Recombination between HIV-1 subtypes B and F has generated several circulating and unique recombinant forms, particularly in Latin American areas. In Italy, subtype B is highly prevalent while subtype F is the most common pure non-B subtype. To investigate the recombination pattern in Italian BF recombinant viruses, we characterized full-length sequences derived from 15 adult patients, mostly Italian and infected by the heterosexual route. One of the BF mosaics was a CRF29, three sequences clustered with low bootstrap values with CRF39, CRF40, and CRF42. With the exception of the CRF29-like sequence, the other recombination patterns were unique, but two possible clusters were identified. Analysis of the gp120 V3 domain suggested a possible link with subtype F from Eastern Europe rather than from Latin America, favoring the hypothesis of local recombination between clade B and F viruses over that of import of BF recombinants from Latin America. HIV-1 subtypes B and F appear prone to generation of unique recombinants in Italy, warranting epidemiological surveillance and investigation of a possible clinical significance.H uman immunodeficiency virus type 1 (HIV-1) is characterized by an extremely broad genetic diversity, caused by high mutation and recombination rates. Currently, HIV-1 group M (''Major''), which is responsible of the worldwide pandemic, is divided into pure subtypes A-D, F-H, J, and K (with subtypes A and F further subdivided into subsubtypes A1-A4 and F1-F2, respectively) as well as 48 circulating recombinant forms (CRFs) of varying epidemiological significance, and untold numbers of unique recombinants that are not known to have spread to many patients. Subtype B has long been predominant in Western European countries but the prevalence of non-B strains has been increasing significantly in past years as a consequence of recent migration waves from Africa, Eastern Europe, and South America.1 Continuous surveillance of HIV-1 molecular epidemiology plays a critical role in the understanding of genetic diversity of HIV-1 and for research purposes such as vaccine development. In clinical practice, pol-based subtype assignment is usually accomplished as a by-product of genotypic antiretroviral resistance testing.A homebrew HIV-1 genotyping assay has been established and offered as a public health service at the HIV Monitoring Laboratory (HML), Department of Molecular Biology, University of Siena, Italy since 1995. 2 The laboratory has been serving a number of clinics for analysis of drug resistance mutations accumulating around 10,000 protease and reverse transcriptase sequences from more than 4000 patients. In addition, some hundred partial gag and env sequences have been obtained for research studies. A recent survey on the whole HIV-1 sequence database at the HML revealed 85% of subtype B sequences and 15% of non-B subtypes, mainly CRF02_AG, F1, C, and A1, based on the pol region.3 In some cases, assignments of subtype based on the pol and env regions were not in agreement. 4 These discrepan...