{'fraction_non_alphanumeric': 0.04054691183404055, 'fraction_numerical': 0.026402640264026403, 'mean_word_length': 5.1686046511627906, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Increasing Prevalence of Non‐Clade B HIV‐1 Strains in Heterosexual Men and Women, as Monitored by Analysis of Reverse Transcriptase and Protease Sequences

Objective: We evaluated the prevalence of HIV‐1 non‐clade B over time in a formerly clade B‐restricted area. Protease and reverse transcriptase regions of the pol gene were used for phylogenetic and recombination analysis and for clade assignment to HIV‐1 A‐D, F‐H, J, and K strains of the M group. Methods: The pol gene of 349 HIV‐1 patients belonging to the Italian Cohort Naive for Antiretrovirals (ICONA) were genotypically analyzed to study the prevalence of antiretroviral‐associated resistance mutations. All HIV‐1 pol sequences and 32 HIV reference strains were analyzed, including the reference strains for the major HIV‐1 subtypes. The non‐clade B sequences according to the HIV‐1 Subtyping Tool program were further studied by a bootscan analysis (SimPlot) to investigate the likelihood of recombination between subtypes. Results: Phylogenetic analysis detected 19 of 349 (5.4%) non‐clade B subtypes. The proportions of patients carrying non‐clade B virus before and after 1997 were 1.9% and 8.4%, respectively (p = .008). Among whites, heterosexual infection and female gender were significantly associated with the presence of non‐clade B subtypes (p = .001 and .005, respectively). Non‐clade B HIV‐1 was harbored by 14.5% of the heterosexuals who were found to be HIV‐1 positive after 1997, 60% of whom were women. Bootscan analysis identified four strains as F, two as A, one as C, one as G, and 11 (57.9 %) as non‐clade B recombinant subtypes. Conclusion: Detection of HIV‐1 subtypes and intersubtype recombinants in a previously clade B‐homogeneous area indicates that the HIV‐1 epidemic is evolving in Italy and that heterosexuals and women are at increased risk of infection with nonclade B HIV‐1 subtypes. Sequences inferred from the pol gene yield to establish the subtype of circulating HIV‐1 strains. As a consequence, genotyping of pol gene for testing resistance to antiretrovirals warrants concomitant surveillance of non‐clade B subtypes.