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TUAB201

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Travel-Nature

Published on March 13, 2008

Author: Nathaniel

Source: authorstream.com

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Evidence of international transmission of HCV in pan-European study of HIV-positive men who have sex with men (MSM). :  Evidence of international transmission of HCV in pan-European study of HIV-positive men who have sex with men (MSM). M Danta1,9*, T van de Laar4*, D Brown1, O Pybus3, S Bhagani2, M Vogel5, S Neifer6, A Baumgarten6, H Gőtz7, J Rockstroh5, S Bruisten4, G Dusheiko1, R Coutinho4,8 1UCL Institute of Hepatology, London, UK; 2Department of HIV Medicine, Royal Free and University College, London, UK; 3Department of Zoology, University of Oxford, UK; 4Cluster of Infectious Diseases, Health Service, Amsterdam, Netherlands; 5University of Bonn, Germany; 6Practice Dupke / Carganico / Baumgarten, Berlin, Germany; 7Department of Infectious Diseases, Health Service Rotterdam, Netherlands; 8Centre for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, Netherlands; 9St Vincent’s Clinical School, UNSW, Australia. *Joint first author. Acute HCV in HIV-positive men in Europe :  Acute HCV in HIV-positive men in Europe N= 389 UK temporal data of acute HCV in HIV-positive MSM :  UK temporal data of acute HCV in HIV-positive MSM Giraudon STI 2007 (in press) Overall incidence: 9.1/1000 patient years UK temporal data of acute HCV in HIV-positive MSM :  UK temporal data of acute HCV in HIV-positive MSM Giraudon STI 2007 (in press) Transmission risk factors:  Transmission risk factors Identified factors: High number of sexual partners. Mucosally traumatic sexual practices. Group sex practices. Ulcerative sexually transmitted infections (STIs). Recreational drug use and sharing (intranasal and intrarectal). Permucosal NOT parenteral transmission. Danta AIDS 2007, Van de Laar JID 2007, Serpaggi AIDS 2006, Gotz AIDS 2005, Brown STI 2004 Aim:  Aim To determine if there is evidence of a HCV transmission network among European MSM using molecular phylogenetic analysis. Study population:  Study population HIV-positive men who have sex with men (MSM) diagnosed with recent HCV since 2000. Cases from European cohorts: UK: n=107 Danta AIDS 2007 Netherlands: n=51 Van de Laar JID 2007 France: n=8 Serpaggi AIDS 2006 Germany: n=24 Vogel AASLD 2005 Recent hepatitis C defined as: documented anti-HCV seroconversion within prior 12 months, or a positive HCV-RNA by polymerase chain reaction assay (PCR) following a negative assay within prior 12 months previously, or a positive HCV-RNA PCR and a serum alanine aminotransferase (ALT) level >10-times the upper limit of normal (ULN) with documented normal ALT during the preceding year. Baseline characteristics of cohort:  Baseline characteristics of cohort Phylogenetic methods :  Phylogenetic methods E1/E2 sequence Phylogenetic comparison to other sequences (cases and Genbank) Construction of neighbour-joining trees (PAUP* software) Reverse Transcription PCR HCV genome c E1 E2 p7 2 3 4 5a 5b 5’ UTR 3’ UTR Phylogenetic trees :  Phylogenetic trees (>70) A B C GENETIC DISTANCE Bootstrap value Genotyping:  Genotyping 166 sequences in phylogenetic analysis Genotype 1a (1) HCV phylogenetic tree:  Genotype 1a (1) HCV phylogenetic tree Cluster 1 n=3 (94) Cluster 2 n=11 (84) Cluster 3 n=16 (90) Cluster 4 n=4 (95) UK Netherlands French German E3_64 Genotype 1a (2) HCV phylogenetic tree:  Genotype 1a (2) HCV phylogenetic tree Cluster 5 n=17 (84) Cluster 6 n=37 (72) UK Netherlands French German Genotype 1a - cluster 5:  Genotype 1a - cluster 5 84 86 85 E27 E32 E62 E63 E67 E72 E87 G13 E34 E33 E42 E18 G16 G21 G22 G3 G7 UK German Genotype 3a HCV phylogenetic tree:  Genotype 3a HCV phylogenetic tree UK Netherlands French German Cluster 2 n=6 (90) Cluster 1 n=3 (53) Genotype 4 HCV phylogenetic tree:  Genotype 4 HCV phylogenetic tree Cluster 1 n=31 (93) Cluster 2 n=12 (83) UK Netherlands French German Comparison of individual sequences:  Comparison of individual sequences • 90% (149/166) of MSM have HCV genotypes 1 or 4 (Difficult treatment genotype SVR < 40%). • 88% (147/166) of MSM have HCV strains similar to ≥ 1 MSM. • 73% (122/166) of MSM have HCV closely related strains to ≥ 1 MSM of another European country. Comparison of cluster size by country mixing:  Comparison of cluster size by country mixing Kruskal-Wallis p=0.11 Conclusion:  Conclusion Molecular analysis reveals large HCV transmission network among HIV-positive MSM in Europe. Travel important factor in HCV transmission in this population. The molecular HCV clusters, which cross subtype and genotype, suggests this epidemic is not due to a hepatitis C viral change, but rather behavioural and/or environmental factors. Suggestion that increased country mixing with larger cluster size consistent with regional spread. Conclusion:  Conclusion National public health agencies need targeted preventive strategies including screening of high-risk HIV-positive MSM to mitigate spread of HCV in this population. Acknowledgements:  Acknowledgements UK: HIV and Acute HCV (HAAC) group: M Nelson, Y Gileece, M Aitkins, D Asboe, R Browne Department of HIV Medicine, Chelsea and Westminster Hospitals S Bhagani, M Johnson, G Mulhoney, T Fernandez, Department of HIV Medicine AM Geretti, Department of Virology D Brown, G Dusheiko, M Jacobs, Centre for Hepatology C Sabin, Department of Primary Care and Population Sciences Royal Free and Hampstead Trust/Royal Free and University College Medical School M Fisher, N Perry, A Phillips Department of HIV Medicine, Brighton and Sussex University Hospitals Trust O Pybus Department of Zoology, Oxford University Netherlands: Cluster of Infectious Diseases, Health Service, Amsterdam Centre for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven Department of Infectious Diseases, Health Service Rotterdam, Netherlands; Germany: University of Bonn Practice Dupke / Carganico / Baumgarten, Berlin France: Institut de Veille Sanitaire, Paris Hospital Necker, Paris

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