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Epidemic dynamics and clinical characteristics of HIV-1 CRF07_BC_N and CRF07_BC_O in Shanghai, 2017-2023

Yingying Ma1, Min Zhang2, Le Cao1

  • 1Basic Research, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.

Virulence
|September 1, 2025
PubMed

Insights

The CRF07_BC lineage, specifically 07BC_N, is rapidly expanding in China, surpassing CRF01_AE. This study details its evolution, transmission, and clinical features, revealing 07BC_N

Area of Science:

  • Virology and Epidemiology
  • HIV-1 Molecular Epidemiology
  • Public Health

Background:

  • The CRF07_BC lineage is expanding in China, with the CRF07_BC_N (07BC_N) lineage becoming dominant.
  • Understanding the intra-host evolution and clinical characteristics of CRF07_BC is crucial for effective HIV-1 management.
  • Previous studies have limited data on the specific dynamics of CRF07_BC subtypes within China.

Purpose of the Study:

  • To systematically investigate the evolution, transmission dynamics, and clinical features of CRF07_BC in Shanghai.
  • To compare the characteristics of the CRF07_BC_N (07BC_N) and CRF07_BC_O (07BC_O) lineages.
  • To assess the prevalence of transmitted drug resistance (TDR) mutations within CRF07_BC.

Main Methods:

  • Conducted surveillance of newly diagnosed HIV-1 patients in Shanghai from 2017 to 2023.
  • Obtained 2508 pol sequences and 130 near-full-length genomes of CRF07_BC using next-generation sequencing (NGS).
  • Analyzed viral loads, CD4+ T cell counts, transmission routes, and intra-host single nucleotide variant (iSNV) diversity.

Main Results:

  • The 07BC_N lineage showed higher prevalence in Shanghai compared to 07BC_O.
  • Individuals with 07BC_N had lower baseline viral loads and higher CD4+ T cell counts.
  • 07BC_N predominantly circulated among men who have sex with men (MSM) and was replacing 07BC_O; 07BC_O was more prevalent in southern provinces among people who inject drugs (PWID) and heterosexuals.
  • 07BC_O exhibited significantly higher iSNV counts than 07BC_N across most genes.
  • The overall prevalence of TDR mutations in CRF07_BC was 5.7%.

Conclusions:

  • CRF07_BC_N is rapidly expanding in China, particularly among MSM in Eastern China, and is replacing CRF07_BC_O.
  • Distinct clinical and evolutionary characteristics differentiate 07BC_N and 07BC_O, impacting transmission dynamics.
  • The findings provide critical insights for targeted public health interventions and HIV-1 management strategies in China.

Keywords:
CRF07_BCHIV-1genomeintra-hostmolecular epidemiologytransmission

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