNA, Viral