Background: The Chinese National Guidelines on Diagnosis and Treatment of Gonorrhea (2020) recommend ceftriaxone 1 g intramuscularly as a single dose for the treatment of uncomplicated gonococcal infections. However, nonadherence to the guidelines remains common among physicians in China, partly due to their poor awareness of the recommendations. Objective: This trial aimed to (1) assess the effectiveness of an app-based training tool in improving adherence to guideline-recommended treatment regimens and (2) identify reasons for nonadherence among physicians who used the training tool. Methods: Using a cluster randomized controlled trial design, we randomly allocated 72 hospitals (clusters) from 4 provinces to the intervention (n=36, 50%) or control (n=36, 50%) arms in a 1:1 ratio. In the intervention arm, physicians received free app-based training via smartphones for 6 months, while the control arm continued routine training. The primary outcome was the proportion of prescriptions adherent to the regimens for treatment of uncomplicated gonorrhea recommended by the national guidelines. We analyzed cluster-level summary outcomes at endline using methods appropriate for stratified cluster randomized controlled trials with relatively few clusters per group, accounting for between-cluster variation. A postintervention survey was administered to all intervention-arm physicians to evaluate their experience with the app-based training module. Additionally, face-to-face interviews were conducted with 32 purposely selected nonadherent physicians from the intervention arm to explore reasons for nonadherence. Results: A total of 715 physicians (n=343, 48% in the control arm and n=372, 52% in the intervention arm) participated in the study. Over the 6-month intervention period, the adherence to 1 g ceftriaxone for the treatment of uncomplicated gonorrhea increased from 53.6% to 54.8% in the intervention arm, whereas the rate decreased from 43.9% to 42.5% in the control arm. The mean difference (5.5%, 95% CI-7% to 18%; P=.37) in changes in the adherence rate between intervention and control arms was not statistically significant (risk ratio 1.12, 95% CI 0.93-1.35; P=.23). Among the 32 (19%) nonadherent physicians from the intervention arm, the primary reason for nonadherence was their concern regarding the sufficiency of the currently recommended dosage of generic ceftriaxone for treating gonorrhea. Conclusions: In our study, the implementation of an app-based training tool did not improve adherence to treatment recommendations. Concern regarding the efficacy of generic ceftriaxone may be one of the intrinsic factors associated with nonadherence.

Background:To effectively control the spread of HIV, this study evaluated contact tracing implementation among newly diagnosed individuals in Yunnan Province, China-a region heavily affected by HIV. Methods:From January to June 2020, contact tracing targeted newly diagnosed HIV cases to identify sexual/drug-injecting partners. Factors correlated with index cases, close contacts, and positive testing outcomes were analyzed. Results:Among 5,695 new HIV cases, 1,612 (28.3%) received tracing counseling, revealing 2,226 close contacts. Of the 1,612 index cases, 182 were recently infected, while 1,430 had been infected long-term. Of the 2,226 close contacts, 910 underwent HIV antibody testing, with 17.8% (162/910) testing positive. Notably, 132 of these contacts were newly diagnosed with HIV, representing 14.5% of those tested. The detection rates for both positive and newly diagnosed infections were higher among contacts identified by recently infected index cases than among those identified by long-term infected index cases. A multivariate analysis showed that HIV index cases of other ethnicities (adjusted odds ratio (aOR) = 1.688, 95% confidence interval (CI): 1.495-1.905), the divorced (aOR = 1.430, 95%CI: 1.237-1.654), those traced through voluntary counselling and testing (VCT) (aOR = 1.707, 95%CI: 1.077-2.705) and those exposed to commercial sex (aOR = 1.437, 95%CI: 1.257-1.642) were more likely to receive tracing counselling. Among close contacts, those who were Han Chinese (aOR = 1.231, 95% CI: 1.012~1.498), married (aOR = 1.738, 95% CI: 1.339 ~ 2.255), had a high school education or higher (aOR = 2.809, 95% CI: 1.849~4.267) or were exposed to positive spouses or regular sex partners (aOR = 2.403, 95% CI: 1.741~3.317) were more likely to undergo HIV testing. A higher positive testing rate was observed among men (aOR = 2.608, 95% CI: 1.740~3.911), ethnic minorities (aOR = 1.645, 95% CI: 1.098~2.465), individuals aged 40-49 (aOR = 2.733, 95% CI: 1.497~4.990) and individuals exposed to positive spouses or regular partners (aOR = 2.215, 95% CI: 1.411~3.477). Conclusion:HIV recent infection testing is instrumental in enhancing the efficiency of contact tracing efforts. The variability in contact tracing uptake among diverse populations underscores the necessity for tailored strategies. These findings provide strong support for optimizing HIV prevention and control strategies, facilitating more precise disease management objectives.

Yunnan Province is recognized as a hotspot for the emergence of HIV-1 recombinant forms due to its complex epidemiological history. This study identified a novel circulating recombinant form (CRF) of HIV-1 in the region, designated as CRF203_cpx. Near-full-length genome sequences were obtained from three individuals infected through heterosexual contact in Wenshan Prefecture, an area located near the border with Vietnam. These sequences formed a distinct monophyletic clade with strong bootstrap support, separate from all known subtypes and CRFs. The genome of this strain can be divided into 14 subregions: S1, S4, S7, and S8 were derived from CRF55_01B; S2, S11, and S13 from CRF07_BC; and S3, S5, S6, and S12 from CRF01_AE. S9, S10 and S14 were likely derived from recombination between CRF01_AE and CRF55_01B. Bayesian Markov chain Monte Carlo analysis indicated that CRF203_cpx emerged between 2018 and 2021. To the best of our knowledge, this is the first time that a complex CRF comprising three CRFs (CRF01_AE, CRF07_BC, and CRF55_01B) has been definitively identified in China. This reveals the dynamic process by which circulating strains accumulate evolutionary changes through multilevel recombination, raising new considerations for current surveillance and control strategies.

The long-term co-circulation of various HIV-1 subtypes and circulating recombinant forms (CRFs) in China has created an environment conducive to viral recombination. This study identified a novel HIV-1 CRF resulting from the recombination of CRF07_BC and CRF55_01B in Xishuangbanna Prefecture, Yunnan Province. Nearly full-length HIV-1 genome sequences were obtained from three individuals with no epidemiological link, including two men who have sex with men and one individual with heterosexual contact. These individuals were reported in 2023. These sequences form a monophyletic clade that is distinct from all known subtypes and CRFs. Recombination and phylogenetic analyses revealed that this recombinant strain exhibited a consistent mosaic genomic structure, with the CRF55_01B backbone incorporating two CRF07_BC segments. Bayesian phylogenetic analyses indicated that this recombinant form originated around 2019. In accordance with standard nomenclature, it has been designated CRF200_0755. In addition, this recombinant strain carries the V179E resistance mutation from CRF55_01B. The discovery of this novel CRF highlights the ongoing evolution of HIV-1 amid the co-circulation of prevalent strains and population mobility. It also emphasizes the importance of continuous molecular surveillance in guiding public health strategies, given the potential presence of preexisting resistance mutations.

Yunnan Province has historically been a major gateway for the introduction of HIV-1 into China. The border region with northern Myanmar has become a significant hotspot for HIV-1 recombination. This study identified and characterized a novel circulating recombinant form (CRF) of HIV-1 in the area, designating it as CRF181_BC. This viral strain was detected in three cases of heterosexual transmission in Baoshan City, Yunnan Province, China. Phylogenetic analysis of the near-full-length genome revealed that the three sequences formed a distinct branch, separate from all recognized subtypes and CRFs. The recombinant structure comprises 12 alternately distributed B and C subtype fragments, with subtype B accounting for 55.1% of the genome length. This contrasts with other known CRF_BC strains, which typically have a C-subtype backbone. Bayesian analysis revealed that this recombinant virus emerged between 2005 and 2006, coinciding with Yunnan Province's critical transition from HIV transmission dominated by injection drug use to HIV transmission predominantly occurring through sexual contact. The discovery of CRF181_BC underscores the intricate genetic diversity of HIV-1 and ongoing active recombination events along the China-Myanmar border. This poses new challenges for local viral diagnosis, treatment, and vaccine development.

China’s HIV-1 epidemic originated in the border regions of Yunnan Province in the late 1980s. Although domestic transmission has been effectively contained in recent years, the border regions continue to face public health challenges. In order to track the dynamic transmission of HIV-1, a molecular epidemiology study was conducted in a China-Myanmar-Laos border area. Between 2022 and 2023, 570 individuals newly diagnosed with HIV/AIDS were recruited in Xishuangbanna prefecture. The viral gene sequences were obtained through amplification and sequencing. The characteristics of the HIV-1 genotype distribution, genetic drug resistance and molecular networks were analyzed to identify relevant influencing factors. Of 486 samples that were genotyped, 16 different HIV-1 genotypes were identified. The predominant strains were CRF08_BC (41.5

The China-Myanmar border region is recognized as a hotspot for the emergence of HIV-1 recombinant forms. This study identified a novel HIV-1 circulating recombinant form (CRF) in this area, designated CRF184_BC. Near-full-length genome sequences were obtained from four individuals infected through heterosexual contact: one Chinese individual and three Burmese individuals. These sequences formed a distinct monophyletic clade with strong bootstrap support, separate from all known subtypes/CRFs. Recombination analysis revealed a conserved mosaic structure comprising four subtype C segments and three subtype B segments: IC (790-2897), IIB (2898-3208), IIIC (3209-5983), IVB (5984-6435), VC (6436-8821), VIB (8822-8969), and VIIC (8970-9468). Bayesian Markov chain Monte Carlo analysis indicated that CRF184_BC emerged between the mid-2000s and the early 2010s. Identifying emerging CRFs highlights the ongoing dynamic evolution of HIV-1 in this region and emphasizes the need for enhanced molecular surveillance to inform effective public health strategies and vaccine development efforts.

Honghe Prefecture, located on the China-Vietnam border, has long suffered from HIV-1. To accurately assess the HIV-1 prevalence situation and promote precise prevention and treatment of AIDS, a recent infection surveillance was conducted to explore the at-risk subpopulations and hotspot areas of HIV-1 transmission in Honghe Prefecture. Combined with the recent infection testing algorithm, HIV-1 recency assay was used to differentiate recent HIV-1 infections among newly reported HIV-1 cases in Honghe Prefecture from 2021 to 2022. Factors associated with recent HIV-1 infection were analyzed by logistic regression. The hotspot areas of recent infections were analyzed by spatial scanning statistics. Of the 2698 HIV-1-infected individuals enrolled in this study (no HIV-2 cases reported), 297 HIV-1 cases were classified as recent HIV-1 infection, and the proportion of recent infection was 11.0

Honghe Prefecture, Yunnan Province, China, is a key area affected by HIV/AIDS. Given the high number of infected individuals, understanding HIV transmission in this region is crucial to controlling the epidemic in Yunnan Province. A molecular epidemiology study with 1004 newly diagnosed HIV-1 cases in 2022 was conducted to characterize transmission and guide targeted interventions. Of the 833 samples genotyped, nine HIV-1 genotypes were identified, with CRF08_BC (56.7%), URFs (17.8%), CRF07_BC (13.9%) and CRF01_AE (7.1%) being the most prevalent. These genotypes were widely distributed but concentrated in the center and east of the prefecture. Molecular network analysis showed varying clustering rates among counties, with Luxi County having the highest and Honghe County the lowest. Low education levels were associated with higher clustering. Cross-county transmission patterns were revealed, with strong links between specific counties. Of the three spatial subdivisions identified by the cohesive subgroup analysis, subgroup I included eight counties running from northeast to southwest. Persons aged 50–59 years and ethnic minorities were more likely to be identified in cross-county transmission. Notably, the overall prevalent level of HIV-1 pre-treatment drug resistance was 6.2% (50/809), with higher levels in Luxi (18.2%, 8/44), Hekou (14.3%, 3/21) and Yuanyang (10.9%, 13/119). This study investigated HIV-1 transmission patterns using molecular network analysis in a hotspot of HIV transmission, and informed the application of HIV molecular surveillance in practice.

In this study, by analyzing the available near full-length genome (NFLG) sequences of CRF55_01B, it was found that two of the NFLG sequences could not be clustered with other NFLG sequences. Recombination analysis and phylogenetic analysis suggested that these two NFLG sequences arose by recombination with subtype B based on CRF55_01B, rather than by recombination directly derived from CRF01_AE and subtype B. In addition, two other HIV-1 partial gene fragments found in the database shared the same characteristics as these two NFLG sequences in the key recombination region. These sequences may therefore represent a previously unrecognized circulating recombinant form (CRF), which has been named CRF149_01B. Evolutionary analyses suggested that CRF149_01B emerged between approximately 2005 and 2007. The discovery of CRF149_01B highlights the complexity of HIV recombinant evolution and advances the refinement of the HIV genotyping system. A deeper understanding of HIV-1 genetics will facilitate molecular tracing and provide a basis for studying the biological properties of HIV.

Extraordinary HIV-1 recombination is occurring in China. Here, a novel second-generation circulating recombinant form (CRF174_0708) was found in Yunnan Province, China. First, Bootscanning revealed a mosaic structure with three subtype B segments inserted into a subtype C backbone. However, phylogenetic analysis showed that subregions 2B (2978-3267) and 4B (6023-6196) were related to CRF07_BC, whereas subregion 6B (8846-8997) was related to CRF08_BC, suggesting that the sequences could be recombined from CRF07_BC and CRF08_BC. Furthermore, Bootscanning-guided partitioning with subregion-specific phylogenetic analysis confirmed that subregions I (790-1902), III (2636-3746), V (4327-5825), VII (6023-6196) and IX (6379-6782) from CRF07_BC, and subregions II (1903-2635), IV (3747-4326), VI (5826-6022), VIII (6197-6378) and XI (7463-9512) from CRF08_BC. Bayesian dating traced the emergence to 2005-2007, consistent with the expansion of the parental strains. This discovery advanced our understanding of HIV-1 evolution.

The current HIV-1 epidemic in China is characterized by the co-circulation of multiple subtypes and recombinant forms. A novel circulating recombinant form of HIV-1 (CRF176_BC) has been identified in Yunnan Province, China. Near-full-length genome sequences were obtained from four individuals who identified as heterosexual and were epidemiologically unlinked. Phylogenetic analysis revealed that these sequences formed a distinct monophyletic cluster from known subtypes and CRFs. Bootscanning analyses revealed a subtype C backbone with two subtype B insertions. Bayesian evolutionary dating estimated that the four genomes shared a common ancestor between 2014 and 2016, which was not far from the present. Unlike earlier CRF_BCs, which were associated with injecting drug use in the 1990s, the emergence of CRF176_BC indicates a shift toward sexual transmission. This finding emphasizes the continuous evolution of HIV-1 in Yunnan, driven by co-circulating lineages and evolving transmission dynamics. It also highlights the importance of targeted surveillance in informing public health strategies in the context of evolving epidemics.

INTRODUCTION:Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections are global public health concerns. Little research has been conducted on HCV incidence in people with HIV (PWH). METHODS:This was a retrospective cohort study to investigate HCV incidence and associated factors in PWH. HCV-negative PWH registered in national HIV databases were enrolled and followed up from 2004 to 2023. Cox proportional hazards models were utilized to identify factors associated with HCV infections. RESULTS:The study followed 50 245 HCV-negative PWH, totaling 272 979.3 person-years (PYs) of observation. We noted an HCV incidence rate of 0.70 per 100 PYs (95% confidence interval (CI) 0.67-0.73). Multivariate analysis indicated that being female (adjusted hazard ratio [aHR] 0.70), married (aHR 0.88), and those involved in homosexual intercourse (aHR 0.57) were associated with a lower risk of HCV infection. Conversely, an increased risk was found among those aged 20-39 years (aHR 2.97), 40-59 years (aHR 3.11), ≥ 60 years (aHR 1.80), treated at county-level antiretroviral therapy (ART) clinics (aHR 1.19), township-level ART clinics (aHR 1.83), those with a history of intravenous drug use (aHR 21.72), and individuals without CD4 testing (aHR 66.05) or HIV viral load testing (aHR 2.09). A 36% relative reduction in HCV transmission (aHR 0.64) was observed from 2010 to 2015, and a 29% relative reduction (aHR 0.71) was noted after 2016 compared with the pre-2010 levels. CONCLUSIONS:Despite the decrease in HCV incidence after 2010, achieving HCV elimination in PWH remains challenging. Future endeavours should prioritize improving HCV testing, intervention, and treatment in PWH.

Yunnan Province is one of the provinces in China severely affected by HIV-1. To track the evolution and epidemiological characteristics of HIV-1 genetics in Yunnan Province, this study conducted a retrospective molecular epidemiological study of HIV-1 in new infections in Yunnan Province. From the newly reported HIV-infected individuals throughout Yunnan Province from January to March 2018, cases with CD4+ T lymphocytes less than 200 cells/µL were excluded for BED capture enzyme immunoassay (BED-CEIA). Samples identified as recent infections by BED-CEIA were subjected to viral gene amplification to analyze the distribution characteristics of HIV-1 genotypes and the prevalence of pretreatment resistance. Of the 1,740 samples tested by BED-CEIA, 448 were identified as newly infected, and 323 were successfully genotyped; 14 HIV-1 genotypes were identified, including 2 subtypes, 11 circulating recombinant forms (CRFs), and several unique recombinant forms (URFs), of which CRF08_BC (37. 5%, 121/323), CRF07_BC (22.6%, 73/323), URFs (18.3%, 59/323), and CRF01_AE (14.9%, 48/323) were the predominant genotypes. CRF08_BC had higher proportions in the northeastern, southeastern, central, and southwestern regions of Yunnan Province than in the northwestern region and was more common in the 40-49-year age group, married, and heterosexual contacts. CRF01_AE had significantly higher proportions in the southeastern and northwestern regions and among those with homosexual contact, whereas no significant correlations were found for CRF07_BC and URFs. The overall prevalence of pretreatment resistance was 8.5% [95% confidence interval (CI): 5.5%-12.4%], with the highest proportion of resistance to nonnucleoside reverse transcriptase inhibitors (NNRTIs; 6.0%, 95% CI: 3.5%-9.4%). This study demonstrated the genetic diversity and regional and subpopulation distribution characteristics of the recently infected HIV-1 population in Yunnan Province, and that pretreatment resistance was at a moderate level, but resistance to NNRTIs needs attention. This study provided the baseline data for a systematic study of the evolution of HIV-1 genetics in a typical endemic area.

Dear Editor, Recent correspondence published in this journal has highlighted that significant and ongoing HIV-1 recombination events are occurring among men who have sex with men (MSM) in China.1Li Y. Chang W. Liang J. Liu Y. Li L. Liu L. et al.Characterization of a new HIV-1 second-generation circulating recombinant form (CRF170_0107) among men who have sex with men in Yunnan, China.J Infect. 2024; 88: 206-209Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar, 2Chen M. Ma Y. Chen H. Dai J. Dong L. Jia M. Identification of a newly emerging second-generation HIV-1 circulating recombinant form (CRF145_0755) among men who have sex with men in China.J Infect. 2024; 88106126Abstract Full Text Full Text PDF Scopus (0) Google Scholar Viral recombination, a key mechanism in HIV variation and evolution, complicates HIV genetics and has the potential to modify the biological properties of the virus, particularly its replication capacity, pathogenicity and drug resistance. Initially, HIV-1 recombination in Chinese MSM occurred mainly between subtype B and CRF01_AE, resulting in the emergence of circulating recombinant forms (CRFs) such as CRF55_01B, CRF59_01B, CRF67_01B and CRF68_01B. However, in recent years, with the emergence of CRF07_BC as the predominant circulating strain among Chinese MSM, recombination between CRF01_AE and CRF07_BC has become a prevalent mode, resulting in novel CRF_0107. The study of prevalent HIV-1 recombination among MSM provides invaluable insights into the recombination properties of the HIV-1 genome. In this study, we identified a novel HIV-1 CRF, designated CRF158_0107, from MSM in Kunming City, Yunnan Province. This novel CRF is composed of CRF01_AE and CRF07_BC genetic elements. We also analyzed its evolutionary history, shedding light on the dynamic and complex nature of HIV-1 recombination in the Chinese MSM population. During an earlier HIV-1 molecular epidemiological survey conducted among MSM in Kunming City, Yunnan Province, China, four partial pol gene sequences were found to form a unique cluster distinct from the previously known subtypes/CRFs, indicating a possible novel CRF. Of the corresponding samples, two (20M082 and 20M108) were collected in 2020, and two (21M114 and 21M115) were in 2021. To further confirm whether they represented a new CRF, these samples were further analyzed. No direct epidemiological link was found between these cases. Demographic data are shown in Table S1. Written informed consent for sample collection and subsequent analysis was obtained from all participants. The HIV-1 near full-length genome (NFLG) sequences from the four subjects were amplified and sequenced as previously described. The NFLG sequences from subjects 20M082, 20M108, 21M114 and 21M115 were 8871 (620–9513 in HXB2), 8851 (649–9513 in HXB2), 8475 (674–9174 in HXB2) and 8317 (673–9036 in HXB2) nt in size, respectively, and ranged from part of the 5′ long terminal repeat (LTR) to part of the 3′ LTR. The sequences were submitted to GenBank under accession numbers PP977572-PP977575. When phylogenetic analysis was performed using NFLG sequences, the four sequences formed a monophyletic cluster with a bootstrap value of 100%, separated from other known subtypes and CRFs (Fig. 1A). To further investigate their recombination structure, recombination analysis was performed using RIP and Bootscaning analysis, which suggested that they were composed of CRF01_AE and CRF07_BC with the same recombination pattern (Fig. 1B). A total of 15 recombination breakpoints divided the genome into eight CRF01_AE subregions and eight CRF07_BC subregions (Fig. 1C), including ICRF01_AE (761–2655), IICRF07_BC (2656–3058), IIICRF01_AE (3059–3217), IVCRF07_BC (3218–3533), VCRF01_AE (3534–3690), VICRF07_BC (3691–3810), VIICRF01_AE (3811–4013), VIIICRF07_BC (4014–4834), IXCRF01_AE (4835–5147), XCRF07_BC (5148–5907), XICRF01_AE (5908–6300), XIICRF07_BC (6301–8599), XIIICRF01_AE (8600–9096), XIVCRF07_BC (9097–9227), XVCRF01_AE (9228–9389), XVICRF07_BC (9390–9513). The subregion Phylogenetic analyses showed that subregions I, III, V, VII, IX, XI, XIII and XV were related to the counterpart of CRF01_AE, and subregions II, IV, VI, VIII, X, XII, XIV and XVI were related to the counterparts of CRF07_BC, confirming the origin of each subregion (Fig. 2A). According to the CRF naming criteria, these sequences represent a novel CRF and were therefore named CRF158_0107.Fig. 2Phylogenetic and evolutionary analysis of concatenated CRF01_AE and concatenated CRF07_BC subregions from CRF158_0107. (A) The maximum likelihood phylogenetic trees of the 16 mosaic fragments. The reliability of tree branches was assessed by 1000 bootstrap replicates. The scale bar indicates 5% nucleotide sequence divergence. (B) The maximum clade credibility (MCC) trees of combined CRF01_AE segments (I+III+V+VII+IX+XI+XIII+XV) and combined CRF07_BC segments (II+IV+VI+VIII+X+XII+XIV+XVI).View Large Image Figure ViewerDownload Hi-res image Download (PPT) To further investigate the origin of CRF158_0107, the concatenated CRF01_AE subregions (I+III+V+VII+IX+XI+XIII+XV) and the concatenated CRF07_BC subregions (II+IV+VI+VIII+X+XII+XIV+XVI) were used to estimate the most recent common ancestor (tMRCA) using Bayesian evolutionary analyses (Fig. 2B). According to maximum clade credibility (MCC) trees, the estimated tMRCAs for the concatenated CRF01_AE subregions and the concatenated CRF07_BC subregions were 2013.0 (95% highest probability density (HPD): 2010.5–2015.2) and 2015.3 (95% HPD: 2013.4–2016.9), respectively, suggesting that CRF158_0107 arose approximately between 2013 and 2015. Furthermore, the components of CRF01_AE were mainly derived from the CRF01_AE-C4 lineage, whereas the components of CRF07_BC were mainly derived from the CRF07_BC-N lineage. CRF01_AE was first introduced into southwest China from Thailand, including Yunnan Province.3Feng Y. He X. Hsi J.H. Li F. Li X. Wang Q. et al.The rapidly expanding CRF01_AE epidemic in China is driven by multiple lineages of HIV-1 viruses introduced in the 1990s.AIDS. 2013; 27: 1793-1802Crossref PubMed Scopus (179) Google Scholar At one time, it was the dominant strain in sexual transmission. Our previous study showed that the estimated time of introduction of CRF01_AE in Yunnan MSM was around 1996.4Chen M. Ma Y. Su Y. Yang L. Zhang R. Yang C. et al.HIV-1 genetic characteristics and transmitted drug resistance among men who have sex with men in Kunming, China.PLoS One. 2014; 9e87033Crossref Scopus (43) Google Scholar According to recent research, a total of 11 CRF01_AE lineages were circulating in China, of which C4 and C5 lineages were found in MSM.5Wang D. Feng Y. Ruan Y. Liao L. Hao J. Song C. et al.Criteria for classification, nomenclature, and reference sequence selection for HIV sub-subtypes of CRF01_AE and CRF07_BC strains in China.AIDS. 2024; 38: 427-430Crossref PubMed Scopus (1) Google Scholar In this study, the evolutionary analysis confirmed that the CRF01_AE segments in CRF158_0107 originated from the CRF01_AE-C4 lineage. On the other hand, CRF07_BC originated from recombination between subtype B and subtype C in intravenous drug users (IDUs) in the early 1990s in Yunnan.6Su L. Graf M. Zhang Y. von Briesen H. Xing H. Kostler J. et al.Characterization of a virtually full-length human immunodeficiency virus type 1 genome of a prevalent intersubtype (C/B′) recombinant strain in China.J Virol. 2000; 74: 11367-11376Crossref PubMed Scopus (0) Google Scholar Through the cross-risk behaviors, CRF07_BC transitioned to sexual transmission, including heterosexual and homosexual transmission. With increased transmissibility and decreased virulence, CRF07_BC spread rapidly in China,7Cheng Z. Yan H. Li Q. Ablan S.D. Kleinpeter A. Freed E.O. et al.Enhanced transmissibility and decreased virulence of HIV-1 CRF07_BC may explain its rapid expansion in China.Microbiol Spectr. 2022; 10e0014622Crossref Scopus (14) Google Scholar and became the predominant strain in China.8Liu X. Wang D. Hu J. Song C. Liao L. Feng Y. et al.Changes in HIV-1 subtypes/sub-subtypes, and transmitted drug resistance among ART-naive HIV-infected individuals – China, 2004-2022.China CDC Wkly. 2023; 5: 664-671Crossref PubMed Scopus (0) Google Scholar During the transmission, CRF07_BC evolved into two lineages, CRF07_BC-O and CRF07_BC-N.5Wang D. Feng Y. Ruan Y. Liao L. Hao J. Song C. et al.Criteria for classification, nomenclature, and reference sequence selection for HIV sub-subtypes of CRF01_AE and CRF07_BC strains in China.AIDS. 2024; 38: 427-430Crossref PubMed Scopus (1) Google Scholar, 9Ge Z. Feng Y. Zhang H. Rashid A. Zaongo S.D. Li K. et al.HIV-1 CRF07_BC transmission dynamics in China: two decades of national molecular surveillance.Emerg Microbes Infect. 2021; 10: 1919-1930Crossref PubMed Scopus (26) Google Scholar CRF07_BC-O is the original lineage that circulated mainly in IDUs and heterosexuals. In contrast, CRF07_BC-N is a new lineage found mainly in MSM. This study confirmed that the CRF07_BC segments in CRF158_0107 were confirmed to be derived from CRF07_BC-N. Kunming is the main cluster of MSM in Yunnan Province, and our previous research also suggested that MSM in Kunming were linked to MSM in the other provinces and were part of a domestic transmission network. Therefore, timely surveillance and intervention for new circulating strains is needed. In this study, we identified a complicated novel CRF in Chinese MSM, named CRF158_0107, which has 15 breakpoints and consists of 16 alternating segments of CRF01_AE and CRF07_BC. This suggests that HIV-1 is very capable of mutating and recombining, and may generate entirely new properties. It is therefore necessary to continuously monitor and study HIV mutation to better understand the mechanisms of HIV transmission and mutation, and to provide new approaches for vaccine and drug development. At the same time, interventions for MSM need to be further strengthened to reduce the potential risk of transmission. This work was supported by the National Natural Science Foundation of China (82160635) and the Revitalizing Yunnan Excellent Talents Support Plan (Famous Doctor Special Project).