Country Level Diversity of the HIV-1 Pandemic between 1990 and 2015
Country Level Diversity of the HIV-1 Pandemic between 1990 and 2015
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DOI：
10.1128/jvi.01580-20
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发表时间：
2021-01-01
影响因子：
5.4
通讯作者：
Kirtley, Shona
中科院分区：
文献类型：
--
作者：
Hemelaar, Joris;Loganathan, Shanghavie;Kirtley, Shona
艾滋病毒的全球多样性对艾滋病毒疫苗以及诊断、耐药性和病毒载量测定的开发构成了重大挑战，而这些对于实现艾滋病规划署90：90：90的目标至关重要。我们试图确定1990年至2015年间全球国家一级的HIV-1多样性。我们通过系统的文献检索和全球调查，建立了一个全球HIV-1分子流行病学数据库。我们检索了PubMed、EMBASE（奥维德）、CINAHL（Ebscohost）和Global Health（奥维德）中1990年1月1日至2015年12月31日期间发表的HIV-1亚型研究。我们通过全球专家调查收集了其他未发表的数据。纳入了1990年至2015年收集的原始HIV-1亚型数据的流行率研究。这导致了一个数据库，其中包含来自116个国家的四个时期（1990年至1999年，2000年至2004年，2005年至2009年和2010年至2015年）的383，519个亚型HIV-1样本。我们分析了每个时间段不同HIV-1亚型、循环重组形式（CRF）和独特重组形式（URF）的国家特定数量。我们还分析了因HIV-1重组体、CRF和URF而感染的国家特定比例，并计算了每个国家的Shannon多样性指数。最后，我们分析了这些HIV-1多样性指标的全球时间趋势。我们发现，世界各地国家一级艾滋病毒多样性的复杂性差异极大。乍得、刚果民主共和国、安哥拉和刚果共和国等中非国家的艾滋病毒流行情况最为多样。不同的HIV-1亚型和重组体的数量在西欧（西班牙和法国）和北美（美国）最多（西班牙多达39种不同的HIV-1变体）。重组体导致的HIV-1感染比例在东南亚（越南、柬埔寨和泰国的感染比例>95%）、中国以及西非和中非最高，主要是由于CRF01_AE和CRF02_AG比例较高。其他CRF在爱沙尼亚（CRF06_cpx）、伊朗（CRF35_AD）和阿尔及利亚（CRF06_cpx）发挥了重要作用（>75%的HIV-1感染）。在缅甸、刚果共和国和阿根廷发现的统一报告格式比例最高（>30%）。全球时间分析表明，随着时间的推移，国家一级不同的HIV-1变异体数量以及CRF和URF的比例持续增加，导致国家一级HIV-1多样性增加。我们的研究提供了流行病学证据，表明艾滋病毒流行病在国家一级正在多样化，并突出了预防和治疗工作面临的日益严峻的挑战。HIV-1分子流行病学监测需要继续和改进。重要性这是第一项分析1990年至2015年全球国家一级HIV-1多样性的研究。我们发现，世界各地国家一级艾滋病毒多样性的复杂性差异极大。中部非洲国家的艾滋病毒流行情况最为多样。不同的HIV-1亚型和重组体的数量在西欧和北美最多。东南亚、中国以及西非和中非因重组体感染HIV-1的比例最高。在缅甸、刚果共和国和阿根廷发现的统一报告格式比例最高。我们的研究提供了流行病学证据，表明艾滋病毒大流行在国家一级正在多样化，并强调了艾滋病毒疫苗开发和诊断，耐药性和病毒载量测定的挑战越来越大。
The global diversity of HIV forms a major challenge to the development of an HIV vaccine, as well as diagnostic, drug resistance, and viral load assays, which are essential to reaching the UNAIDS 90:90:90 targets. We sought to determine country level HIV-1 diversity globally between 1990 and 2015. We assembled a global HIV-1 molecular epidemiology database through a systematic literature search and a global survey. We searched PubMed, EMBASE (Ovid), CINAHL (Ebscohost), and Global Health (Ovid) for HIV-1 subtyping studies published from 1 January 1990 to 31 December 2015. We collected additional unpublished data through a global survey of experts. Prevalence studies with original HIV-1 subtyping data collected between 1990 and 2015 were included. This resulted in a database with 383,519 subtyped HIV-1 samples from 116 countries over four time periods (1990 to 1999, 2000 to 2004, 2005 to 2009, and 2010 to 2015). We analyzed country-specific numbers of distinct HIV-1 subtypes, circulating recombinant forms (CRFs), and unique recombinant forms (URFs) in each time period. We also analyzed country-specific proportions of infections due to HIV-1 recombinants, CRFs, and URFs and calculated the Shannon diversity index for each country. Finally, we analyzed global temporal trends in each of these measures of HIV-1 diversity. We found extremely wide variation in complexity of country level HIV diversity around the world. Central African countries such as Chad, Democratic Republic of the Congo, Angola, and Republic of the Congo have the most diverse HIV epidemics. The number of distinct HIV-1 subtypes and recombinants was greatest in Western Europe (Spain and France) and North America (United States) (up to 39 distinct HIV-1 variants in Spain). The proportion of HIV-1 infections due to recombinants was highest in Southeast Asia (>95% of infections in Viet Nam, Cambodia, and Thailand), China, and West and Central Africa, mainly due to high proportions of CRF01_AE and CRF02_AG. Other CRFs played major roles (>75% of HIV-1 infections) in Estonia (CRF06_cpx), Iran (CRF35_AD), and Algeria (CRF06_cpx). The highest proportions of URFs (>30%) were found in Myanmar, Republic of the Congo, and Argentina. Global temporal analysis showed consistent increases over time in country level numbers of distinct HIV-1 variants and proportions of CRFs and URFs, leading to increases in country level HIV-1 diversity. Our study provides epidemiological evidence that the HIV pandemic is diversifying at country level and highlights the increasing challenge to prevention and treatment efforts. HIV-1 molecular epidemiological surveillance needs to be continued and improved.IMPORTANCE This is the first study to analyze global country level HIV-1 diversity from 1990 to 2015. We found extremely wide variation in complexity of country level HIV diversity around the world. Central African countries have the most diverse HIV epidemics. The number of distinct HIV-1 subtypes and recombinants was greatest in Western Europe and North America. The proportion of HIV-1 infections due to recombinants was highest in South-East Asia, China, and West and Central Africa. The highest proportions of URFs were found in Myanmar, Republic of the Congo, and Argentina. Our study provides epidemiological evidence that the HIV pandemic is diversifying at country level and highlights the increasing challenge to HIV vaccine development and diagnostic, drug resistance, and viral load assays.