Global HIV-1 genetic diversity and evolution form a major challenge to treatment and prevention efforts. An increasing number of distinct HIV-1 recombinants have been identified worldwide (106 distinct recombinants to date), but their contribution to the global epidemic was hitherto unknown.
Dr Hemelaar's article: "Global and regional epidemiology of HIV-1 recombinants in 1990-2015: a systematic review and global survey" is the first study to describe the global and regional distribution of HIV-1 recombinants (viruses that are the result of a cross-over between two or more different strains of HIV). This study is based on nearly 400,000 HIV samples covering the period 1990 to 2015. The global and regional distribution of HIV-1 recombinants was found to be extremely diverse and evolve over time. The number and proportion of recombinants is increasing worldwide, reaching 22.8% of global HIV-1 infections in 2010-2015. Recombinants play prominent roles in several regions, including in sub-Saharan Africa, East and South-east Asia, Middle East and North Africa, Eastern Europe and central Asia, and Latin America. This demonstrates the way the HIV pandemic is evolving and highlights the increasing challenge facing the development of a globally effective HIV vaccine as well as the need for ongoing adaptation of HIV diagnostic, drug resistance, and viral load assays.