Global and regional molecular epidemiology of HIV-1 during 1990–2024: systematic review, global survey, and analysis of prevalence
Issued Date
2026-01-01
Resource Type
ISSN
14733099
eISSN
14744457
Scopus ID
2-s2.0-105040681905
Pubmed ID
42155508
Journal Title
Lancet Infectious Diseases
Rights Holder(s)
SCOPUS
Bibliographic Citation
Lancet Infectious Diseases (2026)
Suggested Citation
Khalid A., Gettins L., Scullion L., Liu X., Lin Wei L.L., Masai A.N., Guerin P.J., Allel K., Hemelaar J., Abidi S.H., Abimiku A.G., Agwale S., Archibald C., Avidor B., Ávila-Ríos S., Áy É., Ba A.A., Barbás M.G., Barre-Sinoussi F., Barugahare B., Bbosa N., Belabbes E.H., Bezemer D., Bobkov A.F., Brandful J., Bredell H., Brennan C.A., Brooks J., Bruckova M., Buonaguro F., Buonaguro L., Buttò S., Buve A., Carrera A., Carrillo M.G., Charles M., Chatzidimitriou D., Chehadeh W., Cooper D., Cunningham P., Dagnra A., De Francesco M.A., Dean J., Del Amo J., Dietrich U., Diop-Ndiaye H., Dwyer D., Ellenberger D., Ensoli B., Essex M., Fall M., Featherstone L.A., Fleury H., Fonjungo P.N., Foulongne V., Fraser C., Gadkari D.A., Gao F., García F., Gershy-Damet G.M., Glynn J.R., Grabowski M.K., Grossman Z., Guimarães M., Hahn B., Handema R., He X., Hemalatha H., Ho D.D., Holguín A., Hosseinipour M., Hunt G., Huo Y., Ito M., Izopet J., Jesus C.S., Kaleebu P., Kalish M., Kamori D., Kang C., Kanki P., Karamov E., Karasi J.C., Kayitenkore K., Kelleher A., Kirichenko A., Kitayaporn D., Kostrikis L.G., Kucherer C., Lara C., Leitner T., Leye N., Liitsola K., Lingappa J., Linka M., Loosli T., Lorenzana de Rivera I., Lukashov V., Luke Elizabeth H., Maggiorella M.T. Global and regional molecular epidemiology of HIV-1 during 1990–2024: systematic review, global survey, and analysis of prevalence. Lancet Infectious Diseases (2026). doi:10.1016/S1473-3099(26)00142-8 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/117181
Title
Global and regional molecular epidemiology of HIV-1 during 1990–2024: systematic review, global survey, and analysis of prevalence
Author(s)
Khalid A.
Gettins L.
Scullion L.
Liu X.
Lin Wei L.L.
Masai A.N.
Guerin P.J.
Allel K.
Hemelaar J.
Abidi S.H.
Abimiku A.G.
Agwale S.
Archibald C.
Avidor B.
Ávila-Ríos S.
Áy É.
Ba A.A.
Barbás M.G.
Barre-Sinoussi F.
Barugahare B.
Bbosa N.
Belabbes E.H.
Bezemer D.
Bobkov A.F.
Brandful J.
Bredell H.
Brennan C.A.
Brooks J.
Bruckova M.
Buonaguro F.
Buonaguro L.
Buttò S.
Buve A.
Carrera A.
Carrillo M.G.
Charles M.
Chatzidimitriou D.
Chehadeh W.
Cooper D.
Cunningham P.
Dagnra A.
De Francesco M.A.
Dean J.
Del Amo J.
Dietrich U.
Diop-Ndiaye H.
Dwyer D.
Ellenberger D.
Ensoli B.
Essex M.
Fall M.
Featherstone L.A.
Fleury H.
Fonjungo P.N.
Foulongne V.
Fraser C.
Gadkari D.A.
Gao F.
García F.
Gershy-Damet G.M.
Glynn J.R.
Grabowski M.K.
Grossman Z.
Guimarães M.
Hahn B.
Handema R.
He X.
Hemalatha H.
Ho D.D.
Holguín A.
Hosseinipour M.
Hunt G.
Huo Y.
Ito M.
Izopet J.
Jesus C.S.
Kaleebu P.
Kalish M.
Kamori D.
Kang C.
Kanki P.
Karamov E.
Karasi J.C.
Kayitenkore K.
Kelleher A.
Kirichenko A.
Kitayaporn D.
Kostrikis L.G.
Kucherer C.
Lara C.
Leitner T.
Leye N.
Liitsola K.
Lingappa J.
Linka M.
Loosli T.
Lorenzana de Rivera I.
Lukashov V.
Luke Elizabeth H.
Maggiorella M.T.
Gettins L.
Scullion L.
Liu X.
Lin Wei L.L.
Masai A.N.
Guerin P.J.
Allel K.
Hemelaar J.
Abidi S.H.
Abimiku A.G.
Agwale S.
Archibald C.
Avidor B.
Ávila-Ríos S.
Áy É.
Ba A.A.
Barbás M.G.
Barre-Sinoussi F.
Barugahare B.
Bbosa N.
Belabbes E.H.
Bezemer D.
Bobkov A.F.
Brandful J.
Bredell H.
Brennan C.A.
Brooks J.
Bruckova M.
Buonaguro F.
Buonaguro L.
Buttò S.
Buve A.
Carrera A.
Carrillo M.G.
Charles M.
Chatzidimitriou D.
Chehadeh W.
Cooper D.
Cunningham P.
Dagnra A.
De Francesco M.A.
Dean J.
Del Amo J.
Dietrich U.
Diop-Ndiaye H.
Dwyer D.
Ellenberger D.
Ensoli B.
Essex M.
Fall M.
Featherstone L.A.
Fleury H.
Fonjungo P.N.
Foulongne V.
Fraser C.
Gadkari D.A.
Gao F.
García F.
Gershy-Damet G.M.
Glynn J.R.
Grabowski M.K.
Grossman Z.
Guimarães M.
Hahn B.
Handema R.
He X.
Hemalatha H.
Ho D.D.
Holguín A.
Hosseinipour M.
Hunt G.
Huo Y.
Ito M.
Izopet J.
Jesus C.S.
Kaleebu P.
Kalish M.
Kamori D.
Kang C.
Kanki P.
Karamov E.
Karasi J.C.
Kayitenkore K.
Kelleher A.
Kirichenko A.
Kitayaporn D.
Kostrikis L.G.
Kucherer C.
Lara C.
Leitner T.
Leye N.
Liitsola K.
Lingappa J.
Linka M.
Loosli T.
Lorenzana de Rivera I.
Lukashov V.
Luke Elizabeth H.
Maggiorella M.T.
Author's Affiliation
University of Oxford
University of Washington
University of Pennsylvania
The University of North Carolina at Chapel Hill
Johns Hopkins University
Karolinska Institutet
Seoul National University
Universiteit van Amsterdam
Universität Zürich
Zhengzhou University
Emory University School of Medicine
Duke University Medical Center
Université de Bordeaux
Los Alamos National Laboratory
Aristotle University of Thessaloniki
University of Cape Town
Centers for Disease Control and Prevention
Universidad de Buenos Aires
University of Oxford Medical Sciences Division
Harvard T.H. Chan School of Public Health
University College Dublin
London School of Hygiene & Tropical Medicine
Vanderbilt University School of Medicine
Instituto de Salud Carlos III
Institut Pasteur, Paris
Fundacao Oswaldo Cruz
Rockefeller University
Università degli Studi di Brescia
Istituto Superiore Di Sanita
Kuwait University
Hospital Universitario Ramón y Cajal
Terveyden ja Hyvinvoinnin Laitos
Nuffield Department of Medicine
Tel Aviv Sourasky Medical Center
University of Yamanashi
Centre Hospitalier Universitaire de Montpellier
Westmead Hospital
CHU de Toulouse
St. Vincent's Hospital Sydney
Abbott Laboratories
Robert Koch Institute
Prins Leopold Instituut voor Tropische Geneeskunde
Université Cheikh Anta Diop de Dakar
Istituto Nazionale Tumori IRCCS - Fondazione G Pascale, Napoli
The Kirby Institute
Public Health Agency of Canada
Hospital Universitario San Cecilio
Muhimbili University of Health and Allied Sciences
Ministry of Health
Instituto Nacional de Enfermedades Respiratorias
D.I. Ivanovsky Institute of Virology
N. F. Gamaleya Institute of Epidemiology and Microbiology, Ministry of Health of the Russian Federation
National Institute for Communicable Diseases
National Institute of Public Health Prague
University of Lome
Institute of Human Virology
Noguchi Memorial Institute for Medical Research
Uganda Ministry of Health
Tuberculosis Research Centre India
Universidad Nacional Autónoma de Honduras
Uganda Virus Research Institute
National Center for AIDS/STD Control and Prevention
Central Research Institute of Epidemiology
Ministerio de Salud
Nazarbayev University School of Medicine
Georg-Speyer-Haus
National AIDS Research Institute India
Stichting HIV Monitoring
Institut Pasteur - Alger
Groupe d’étude Haïtien sur le Sarcome de Kaposi et les Infections Opportunistes
HIV/AIDS Collaboration
National Reference Laboratory
National Center for Public Health and Pharmacy
Gede Foundation
World Health Organisation
University of Washington
University of Pennsylvania
The University of North Carolina at Chapel Hill
Johns Hopkins University
Karolinska Institutet
Seoul National University
Universiteit van Amsterdam
Universität Zürich
Zhengzhou University
Emory University School of Medicine
Duke University Medical Center
Université de Bordeaux
Los Alamos National Laboratory
Aristotle University of Thessaloniki
University of Cape Town
Centers for Disease Control and Prevention
Universidad de Buenos Aires
University of Oxford Medical Sciences Division
Harvard T.H. Chan School of Public Health
University College Dublin
London School of Hygiene & Tropical Medicine
Vanderbilt University School of Medicine
Instituto de Salud Carlos III
Institut Pasteur, Paris
Fundacao Oswaldo Cruz
Rockefeller University
Università degli Studi di Brescia
Istituto Superiore Di Sanita
Kuwait University
Hospital Universitario Ramón y Cajal
Terveyden ja Hyvinvoinnin Laitos
Nuffield Department of Medicine
Tel Aviv Sourasky Medical Center
University of Yamanashi
Centre Hospitalier Universitaire de Montpellier
Westmead Hospital
CHU de Toulouse
St. Vincent's Hospital Sydney
Abbott Laboratories
Robert Koch Institute
Prins Leopold Instituut voor Tropische Geneeskunde
Université Cheikh Anta Diop de Dakar
Istituto Nazionale Tumori IRCCS - Fondazione G Pascale, Napoli
The Kirby Institute
Public Health Agency of Canada
Hospital Universitario San Cecilio
Muhimbili University of Health and Allied Sciences
Ministry of Health
Instituto Nacional de Enfermedades Respiratorias
D.I. Ivanovsky Institute of Virology
N. F. Gamaleya Institute of Epidemiology and Microbiology, Ministry of Health of the Russian Federation
National Institute for Communicable Diseases
National Institute of Public Health Prague
University of Lome
Institute of Human Virology
Noguchi Memorial Institute for Medical Research
Uganda Ministry of Health
Tuberculosis Research Centre India
Universidad Nacional Autónoma de Honduras
Uganda Virus Research Institute
National Center for AIDS/STD Control and Prevention
Central Research Institute of Epidemiology
Ministerio de Salud
Nazarbayev University School of Medicine
Georg-Speyer-Haus
National AIDS Research Institute India
Stichting HIV Monitoring
Institut Pasteur - Alger
Groupe d’étude Haïtien sur le Sarcome de Kaposi et les Infections Opportunistes
HIV/AIDS Collaboration
National Reference Laboratory
National Center for Public Health and Pharmacy
Gede Foundation
World Health Organisation
Corresponding Author(s)
Other Contributor(s)
Abstract
Background: The extensive genetic diversity of HIV presents major challenges to treatment and prevention. We aimed to estimate the global and regional distribution of HIV-1 subtypes and recombinants during 1990–2024. Methods: We conducted a systematic literature review by searching PubMed, Embase, Global Health, and CINAHL for country-specific HIV-1 subtyping data published between Jan 1, 2022, and Jan 22, 2025, and a global survey of the Global HIV Molecular Epidemiology Collaboration for unpublished data collected between 2016 and 2024. We included primary HIV-1 subtyping data with ≥20 samples and known country and years of sample collection during 1990–2024. We excluded publications and survey responses that had no or incomplete subtyping data, were restricted to specific HIV-1 variants, included superinfections, or used secondary data. These data were combined with HIV-1 subtyping data previously collected between 1990 and 2021. Data were aggregated by country for six time periods (1990–99, 2000–04, 2005–09, 2010–14, 2015–19, and 2020–24). Proportions of HIV-1 subtypes, circulating recombinant forms (CRFs), and unique recombinant forms (URFs) were calculated by country and period and were weighted using UNAIDS country estimates of numbers of people living with HIV to estimate regional and global HIV-1 variant proportions. The systematic review is registered with PROSPERO, CRD42017067164. Findings: HIV-1 subtyping data were available for 1 395 222 samples from 154 countries during 1990–2024. In 2020–24, subtype C accounted for 48·7% (95% CI 48·3–49·1) of global HIV-1 infections, followed by subtype A (11·5%; 10·9–12·1), subtype B (10·3%; 10·0–10·5) URFs (5·3%; 4·4–6·3), CRF02_AG (5·1%; 4·5–5·8), CRF01_AE (5·1%; 4·8–5·4), other CRFs (3·9%; 3·3–4·5), subtype G (3·1%; 2·1–4·1), subtype D (3·0%; 2·7–3·3), and CRF07_BC (2·1%; 2·0–2·1). Subtypes F, H, J, K, and L combined accounted for 1·1% of infections and unspecified recombinants for 0·9% (0·7–1·0). HIV-1 variants are differentially distributed across regions, with subtype C dominating in southern Africa; Ethiopia, Eritrea, and Djibouti; and south Asia; subtype A in east Africa and eastern Europe and central Asia; subtype B in North America, Latin America, and western and central Europe; CRF01_AE in southeast Asia; and CRF07_BC in east Asia. Central Africa exhibited the greatest HIV-1 diversity. Global HIV-1 variant distributions were broadly stable during 2000–24, but notable regional changes included increases of HIV-1 recombinants in western and central Europe and of CRF07_BC in east Asia. Interpretation: Global and regional HIV-1 genetic diversity is complex and evolving, affecting the efficacy of diagnostic and viral load assays, emergence of drug resistance, and vaccine development. Continued surveillance of spatiotemporal trends in HIV-1 genetic diversity is essential. Funding: Nuffield Department of Population Health, University of Oxford, UK.