Previous Article | Next Article 
Journal of Virology, September 2008, p. 9206-9215, Vol. 82, No. 18
0022-538X/08/$08.00+0 doi:10.1128/JVI.00399-08
Copyright © 2008, American Society for Microbiology. All Rights Reserved.
Temporal and Spatial Dynamics of Human Immunodeficiency Virus Type 1 Circulating Recombinant Forms 08_BC and 07_BC in Asia
,
Kok Keng Tee,1,2
Oliver G. Pybus,3
Xiao-Jie Li,1,
Xiaoxu Han,4
Hong Shang,4
Adeeba Kamarulzaman,2 and
Yutaka Takebe1,4*
Laboratory of Molecular Virology and Epidemiology, AIDS Research Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan,1
Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia,2
Department of Zoology, University of Oxford, South Parks Road, Oxford OX1 3PS, United Kingdom,3
Key Laboratory of AIDS Immunology, Ministry of Health, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning 110001, The People's Republic of China4
Received 25 February 2008/
Accepted 24 June 2008

ABSTRACT
Human immunodeficiency virus type 1 (HIV-1) CRF08_BC and CRF07_BC
are two major recombinants descended from subtypes B' and C.
Despite their massive epidemic impact in China, their migration
patterns and divergence times remain unknown. Phylogenetic and
population genetic analyses were performed on 228 HIV-1 sequences
representing CRF08_BC, CRF07_BC, and subtype C strains from
different locations across China, India, and Myanmar. Genome-specific
rates of evolution and divergence times were estimated using
a Bayesian Markov chain Monte Carlo framework under various
evolutionary models. CRF08_BC originated in 1990.3 (95% credible
region [CR], 1988.6 to 1991.9) in Yunnan province before spreading
to Guangxi (south) and Liaoning (northeast) around 1995. Inside
Guangxi region, the eastward expansion of CRF08_BC continued
from Baise city (west) to Binyang (central) between 1997 and
1998 and later spread into Pingxiang around 1999 in the south,
mainly through injecting drug users. Additionally, CRF07_BC
diverged from its common ancestor in 1993.3 (95% CR, 1991.2
to 1995.2) before crossing the border into southern Taiwan in
late 1990s. Phylogenetic analysis indicates that both CRF08_BC
and CRF07_BC can trace their origins to Yunnan. The parental
Indian subtype C lineage likely entered China around 1981.2
(95% CR, 1976.7 to 1985.9). Using a multiple unlinked locus
model, we also showed that the dates of divergence calculated
in this study may not be significantly affected by intrasubtype
recombination among different lineages. This is the first phylodynamic
study depicting the spatiotemporal dynamics of HIV/AIDS in East
Asia.

INTRODUCTION
The human immunodeficiency virus type 1 (HIV-1) circulating
recombinant forms (CRFs) 08_BC (CRF08_BC) and 07_BC (CRF07_BC)
are two highly prevalent strains that are circulating in Asia
and causing hundreds of thousands of infections in China (
42).
HIV-1 CRF08_BC, a descendant of the parental subtypes B' and
C, was first described in the Guangxi province in southern China
around 1997 (
26). CRF08_BC is thought to have originated in
Yunnan province (
20,
49) and has spread to other regions of
China, particularly in the south (
26,
51). HIV-1 CRF07_BC is
a related but distinct B'/C recombinant that was first reported
in 1997 in Xinjiang and is predominant in the north of China;
its origin has also been traced to Yunnan province (
38).
Yunnan is located in southwestern China, bordering the "Golden Triangle" region of Southeast Asia, one of the world's largest heroin-producing regions. Yunnan plays an important role as the entry point for heroin smuggling into, and possibly beyond, China (2). Yunnan province is considered an epicenter of HIV/AIDS in China, and an HIV-1 outbreak there was first detected among injecting drug users (IDU) in 1989 (53). The early phase of the epidemic was due to subtype B strains of both North American and Southeast Asian (B' or Thai B) origin (47), with subtype B' later becoming the dominant strain among IDU in the region (10, 45). The subtype distribution then shifted in the early 1990s, when a subtype C strain closely related to Indian isolates emerged and subsequently became the predominant circulating strain (19). CRF01_AE from Thailand may also have entered Yunnan as early as 1993, possibly through sexual transmission networks (3). Following cocirculation of subtypes B' and C in the region, various phylogenetically distinct B'/C recombinants—including CRF08_BC and CRF07_BC—were formed and subsequently spread outside Yunnan province. Drug trafficking activities, compounded by local heroin use along the trafficking routes, have been implicated in the spread of CRF08_BC and CRF07_BC across China (2). Although molecular epidemiologic surveys have previously reported the identification and characterization in various parts of China of CRF08_BC, CRF07_BC and their putative subtype C parental lineages (19, 26, 32, 38), the specific times of emergence and divergence of these strains in the world's most populous nation remain uninvestigated and unknown. Genealogical analysis is needed to reconstruct the epidemiological history of viral populations (8, 9, 43), which can lead to better understanding of HIV transmission and improved prevention programs.
In this study, we investigated the spatial and temporal spread of HIV-1 CRF08_BC and CRF07_BC in China by reconstructing the evolutionary histories of these strains using recently developed Bayesian analysis methods. In addition, we also assessed the phylodynamics of the subtype C lineage of Indian origin in order to provide a more comprehensive picture of the movement of subtype C and its related recombinants in the region. Here, we demonstrate and provide a timescale for the eastwards spread of HIV/AIDS in East Asia, and we highlight the significance of HIV-1 evolutionary history upon viral epidemiology, migration and molecular taxonomy.

MATERIALS AND METHODS
HIV-1 CRF08_BC and CRF07_BC sequence information.
HIV-1 CRF08_BC nucleotide sequences with known sampling dates
were retrieved from the Los Alamos HIV Sequence Database (
www.hiv.lanl.gov).
Eighty-one CRF08_BC sequences, including the reference strains
previously reported by our laboratory and others, were isolated
from the provinces of Yunnan (
n = 31; southwestern China), Guangxi
(
n = 44; southern China), Gansu (
n = 1; northwestern China),
and Liaoning (
n = 5; northeastern China) (
11,
15,
17,
26,
32,
48,
49). Samples from Yunnan province were collected mainly
from Kunming, Honghe, and Wenshan prefectures, while isolates
from Baise city, Binyang, and Pingxiang counties represented
the Guangxi autonomous region. Liaoning sequences were derived
from the provincial capital Shenyang. The nonrecombinant
gag-
pol region of CRF08_BC was selected for codon-based alignment, phylogenetic
reconstruction, and coalescent analysis (
14). This spans the
region from p2 in
gag to the reverse transcriptase in
pol (strain
HXB2 nucleotides 1918 to 2852; 921 bp in length) and is of subtype
C origin. Similarly, 22 CRF07_BC sequences with known sampling
years were retrieved from the database. These CRF07_BC sequences
were isolated from Yunnan (
n = 10), Xinjiang (
n = 6; northwestern
China), and Liaoning (
n = 6) provinces (
11,
17,
22,
32,
38,
48,
49). Except for five sequences from Xinjiang, all of the
CRF07_BC nucleotide sequences have been previously reported
by our laboratory. Although the Liaoning patients were recruited
in the provincial capital Shenyang, interviews with the patients
revealed that only one was possibly infected in Liaoning, whereas
four patients reported having acquired the infection in Guangdong
(southeastern) province and one patient in Sichuan (central)
province. The 420-bp nonrecombinant
gag region of CRF07_BC,
which is of subtype C origin and encompasses the p17 and partial
p24 proteins (HXB2 nucleotides 790 to 1218) was aligned for
phylogenetic and evolutionary analyses. Demographic information
and risk category for the persons from whom studied isolates
were obtained are summarized in Table
1.
Bayesian MCMC evolutionary analyses.
Genome region-specific rates of evolution were obtained from
a reference set of subtype C sequences using BEAST, version
1.4 (
7), a program that employs a Markov chain Monte Carlo (MCMC)
algorithm to estimate evolutionary parameters. To perform these
analyses, subtype C regions of
gag-
pol and
gag that correspond
to the nonrecombinant subtype C segments of CRF08_BC and CRF07_BC,
respectively, were retrieved from the HIV sequence database.
The resulting heterochronous reference data set contains 41
subtype C sequences sampled between 1989 and 2005, a date range
of about 17 years. Maximum-likelihood phylogenies were estimated
for each subgenomic region of CRF08_BC and CRF07_BC and for
the heterochronous subtype C reference data set using PAUP*,
version 4.0 beta (
40), and BEAST, version 1.4 (
7). All nucleotide
alignments are available from the authors upon request.
Strict and relaxed molecular clock (5) analyses were performed under the Hasegawa-Kishino-Yano (HKY) (12) and general time-reversible (33) substitution models, with a gamma-distributed model of among-site rate variation with four rate categories (
4) (50). Here, the demographic model component of the BEAST analysis was not of interest, and, hence, it was treated as a nuisance parameter. Each analysis was therefore repeated using constant size, exponential, and logistic growth models in order to investigate the degree to which dating estimates are affected by the demographic model chosen (6). Each MCMC analysis was run for 20 million steps and sampled every 10,000 states. The posterior densities were calculated with 10% burn-in and checked for convergence using Tracer, version 1.4 (28). The posterior distribution of evolutionary rate obtained from the heterochronous reference data set was subsequently incorporated as a prior distribution for the evolutionary rate in the HIV-1 CRF08_BC and CRF07_BC analyses, thereby placing a timescale on the histories of these strains and enabling an estimation of the time to the most recent common ancestor (tMRCA) for the strains (27).
In order to test the possible effects of intrasubtype recombination on the estimated dates, we applied in BEAST a multiple unlinked locus model that allows independent coalescent pathways for different gene loci (16). The "linked" gag-pol gene was partitioned into two unlinked loci of equivalent length, denoted locus 1 (HXB2 nucleotides 1918 to 2390) and 2 (HXB2 nucleotides 2391 to 2852), and their tMRCAs were estimated in the Bayesian coalescent framework assuming a shared demographic history among all loci. Genealogical correlation between the linked and unlinked loci was evaluated by assessing their divergence dates.
Evolutionary analysis of subtype C.
HIV-1 subtype C, probably of Indian origin, was identified as a major circulating strain in China in the early 1990s and is believed to be the putative parent for CRF08_BC and CRF07_BC (19, 20). To assess the divergence times of subtype C in both India and China, "pure" nonrecombinant subtype C genetic regions from 12 nearly full-length subtype C sequences of Indian origin (including a nearly full-length sequence from Myanmar [41]) were retrieved from the HIV Sequence Database. Additionally, 112 subtype C-related env sequences (HXB2 nucleotides 6984 to 7328; 336 bp) isolated from China were retrieved; these Chinese sequences were typed as subtype C (n = 14), CRF08_BC (n = 87), and CRF07_BC (n = 10) and one B'/C unique recombinant form. The methods described above were used to estimate phylogenies, genome region-specific evolutionary rates, and tMRCAs of the Indian and Chinese strains from the gag-pol and/or env genes. Furthermore, select subtype C sequences from other localities (31 full-length sequences from Africa and also Brazil) were also studied in order to assess the time of origin of the global HIV-1 subtype C.

RESULTS
A total of 103 HIV-1 B'/C circulating recombinant forms were
retrieved from at least five provinces/autonomous regions representing
a relatively wide range of locations across mainland China,
three of which have the highest recorded HIV prevalences in
the country (Yunnan, Guangxi, and Xinjiang) (
23). Nucleotide
sequences of the nonrecombinant regions of HIV-1 CRF08_BC (
n = 81) and CRF07_BC (
n = 22) from IDU (86.3%) and sexual risk
patients (13.7%) were selected, codon aligned, and analyzed
using likelihood and Bayesian approaches to determine their
evolutionary relationships in various regions. Additionally,
subtype C or subtype C-related sequences from India and China
(
n = 124) were also analyzed to determine the time of origin
of these lineages.
Phylogenetic reconstruction of the gag-pol gene (Fig. 1a) showed that all CRF08_BC sequences grouped in a single clade containing isolates from four Chinese regions: Yunnan, Gansu, Liaoning, and Guangxi (Baise city and Binyang and Pingxiang counties). These sequences were descended from subtype C isolates of Indian origin, confirming the parental relationship of Indian subtype C with respect to CRF08_BC. Yunnan sequences collected from different prefectures (Kunming, Honghe, and Wenshan) (49) were largely intermingled with sequences from Gansu, Liaoning, and Guangxi (Baise), suggesting close relationships among these sequences. However, other sequences from Binyang county (and also Pingxiang) in Guangxi formed a distinct monophyletic cluster that diverged from the Yunnan/Baise isolates and further bifurcated into three major clusters (indicated as clusters 1 to 3). Cluster 1 contained sequences from Binyang (n = 30) and Pingxiang (n = 2), while clusters 2 and 3 contained seven and two Binyang sequences, respectively. The robustness of each cluster was supported by high posterior clade probabilities (P > 0.95). Similarly, CRF08_BC sequences from Liaoning province (except that of one subject who acquired the infection in Yunnan) also formed a single cluster.
Bayesian analyses under different evolutionary models estimated
consistent mean rates of evolution (µ) for the CRF08_BC
gag-
pol gene, in the range of 1.7
x 10
–3 to 1.8
x 10
–3 substitutions/site/year. This range of rates was included as
a prior probability distribution in subsequent analyses in order
to calculate the tMRCA of the respective CRF08_BC clusters.
When the constant size population model and HKY substitution
model were used, the Yunnan (and Gansu) clusters were dated
to 1990.3 (95% credible region [CR], 1988.6 to 1991.9) (Table
2). CRF08_BC was probably introduced later into Baise city in
neighboring Guangxi around 1995.5 (95% CR, 1994.3 to 1996.5).
This is in agreement with previous epidemiological investigations,
which reported the first outbreaks of CRF08_BC (then classified
as subtype C based on
env gene sequencing) in this area (
26,
51). Interestingly, the tMRCA of the Liaoning cluster is estimated
at 1995.6 (95% CR, 1993.4 to 1997.5), comparable to that of
Guangxi, and sequences from both these regions trace their origins
to Yunnan. This suggests that the epidemics in Liaoning, an
area with low HIV/AIDS prevalence, and Guangxi could have started
at almost the same time. As shown in the
gag-
pol phylogeny (Fig.
1a), subsequent spread of CRF08_BC among the IDU populations
in Binyang and Pingxiang involved at least three viral lineages
(clusters 1 to 3) descended from the Yunnan or Baise sequences
between 1997 and 1999 (Table
2). In addition, all Binyang and
Pingxiang sequences contained signature amino acid deletions
in
gag (p7, p1, and p6) and in reverse transcriptase at position
P25 (amino acid alignment not shown) that were not found in
other CRF08_BC sequences, suggesting a shared common ancestor
for these strains. Overall, the evolutionary and statistical
assumptions applied in the coalescence analyses have almost
no effect on the estimated dates (results generated under the
general time-reversible nucleotide substitution model are shown
in Table S1 in the supplemental material). In addition to strict
molecular clock analyses, we also explored the relaxed phylogenetic
method (
5) to estimate the divergence times for each data set.
The results, under selected evolutionary priors, were comparable
to those described above (see Fig. S1 in the supplemental material
for a summary). Our analysis reconstructs the chronological
events of HIV-1 expansion by retracing the north-eastward and
eastward migration of CRF08_BC to Liaoning and Guangxi, respectively,
most likely from a common source in Yunnan province. However,
we note that the estimated coalescence times, particularly for
clusters with a small number of sequences, may be biased and
hence more recent than the date of outbreak. This is because,
among other factors, the extant virus diversity has been partially
sampled; alternatively, the founding/parental lineages of the
outbreak have since become extinct or are yet to be discovered
(
1,
43).
Conversely, all
gag sequences of CRF07_BC from Yunnan, Xinjiang,
and Liaoning formed a single cluster, with subtype C isolates
of Indian origin paraphyletic with respect to CRF07_BC (Fig.
1b). Coalescence analyses under a constant size population model
(estimated evolutionary rate, µ = 4.4
x 10
–3 substitutions/site/year)
imply that the common ancestor of the Chinese CRF07_BC isolates
existed around 1993.3 (95% CR, 1991.2 to 1995.2) (Table
2).
This is in agreement with previous studies, based on the
env gene, which dated the divergence time of CRF07_BC to about 1993
(
43). The exponential and logistic demographic model gave slightly
lower substitution rates and hence older MRCA estimates. Harmonic
means of the coalescent likelihood estimated using marginal
likelihood analysis (
39), however, showed that other tree models
do not significantly fit the
gag data set better than the constant
size population model (log
10 Bayes factors of <3.0), suggesting
that there could be insufficient information in the data to
fit a more complex model. The logistic model meanwhile was strongly
supported over the exponential model (log
10 Bayes factors of
4.4). In addition, it is important to note that among the six
Liaoning sequences, only one patient reported having acquired
the infection in Liaoning while other patients referred to Guangdong
or Sichuan provinces as the likely location of HIV infection,
mainly through intravenous drug use. The evidence, therefore,
suggests that CRF07_BC sequences from Xinjiang, Liaoning, Guangdong,
and Sichuan can probably be traced to a common origin in Yunnan
province, a similar pattern to that observed for the CRF08_BC
sequences from different regions.
Maximum clade credibility trees revealed that the env sequences of subtype C (from India, China, and Myanmar) and of CRF08_BC, CRF07_BC, and other subtype C-related recombinants from China were intermingled in a single cluster, indicating a shared common ancestry, with subtype C strains of Indian origin as outgroup founder strains (Fig. 1c). Coalescence analyses of the gag-pol and env genes dated the tMRCA of subtype C strains from India and Myanmar to around the mid- to late 1970s (Table 2). Analysis of 14 env sequences suggests that subtype C spread into neighboring China later, in 1981.2 (95% CR, 1976.7 to 1985.9), most likely in Yunnan province. Together, the phylogenetic and coalescent results map the eastward movement of subtype C from India to China, probably through Myanmar (2), between the mid-1970s and early 1980s. Finally, the time of origin of the global HIV-1 subtype C was dated 1967.6 (95% CR, 1962.5 to 1972.0) and was highly consistent with previous estimates (44).
To evaluate the possible effects of intrasubtype recombination on the tMRCA estimates, we considered a multilocus model (16) that assumes different genealogies for each locus of the unlinked gag-pol data set. BEAST analyses revealed that the tree topologies (figures not shown) and the estimated tMRCAs for the unlinked loci were not significantly different from those of the linked gag-pol locus among the overlapping 95% CRs for each locus, especially in those states with younger tMRCAs (Fig. 2). The results suggest that intrasubtype recombination within HIV-1 subtype C and CRF08_BC may not have significant biases on the MRCA dates (16).

DISCUSSION
To our knowledge, this is the first genealogy-based population
genetic study of the divergence times of HIV-1 CRF08_BC and
CRF07_BC across China. CRF08_BC and CRF07_BC are two subtype
C-related recombinants with significant epidemic impact in China
and beyond (
42,
43). Prior to the emergence of CRF08_BC and
CRF07_BC (
26,
38), subtype C isolates closely related to Indian
strains predominated, especially in the southern part of China
(
19). Later, subtype C recombined with subtype B' (
10,
45,
47)
to form these recombinants. Both recombinants, long thought
to have originated from a common birthplace in Yunnan province
(
20,
49), later dispersed to other areas primarily through drug
use and trafficking activities (
2). The present study provides
new information on the evolutionary and epidemiological characteristics
of HIV-1 by establishing the plausible dates of origin and geographic
migration patterns of CRF08_BC and CRF07_BC across China. Although
the early Indian subtype C strains play no major role in today's
epidemic in China, the date of introduction of subtype C into
China helps to provide a more complete picture of the epidemic
history of subtype C and its related recombinants in East Asia
(Fig.
3).
The Bayesian coalescence analyses show that CRF08_BC emerged
in Yunnan province of China in the early 1990s. The virus then
spread eastward to neighboring Guangxi (in Baise city near the
Yunnan-Guangxi border) in the mid-1990s; this is consistent
with historical accounts of CRF08_BC among IDU in this region
(
24). Inside Guangxi, highly homogeneous CRF08_BC strains from
Baise (
26,
52) were multiply introduced into Binyang county
in 1996 to 1999 and are predominant among IDU (
15). Moreover,
the relatively recent introduction of CRF08_BC into Pingxiang
in the late 1990s estimated here suggests a southward distribution
of CRF08_BC near the China-Vietnam border, although CRF01_AE
strains closely related to strains of northern Vietnam account
for the majority of IDU infections in this region (
13,
15).
It is also interesting that the CRF08_BC epidemic in Liaoning
province, a geographically remote area with low HIV prevalence
located in northeastern China, started at almost the same time
as that in Guangxi. Our results imply a rapid and simultaneous
expansion of CRF08_BC from a common origin in Yunnan to Guangxi
and as far as Liaoning province. Although a general trend of
migration has been observed, it is essential to stress that
the estimated dates—which merely imply the coalescence
times of select viral strains—might not accurately reflect
the actual time of CRF08_BC spread in a given region, especially
when the sampled population clusters are small. Until more archival
specimens are retrieved and thoroughly studied, the complex
temporal movement of CRF08_BC lineages (and also other subtypes/CRFs)
must be interpreted with discretion.
Phylogenetic reconstruction and coalescence inference show that the CRF07_BC isolates from different mainland Chinese regions (including Xinjiang, Liaoning, and probably Guangdong and Sichuan) most likely share a common ancestor that existed in 1993 in Yunnan province (20, 49). However, it is noteworthy that a single CRF07_BC sequence and a unique B'/C recombinant sequence were located at the base of the env maximum-likelihood tree, along with Indian subtype C sequences. This could be explained by two possibilities: (i) there is a recombination breakpoint within the region studied that rendered the phylogenetic inference inaccurate, or (ii) this is a new recombinant that has acquired an Indian subtype C env gene. Since no recombination breakpoint is identified within this region, it is likely that a recombination event in the env gene involving CRF07_BC and a "founder" Indian C lineage has occurred before the sequence was sampled (where the putative recombination breakpoints are probably located outside the studied region), a phenomenon which is not uncommon (49). Similar explanations also can be applied for the few CRF08_BC sequences that grouped outside the monophyletic cluster in the env region.
We previously investigated the spatiotemporal spread of CRF07_BC in Taiwan using env gene sequences (43). CRF07_BC was first introduced into southern Taiwan in the late 1990s, most probably from southwestern China (18), and later spread to the central-northern part of Taiwan in the early 2000s, resulting in the largest-ever HIV epidemic in Taiwan, mostly affecting IDU populations. Adding these results to our new analyses performed here, we have retraced the expansive migration of HIV-1 CRF07_BC from its origin in Yunnan to (a) Xinjiang by the north-westward drug trafficking paths, (b) to Liaoning either by direct introduction from Yunnan or through Guangdong/Sichuan, and (c) to Taiwan, possibly through southeastern China via drug trafficking routes.
Recombination is common in HIV infection (31) and serves as one of the intrinsic evolutionary mechanisms that shape the complex HIV diversity. Besides intersubtype recombination, recombination involving closely related lineages of the same subtype within a single individual has been reported (25, 34, 36), leading to possible quantitative discrepancies on linkage disequilibrium, including the loss of phylogenetic correlation between different loci and biases in the genealogical characteristics (i.e., overestimation of the tMRCA) along the HIV genome (35, 46). Our study, however, showed that intrasubtype recombination has no significant impact on the estimated coalescence dates (Fig. 2)—a feature previously observed in HIV-1 group O (16). This could possibly be explained by the high growth rates of HIV-1, as characterized by its star-like population phylogeny (29) where the terminal branches form a substantial proportion of a tree. In the rapidly growing HIV-1 population, recombination events are more likely to affect the terminal branches by increasing the variance in mutation rates rather than biasing the tree topology (16, 21). Consequently, intrasubtype recombination, despite occurring at high frequency, may not significantly influence the divergence times of HIV.
The currently adopted HIV-1 nomenclature guidelines classify HIV-1 CRFs sequentially, according to the first described full-length or nearly full-length genetic sequences obtained (30), without taking into account the evolutionary history of the viruses (1). Our studies of all available CRF08_BC and CRF07_BC sequences with known sampling dates have shown that CRF08_BC has an earlier evolutionary history than CRF07_BC, which is not readily indicated by the current naming system. We show that CRF08_BC was probably generated approximately 10 years after subtype C of Indian origin was first introduced to Yunnan province, around 1981. CRF07_BC was formed in the same province a few years later, around 1993. The findings highlight the feasibility and relevance of incorporating evolutionary population biology into HIV-1 classification to better reflect the evolutionary pathways of the viruses, particularly for those recombinants with close phylogenetic, genealogical and geographical links (4, 37).
Here, we reconstruct the epidemic histories of HIV-1 CRF08_BC, CRF07_BC and related sequences, inside and beyond China. Injection drug use remains a major transmission mode for HIV-1 CRF08_BC and CRF07_BC throughout China. Phylodynamic investigations are therefore important in unifying the epidemiological and evolutionary dynamics of the highly divergent and rapidly expanding HIV-1 subtypes and CRFs in Asia and elsewhere.

ACKNOWLEDGMENTS
The authors gratefully acknowledge Philippe Lemey and Chung-Chau
Hon for assistance, Naoki Yamamoto for support, and Timothy
D. Mastro for critical reading of the manuscript. We also thank
the anonymous reviewers for their insightful comments.
This study was supported in part by grants from the Ministry of Health, Labour and Welfare (H18-AIDS-General-016); Ministry of Education, Culture, Sports, Science and Technology (Overseas Research Fund); the Japanese Foundation for AIDS Prevention (JFAP) to Y.T.; the Ministry of Science, Technology and Innovation (eScienceFund 02-01-03-SF0379) to A.K.; and the Royal Society University Research Fellowship to O.G.P. and Y.T. K.K.T. is a recipient of the JFAP research resident fellowship.

FOOTNOTES
* Corresponding author. Mailing address: Laboratory of Molecular Virology and Epidemiology, AIDS Research Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan. Phone: 8 13 5285 1111, ext. 2537. Fax: 81 3 5285 1258. E-mail:
takebe{at}nih.go.jp 
Published ahead of print on 2 July 2008. 
Supplemental material for this article may be found at http://jvi.asm.org/. 
Present address: Department of Dermatology, The First People's Hospital, Shanghai Jiao Tong University, 85 Wujin Road, Shanghai 200080, The People's Republic of China. 

REFERENCES
1 - Abecasis, A. B., P. Lemey, N. Vidal, T. de Oliveira, M. Peeters, R. Camacho, B. Shapiro, A. Rambaut, and A. M. Vandamme. 2007. Recombination confounds the early evolutionary history of human immunodeficiency virus type 1: subtype G is a circulating recombinant form. J. Virol. 81:8543-8551.[Abstract/Free Full Text]
2 - Beyrer, C., M. H. Razak, K. Lisam, J. Chen, W. Lui, and X. F. Yu. 2000. Overland heroin trafficking routes and HIV-1 spread in South and South-East Asia. AIDS 14:75-83.[CrossRef][Medline]
3 - Cheng, H., J. Zhang, J. Capizzi, N. L. Young, and T. D. Mastro. 1994. HIV-1 subtype E in Yunnan, China. Lancet 344:953-954.[Medline]
4 - De Sa Filho, D. J., M. C. Sucupira, M. M. Caseiro, E. C. Sabino, R. S. Diaz, and L. M. Janini. 2006. Identification of two HIV type 1 circulating recombinant forms in Brazil. AIDS Res. Hum. Retrovir. 22:1-13.[CrossRef][Medline]
5 - Drummond, A. J., S. Y. Ho, M. J. Phillips, and A. Rambaut. 2006. Relaxed phylogenetics and dating with confidence. PLoS Biol. 4:e88.[CrossRef][Medline]
6 - Drummond, A. J., G. K. Nicholls, A. G. Rodrigo, and W. Solomon. 2002. Estimating mutation parameters, population history and genealogy simultaneously from temporally spaced sequence data. Genetics 161:1307-1320.[Abstract/Free Full Text]
7 - Drummond, A. J., and A. Rambaut. 2007. BEAST: Bayesian evolutionary analysis by sampling trees. BMC Evol. Biol. 7:214.[CrossRef][Medline]
8 - Gifford, R. J., T. de Oliveira, A. Rambaut, O. G. Pybus, D. Dunn, A. M. Vandamme, P. Kellam, and D. Pillay. 2007. Phylogenetic surveillance of viral genetic diversity and the evolving molecular epidemiology of human immunodeficiency virus type 1. J. Virol. 81:13050-13056.[Abstract/Free Full Text]
9 - Gilbert, M. T., A. Rambaut, G. Wlasiuk, T. J. Spira, A. E. Pitchenik, and M. Worobey. 2007. The emergence of HIV/AIDS in the Americas and beyond. Proc. Natl. Acad. Sci. USA 104:18566-18570.[Abstract/Free Full Text]
10 - Graf, M., Y. Shao, Q. Zhao, T. Seidl, J. Kostler, H. Wolf, and R. Wagner. 1998. Cloning and characterization of a virtually full-length HIV type 1 genome from a subtype B'-Thai strain representing the most prevalent B-clade isolate in China. AIDS Res. Hum. Retrovir. 14:285-288.[Medline]
11 - Han, X., M. Zhang, D. Dai, Y. Wang, Z. Zhang, J. Liu, W. Geng, Y. Jiang, Y. Takebe, and H. Shang. 2007. Genotypic resistance mutations to antiretroviral drugs in treatment-naive HIV/AIDS patients living in Liaoning Province, China: baseline prevalence and subtype-specific difference. AIDS Res. Hum. Retrovir. 23:357-364.[CrossRef][Medline]
12 - Hasegawa, M., H. Kishino, and T. Yano. 1985. Dating of the human-ape splitting by a molecular clock of mitochondrial DNA. J. Mol. Evol. 22:160-174.[CrossRef][Medline]
13 - Kato, K., T. Shiino, S. Kusagawa, H. Sato, K. Nohtomi, K. Shibamura, T. H. Nguyen, K. C. Pham, X. L. Truong, H. A. Mai, T. L. Hoang, G. Bunyaraksyotin, Y. Fukushima, M. Honda, C. Wasi, S. Yamazaki, Y. Nagai, and Y. Takebe. 1999. Genetic similarity of HIV type 1 subtype E in a recent outbreak among injecting drug users in northern Vietnam to strains in Guangxi Province of southern China. AIDS Res. Hum. Retrovir. 15:1157-1168.[CrossRef][Medline]
14 - Kingman, J. F. C. 1982. The coalescent. Stochastic Processes Appl. 13:235-248.[CrossRef]
15 - Laeyendecker, O., G. W. Zhang, T. C. Quinn, R. Garten, S. C. Ray, S. Lai, W. Liu, J. Chen, and X. F. Yu. 2005. Molecular epidemiology of HIV-1 subtypes in southern China. J. Acquir. Immune Defic. Syndr. 38:356-362.[Medline]
16 - Lemey, P., O. G. Pybus, A. Rambaut, A. J. Drummond, D. L. Robertson, P. Roques, M. Worobey, and A. M. Vandamme. 2004. The molecular population genetics of HIV-1 group O. Genetics 167:1059-1068.[Abstract/Free Full Text]
17 - Li, X. J., S. Kusagawa, X. Xia, C. Yang, Q. Wang, Y. Yokota, Y. Hoshina, T. Onogi, K. Nohtomi, Y. Imamura, T. Shiino, R. Yang, N. Yamamoto, K. Ben, and Y. Takebe. 2005. Molecular epidemiology of the heterosexual HIV-1 transmission in Kunming, Yunnan Province of China suggests origin from the local IDU epidemic. AIDS Res. Hum. Retrovir. 21:977-980.[CrossRef][Medline]
18 - Lin, H. H., Y. L. Shih, Y. C. Liu, S. S. Lee, C. K. Huang, Y. L. Chen, C. Chin, C. H. Lai, H. C. Tsai, Y. C. Guo, and L. Zhang. 2006. An epidemic of HIV type I CRF07_BC infection among injection drug users in Taiwan. J. Acquir. Immune Defic. Syndr. 42:248-255.[CrossRef][Medline]
19 - Luo, C. C., C. Tian, D. J. Hu, M. Kai, T. Dondero, and X. Zheng. 1995. HIV-1 subtype C in China. Lancet 345:1051-1052.[Medline]
20 - McClutchan, F. E., J. K. Carr, D. Murphy, S. Piyasirisilp, F. Gao, B. Hahn, X. F. Yu, C. Beyrer, and D. L. Birx. 2002. Precise mapping of recombination breakpoints suggests a common parent of two BC recombinant HIV type 1 strains circulating in China. AIDS Res. Hum. Retrovir. 18:1135-1140.[CrossRef][Medline]
21 - McVean, G. A. 2002. A genealogical interpretation of linkage disequilibrium. Genetics 162:987-991.[Abstract/Free Full Text]
22 - Meng, Z., H. Xing, X. He, L. Ma, W. Xu, and Y. Shao. 2007. Genetic characterization of three newly isolated CRF07_BC near full-length genomes in China. AIDS Res. Hum. Retrovir. 23:1049-1054.[CrossRef][Medline]
23 - Ministry of Health, People's Republic of China, Joint United Nations Programme on HIV/AIDs, and the World Health Organization. 2006. 2005 Update on the HIV/AIDS epidemic and response in China. National Center for AIDS/STD Prevention and Control, China CDC, Beijing, People's Republic of China.
24 - Ministry of Health, People's Republic of China, and United Nations Theme Group on HIV/AIDS in China. 1997. China responds to AIDS: HIV/AIDS situation and needs assessment report. Chinese Ministry of Health, Beijing, People's Republic of China.
25 - Philpott, S., H. Burger, C. Tsoukas, B. Foley, K. Anastos, C. Kitchen, and B. Weiser. 2005. Human immunodeficiency virus type 1 genomic RNA sequences in the female genital tract and blood: compartmentalization and intrapatient recombination. J. Virol. 79:353-363.[Abstract/Free Full Text]
26 - Piyasirisilp, S., F. E. McCutchan, J. K. Carr, E. Sanders-Buell, W. Liu, J. Chen, R. Wagner, H. Wolf, Y. Shao, S. Lai, C. Beyrer, and X. F. Yu. 2000. A recent outbreak of human immunodeficiency virus type 1 infection in southern China was initiated by two highly homogeneous, geographically separated strains, circulating recombinant form AE and a novel BC recombinant. J. Virol. 74:11286-11295.[Abstract/Free Full Text]
27 - Pybus, O. G., A. J. Drummond, T. Nakano, B. H. Robertson, and A. Rambaut. 2003. The epidemiology and iatrogenic transmission of hepatitis C virus in Egypt: a Bayesian coalescent approach. Mol. Biol. Evol. 20:381-387.[Abstract/Free Full Text]
28 - Rambaut, A., and A. J. Drummond. 2007. Tracer v1.4. Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, Scotland. http://tree.bio.ed.ac.uk.
29 - Robbins, K. E., P. Lemey, O. G. Pybus, H. W. Jaffe, A. S. Youngpairoj, T. M. Brown, M. Salemi, A. M. Vandamme, and M. L. Kalish. 2003. U.S. Human immunodeficiency virus type 1 epidemic: date of origin, population history, and characterization of early strains. J. Virol. 77:6359-6366.[Abstract/Free Full Text]
30 - Robertson, D. L., J. P. Anderson, J. A. Bradac, J. K. Carr, B. Foley, R. K. Funkhouser, F. Gao, B. H. Hahn, M. L. Kalish, C. Kuiken, G. H. Learn, T. Leitner, F. McCutchan, S. Osmanov, M. Peeters, D. Pieniazek, M. Salminen, P. M. Sharp, S. Wolinsky, and B. Korber. 2000. HIV-1 nomenclature proposal. Science 288:55-56.[Medline]
31 - Robertson, D. L., B. H. Hahn, and P. M. Sharp. 1995. Recombination in AIDS viruses. J. Mol. Evol. 40:249-259.[CrossRef][Medline]
32 - Rodenburg, C. M., Y. Li, S. A. Trask, Y. Chen, J. Decker, D. L. Robertson, M. L. Kalish, G. M. Shaw, S. Allen, B. H. Hahn, and F. Gao. 2001. Near full-length clones and reference sequences for subtype C isolates of HIV type 1 from three different continents. AIDS Res. Hum. Retrovir. 17:161-168.[CrossRef][Medline]
33 - Rodriguez, F., J. L. Oliver, A. Marin, and J. R. Medina. 1990. The general stochastic model of nucleotide substitution. J. Theor. Biol. 142:485-501.[Medline]
34 - Rousseau, C. M., G. H. Learn, T. Bhattacharya, D. C. Nickle, D. Heckerman, S. Chetty, C. Brander, P. J. Goulder, B. D. Walker, P. Kiepiela, B. T. Korber, and J. I. Mullins. 2007. Extensive intrasubtype recombination in South African human immunodeficiency virus type 1 subtype C infections. J. Virol. 81:4492-4500.[Abstract/Free Full Text]
35 - Schierup, M. H., and J. Hein. 2000. Consequences of recombination on traditional phylogenetic analysis. Genetics 156:879-891.[Abstract/Free Full Text]
36 - Shriner, D., A. G. Rodrigo, D. C. Nickle, and J. I. Mullins. 2004. Pervasive genomic recombination of HIV-1 in vivo. Genetics 167:1573-1583.[Abstract/Free Full Text]
37 - Sierra, M., M. M. Thomson, D. Posada, L. Perez, C. Aragones, Z. Gonzalez, J. Perez, G. Casado, and R. Najera. 2007. Identification of 3 phylogenetically related HIV-1 BG intersubtype circulating recombinant forms in Cuba. J. Acquir. Immune Defic. Syndr. 45:151-160.[CrossRef][Medline]
38 - Su, L., M. Graf, Y. Zhang, H. von Briesen, H. Xing, J. Kostler, H. Melzl, H. Wolf, Y. Shao, and R. Wagner. 2000. Characterization of a virtually full-length human immunodeficiency virus type 1 genome of a prevalent intersubtype (C/B') recombinant strain in China. J. Virol. 74:11367-11376.[Abstract/Free Full Text]
39 - Suchard, M. A., R. E. Weiss, and J. S. Sinsheimer. 2001. Bayesian selection of continuous-time Markov chain evolutionary models. Mol. Biol. Evol. 18:1001-1013.[Abstract/Free Full Text]
40 - Swofford, D. L. 2003. PAUP*, phylogenetic analysis using parsimony (*and other methods), 4.0 beta ed. Sinauer Associates, Sunderland, MA.
41 - Takebe, Y., K. Motomura, M. Tatsumi, H. H. Lwin, M. Zaw, and S. Kusagawa. 2003. High prevalence of diverse forms of HIV-1 intersubtype recombinants in central Myanmar: geographical hot spot of extensive recombination. AIDS 17:2077-2087.[CrossRef][Medline]
42 - Tebit, D. M., I. Nankya, E. J. Arts, and Y. Gao. 2007. HIV diversity, recombination and disease progression: how does fitness "fit" into the puzzle? AIDS Rev. 9:75-87.[Medline]
43 - Tee, K. K., O. G. Pybus, H. Liao, R. Uenishi, S. Hase, A. Kamarulzaman, X. J. Li, and Y. Takebe. 2008. Chronology of the HIV-1 CRF07_BC expansion in East Asia. AIDS 22:156-158.[Medline]
44 - Travers, S. A., J. P. Clewley, J. R. Glynn, P. E. Fine, A. C. Crampin, F. Sibande, D. Mulawa, J. O. McInerney, and G. P. McCormack. 2004. Timing and reconstruction of the most recent common ancestor of the subtype C clade of human immunodeficiency virus type 1. J. Virol. 78:10501-10506.[Abstract/Free Full Text]
45 - Weniger, B. G., Y. Takebe, C. Y. Ou, and S. Yamazaki. 1994. The molecular epidemiology of HIV in Asia. AIDS 8(Suppl. 2):S13-S28.[Medline]
46 - Worobey, M. 2001. A novel approach to detecting and measuring recombination: new insights into evolution in viruses, bacteria, and mitochondria. Mol. Biol. Evol. 18:1425-1434.[Abstract/Free Full Text]
47 - Xia, M., J. K. Kreiss, and K. K. Holmes. 1994. Risk factors for HIV infection among drug users in Yunnan province, China: association with intravenous drug use and protective effect of boiling reusable needles and syringes. AIDS 8:1701-1706.[Medline]
48 - Yang, R., S. Kusagawa, C. Zhang, X. Xia, K. Ben, and Y. Takebe. 2003. Identification and characterization of a new class of human immunodeficiency virus type 1 recombinants comprised of two circulating recombinant forms, CRF07_BC and CRF08_BC, in China. J. Virol. 77:685-695.[CrossRef][Medline]
49 - Yang, R., X. Xia, S. Kusagawa, C. Zhang, K. Ben, and Y. Takebe. 2002. On-going generation of multiple forms of HIV-1 intersubtype recombinants in the Yunnan Province of China. AIDS 16:1401-1407.[CrossRef][Medline]
50 - Yang, Z. 1994. Maximum likelihood phylogenetic estimation from DNA sequences with variable rates over sites: approximate methods. J. Mol. Evol. 39:306-314.[CrossRef][Medline]
51 - Yu, X. F., J. Chen, Y. Shao, C. Beyrer, and S. Lai. 1998. Two subtypes of HIV-1 among injection-drug users in southern China. Lancet 351:1250.[CrossRef][Medline]
52 - Yu, X. F., W. Liu, J. Chen, W. Kong, B. Liu, Q. Zhu, F. Liang, F. McCutchan, S. Piyasirisilp, and S. Lai. 2002. Maintaining low HIV type 1 env genetic diversity among injection drug users infected with a B/C recombinant and CRF01_AE HIV type 1 in southern China. AIDS Res. Hum Retrovir. 18:167-170.[CrossRef][Medline]
53 - Zheng, X., C. Tian, K. H. Choi, J. Zhang, H. Cheng, X. Yang, D. Li, J. Lin, S. Qu, X. Sun, T. Hall, J. Mandel, and N. Hearst. 1994. Injecting drug use and HIV infection in southwest China. AIDS 8:1141-1147.[Medline]
Journal of Virology, September 2008, p. 9206-9215, Vol. 82, No. 18
0022-538X/08/$08.00+0 doi:10.1128/JVI.00399-08
Copyright © 2008, American Society for Microbiology. All Rights Reserved.
This article has been cited by other articles:
-
Xin, R., He, X., Xing, H., Sun, F., Ni, M., Zhang, Y., Meng, Z., Feng, Y., Liu, S., Wei, J., Shao, Y.
(2009). Genetic and temporal dynamics of human immunodeficiency virus type 1 CRF07_BC in Xinjiang, China. J. Gen. Virol.
90: 1757-1761
[Abstract]
[Full Text]
-
Abraha, A., Nankya, I. L., Gibson, R., Demers, K., Tebit, D. M., Johnston, E., Katzenstein, D., Siddiqui, A., Herrera, C., Fischetti, L., Shattock, R. J., Arts, E. J.
(2009). CCR5- and CXCR4-Tropic Subtype C Human Immunodeficiency Virus Type 1 Isolates Have a Lower Level of Pathogenic Fitness than Other Dominant Group M Subtypes: Implications for the Epidemic. J. Virol.
83: 5592-5605
[Abstract]
[Full Text]