Travel and the Introduction of Human Immunodeficiency Virus Type 1 Non-B Subtype Genetic Forms into Western Countries
Identifieur interne : 001938 ( Istex/Corpus ); précédent : 001937; suivant : 001939Travel and the Introduction of Human Immunodeficiency Virus Type 1 Non-B Subtype Genetic Forms into Western Countries
Auteurs : Charles D. Ericsson ; Robert Steffen ; Michael M. Thomson ; Rafael Nájera ; Charles D. Ericsson ; Robert Steffen ; Michael M. Thomson ; Rafael NájeraSource :
- Clinical Infectious Diseases [ 1058-4838 ] ; 2001-06-15.
Abstract
Both high mutation rates and recombination contribute to the genetic diversity of human immunodeficiency virus type 1 (HIV-1). Among viruses of the main group, which are responsible for the HIV-1 pandemic, 21 circulating genetic forms have been reported, 11 of which are recombinant between ⩾2 subtypes. In Western Europe and the Americas, the HIV-1 epidemic is largely dominated by B subtype viruses; however, infections with diverse non-B subtype genetic forms are increasingly being recognized. In Western Europe and North America, most of them have been identified in immigrants or travelers returning from areas with high HIV-1 prevalence, mainly from sub-Saharan Africa and Southeast Asia, where non-B subtype genetic forms predominate, but propagation within other groups has been reported in some Western countries. This may have implications for prophylactic and therapeutic strategies and, by bringing in contact different genetic forms, may favor the generation of novel recombinant viruses. Travelers from different categories—including immigrants, military personnel, seamen, tourists, expatriates, diplomats, and businessmen—may be at risk of transporting HIV non-B subtype genetic forms to Western countries.
Url:
DOI: 10.1086/320764
Links to Exploration step
ISTEX:4D7BD0C864C46040041179DFE5E92F5812EC0E2BLe document en format XML
<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title>Travel and the Introduction of Human Immunodeficiency Virus Type 1 Non-B Subtype Genetic Forms into Western Countries</title><author><name sortKey="Ericsson, Charles D" sort="Ericsson, Charles D" uniqKey="Ericsson C" first="Charles D." last="Ericsson">Charles D. Ericsson</name><affiliation><mods:affiliation>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</mods:affiliation></affiliation></author><author><name sortKey="Steffen, Robert" sort="Steffen, Robert" uniqKey="Steffen R" first="Robert" last="Steffen">Robert Steffen</name><affiliation><mods:affiliation>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</mods:affiliation></affiliation></author><author><name sortKey="Thomson, Michael M" sort="Thomson, Michael M" uniqKey="Thomson M" first="Michael M." last="Thomson">Michael M. Thomson</name><affiliation><mods:affiliation>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</mods:affiliation></affiliation></author><author><name sortKey="Najera, Rafael" sort="Najera, Rafael" uniqKey="Najera R" first="Rafael" last="Nájera">Rafael Nájera</name><affiliation><mods:affiliation>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: rafael.najera@isciii.es</mods:affiliation></affiliation><affiliation><mods:affiliation>Reprints or correspondence: Dr. Rafael Nájera, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Ctra. Majadahonda-Pozuelo, Km. 2, 28220 Majadahonda, Madrid, Spain</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: rafael.najera@isciii.es</mods:affiliation></affiliation></author><author><name sortKey="Ericsson, Charles D" sort="Ericsson, Charles D" uniqKey="Ericsson C" first="Charles D." last="Ericsson">Charles D. Ericsson</name><affiliation><mods:affiliation>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</mods:affiliation></affiliation></author><author><name sortKey="Steffen, Robert" sort="Steffen, Robert" uniqKey="Steffen R" first="Robert" last="Steffen">Robert Steffen</name><affiliation><mods:affiliation>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</mods:affiliation></affiliation></author><author><name sortKey="Thomson, Michael M" sort="Thomson, Michael M" uniqKey="Thomson M" first="Michael M." last="Thomson">Michael M. Thomson</name><affiliation><mods:affiliation>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</mods:affiliation></affiliation></author><author><name sortKey="Najera, Rafael" sort="Najera, Rafael" uniqKey="Najera R" first="Rafael" last="Nájera">Rafael Nájera</name><affiliation><mods:affiliation>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: rafael.najera@isciii.es</mods:affiliation></affiliation><affiliation><mods:affiliation>Reprints or correspondence: Dr. Rafael Nájera, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Ctra. Majadahonda-Pozuelo, Km. 2, 28220 Majadahonda, Madrid, Spain</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: rafael.najera@isciii.es</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:4D7BD0C864C46040041179DFE5E92F5812EC0E2B</idno><date when="2001" year="2001">2001</date><idno type="doi">10.1086/320764</idno><idno type="url">https://api.istex.fr/document/4D7BD0C864C46040041179DFE5E92F5812EC0E2B/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">001938</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">001938</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a">Travel and the Introduction of Human Immunodeficiency Virus Type 1 Non-B Subtype Genetic Forms into Western Countries</title><author><name sortKey="Ericsson, Charles D" sort="Ericsson, Charles D" uniqKey="Ericsson C" first="Charles D." last="Ericsson">Charles D. Ericsson</name><affiliation><mods:affiliation>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</mods:affiliation></affiliation></author><author><name sortKey="Steffen, Robert" sort="Steffen, Robert" uniqKey="Steffen R" first="Robert" last="Steffen">Robert Steffen</name><affiliation><mods:affiliation>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</mods:affiliation></affiliation></author><author><name sortKey="Thomson, Michael M" sort="Thomson, Michael M" uniqKey="Thomson M" first="Michael M." last="Thomson">Michael M. Thomson</name><affiliation><mods:affiliation>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</mods:affiliation></affiliation></author><author><name sortKey="Najera, Rafael" sort="Najera, Rafael" uniqKey="Najera R" first="Rafael" last="Nájera">Rafael Nájera</name><affiliation><mods:affiliation>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: rafael.najera@isciii.es</mods:affiliation></affiliation><affiliation><mods:affiliation>Reprints or correspondence: Dr. Rafael Nájera, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Ctra. Majadahonda-Pozuelo, Km. 2, 28220 Majadahonda, Madrid, Spain</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: rafael.najera@isciii.es</mods:affiliation></affiliation></author><author><name sortKey="Ericsson, Charles D" sort="Ericsson, Charles D" uniqKey="Ericsson C" first="Charles D." last="Ericsson">Charles D. Ericsson</name><affiliation><mods:affiliation>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</mods:affiliation></affiliation></author><author><name sortKey="Steffen, Robert" sort="Steffen, Robert" uniqKey="Steffen R" first="Robert" last="Steffen">Robert Steffen</name><affiliation><mods:affiliation>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</mods:affiliation></affiliation></author><author><name sortKey="Thomson, Michael M" sort="Thomson, Michael M" uniqKey="Thomson M" first="Michael M." last="Thomson">Michael M. Thomson</name><affiliation><mods:affiliation>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</mods:affiliation></affiliation></author><author><name sortKey="Najera, Rafael" sort="Najera, Rafael" uniqKey="Najera R" first="Rafael" last="Nájera">Rafael Nájera</name><affiliation><mods:affiliation>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: rafael.najera@isciii.es</mods:affiliation></affiliation><affiliation><mods:affiliation>Reprints or correspondence: Dr. Rafael Nájera, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Ctra. Majadahonda-Pozuelo, Km. 2, 28220 Majadahonda, Madrid, Spain</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: rafael.najera@isciii.es</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Clinical Infectious Diseases</title><title level="j" type="abbrev">Clinical Infectious Diseases</title><idno type="ISSN">1058-4838</idno><idno type="eISSN">1537-6591</idno><imprint><publisher>The University of Chicago Press</publisher><date type="published" when="2001-06-15">2001-06-15</date><biblScope unit="volume">32</biblScope><biblScope unit="issue">12</biblScope><biblScope unit="page" from="1732">1732</biblScope><biblScope unit="page" to="1737">1737</biblScope></imprint><idno type="ISSN">1058-4838</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">1058-4838</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract">Both high mutation rates and recombination contribute to the genetic diversity of human immunodeficiency virus type 1 (HIV-1). Among viruses of the main group, which are responsible for the HIV-1 pandemic, 21 circulating genetic forms have been reported, 11 of which are recombinant between ⩾2 subtypes. In Western Europe and the Americas, the HIV-1 epidemic is largely dominated by B subtype viruses; however, infections with diverse non-B subtype genetic forms are increasingly being recognized. In Western Europe and North America, most of them have been identified in immigrants or travelers returning from areas with high HIV-1 prevalence, mainly from sub-Saharan Africa and Southeast Asia, where non-B subtype genetic forms predominate, but propagation within other groups has been reported in some Western countries. This may have implications for prophylactic and therapeutic strategies and, by bringing in contact different genetic forms, may favor the generation of novel recombinant viruses. Travelers from different categories—including immigrants, military personnel, seamen, tourists, expatriates, diplomats, and businessmen—may be at risk of transporting HIV non-B subtype genetic forms to Western countries.</div></front></TEI><istex><corpusName>oup</corpusName><author><json:item><name>Charles D. Ericsson</name><affiliations><json:string>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</json:string></affiliations></json:item><json:item><name>Robert Steffen</name><affiliations><json:string>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</json:string></affiliations></json:item><json:item><name>Michael M. Thomson</name><affiliations><json:string>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</json:string></affiliations></json:item><json:item><name>Rafael Nájera</name><affiliations><json:string>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</json:string><json:string>E-mail: rafael.najera@isciii.es</json:string></affiliations></json:item><json:item><name>Charles D. Ericsson</name><affiliations><json:string>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</json:string></affiliations></json:item><json:item><name>Robert Steffen</name><affiliations><json:string>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</json:string></affiliations></json:item><json:item><name>Michael M. Thomson</name><affiliations><json:string>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</json:string></affiliations></json:item><json:item><name>Rafael Nájera</name><affiliations><json:string>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</json:string><json:string>E-mail: rafael.najera@isciii.es</json:string></affiliations></json:item></author><language><json:string>unknown</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><abstract>Both high mutation rates and recombination contribute to the genetic diversity of human immunodeficiency virus type 1 (HIV-1). Among viruses of the main group, which are responsible for the HIV-1 pandemic, 21 circulating genetic forms have been reported, 11 of which are recombinant between ⩾2 subtypes. In Western Europe and the Americas, the HIV-1 epidemic is largely dominated by B subtype viruses; however, infections with diverse non-B subtype genetic forms are increasingly being recognized. In Western Europe and North America, most of them have been identified in immigrants or travelers returning from areas with high HIV-1 prevalence, mainly from sub-Saharan Africa and Southeast Asia, where non-B subtype genetic forms predominate, but propagation within other groups has been reported in some Western countries. This may have implications for prophylactic and therapeutic strategies and, by bringing in contact different genetic forms, may favor the generation of novel recombinant viruses. Travelers from different categories—including immigrants, military personnel, seamen, tourists, expatriates, diplomats, and businessmen—may be at risk of transporting HIV non-B subtype genetic forms to Western countries.</abstract><qualityIndicators><score>8.016</score><pdfWordCount>3940</pdfWordCount><pdfCharCount>24834</pdfCharCount><pdfVersion>1.2</pdfVersion><pdfPageCount>6</pdfPageCount><pdfPageSize>612 x 792 pts (letter)</pdfPageSize><refBibsNative>true</refBibsNative><abstractWordCount>173</abstractWordCount><abstractCharCount>1223</abstractCharCount><keywordCount>0</keywordCount></qualityIndicators><title>Travel and the Introduction of Human Immunodeficiency Virus Type 1 Non-B Subtype Genetic Forms into Western Countries</title><genre><json:string>research-article</json:string></genre><host><title>Clinical Infectious Diseases</title><language><json:string>unknown</json:string></language><issn><json:string>1058-4838</json:string></issn><eissn><json:string>1537-6591</json:string></eissn><publisherId><json:string>cid</json:string></publisherId><volume>32</volume><issue>12</issue><pages><first>1732</first><last>1737</last></pages><genre><json:string>journal</json:string></genre></host><categories><wos><json:string>science</json:string><json:string>microbiology</json:string><json:string>infectious diseases</json:string><json:string>immunology</json:string></wos><scienceMetrix><json:string>health sciences</json:string><json:string>biomedical research</json:string><json:string>microbiology</json:string></scienceMetrix></categories><publicationDate>2001</publicationDate><copyrightDate>2001</copyrightDate><doi><json:string>10.1086/320764</json:string></doi><id>4D7BD0C864C46040041179DFE5E92F5812EC0E2B</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/4D7BD0C864C46040041179DFE5E92F5812EC0E2B/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/4D7BD0C864C46040041179DFE5E92F5812EC0E2B/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/4D7BD0C864C46040041179DFE5E92F5812EC0E2B/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a">Travel and the Introduction of Human Immunodeficiency Virus Type 1 Non-B Subtype Genetic Forms into Western Countries</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher scheme="https://publisher-list.data.istex.fr">The University of Chicago Press</publisher><availability><licence><p>© 2001 Infectious Diseases Society of America</p></licence><p scheme="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-GTWS0RDP-M">oup</p></availability><date>2001</date></publicationStmt><notesStmt><note type="research-article" scheme="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</note><note type="journal" scheme="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Travel and the Introduction of Human Immunodeficiency Virus Type 1 Non-B Subtype Genetic Forms into Western Countries</title><author xml:id="author-0000"><persName><forename type="first">Charles D.</forename><surname>Ericsson</surname></persName><note type="biography">Section Editor</note><affiliation>Section Editor</affiliation><affiliation>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</affiliation></author><author xml:id="author-0001"><persName><forename type="first">Robert</forename><surname>Steffen</surname></persName><note type="biography">Section Editor</note><affiliation>Section Editor</affiliation><affiliation>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</affiliation></author><author xml:id="author-0002"><persName><forename type="first">Michael M.</forename><surname>Thomson</surname></persName><affiliation>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</affiliation></author><author xml:id="author-0003" corresp="yes"><persName><forename type="first">Rafael</forename><surname>Nájera</surname></persName><email>rafael.najera@isciii.es</email><email>rafael.najera@isciii.es</email><affiliation>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</affiliation><affiliation>Reprints or correspondence: Dr. Rafael Nájera, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Ctra. Majadahonda-Pozuelo, Km. 2, 28220 Majadahonda, Madrid, Spain</affiliation></author><author xml:id="author-0004"><persName><forename type="first">Charles D.</forename><surname>Ericsson</surname></persName><note type="biography">Section Editor</note><affiliation>Section Editor</affiliation><affiliation>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</affiliation></author><author xml:id="author-0005"><persName><forename type="first">Robert</forename><surname>Steffen</surname></persName><note type="biography">Section Editor</note><affiliation>Section Editor</affiliation><affiliation>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</affiliation></author><author xml:id="author-0006"><persName><forename type="first">Michael M.</forename><surname>Thomson</surname></persName><affiliation>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</affiliation></author><author xml:id="author-0007" corresp="yes"><persName><forename type="first">Rafael</forename><surname>Nájera</surname></persName><email>rafael.najera@isciii.es</email><email>rafael.najera@isciii.es</email><affiliation>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</affiliation><affiliation>Reprints or correspondence: Dr. Rafael Nájera, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Ctra. Majadahonda-Pozuelo, Km. 2, 28220 Majadahonda, Madrid, Spain</affiliation></author><idno type="istex">4D7BD0C864C46040041179DFE5E92F5812EC0E2B</idno><idno type="ark">ark:/67375/HXZ-T58RC1QD-X</idno><idno type="DOI">10.1086/320764</idno></analytic><monogr><title level="j">Clinical Infectious Diseases</title><title level="j" type="abbrev">Clinical Infectious Diseases</title><idno type="pISSN">1058-4838</idno><idno type="eISSN">1537-6591</idno><idno type="publisher-id">cid</idno><idno type="PublisherID-hwp">cid</idno><imprint><publisher>The University of Chicago Press</publisher><date type="published" when="2001-06-15"></date><biblScope unit="volume">32</biblScope><biblScope unit="issue">12</biblScope><biblScope unit="page" from="1732">1732</biblScope><biblScope unit="page" to="1737">1737</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2001</date></creation><abstract><p>Both high mutation rates and recombination contribute to the genetic diversity of human immunodeficiency virus type 1 (HIV-1). Among viruses of the main group, which are responsible for the HIV-1 pandemic, 21 circulating genetic forms have been reported, 11 of which are recombinant between ⩾2 subtypes. In Western Europe and the Americas, the HIV-1 epidemic is largely dominated by B subtype viruses; however, infections with diverse non-B subtype genetic forms are increasingly being recognized. In Western Europe and North America, most of them have been identified in immigrants or travelers returning from areas with high HIV-1 prevalence, mainly from sub-Saharan Africa and Southeast Asia, where non-B subtype genetic forms predominate, but propagation within other groups has been reported in some Western countries. This may have implications for prophylactic and therapeutic strategies and, by bringing in contact different genetic forms, may favor the generation of novel recombinant viruses. Travelers from different categories—including immigrants, military personnel, seamen, tourists, expatriates, diplomats, and businessmen—may be at risk of transporting HIV non-B subtype genetic forms to Western countries.</p></abstract><textClass><keywords scheme="Journal Subject"><list><head></head><item><term>Invited Articles</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2001-06-15">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/4D7BD0C864C46040041179DFE5E92F5812EC0E2B/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus oup, element #text not found" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Publishing DTD v2.3 20070202//EN" URI="journalpublishing.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article">
<front>
<journal-meta>
<journal-id journal-id-type="hwp">cid</journal-id>
<journal-id journal-id-type="publisher-id">cid</journal-id>
<journal-title>Clinical Infectious Diseases</journal-title>
<abbrev-journal-title>Clinical Infectious Diseases</abbrev-journal-title>
<issn pub-type="ppub">1058-4838</issn>
<issn pub-type="epub">1537-6591</issn>
<publisher>
<publisher-name>The University of Chicago Press</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.1086/320764</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Travel Medicine</subject>
<subj-group>
<subject>Invited Articles</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Travel and the Introduction of Human Immunodeficiency Virus Type 1 Non-B Subtype Genetic Forms into Western Countries</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="editor">
<name>
<surname>Ericsson</surname>
<given-names>Charles D.</given-names>
</name>
<role>Section Editor</role>
</contrib>
<contrib contrib-type="editor">
<name>
<surname>Steffen</surname>
<given-names>Robert</given-names>
</name>
<role>Section Editor</role>
</contrib>
</contrib-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Thomson</surname>
<given-names>Michael M.</given-names>
</name>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Nájera</surname>
<given-names>Rafael</given-names>
</name>
<xref ref-type="corresp" rid="cor1"></xref>
</contrib>
<aff>
<institution>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III</institution>, <addr-line>Madrid</addr-line>
</aff>
</contrib-group>
<author-notes>
<corresp id="cor1">Reprints or correspondence: Dr. Rafael Nájera, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Ctra. Majadahonda-Pozuelo, Km. 2, 28220 Majadahonda, Madrid, Spain (<email>rafael.najera@isciii.es</email>).</corresp>
</author-notes>
<pub-date pub-type="ppub">
<day>15</day>
<month>6</month>
<year>2001</year>
</pub-date>
<volume>32</volume>
<issue>12</issue>
<fpage>1732</fpage>
<lpage>1737</lpage>
<history>
<date date-type="received">
<day>18</day>
<month>12</month>
<year>2000</year>
</date>
<date date-type="rev-recd">
<day>9</day>
<month>2</month>
<year>2001</year>
</date>
</history>
<copyright-statement>© 2001 Infectious Diseases Society of America</copyright-statement>
<copyright-year>2001</copyright-year>
<abstract>
<p>Both high mutation rates and recombination contribute to the genetic diversity of human immunodeficiency virus type 1 (HIV-1). Among viruses of the main group, which are responsible for the HIV-1 pandemic, 21 circulating genetic forms have been reported, 11 of which are recombinant between ⩾2 subtypes. In Western Europe and the Americas, the HIV-1 epidemic is largely dominated by B subtype viruses; however, infections with diverse non-B subtype genetic forms are increasingly being recognized. In Western Europe and North America, most of them have been identified in immigrants or travelers returning from areas with high HIV-1 prevalence, mainly from sub-Saharan Africa and Southeast Asia, where non-B subtype genetic forms predominate, but propagation within other groups has been reported in some Western countries. This may have implications for prophylactic and therapeutic strategies and, by bringing in contact different genetic forms, may favor the generation of novel recombinant viruses. Travelers from different categories—including immigrants, military personnel, seamen, tourists, expatriates, diplomats, and businessmen—may be at risk of transporting HIV non-B subtype genetic forms to Western countries.</p>
</abstract>
</article-meta>
</front>
<body>
<p>An association between AIDS/HIV infection and travel was already noticed among the earlier cases in the epidemic in Western Europe: HIV type 1 (HIV-1) infection among homosexual men was found to correlate with sexual exposure to men in the United States [<xref ref-type="bibr" rid="R1">1</xref>], and heterosexually acquired AIDS cases were associated with origin from or travel to Central Africa [<xref ref-type="bibr" rid="R2">2</xref>]. In fact, the first cases of HIV-1 infection documented to have been present in Europe were those of a Norwegian family—a seaman (who was probably infected in the early 1960s by heterosexual contact in a West African seaport), his wife, and his daughter, all of whom died in 1976 [<xref ref-type="bibr" rid="R3">3</xref>]. The relative risk of acquiring HIV-1 during travel by heterosexuals residing in the United Kingdom in 1986 was estimated to be 300-fold greater during a period of time abroad than in the same period of time in the United Kingdom [<xref ref-type="bibr" rid="R4">4</xref>]. In sub-Saharan Africa, travel has also been associated with HIV-1 propagation, as illustrated by the high prevalence of HIV-1 infection documented among long-distance truck drivers [<xref ref-type="bibr" rid="R5">5</xref>] and expatriate migrant workers [<xref ref-type="bibr" rid="R6">6</xref>]. Increase in international travel in the last several decades, in great part facilitated by the expansion of commercial passenger air transport, has contributed in a determinant way to the rapid dissemination of HIV-1 around the world.</p>
<p>The association of travel with HIV infection largely reflects the long-recognized link of travel with the risk of acquiring sexually transmitted infections. Travel may involve changes in sexual behavior, including an increase in sexual promiscuity and contacts with prostitutes [<xref ref-type="bibr" rid="R7">7</xref>], among whom, in some areas, particularly sub-Saharan Africa, Southeast Asia, and India, where HIV-1 is mainly transmitted heterosexually, the prevalence of HIV-1 infection may be remarkably high. Also contributing to the increased risk of HIV-1 acquisition while abroad may be the lower availability of condoms in some developing countries and injections by unqualified medical staff using improperly sterilized equipment, as has been reported among expatriates in sub-Saharan Africa [<xref ref-type="bibr" rid="R8">8</xref>].</p>
<sec>
<title>HIV-1 Genetic Forms</title>
<p>With the spread of HIV-1 around the globe, different genetic forms of HIV-1 have become established in different geographic areas [<xref ref-type="bibr" rid="R9">9</xref>]. On the basis of phylogenetic sequence analyses, 3 HIV-1 groups are recognized, M (main), O (outlier), and N (non-M, non-O, which were probably derived from separate zoonotic transmission episodes from chimpanzees in West Central Africa) [<xref ref-type="bibr" rid="R10">10</xref>]. Among group M viruses, which are responsible for the global HIV-1 pandemic, 21 circulating genetic forms are currently listed in the Los Alamos National Laboratory HIV Sequence Database (<ext-link ext-link-type="uri" xlink:href="http://hiv-web.lanl.gov">http://hiv-web.lanl.gov</ext-link>). Ten of them are nonrecombinant, which implies that phylogenetic tree topologies are consistent all along the genome, and are designated as subtypes A-D, F1, F2, G-J, and K. F1 and F2 viruses diverge from a common branch in phylogenetic trees, and for this reason F1 and F2 may be considered to be sub-subtypes belonging to a single subtype; similarly, B and D may also be regarded as phylogenetically related sub-subtypes, but for historical reasons and consistency with the literature they are designated with different letters. Eleven circulating genetic forms are intersubtype recombinant, with different segments of the genome grouping with different subtypes, and are known as circulating recombinant forms (CRF). They have been given identifying numbers according to the order of their discovery (CRF01-CRF11). Intersubtype recombinant viruses are generated in individuals infected with >1 virus of different subtypes, a not uncommon circumstance in areas where diverse subtypes are circulating.</p>
<p>HIV-1 genetic forms vary in their geographic distribution and in the extent of their spread (<xref ref-type="fig" rid="F1">figure 1</xref>). Subtype B is predominant in Western and Central Europe and is also the most common genetic form in the Americas, although subtype F viruses are not uncommon in Brazil, and in Argentina [<xref ref-type="bibr" rid="R11">11</xref>, <xref ref-type="bibr" rid="R12">12</xref>] and Cuba [<xref ref-type="bibr" rid="R13">13</xref>, <xref ref-type="bibr" rid="R14">14</xref>] substantial proportions of infections with non-B subtype or intersubtype recombinant viruses have recently been reported. In Eastern European countries that were formerly part of the Soviet Union, subtype A is the most common genetic form, transmitted mainly among injection drug users (IDUs). In sub-Saharan Africa, CRF02_AG is the predominant genetic form in Western Africa, subtypes A and D in most of East Africa, and subtype C in Southern Africa and in Ethiopia; in West Central Africa, a higher heterogeneity of genetic forms is found, with all group M subtypes and several recombinant forms present as well as group O and group N viruses. In Asia, the areas with highest HIV prevalence are India and Southeast Asia, where the predominant forms are, respectively, subtypes C and CRF01_AE, although subtype B viruses are also common among IDUs in Thailand.</p>
<p>Although evidence demonstrating significant differences in transmission or pathogenicity between different HIV-1 genetic forms may be conflicting or inconclusive, knowledge of the prevalence and temporal changes in the incidence of infections with the various HIV-1 genetic forms in different geographic areas is significant for several reasons. First, it helps in tracking the origin and propagation of the epidemics in each area, which may be useful in future preventive efforts. Second, it may be relevant for vaccine design adapted specifically to HIV variants circulating in each area. Although crossclade immune reactivities have been detected among infected individuals and vaccine recipients, it is reasonable to expect that a vaccine with an antigenic composition incorporating the antigenic diversity of locally circulating genetic forms might induce more effective responses against these variants. Third, decreased in vitro susceptibilities to some antiretroviral drugs have been reported for some HIV-1 genetic forms [<xref ref-type="bibr" rid="R15">15</xref>, <xref ref-type="bibr" rid="R16">16</xref>]. Fourth, marketed assays for detection of antiretroviral resistance-associated mutations based on hybridization to immobilized oligonucleotides have been developed specifically for subtype B viruses, and there are reports indicating that they may not be applicable to other genetic forms [<xref ref-type="bibr" rid="R17">17</xref>, <xref ref-type="bibr" rid="R18">18</xref>]. And fifth, virus load quantitation using some commercial assays, as currently marketed, may not provide equivalent results for different genetic forms [<xref ref-type="bibr" rid="R19">19</xref>, <xref ref-type="bibr" rid="R20">20</xref>].</p></sec>
<sec>
<title>Non-B Subtype Genetic Forms</title>
<p>Following the spread of HIV-1 within Western countries, mainly among homosexual men and IDUs, the proportion of imported HIV-1 infections decreased, although in several European countries with large immigrant communities they still represent a substantial fraction, or even a majority, of infections acquired via heterosexual contact [<xref ref-type="bibr" rid="R21">21</xref>]; however, although imported cases may currently represent a minority of all HIV-1 infections in Western countries, among cases of infection with genetic forms other than subtype B in Western Europe and North America, a great majority have been acquired abroad, most of them via heterosexual contact (<xref ref-type="table" rid="T1">table 1</xref>). Among HIV-1 infections transmitted by this route, the proportions of non-B subtype infections have been reported to be as high as 80% in Belgium, 40% in Netherlands, or 43% in Scotland. In newly diagnosed cases, non-B subtype infections of 33% in Germany and 28% in Switzerland (71% and 44%, respectively, among heterosexuals) have been reported. Most of these infections were acquired in areas of high HIV-1 prevalence with predominantly non-B subtype epidemics, mainly in sub-Saharan Africa and Southeast Asia. Travelers who acquire infections when visiting these areas may therefore serve as a bridge population that transports diverse HIV-1 genetic forms into Western countries, brings them into close proximity, and, therefore, potentially facilitates the generation of novel circulating recombinant forms. The lack of propagation of non-B genetic forms in most countries of Western Europe outside of this group of individuals and their immediate contacts (with the exception of recently reported cases in Finland [<xref ref-type="bibr" rid="R22">22</xref>] and Spain [<xref ref-type="bibr" rid="R23">23</xref>]) has not been adequately explained. These genetic forms have been present in a significant proportion of infected individuals in some European countries for many years [<xref ref-type="bibr" rid="R24">24</xref>], perhaps as early as were the B subtype viruses (in fact, the first cases in Europe detected in the Norwegian family described above were caused by a group O virus [<xref ref-type="bibr" rid="R3">3</xref>]). By contrast, subtype A viruses have spread widely among IDUs in countries formerly part of the Soviet Union, subtype F is common in Brazil, CRFs generated by recombination with subtype B are widely circulating in Kaliningrad (Russia), Argentina, and China, and CRF01_AE has replaced subtype B as the predominant form transmitted among IDUs in Thailand [<xref ref-type="bibr" rid="R25">25</xref>]. Therefore, the possibility of significant spread of imported non-B subtype viruses or of locally generated recombinant forms in Western countries, as has occurred elsewhere, should not be neglected.</p></sec>
<sec>
<title>Travelers at Risk for Importing Non-B Subtype Infections Into Western Countries</title>
<p>There are several categories of travelers who may be particularly susceptible to being infected with non-B subtype genetic forms in high prevalence areas and to transport them to Western countries. They include immigrants, military personnel, seamen, expatriates, tourists, diplomats, and businessmen. Data concerning the relative contribution of each group to introducing non-B genetic forms into Western countries are limited, because epidemiological information is often scarce, failing to detail in many cases the reasons for travel and sexual behaviors or other risk exposure associated with the acquisition of these genetic forms. Several studies have provided information regarding risks of HIV-1 infection in some of these groups of travelers.</p>
<p><bold><italic>Immigrants from high-prevalence areas.</italic></bold> The largest proportion of non-B subtype infections reported in Western Europe and North America correspond to this category, most of them originating from sub-Saharan Africa (<xref ref-type="table" rid="T1">table 1</xref>). This group is considerably more numerous in Europe than in America, in part because of the historical and political ties linking some European countries with their former African colonies. It is often assumed that infection was acquired prior to the date of immigration, but subsequent visits to the country of origin are frequent, with men frequently engaging in high-risk sexual behavior [<xref ref-type="bibr" rid="R34">34</xref>]. Therefore, these individuals are potential targets for intervention to prevent HIV infection during travel.</p>
<p><bold><italic>Military personnel.</italic></bold> Apart from immigrants, military personnel who have been deployed overseas comprise the largest group that has been reported to have introduced non-B subtype viruses into Western countries [<xref ref-type="bibr" rid="R28">28</xref>, <xref ref-type="bibr" rid="R33">33</xref>, <xref ref-type="bibr" rid="R35">35</xref>]. This is particularly true in the United States, where the majority of cases of non-B subtype infections reported among nonimmigrant individuals are in this category. Infections contracted in both sub-Saharan Africa and Southeast Asia have been documented. Military personnel deployed in foreign countries have long been recognized to be at increased risk for sexually acquired infections. There are a number of contributing reasons for this increased risk: among them are the fact that many military personnel are young, sexually active men who are away from home for long periods, and they are deployed in countries with widespread poverty, which fuels the growth of prostitution, often in the vicinity of military stations. Also favoring the more frequent identification of non-B subtype infections among military personnel is the fact that they often undergo routine screening for HIV antibodies before and after overseas deployment, which increases the chances of detecting HIV seroconversion.</p>
<p>In Cuba, where we have found that 52% HIV-1 infections, identified in both heterosexual and homosexual patients, are caused by a high diversity of non-B subtype genetic forms, these viruses were probably introduced by the troops who served in large numbers in Angola in the 1970s and 1980s and by advisers and other aid workers who have served in several countries in sub-Saharan Africa [<xref ref-type="bibr" rid="R36">36</xref>]. At present, only a minority of individuals with non-B subtype infections in Cuba were infected in Africa, which implies that these viruses have been circulating on the island. In addition, phylogenetic sequence analysis indicates that several intersubtype recombinant forms have been generated within Cuba, resulting in an extraordinarily high diversity of HIV genetic forms [<xref ref-type="bibr" rid="R13">13</xref>]. This is an example of how the introduction of HIV genetic forms by people who travel abroad can be a determinant factor contributing to shaping HIV genetic diversity in a country.</p>
<p><bold><italic>Seamen.</italic></bold> High-risk behaviors for acquisition of HIV-1 and other sexually transmitted infections are found among seamen. Often, however, insufficient attention has been paid to this population as a target for prophylactic intervention. As in the case of the military, prolonged absence from home and prostitution as an accepted feature of seaport life are contributing factors for HIV infection. In a survey of 203 Spanish deep-sea fishermen who had traveled to West Africa [<xref ref-type="bibr" rid="R37">37</xref>], 83 (41%) reported sexual contacts with African prostitutes, usually without use of condoms, which indicates a lack of awareness of the risks involved in such practices. In addition, 80 (39%) had received injections and 41 (20%) had undergone surgery in Africa. Four (2%) seamen were seropositive for HIV-1; 3 of them were probably infected in sub-Saharan Africa. This prevalence was similar to that of non-IDU prostitutes in Spain. A high prevalence (15.5%) of HIV-1 infection has been reported among fishermen in Thailand, and association with visits to prostitutes was found [<xref ref-type="bibr" rid="R38">38</xref>]. In Galicia, a region in northwestern Spain in which fishing is one of the main economic activities, we have found a prevalence of non-B subtype viruses of 4.4% among 451 HIV-1 infections [<xref ref-type="bibr" rid="R23">23</xref>]. Nineteen of 20 patients were native of Spain or Portugal; and 4 were fishermen who had traveled to sub-Saharan Africa, 3 of whom admitted heterosexual contact with African women. In addition, BG recombinant and G-subtype viruses were found to be circulating in 3% of HIV-1—infected IDUs. Those infections were not attributable to direct contacts with non-European sources, which implies that non-B subtype viruses have entered this population, with a likely source among seamen, because the population of immigrants of African origin is small in this region.</p>
<p><bold><italic>Expatriates.</italic></bold> These are individuals residing temporarily outside of their country. Increased risk for acquiring HIV was recognized early among Europeans living in sub-Saharan Africa. In 1988 it was reported that 0.9% of Europeans living in Africa had antibodies to HIV-1 and that seropositivity was correlated with sexual contacts with prostitutes and injections by unqualified staff [<xref ref-type="bibr" rid="R8">8</xref>]. Several studies of Europeans living in areas with high HIV-1 prevalence have reported that casual sexual contacts are common, including contacts with prostitutes [<xref ref-type="bibr" rid="R8">8</xref>, <xref ref-type="bibr" rid="R39">39</xref>].</p>
<p><bold><italic>Tourists.</italic></bold> In a study of travelers in Britain, most of whom were holiday travelers, new sexual partners were reported by 5%, more likely to be single men traveling without a partner, and condom use was not consistent in a majority [<xref ref-type="bibr" rid="R40">40</xref>]. In some cases, tourists travel with the specific purpose of engaging in sexual contacts in the country of destination (which is often referred to as “sexual tourism”), and prostitution has developed around tourist resorts in some places. The case of Thailand is notorious, and several sexually acquired infections with CRF01_AE viruses among Europeans traveling to this country have been reported [<xref ref-type="bibr" rid="R41">41</xref>, <xref ref-type="bibr" rid="R42">42</xref>]. More recently, Cuba has become one of the preferred destinations for tourists from Western Europe, and, although Cuba has one of the lowest prevalences of HIV infection in the Western world, the possibility of propagation of HIV-1 among prostitutes may put the tourist at a nonnegligible risk of acquiring some of the diverse non-B subtype genetic forms circulating in the island.</p></sec>
<sec sec-type="conclusions">
<title>Conclusions</title>
<p>Non-B subtype infections in most Western countries are commonly linked to travel to or immigration from areas with high HIV-1 prevalence in which non-B subtype infections are predominant. In some countries, such as Brazil, Cuba, and Finland, imported non-B genetic forms have spread to and are circulating locally among the native populations. Introduction of non-B subtypes may allow for the generation of novel genetic forms by recombination with locally circulating B subtype viruses, as has occurred in Russia, China, Argentina, and Spain. An increasing genetic diversity of HIV in Western countries may complicate the design of vaccines, response to antiretroviral drugs, detection of drug resistance, and monitoring of response to therapy. Travelers at risk of acquiring HIV infection should be targeted for intervention to minimize this risk. Public health officials, travel agencies, embassies, military authorities, companies and nongovernmental organizations with personnel assigned to high-prevalence countries, and shipping companies should provide travelers with information on the risks of acquiring HIV infection and on the means of avoiding it. Unprotected sexual intercourse with local casual contacts in areas of high HIV prevalence—particularly with prostitutes in sub-Saharan Africa, Southeast Asia, and India—poses the highest risk, but travelers should also be warned about the risks of drug injections by unqualified persons. In Western countries, molecular epidemiological surveillance on the prevalence of HIV genetic forms should continue or be implemented for the early detection of the possible propagation of imported non-B subtype viruses or of locally generated recombinants.</p></sec>
</body>
<back>
<ref-list>
<title>References</title>
<ref id="R1">
<label>1</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Melbye</surname>
<given-names>M</given-names>
</name>
<name>
<surname>Biggar</surname>
<given-names>RJ</given-names>
</name>
<name>
<surname>Ebbesen</surname>
<given-names>P</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Seroepidemiology of HTLV-III antibody in Danish homosexual men: prevalence, transmission, and disease outcome</article-title>
<source>Br Med J (Clin Res Ed)</source>
<year>1984</year>
<volume>289</volume>
<fpage>573</fpage>
<lpage>5</lpage>
</nlm-citation>
</ref>
<ref id="R2">
<label>2</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Clumeck</surname>
<given-names>N</given-names>
</name>
<name>
<surname>Sonnet</surname>
<given-names>J</given-names>
</name>
<name>
<surname>Taelman</surname>
<given-names>H</given-names>
</name>
<name>
<surname>Cran</surname>
<given-names>S</given-names>
</name>
<name>
<surname>Henrivaux</surname>
<given-names>P</given-names>
</name>
</person-group>
<article-title>Acquired immune deficiency syndrome in Belgium and its relation to Central Africa</article-title>
<source>Ann N Y Acad Sci</source>
<year>1984</year>
<volume>437</volume>
<fpage>264</fpage>
<lpage>9</lpage>
</nlm-citation>
</ref>
<ref id="R3">
<label>3</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Jonassen</surname>
<given-names>TO</given-names>
</name>
<name>
<surname>Stene-Johansen</surname>
<given-names>K</given-names>
</name>
<name>
<surname>Berg</surname>
<given-names>ES</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Sequence analysis of HIV-1 group O from Norwegian patients infected in the 1960s</article-title>
<source>Virology</source>
<year>1997</year>
<volume>231</volume>
<fpage>43</fpage>
<lpage>7</lpage>
</nlm-citation>
</ref>
<ref id="R4">
<label>4</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Feachem</surname>
<given-names>RG</given-names>
</name>
<name>
<surname>Phillips-Howard</surname>
<given-names>PA</given-names>
</name>
</person-group>
<article-title>Risk to UK heterosexuals of contracting AIDS abroad</article-title>
<source>Lancet</source>
<year>1988</year>
<volume>2</volume>
<issue>8607</issue>
<fpage>394</fpage>
<lpage>5</lpage>
</nlm-citation>
</ref>
<ref id="R5">
<label>5</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Bwayo</surname>
<given-names>J</given-names>
</name>
<name>
<surname>Plummer</surname>
<given-names>F</given-names>
</name>
<name>
<surname>Omari</surname>
<given-names>M</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Human immunodeficiency virus infection in long-distance truck drivers in east Africa</article-title>
<source>Arch Intern Med</source>
<year>1994</year>
<volume>154</volume>
<fpage>1391</fpage>
<lpage>6</lpage>
</nlm-citation>
</ref>
<ref id="R6">
<label>6</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kane</surname>
<given-names>F</given-names>
</name>
<name>
<surname>Alary</surname>
<given-names>M</given-names>
</name>
<name>
<surname>Ndoye</surname>
<given-names>I</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Temporary expatriation is related to HIV-1 infection in rural Senegal</article-title>
<source>AIDS</source>
<year>1993</year>
<volume>7</volume>
<fpage>1261</fpage>
<lpage>5</lpage>
</nlm-citation>
</ref>
<ref id="R7">
<label>7</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Hawkes</surname>
<given-names>S</given-names>
</name>
<name>
<surname>Hart</surname>
<given-names>GJ</given-names>
</name>
<name>
<surname>Johnson</surname>
<given-names>AM</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Risk behaviour and HIV prevalence in international travellers</article-title>
<source>AIDS</source>
<year>1994</year>
<volume>8</volume>
<fpage>247</fpage>
<lpage>52</lpage>
</nlm-citation>
</ref>
<ref id="R8">
<label>8</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Bonneux</surname>
<given-names>L</given-names>
</name>
<name>
<surname>Van der</surname>
<given-names>SP</given-names>
</name>
<name>
<surname>Taelman</surname>
<given-names>H</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Risk factors for infection with human immunodeficiency virus among European expatriates in Africa</article-title>
<source>BMJ</source>
<year>1988</year>
<volume>297</volume>
<fpage>581</fpage>
<lpage>4</lpage>
</nlm-citation>
</ref>
<ref id="R9">
<label>9</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>McCutchan</surname>
<given-names>FE</given-names>
</name>
</person-group>
<article-title>Understanding the genetic diversity of HIV-1</article-title>
<source>AIDS</source>
<year>2000</year>
<volume>14</volume>
<issue>Suppl 3</issue>
<fpage>S31</fpage>
<lpage>44</lpage>
</nlm-citation>
</ref>
<ref id="R10">
<label>10</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Gao</surname>
<given-names>F</given-names>
</name>
<name>
<surname>Bailes</surname>
<given-names>E</given-names>
</name>
<name>
<surname>Robertson</surname>
<given-names>DL</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Origin of HIV-1 in the chimpanzee <italic>Pan troglodytes troglodytes</italic></article-title>
<source>Nature</source>
<year>1999</year>
<volume>397</volume>
<fpage>436</fpage>
<lpage>41</lpage>
</nlm-citation>
</ref>
<ref id="R11">
<label>11</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Thomson</surname>
<given-names>MM</given-names>
</name>
<name>
<surname>Villahermosa</surname>
<given-names>ML</given-names>
</name>
<name>
<surname>Vázquez-de-Parga</surname>
<given-names>E</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Widespread circulation of a B/F intersubtype recombinant form among HIV-1-infected individuals in Buenos Aires, Argentina</article-title>
<source>AIDS</source>
<year>2000</year>
<volume>14</volume>
<fpage>897</fpage>
<lpage>9</lpage>
</nlm-citation>
</ref>
<ref id="R12">
<label>12</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Masciotra</surname>
<given-names>S</given-names>
</name>
<name>
<surname>Livellara</surname>
<given-names>B</given-names>
</name>
<name>
<surname>Belloso</surname>
<given-names>W</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Evidence of a high frequency of HIV-1 subtype F infections in a heterosexual population in Buenos Aires, Argentina</article-title>
<source>AIDS Res Human Retroviruses</source>
<year>2000</year>
<volume>16</volume>
<fpage>1007</fpage>
<lpage>14</lpage>
</nlm-citation>
</ref>
<ref id="R13">
<label>13</label>
<nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname>Nájera</surname>
<given-names>R</given-names>
</name>
</person-group>
<article-title>Molecular epidemiological survey of HIV-1 genotypes in four countries of Latin America: high prevalence of non-B sub types and intersubtype recombinant viruses [abstract 72]</article-title>
<source>Institute of Human Virology 2000 meeting abstracts (Journal of Human Virology 2000; 3)</source>
<year>2000</year>
<publisher-loc>Baltimore, MD</publisher-loc>
<publisher-name>Institute of Human Virology</publisher-name>
<fpage>244</fpage>
</nlm-citation>
</ref>
<ref id="R14">
<label>14</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Gómez</surname>
<given-names>CE</given-names>
</name>
<name>
<surname>Iglesias</surname>
<given-names>E</given-names>
</name>
<name>
<surname>Perdomo</surname>
<given-names>W</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Isolates from four different HIV type 1 clades circulating in Cuba identified by DNA sequence of the C2-V3 region</article-title>
<source>AIDS Res Hum Retroviruses</source>
<year>2001</year>
<volume>17</volume>
<fpage>55</fpage>
<lpage>8</lpage>
</nlm-citation>
</ref>
<ref id="R15">
<label>15</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Descamps</surname>
<given-names>D</given-names>
</name>
<name>
<surname>Collin</surname>
<given-names>G</given-names>
</name>
<name>
<surname>Letourneur</surname>
<given-names>F</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Susceptibility of human immunodeficiency virus type 1 group O isolates to antiretroviral agents: in vitro phenotypic and genotypic analyses</article-title>
<source>J Virol</source>
<year>1997</year>
<volume>71</volume>
<fpage>8893</fpage>
<lpage>8</lpage>
</nlm-citation>
</ref>
<ref id="R16">
<label>16</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Descamps</surname>
<given-names>D</given-names>
</name>
<name>
<surname>Apetrei</surname>
<given-names>C</given-names>
</name>
<name>
<surname>Collin</surname>
<given-names>G</given-names>
</name>
<name>
<surname>Damond</surname>
<given-names>F</given-names>
</name>
<name>
<surname>Simon</surname>
<given-names>F</given-names>
</name>
<name>
<surname>Brun-Vezinet</surname>
<given-names>F</given-names>
</name>
</person-group>
<article-title>Naturally occurring decreased susceptibility of HIV-1 subtype G to protease inhibitors</article-title>
<source>AIDS</source>
<year>1998</year>
<volume>12</volume>
<fpage>1109</fpage>
<lpage>11</lpage>
</nlm-citation>
</ref>
<ref id="R17">
<label>17</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Vahey</surname>
<given-names>M</given-names>
</name>
<name>
<surname>Nau</surname>
<given-names>ME</given-names>
</name>
<name>
<surname>Barrick</surname>
<given-names>S</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Performance of the Affymetrix GeneChip HIV PRT 440 platform for antiretroviral drug resistance genotyping of human immunodeficiency virus type 1 clades and viral isolates with length polymorphisms</article-title>
<source>J Clin Microbiol</source>
<year>1999</year>
<volume>37</volume>
<fpage>2533</fpage>
<lpage>7</lpage>
</nlm-citation>
</ref>
<ref id="R18">
<label>18</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Lee</surname>
<given-names>CC</given-names>
</name>
<name>
<surname>Thoe</surname>
<given-names>SY</given-names>
</name>
<name>
<surname>Leo</surname>
<given-names>YS</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Detection of drug-selected mutations in HIV-1 subtype E reverse transcriptase sequence using the line probe assay</article-title>
<source>AIDS</source>
<year>2000</year>
<volume>14</volume>
<fpage>1064</fpage>
<lpage>5</lpage>
</nlm-citation>
</ref>
<ref id="R19">
<label>19</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Jagodzinski</surname>
<given-names>JL</given-names>
</name>
<name>
<surname>Wiggins</surname>
<given-names>DL</given-names>
</name>
<name>
<surname>McManis</surname>
<given-names>JL</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Use of calibrated viral load standards for group M subtypes of human immunodeficiency virus type 1 to assess the performance of viral RNA quantitation tests</article-title>
<source>J Clin Microbiol</source>
<year>2000</year>
<volume>38</volume>
<fpage>1247</fpage>
<lpage>9</lpage>
</nlm-citation>
</ref>
<ref id="R20">
<label>20</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Walter</surname>
<given-names>EA</given-names>
</name>
<name>
<surname>Gilliam</surname>
<given-names>B</given-names>
</name>
<name>
<surname>Delmar</surname>
<given-names>JA</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Clinical implications of identifying non-B subtypes of human immunodeficiency virus type 1 infection</article-title>
<source>Clin Infect Dis</source>
<year>2000</year>
<volume>31</volume>
<fpage>798</fpage>
<lpage>802</lpage>
</nlm-citation>
</ref>
<ref id="R21">
<label>21</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Garrigle</surname>
<given-names>CM</given-names>
</name>
<name>
<surname>Gilbart</surname>
<given-names>V</given-names>
</name>
<name>
<surname>Nicoll</surname>
<given-names>A</given-names>
</name>
</person-group>
<article-title>AIDS and HIV infection acquired heterosexually</article-title>
<source>Commun Dis Rep CDR Rev</source>
<year>1997</year>
<volume>7</volume>
<fpage>R125</fpage>
<lpage>8</lpage>
</nlm-citation>
</ref>
<ref id="R22">
<label>22</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Liitsola</surname>
<given-names>K</given-names>
</name>
<name>
<surname>Ristola</surname>
<given-names>M</given-names>
</name>
<name>
<surname>Holmstrom</surname>
<given-names>P</given-names>
</name>
<etal></etal>
</person-group>
<article-title>An outbreak of the circulating recombinant form AECM240 HIV-1 in the Finnish injection drug user population</article-title>
<source>AIDS</source>
<year>2000</year>
<volume>14</volume>
<fpage>2613</fpage>
<lpage>5</lpage>
</nlm-citation>
</ref>
<ref id="R23">
<label>23</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Thomson</surname>
<given-names>MM</given-names>
</name>
<name>
<surname>Delgado</surname>
<given-names>E</given-names>
</name>
<name>
<surname>Manjón</surname>
<given-names>N</given-names>
</name>
<etal></etal>
</person-group>
<article-title>HIV-1 genetic diversity in Galicia, Spain: BG intersubtype recombinant viruses are circulating among injecting drug users</article-title>
<source>AIDS</source>
<year>2001</year>
<volume>15</volume>
<fpage>509</fpage>
<lpage>16</lpage>
</nlm-citation>
</ref>
<ref id="R24">
<label>24</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Fransen</surname>
<given-names>K</given-names>
</name>
<name>
<surname>Buve</surname>
<given-names>A</given-names>
</name>
<name>
<surname>Nkengasong</surname>
<given-names>JN</given-names>
</name>
<name>
<surname>Laga</surname>
<given-names>M</given-names>
</name>
<name>
<surname>van der Groen</surname>
<given-names>G</given-names>
</name>
</person-group>
<article-title>Longstanding presence in Belgians of multiple non-B HIV-1 subtypes</article-title>
<source>Lancet</source>
<year>1996</year>
<volume>347</volume>
<issue>9012</issue>
<fpage>1403</fpage>
</nlm-citation>
</ref>
<ref id="R25">
<label>25</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Subbarao</surname>
<given-names>S</given-names>
</name>
<name>
<surname>Vanichseni</surname>
<given-names>S</given-names>
</name>
<name>
<surname>Hu</surname>
<given-names>DJ</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Genetic characterization of incident HIV type 1 subtype E and B strains from a prospective cohort of injecting drug users in Bangkok, Thailand</article-title>
<source>AIDS Res Hum Retroviruses</source>
<year>2000</year>
<volume>16</volume>
<fpage>699</fpage>
<lpage>707</lpage>
</nlm-citation>
</ref>
<ref id="R26">
<label>26</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Barin</surname>
<given-names>F</given-names>
</name>
<name>
<surname>Courouce</surname>
<given-names>AM</given-names>
</name>
<name>
<surname>Pillonel</surname>
<given-names>J</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Increasing diversity of HIV-1<sub>M</sub> serotypes in French blood donors over a 10-year period (1985–1995). Retrovirus Study Group of the French Society of Blood Transfusion</article-title>
<source>AIDS</source>
<year>1997</year>
<volume>11</volume>
<fpage>1503</fpage>
<lpage>8</lpage>
</nlm-citation>
</ref>
<ref id="R27">
<label>27</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Couturier</surname>
<given-names>E</given-names>
</name>
<name>
<surname>Damond</surname>
<given-names>F</given-names>
</name>
<name>
<surname>Roques</surname>
<given-names>P</given-names>
</name>
<etal></etal>
</person-group>
<article-title>HIV-1 diversity in France, 1996–1998</article-title>
<source>AIDS</source>
<year>2000</year>
<volume>14</volume>
<fpage>289</fpage>
<lpage>96</lpage>
</nlm-citation>
</ref>
<ref id="R28">
<label>28</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Lasky</surname>
<given-names>M</given-names>
</name>
<name>
<surname>Perret</surname>
<given-names>JL</given-names>
</name>
<name>
<surname>Peeters</surname>
<given-names>M</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Presence of multiple non-B subtypes and divergent subtype B strains of HIV-1 in individuals infected after overseas deployment</article-title>
<source>AIDS</source>
<year>1997</year>
<volume>11</volume>
<fpage>43</fpage>
<lpage>51</lpage>
</nlm-citation>
</ref>
<ref id="R29">
<label>29</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Stoeckli</surname>
<given-names>TC</given-names>
</name>
<name>
<surname>Steffen-Klopfstein</surname>
<given-names>I</given-names>
</name>
<name>
<surname>Erb</surname>
<given-names>P</given-names>
</name>
<name>
<surname>Brown</surname>
<given-names>TM</given-names>
</name>
<name>
<surname>Kalish</surname>
<given-names>ML</given-names>
</name>
</person-group>
<article-title>Molecular epidemiology of HIV-1 in Switzerland: evidence for a silent mutation in the C2V3 region distinguishing intravenous drug users from homosexual men</article-title>
<source>J Acquir Immune Defic Syndr</source>
<year>2000</year>
<volume>23</volume>
<fpage>58</fpage>
<lpage>67</lpage>
<comment>and the Swiss HIV Cohort Study</comment>
</nlm-citation>
</ref>
<ref id="R30">
<label>30</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Böni</surname>
<given-names>J</given-names>
</name>
<name>
<surname>Pyra</surname>
<given-names>H</given-names>
</name>
<name>
<surname>Gebhardt</surname>
<given-names>M</given-names>
</name>
<etal></etal>
</person-group>
<article-title>High frequency of non-B subtypes in newly diagnosed HIV-1 infections in Switzerland</article-title>
<source>J Acquir Immune Defic Syndr</source>
<year>1999</year>
<volume>22</volume>
<fpage>174</fpage>
<lpage>9</lpage>
</nlm-citation>
</ref>
<ref id="R31">
<label>31</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Op de Coul</surname>
<given-names>ELM</given-names>
</name>
<name>
<surname>Lukashov</surname>
<given-names>VV</given-names>
</name>
<name>
<surname>van Doornum</surname>
<given-names>GJ</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Multiple HIV-1 subtypes present amongst heterosexuals in Amsterdam 1988–1996: No evidence for spread of non-B subtypes</article-title>
<source>AIDS</source>
<year>1998</year>
<volume>12</volume>
<fpage>1253</fpage>
<lpage>5</lpage>
</nlm-citation>
</ref>
<ref id="R32">
<label>32</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Yirrell</surname>
<given-names>DL</given-names>
</name>
<name>
<surname>Goldberg</surname>
<given-names>DJ</given-names>
</name>
<name>
<surname>Whitelaw</surname>
<given-names>J</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Viral subtype and heterosexual acquisition of HIV infections diagnosed in Scotland</article-title>
<source>Sex Transm Inf</source>
<year>1999</year>
<volume>75</volume>
<fpage>392</fpage>
<lpage>5</lpage>
</nlm-citation>
</ref>
<ref id="R33">
<label>33</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Brodine</surname>
<given-names>SK</given-names>
</name>
<name>
<surname>Shaffer</surname>
<given-names>RA</given-names>
</name>
<name>
<surname>Starkey</surname>
<given-names>MJ</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Drug resistance patterns, genetic subtypes, clinical features, and risk factors in military personnel with HIV-1 seroconversion</article-title>
<source>Ann Intern Med</source>
<year>1999</year>
<volume>131</volume>
<fpage>502</fpage>
<lpage>6</lpage>
</nlm-citation>
</ref>
<ref id="R34">
<label>34</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Gras</surname>
<given-names>MJ</given-names>
</name>
<name>
<surname>Weide</surname>
<given-names>JF</given-names>
</name>
<name>
<surname>Langendam</surname>
<given-names>MW</given-names>
</name>
<name>
<surname>Coutinho</surname>
<given-names>RA</given-names>
</name>
<name>
<surname>van den Hoek</surname>
<given-names>A</given-names>
</name>
</person-group>
<article-title>HIV prevalence, sexual risk behaviour and sexual mixing patterns among migrants in Amsterdam, The Netherlands</article-title>
<source>AIDS</source>
<year>1999</year>
<volume>13</volume>
<fpage>1953</fpage>
<lpage>62</lpage>
</nlm-citation>
</ref>
<ref id="R35">
<label>35</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Brodine</surname>
<given-names>SK</given-names>
</name>
<name>
<surname>Mascola</surname>
<given-names>JR</given-names>
</name>
<name>
<surname>Weiss</surname>
<given-names>PJ</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Detection of diverse HIV-1 genetic subtypes in the USA</article-title>
<source>Lancet</source>
<year>1995</year>
<volume>346</volume>
<issue>8984</issue>
<fpage>1198</fpage>
<lpage>9</lpage>
</nlm-citation>
</ref>
<ref id="R36">
<label>36</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Scheper-Hughes</surname>
<given-names>N</given-names>
</name>
</person-group>
<article-title>AIDS, public health, and human rights in Cuba</article-title>
<source>Lancet</source>
<year>1993</year>
<volume>342</volume>
<issue>8877</issue>
<fpage>965</fpage>
<lpage>7</lpage>
</nlm-citation>
</ref>
<ref id="R37">
<label>37</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ollero</surname>
<given-names>M</given-names>
</name>
<name>
<surname>Pujol</surname>
<given-names>E</given-names>
</name>
<name>
<surname>Gimeno</surname>
<given-names>A</given-names>
</name>
<name>
<surname>Gea</surname>
<given-names>A</given-names>
</name>
<name>
<surname>Marquez</surname>
<given-names>P</given-names>
</name>
<name>
<surname>Iturriaga</surname>
<given-names>JM</given-names>
</name>
</person-group>
<article-title>[Risky practices associated with HIV infection of seamen who travel in sub-Saharan West Africa]</article-title>
<source>Rev Clin Esp</source>
<year>1991</year>
<volume>189</volume>
<fpage>416</fpage>
<lpage>21</lpage>
</nlm-citation>
</ref>
<ref id="R38">
<label>38</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Entz</surname>
<given-names>AT</given-names>
</name>
<name>
<surname>Ruffolo</surname>
<given-names>VP</given-names>
</name>
<name>
<surname>Chinveschakitvanich</surname>
<given-names>V</given-names>
</name>
<name>
<surname>Soskolne</surname>
<given-names>V</given-names>
</name>
<name>
<surname>van Griensven</surname>
<given-names>GJ</given-names>
</name>
</person-group>
<article-title>HIV-1 prevalence, HIV-1 subtypes and risk factors among fishermen in the Gulf of Thailand and the Andaman Sea</article-title>
<source>AIDS</source>
<year>2000</year>
<volume>14</volume>
<fpage>1027</fpage>
<lpage>34</lpage>
</nlm-citation>
</ref>
<ref id="R39">
<label>39</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Houweling</surname>
<given-names>H</given-names>
</name>
<name>
<surname>Coutinho</surname>
<given-names>RA</given-names>
</name>
</person-group>
<article-title>Risk of HIV infection among Dutch expatriates in sub-Saharan Africa</article-title>
<source>Int J STD AIDS</source>
<year>1991</year>
<volume>2</volume>
<fpage>252</fpage>
<lpage>7</lpage>
</nlm-citation>
</ref>
<ref id="R40">
<label>40</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Gillies</surname>
<given-names>P</given-names>
</name>
<name>
<surname>Slack</surname>
<given-names>R</given-names>
</name>
<name>
<surname>Stoddart</surname>
<given-names>N</given-names>
</name>
<name>
<surname>Conway</surname>
<given-names>S</given-names>
</name>
</person-group>
<article-title>HIV-related risk behaviour in UK holiday-makers</article-title>
<source>AIDS</source>
<year>1992</year>
<volume>6</volume>
<fpage>339</fpage>
<lpage>41</lpage>
</nlm-citation>
</ref>
<ref id="R41">
<label>41</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Belda</surname>
<given-names>FJ</given-names>
</name>
<name>
<surname>Barlow</surname>
<given-names>KL</given-names>
</name>
<name>
<surname>Murphy</surname>
<given-names>G</given-names>
</name>
<name>
<surname>Parry</surname>
<given-names>JV</given-names>
</name>
<name>
<surname>Clewley</surname>
<given-names>JP</given-names>
</name>
</person-group>
<article-title>A dual subtype B/E HIV type 1 infection with a novel V3 loop crown motif among infections acquired in Thailand and imported into England</article-title>
<source>AIDS Res Hum Retroviruses</source>
<year>1998</year>
<volume>14</volume>
<fpage>911</fpage>
<lpage>6</lpage>
</nlm-citation>
</ref>
<ref id="R42">
<label>42</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Dietrich</surname>
<given-names>U</given-names>
</name>
<name>
<surname>Ruppach</surname>
<given-names>H</given-names>
</name>
<name>
<surname>Gehring</surname>
<given-names>S</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Large proportion of non-B HIV-1 subtypes and presence of zidovudine resistance mutations among German seroconvertors</article-title>
<source>AIDS</source>
<year>1997</year>
<volume>11</volume>
<fpage>1532</fpage>
<lpage>3</lpage>
</nlm-citation>
</ref></ref-list>
<sec sec-type="display-objects">
<title>Figures and Tables</title>
<fig id="F1" position="float">
<label>Figure 1</label>
<caption><p>Geographic distribution of predominant human immunodeficiency virus type 1 subtypes and circulating recombinant forms. A/E, CRF01_AE; A/G, CRF02_AG; A/B, CRF03_AB; B/C, CRF07_BC and CRF08_BC.</p></caption>
<graphic mimetype="image" xlink:href="32-12-1732-fig001.tif"></graphic>
</fig>
<fig id="T1" position="float">
<label>Table 1</label>
<caption><p>Non-B subtype human immunodeficiency virus type 1 (HIV-1) infections in selected studies in Western Europe and the United States.</p></caption>
<graphic mimetype="image" xlink:href="32-12-1732-tbl001.tif"></graphic>
</fig></sec>
</back>
</article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Travel and the Introduction of Human Immunodeficiency Virus Type 1 Non-B Subtype Genetic Forms into Western Countries</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Travel and the Introduction of Human Immunodeficiency Virus Type 1 Non-B Subtype Genetic Forms into Western Countries</title></titleInfo><name type="personal"><namePart type="given">Charles D.</namePart><namePart type="family">Ericsson</namePart><affiliation>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</affiliation><description>Section Editor</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Robert</namePart><namePart type="family">Steffen</namePart><affiliation>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</affiliation><description>Section Editor</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Michael M.</namePart><namePart type="family">Thomson</namePart><affiliation>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal" displayLabel="corresp"><namePart type="given">Rafael</namePart><namePart type="family">Nájera</namePart><affiliation>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</affiliation><affiliation>E-mail: rafael.najera@isciii.es</affiliation><affiliation>Reprints or correspondence: Dr. Rafael Nájera, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Ctra. Majadahonda-Pozuelo, Km. 2, 28220 Majadahonda, Madrid, Spain</affiliation><affiliation>E-mail: rafael.najera@isciii.es</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Charles D.</namePart><namePart type="family">Ericsson</namePart><affiliation>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</affiliation><description>Section Editor</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Robert</namePart><namePart type="family">Steffen</namePart><affiliation>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</affiliation><description>Section Editor</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Michael M.</namePart><namePart type="family">Thomson</namePart><affiliation>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal" displayLabel="corresp"><namePart type="given">Rafael</namePart><namePart type="family">Nájera</namePart><affiliation>Área de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Madrid</affiliation><affiliation>E-mail: rafael.najera@isciii.es</affiliation><affiliation>Reprints or correspondence: Dr. Rafael Nájera, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Ctra. Majadahonda-Pozuelo, Km. 2, 28220 Majadahonda, Madrid, Spain</affiliation><affiliation>E-mail: rafael.najera@isciii.es</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</genre><originInfo><publisher>The University of Chicago Press</publisher><dateIssued encoding="w3cdtf">2001-06-15</dateIssued><copyrightDate encoding="w3cdtf">2001</copyrightDate></originInfo><abstract>Both high mutation rates and recombination contribute to the genetic diversity of human immunodeficiency virus type 1 (HIV-1). Among viruses of the main group, which are responsible for the HIV-1 pandemic, 21 circulating genetic forms have been reported, 11 of which are recombinant between ⩾2 subtypes. In Western Europe and the Americas, the HIV-1 epidemic is largely dominated by B subtype viruses; however, infections with diverse non-B subtype genetic forms are increasingly being recognized. In Western Europe and North America, most of them have been identified in immigrants or travelers returning from areas with high HIV-1 prevalence, mainly from sub-Saharan Africa and Southeast Asia, where non-B subtype genetic forms predominate, but propagation within other groups has been reported in some Western countries. This may have implications for prophylactic and therapeutic strategies and, by bringing in contact different genetic forms, may favor the generation of novel recombinant viruses. Travelers from different categories—including immigrants, military personnel, seamen, tourists, expatriates, diplomats, and businessmen—may be at risk of transporting HIV non-B subtype genetic forms to Western countries.</abstract><relatedItem type="host"><titleInfo><title>Clinical Infectious Diseases</title></titleInfo><titleInfo type="abbreviated"><title>Clinical Infectious Diseases</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><subject><topic>Invited Articles</topic></subject><identifier type="ISSN">1058-4838</identifier><identifier type="eISSN">1537-6591</identifier><identifier type="PublisherID">cid</identifier><identifier type="PublisherID-hwp">cid</identifier><part><date>2001</date><detail type="volume"><caption>vol.</caption><number>32</number></detail><detail type="issue"><caption>no.</caption><number>12</number></detail><extent unit="pages"><start>1732</start><end>1737</end></extent></part></relatedItem><identifier type="istex">4D7BD0C864C46040041179DFE5E92F5812EC0E2B</identifier><identifier type="DOI">10.1086/320764</identifier><accessCondition type="use and reproduction" contentType="copyright">© 2001 Infectious Diseases Society of America</accessCondition><recordInfo><recordContentSource authority="ISTEX" authorityURI="https://loaded-corpus.data.istex.fr" valueURI="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-GTWS0RDP-M">oup</recordContentSource><recordOrigin>© 2001 Infectious Diseases Society of America</recordOrigin></recordInfo></mods><json:item><extension>json</extension><original>false</original><mimetype>application/json</mimetype><uri>https://api.istex.fr/document/4D7BD0C864C46040041179DFE5E92F5812EC0E2B/metadata/json</uri></json:item></metadata><covers><json:item><extension>tiff</extension><original>true</original><mimetype>image/tiff</mimetype><uri>https://api.istex.fr/document/4D7BD0C864C46040041179DFE5E92F5812EC0E2B/covers/tiff</uri></json:item><json:item><extension>html</extension><original>true</original><mimetype>text/html</mimetype><uri>https://api.istex.fr/document/4D7BD0C864C46040041179DFE5E92F5812EC0E2B/covers/html</uri></json:item></covers><annexes><json:item><extension>jpeg</extension><original>true</original><mimetype>image/jpeg</mimetype><uri>https://api.istex.fr/document/4D7BD0C864C46040041179DFE5E92F5812EC0E2B/annexes/jpeg</uri></json:item><json:item><extension>gif</extension><original>true</original><mimetype>image/gif</mimetype><uri>https://api.istex.fr/document/4D7BD0C864C46040041179DFE5E92F5812EC0E2B/annexes/gif</uri></json:item><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/4D7BD0C864C46040041179DFE5E92F5812EC0E2B/annexes/pdf</uri></json:item></annexes><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/Sante/explor/SidaSubSaharaV1/Data/Istex/Corpus
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 001938 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Istex/Corpus/biblio.hfd -nk 001938 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Wicri/Sante
|area= SidaSubSaharaV1
|flux= Istex
|étape= Corpus
|type= RBID
|clé= ISTEX:4D7BD0C864C46040041179DFE5E92F5812EC0E2B
|texte= Travel and the Introduction of Human Immunodeficiency Virus Type 1 Non-B Subtype Genetic Forms into Western Countries
}}
| This area was generated with Dilib version V0.6.32. |  |