Rising Epidemic of HIV-1 Infections Among General Populations in Fujian, China

Background: HIV-1 infections have increased significantly with a doubled number of cases identified between 2006-2007 and 2008-2009 in Fujian, a southeastern province of China. No study has investigated the cause and the evolving epidemic there. Methods: In a province-wide study of recently identified infections from 2006 to 2009, we sought to investigate the rising epidemic of HIV-1 infections among general populations and conducted a molecular epidemiology study to determine the new trends of HIV-1 evolution there. Results: About 915,830 and 2,152,658 specimens collected in 2006-2007 and 2008-2009 were tested for HIV-1 infection. We found that the overall prevalence of infections elevated from 0.064% in 2006-2007 to 0.074% in 2008-2009 (P = 0.003). A high frequency of HIV-1 infections was consistently related to unprotected heterosexual transmissions compared with other risk groups such as intravenous drug users. Critically, the prevalence rate had significantly increased in recent years among general populations such as voluntary blood donors (P < 0.001), recipients of blood transfusion (P < 0.001) and people during presurgery screening (P < 0.001). Besides CRF01_AE as the major circulating subtype (61/86, 70.9%), 25 non-CRF01_AE strains were found contributing to increased HIV-1 genetic diversity including C/CRF07_BC/CRF08_BC (5.8%), B/B' (15.1%), unique recombinant forms (8.1%), and some minor drug-resistant variants. Conclusions: Increased prevalence of HIV-1 infections among general populations likely accounts for the rising epidemic in recent years in Fujian. The epidemic was no longer dictated by CRF01_AE but rather by multisubtype viruses. Our findings call for an enhanced surveillance system and have implications to strategic prevention programs among general populations.