Introduced in Dead in the Family, the character is the vampire incarnation of the historical prince Alexei Nikolaevich, the last Tsarevich of Russia. He was sired by Appius Livius Ocella, thus, making him Eric Northman's vampire "brother". He was spoiled while alive due to his hemophilia and his royal position, and was psychologically scarred by the massacre of his entire family.
After Ocella made him a vampire, he was obligated to become Ocella's lover. The combination of factors made Alexei mentally unstable and uncontrollable even decades after becoming a vampire.
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