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A large HCV transmission network enabled a fast-growing HIV outbreak in rural Indiana, 2015

BACKGROUND: A high prevalence (92.3%) 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 in...

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Autores principales: Ramachandran, Sumathi, Thai, Hong, Forbi, Joseph C., Galang, Romeo Regi, Dimitrova, Zoya, Xia, Guo-liang, Lin, Yulin, Punkova, Lili T., Pontones, Pamela R., Gentry, Jessica, Blosser, Sara J., Lovchik, Judith, Switzer, William M., Teshale, Eyasu, Peters, Philip, Ward, John, Khudyakov, Yury
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6284413/
https://www.ncbi.nlm.nih.gov/pubmed/30448155
http://dx.doi.org/10.1016/j.ebiom.2018.10.007
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author Ramachandran, Sumathi
Thai, Hong
Forbi, Joseph C.
Galang, Romeo Regi
Dimitrova, Zoya
Xia, Guo-liang
Lin, Yulin
Punkova, Lili T.
Pontones, Pamela R.
Gentry, Jessica
Blosser, Sara J.
Lovchik, Judith
Switzer, William M.
Teshale, Eyasu
Peters, Philip
Ward, John
Khudyakov, Yury
author_facet Ramachandran, Sumathi
Thai, Hong
Forbi, Joseph C.
Galang, Romeo Regi
Dimitrova, Zoya
Xia, Guo-liang
Lin, Yulin
Punkova, Lili T.
Pontones, Pamela R.
Gentry, Jessica
Blosser, Sara J.
Lovchik, Judith
Switzer, William M.
Teshale, Eyasu
Peters, Philip
Ward, John
Khudyakov, Yury
author_sort Ramachandran, Sumathi
collection PubMed
description BACKGROUND: A high prevalence (92.3%) 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 of 2 major endemic NS5B clusters involving 49.8% of the sequenced strains. Among 76 HIV co-infected patients, 60.5% 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 clusters. 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 clusters 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. FUND: US Centers for Disease Control and Prevention, and US state and local public health departments.
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spelling pubmed-62844132018-12-13 A large HCV transmission network enabled a fast-growing HIV outbreak in rural Indiana, 2015 Ramachandran, Sumathi Thai, Hong Forbi, Joseph C. Galang, Romeo Regi Dimitrova, Zoya Xia, Guo-liang Lin, Yulin Punkova, Lili T. Pontones, Pamela R. Gentry, Jessica Blosser, Sara J. Lovchik, Judith Switzer, William M. Teshale, Eyasu Peters, Philip Ward, John Khudyakov, Yury EBioMedicine Research paper BACKGROUND: A high prevalence (92.3%) 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 of 2 major endemic NS5B clusters involving 49.8% of the sequenced strains. Among 76 HIV co-infected patients, 60.5% 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 clusters. 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 clusters 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. FUND: US Centers for Disease Control and Prevention, and US state and local public health departments. Elsevier 2018-11-15 /pmc/articles/PMC6284413/ /pubmed/30448155 http://dx.doi.org/10.1016/j.ebiom.2018.10.007 Text en http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Research paper
Ramachandran, Sumathi
Thai, Hong
Forbi, Joseph C.
Galang, Romeo Regi
Dimitrova, Zoya
Xia, Guo-liang
Lin, Yulin
Punkova, Lili T.
Pontones, Pamela R.
Gentry, Jessica
Blosser, Sara J.
Lovchik, Judith
Switzer, William M.
Teshale, Eyasu
Peters, Philip
Ward, John
Khudyakov, Yury
A large HCV transmission network enabled a fast-growing HIV outbreak in rural Indiana, 2015
title A large HCV transmission network enabled a fast-growing HIV outbreak in rural Indiana, 2015
title_full A large HCV transmission network enabled a fast-growing HIV outbreak in rural Indiana, 2015
title_fullStr A large HCV transmission network enabled a fast-growing HIV outbreak in rural Indiana, 2015
title_full_unstemmed A large HCV transmission network enabled a fast-growing HIV outbreak in rural Indiana, 2015
title_short A large HCV transmission network enabled a fast-growing HIV outbreak in rural Indiana, 2015
title_sort large hcv transmission network enabled a fast-growing hiv outbreak in rural indiana, 2015
topic Research paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6284413/
https://www.ncbi.nlm.nih.gov/pubmed/30448155
http://dx.doi.org/10.1016/j.ebiom.2018.10.007
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