The epidemic of Human Immunodeficiency Virus type 1 infection in Italy is mostly ascribed to the B subtype, which represents the prevalent subtype in Western Countries. The virus isolates of the B subtype, moreover, show an increasing nucleotide heterogeneity over time, indicating a continuous intra-subtype dynamic evolution, typical of long-lasting epidemics. In recent years, however, the progressive decrease in the transmission rate among the historically defined risk groups (i.e. homosexuals and IDUs) and the parallel increase in heterosexual transmission are slowly introducing variants of non-B subtype into the Italian HIV-1 epidemic. This appears to be strictly linked to the growing number of immigrants from non-Western Countries, where non-B clades and CRFs are prevalent, and consequent inter-racial blending. The distribution of these novel genetic forms needs to be evaluated by continuous molecular monitoring nationwide to verify whether they will overcome the pre-existing B-clade epidemic, which could have significant implications for diagnosis, treatment and vaccine development. Here we review the genetic evolution of HIV-1 spreading within the Italian epidemic.