A large HCV transmission network enabled a fast-growing HIV outbreak in rural Indiana, 2015
A large HCV transmission network enabled a fast-growing HIV outbreak in rural Indiana, 2015
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DOI：
10.1016/j.ebiom.2018.10.007
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发表时间：
2018-11-01
期刊：
影响因子：
11.1
通讯作者：
Khudyakov, Yury
中科院分区：
文献类型：
--
作者：
Ramachandran, Sumathi;Thai, Hong;Khudyakov, Yury
背景：在印第安纳州注射羟吗啡的大规模HIV暴发期间发现的HIV患者中，丙型肝炎病毒(HCV)合并感染的高流行率(923%)促使对丙型肝炎病毒株进行基因分析。方法：对丙型肝炎病毒阳性样本进行分子流行病学分析，包括基因分型，用下一代测序(NGS)对宿主内的HVR1变异进行采样，以及利用全球肝炎暴发和监测技术(GHOST)构建传播网络。结果：492份样本的结果表明，丙型肝炎病毒以1a(72.2%)和3a(20.4%)为主，存在主要的地方性NS5B尘埃，占测序菌株的49.8%。在76名HIV混合感染者中，605%被分成两个流行聚集区。对281例病例的NGS分析确定了826,917个独特的hvr1序列和51例亚型/基因型混合感染。幽灵映射了23台变速箱除尘器。一个大聚集组(n=130)包括50例感染>；=2亚型/基因的患者和43例合并感染HIV的患者。在随访的12例患者中，有7例发现了迅速的毒株替换和不同毒株的重叠感染。解释：Ghost Enable标测注射吸毒者之间的丙型肝炎病毒传播网络(PWID)。许多传播聚集性、混合基因感染和不同丙型肝炎病毒株感染的快速接连表明，丙型肝炎病毒的传播率很高。HIV合并感染患者在主要的丙型肝炎病毒感染者中的共同定位表明，艾滋病毒的传播是由现有的丙型肝炎病毒传播网络实现的，该网络可能使丙型肝炎病毒在社区中持续多年。确定传播网络是指导有效的公共卫生干预措施以预防和阻断丙型肝炎病毒和艾滋病毒在PWID中传播的重要步骤。爱思唯尔出版公司(Elsevier B.V.)
Background: A high prevalence (923%) of hepatitis C virus (HCV) co-infection among HIV patients identified during a large HIV outbreak associated with injection of oxymorphone in Indiana prompted genetic analysis of HCV strains.Methods: Molecular epidemiological analysis of HCV-positive samples included genotyping, sampling intra-host HVR1 variants by next-generation sequencing (NGS) and constructing transmission networks using Global Hepatitis Outbreak and Surveillance Technology (GHOST).Findings: Results from the 492 samples indicate predominance of HCV genotypes 1a (72.2%) and 3a (20.4%), and existence oft major endemic NS5B dusters involving 49.8% of the sequenced strains. Among 76 HIV co-infected patients, 605% segregated into 2 endemic clusters. NGS analyses of 281 cases identified 826,917 unique HVR1 sequences and 51 cases of mixed subtype/genotype infections. GHOST mapped 23 transmission dusters. One large cluster (n = 130) included 50 cases infected with >= 2 subtypes/genotypes and 43 cases co-infected with HIV. Rapid strain replacement and superinfection with different strains were found among 7 of 12 cases who were followed up.Interpretation: GHOST enabled mapping of HCV transmission networks among persons who inject drugs (PWID). Findings of numerous transmission clusters, mixed-genotype infections and rapid succession of infections with different HCV strains indicate a high rate of HCV spread. Co-localization of HIV co-infected patients in the major HCV dusters suggests that HIV dissemination was enabled by existing HCV transmission networks that likely perpetuated HCV in the community for years. Identification of transmission networks is an important step to guiding efficient public health interventions for preventing and interrupting HCV and HIV transmission among PWID. Published by Elsevier B.V.