Ed with Potential Transmission Links.Scientific RepoRts | 6:34729 | DOI: 10.1038/srepwww.nature.com/scientificreports/links were involved in 474 (69.6 ) persons XAV-939 site through multiple links in the established genetic transmission network. Of note, 17 individuals with 5 links were involved in 112 (16.4 ) persons (Fig. 2).Drug resistant-associated genetic transmission networks. Among the 1, 152 studied individuals, 59 (5.1 ) harbored drug resistance SB 202190 site mutations conferring resistance to at least one class of antiretroviral (ARV) drugs. Only one individual harbored three mutations including M46I, A62V and T69N. The rate of drug resistant mutation did not differ between sampling years (from 2008 to 2013, 8.0 , 7.4 , 3.7 , 6.8 , 5.2 , 4.2 , respectively; P = 0.441). Overall, four main network-related drug resistant mutations (some were non-tansmitted drug resistance mutations) were discovered at V179D/E (n = 53), M46L (n = 15), T69N (n = 8), and P225H (n = 2), Fig. 4B. Clearly, Among 1, 152 Shanghai CRF01_AE, the proportion of V179D/E was 7.1 (82/1, 152), higher than all other China CRF01_AE (2.7 , 90/3, 291), P < 0.001. V179D/E mutation distributed in 26 networks in lineage 1B (n = 8), 1C (n = 33), lineage 2 (n = 3), and small lineage (n = 9). Only 2 networks for M46L, 6 networks for T69N, and 1 network for P225H were found in lineage 1C and 1B, lineage 1D, 1B, 1 A, small lineage, lineage1D, and lineage 1D, respectively.In this study, we identified two major CRF01_AE lineages circulating among Shanghai MSM individuals and a new sub-lineage that was unreported elsewhere in China. The SH-L1 included most of subjects' sequences (87.2 ) and had a close match with China-lineage 4, the most common CRF01_AE lineage in MSM epidemic nationwide, while SH-L2 was closely associated with China-lineage 5, a common lineage related to heterosexuals and injection drug users epidemic14. Our previous study and others indicated that about 20 MSM in Shanghai had sex with women and an estimated 8.3 MSM in China was reported to have used illicit drugs in the past 6 months. In this study, the genetic transmission network analysis reconfirmed the interaction between MSM and other groups. Although the introduction of SH-L1 into Shanghai MSM was slightly earlier than SH-L2, it showed an obviously evolutionary divergence of CRF01_AE which had resulted in at least 4 sub-lineages epidemics. We speculate that the new sub-lineage would probably continue to expand given 60.6 of its members are domestic migrants. As a coastal international metropolis, Shanghai attracted an increasing numbers of domestic migrant people in recent years. As these migrants constantly face difficulties in accessing employment, social welfare, education, and health services locally under the current household registration system, they usually flow between hometowns and different cities15. Our network analysis revealed the occurrence of transmission not only inside Shanghai city, but also between Shanghai and other provinces, indicating the complicated transmission patterns and the difficulty in intervention among MSM population. We realize that ongoing HIV infection and the high proportion of networking may also reflect a concentrated uncontrolled MSM epidemic in Shanghai, due to lack of diagnosis, non-treatment in time after diagnosis, failure of viral suppression after ART initiated, and lack of contact with care11,16?8. In this study, we found that recent infection was closely related to potential.Ed with Potential Transmission Links.Scientific RepoRts | 6:34729 | DOI: 10.1038/srepwww.nature.com/scientificreports/links were involved in 474 (69.6 ) persons through multiple links in the established genetic transmission network. Of note, 17 individuals with 5 links were involved in 112 (16.4 ) persons (Fig. 2).Drug resistant-associated genetic transmission networks. Among the 1, 152 studied individuals, 59 (5.1 ) harbored drug resistance mutations conferring resistance to at least one class of antiretroviral (ARV) drugs. Only one individual harbored three mutations including M46I, A62V and T69N. The rate of drug resistant mutation did not differ between sampling years (from 2008 to 2013, 8.0 , 7.4 , 3.7 , 6.8 , 5.2 , 4.2 , respectively; P = 0.441). Overall, four main network-related drug resistant mutations (some were non-tansmitted drug resistance mutations) were discovered at V179D/E (n = 53), M46L (n = 15), T69N (n = 8), and P225H (n = 2), Fig. 4B. Clearly, Among 1, 152 Shanghai CRF01_AE, the proportion of V179D/E was 7.1 (82/1, 152), higher than all other China CRF01_AE (2.7 , 90/3, 291), P < 0.001. V179D/E mutation distributed in 26 networks in lineage 1B (n = 8), 1C (n = 33), lineage 2 (n = 3), and small lineage (n = 9). Only 2 networks for M46L, 6 networks for T69N, and 1 network for P225H were found in lineage 1C and 1B, lineage 1D, 1B, 1 A, small lineage, lineage1D, and lineage 1D, respectively.In this study, we identified two major CRF01_AE lineages circulating among Shanghai MSM individuals and a new sub-lineage that was unreported elsewhere in China. The SH-L1 included most of subjects' sequences (87.2 ) and had a close match with China-lineage 4, the most common CRF01_AE lineage in MSM epidemic nationwide, while SH-L2 was closely associated with China-lineage 5, a common lineage related to heterosexuals and injection drug users epidemic14. Our previous study and others indicated that about 20 MSM in Shanghai had sex with women and an estimated 8.3 MSM in China was reported to have used illicit drugs in the past 6 months. In this study, the genetic transmission network analysis reconfirmed the interaction between MSM and other groups. Although the introduction of SH-L1 into Shanghai MSM was slightly earlier than SH-L2, it showed an obviously evolutionary divergence of CRF01_AE which had resulted in at least 4 sub-lineages epidemics. We speculate that the new sub-lineage would probably continue to expand given 60.6 of its members are domestic migrants. As a coastal international metropolis, Shanghai attracted an increasing numbers of domestic migrant people in recent years. As these migrants constantly face difficulties in accessing employment, social welfare, education, and health services locally under the current household registration system, they usually flow between hometowns and different cities15. Our network analysis revealed the occurrence of transmission not only inside Shanghai city, but also between Shanghai and other provinces, indicating the complicated transmission patterns and the difficulty in intervention among MSM population. We realize that ongoing HIV infection and the high proportion of networking may also reflect a concentrated uncontrolled MSM epidemic in Shanghai, due to lack of diagnosis, non-treatment in time after diagnosis, failure of viral suppression after ART initiated, and lack of contact with care11,16?8. In this study, we found that recent infection was closely related to potential.
