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The number of distinct HIV-1 subtypes and recombinants was greatest in Western Europe and North America. The proportion of HIV-1 infections due to recombinants was highest in South-East Asia, China, and West and Central Africa. The highest proportions of URFs were found in Myanmar, Republic of the Congo, and Argentina. Our study provides epidemiological evidence that the HIV pandemic is diversifying at country level and highlights the increasing challenge to HIV vaccine development and diagnostic, drug resistance, and viral load assays.<\/jats:p>","DOI":"10.1128\/jvi.01580-20","type":"journal-article","created":{"date-parts":[[2020,10,19]],"date-time":"2020-10-19T15:10:16Z","timestamp":1603120216000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":44,"title":["Country Level Diversity of the HIV-1 Pandemic between 1990 and 2015"],"prefix":"10.1128","volume":"95","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3523-7457","authenticated-orcid":false,"given":"Joris","family":"Hemelaar","sequence":"first","affiliation":[{"name":"Nuffield Department of Women\u2019s and Reproductive Health, University of Oxford, Women\u2019s Centre, John Radcliffe Hospital, Oxford, United Kingdom"},{"name":"Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shanghavie","family":"Loganathan","sequence":"additional","affiliation":[{"name":"Nuffield Department of Women\u2019s and Reproductive Health, University of Oxford, Women\u2019s Centre, John Radcliffe Hospital, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramyiadarsini","family":"Elangovan","sequence":"additional","affiliation":[{"name":"Nuffield Department of Women\u2019s and Reproductive Health, University of Oxford, Women\u2019s Centre, John Radcliffe Hospital, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Yun","sequence":"additional","affiliation":[{"name":"Nuffield Department of Women\u2019s and Reproductive Health, University of Oxford, Women\u2019s Centre, John Radcliffe Hospital, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leslie","family":"Dickson-Tetteh","sequence":"additional","affiliation":[{"name":"Nuffield Department of Women\u2019s and Reproductive Health, University of Oxford, Women\u2019s Centre, John Radcliffe Hospital, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shona","family":"Kirtley","sequence":"additional","affiliation":[{"name":"Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"WHO-UNAIDS Network for HIV Isolation and Characterization","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_3_2_2","volume-title":"Global AIDS update","author":"UNAIDS","year":"2020","unstructured":"UNAIDS. 2020. 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