HIV-1 subtype diversity among clinical specimens submitted for routine antiviral drug resistance testing in the United States

• Retrospectively examined 3895 HIV-1 pol sequences collected in the United States.
• HIV-1 subtypes assigned with an algorithm employing COMET and REGAv3 subtyping tools.
• Of 3895 sequences, 207 (5.31%) were determined to be from non-B subtypes.
• Percentages of non-B subtypes ranged from 0% to 28.57% among individual states.
• Highest percentages of non-B subtypes found in the West North Central region of United States.

Diversity of human immunodeficiency virus type 1 (HIV-1) has important implications for the diagnosis, treatment, and management of HIV-1–infected individuals. HIV-1 pol sequences from 3895 clinical plasma specimens collected in the United States over a 1-year period and submitted for routine HIV-1 genotypic drug resistance testing were retrospectively analyzed for HIV-1 subtype. Of these 3895 HIV-1 sequences, 207 (5.31%) were determined to be non-B subtypes (including recombinant forms). Among individual states, the percentage of non-B subtypes ranged from 0% (12 states) to 28.57% in South Dakota, with 7 states having percentages of >10%. All 4 states with the highest percentages of non-B subtypes were located within the US West North Central region: Minnesota, 11.82%; Iowa, 15.38%; North Dakota, 25.00%; and South Dakota, 28.57%. Reasons for the unexpectedly wide diversity of HIV-1 subtypes present in multiple states located in the West North Central region of the United States remain to be determined.