HIV-1 Genotypes and Disease Progression Among Chinese Men Who Have Sex with Men: An Observational Cohort Study

Background HIV-1 genetic diversity is increasing among MSM living with HIV in China, but it is not known whether disease progression and response to antiretroviral therapy (ART) vary with different HIV-1 genotypes. Methods In an observational cohort of 860 HIV-1-infected MSM in Guangzhou, China between January 2008 and December 2012, Kaplan-Meier curve analysis and the Cox proportional hazard model were used to predict the median time between HIV-1 diagnosis and progression of AIDS-defining illness as well as the adjusted hazard ratio (aHR). A generalized estimating equation (GEE) model was adapted to evaluate the effect of HIV-1 genotypes on the response to ART. Findings The four major HIV-1 genotypes CRF01_AE, CRF07_BC, CRF55_01B, and subtype B accounted for 37·0%, 37·0%, 15·3%, and 8·0% of the total, respectively. The median time and risk from HIV diagnosis to progression to AIDS was different among HIV-1 genotypes, ranked in descending order: CRF07_BC (7·03y) > CRF55_01B (5·71y, p = 0·014; aHR=2·29, p = 0·137) > CRF01_AE (5·18y, p subtype B (3·96y, p 350 cell/mm3 was statistically different between CRF07_BC and CRF01_AE (1·04 vs 1·95 years, p=0·002), but similar between CRF07_BC and subtype B (1·04 vs 1·07 years, p=0·292). After adjustment for baseline CD4 cell counts, no significant differences were observed in the rates of CD4 increases by HIV-1 genotype. Interpretation Differential rates of disease progression were observed as a function of HIV-1 genotype with HIV-1B and CRF01_AE being the most virulent, followed by CRF55_01B, with CRF07_BC, being the least pathogenic. Individuals infected with CRF07_BC had an improved virological but similar immunological response to ART compared to those infected with subtype B or CRF01_AE. Funding Bureau of Science and Information Technology of Guangzhou Municipality (Project No. 201704020219, and 201707010184). Declaration of Interest: All authors declare that they have no conflicts of interest. Ethical Approval: This study was approved by the Institutional Review Board of the Guangzhou CDC. It was performed in accordance with relevant local laws and the ethical requirements of the Helsinki Declaration.