Expanding epidemic of recently acquired HCV in HIV-coinfected patients over a period of 10 years
Christiana Graf,
Lara Fuhrmann,
Thomas Lutz,
Christoph Stephan,
Gaby Knecht,
Peter Gute,
Markus Bickel,
Kai-Henrik Peiffer,
Fabian Finkelmeier,
Georg Dultz,
Antonia Mondorf,
Nils Wetzstein,
Natalie Filmann,
Eva Herrmann,
Stefan Zeuzem,
Niko Beerenwinkel,
Julia Dietz,
Christoph Sarrazin
Affiliations
Christiana Graf
Department of Internal Medicine 1, University Hospital, Goethe University, Frankfurt, Germany
Lara Fuhrmann
Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland; SIB Swiss Institute of Bioinformatics, Basel, Switzerland
Thomas Lutz
Infektiologikum, Frankfurt, Germany
Christoph Stephan
HIVCENTER, Department of Infectious Diseases, University Hospital, Goethe University, Frankfurt, Germany
Gaby Knecht
Infektiologikum, Frankfurt, Germany
Peter Gute
Infektiologikum, Frankfurt, Germany
Markus Bickel
Infektiologikum, Frankfurt, Germany
Kai-Henrik Peiffer
Department of Internal Medicine 1, University Hospital, Goethe University, Frankfurt, Germany
Fabian Finkelmeier
Department of Internal Medicine 1, University Hospital, Goethe University, Frankfurt, Germany
Georg Dultz
Department of Internal Medicine 1, University Hospital, Goethe University, Frankfurt, Germany
Antonia Mondorf
Department of Internal Medicine 1, University Hospital, Goethe University, Frankfurt, Germany
Nils Wetzstein
HIVCENTER, Department of Infectious Diseases, University Hospital, Goethe University, Frankfurt, Germany
Natalie Filmann
Institute of Biostatistics and Mathematical Modeling, Goethe University, Frankfurt, Germany
Eva Herrmann
Institute of Biostatistics and Mathematical Modeling, Goethe University, Frankfurt, Germany
Stefan Zeuzem
Department of Internal Medicine 1, University Hospital, Goethe University, Frankfurt, Germany
Niko Beerenwinkel
Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland; SIB Swiss Institute of Bioinformatics, Basel, Switzerland
Julia Dietz
Department of Internal Medicine 1, University Hospital, Goethe University, Frankfurt, Germany
Christoph Sarrazin
Department of Internal Medicine 1, University Hospital, Goethe University, Frankfurt, Germany; Medizinische Klinik II, St. Josefs-Hospital, Wiesbaden, Germany; Corresponding author. Address: Department of Internal Medicine 1, Theodor-Stern-Kai 7, D-60590, Frankfurt, Germany. Tel.: +49-69-6301-87661; Fax: +49-69-6301-84441
Background & Aims: Ongoing transmission of HCV infections is associated with risk factors such as drug injection, needlestick injuries, and men who have sex with men (MSM). Ways of transmission, the course of acute infection, changes of virologic features, and incidence over time are not well known. Methods: Over a period of 10 years, n = 161 patients with recently acquired HCV infection (RAHC) (median follow-up 6.8 years) were prospectively enrolled. NS5B sequencing was performed to re-evaluate the HCV genotype (GT) and for phylogenetic analyses. Results: Patients with RAHC were mainly male (92.5%), MSM (90.1%), and HIV-coinfected (86.3%). Transmission risk factors for MSM and non-MSM were sexual risk behaviour (100 and 6.3%, respectively), injection drug use (9.7 and 37.5%, respectively), and nasal drug use (15.2 and 0%, respectively). Spontaneous and interferon- or direct-acting antiviral-based clearance rates were 13.6, 84.3 and 93.4%, respectively. Mean RAHC declined from 19.8 in the first to 13.2 in the past five study years. Although the majority of infections was caused by HCV GT1a, the frequency of HCV GT4d and slightly HCV GT3a increased over time. No relevant clustering of HCV isolates was observed in non-MSM. However, 45% of HCV GT1a and 100% of HCV GT4d MSM cases clustered with MSM isolates from other countries. Travel-associated infections were supported by personal data in an MSM subgroup. No international clustering was detected in MSM with HCV GT1b or HCV GT3a. Conclusions: RAHCs were mainly diagnosed in HIV-coinfected MSM patients and were associated with sexual risk behaviour. Spontaneous clearance rates were low, and phylogenetic clusters were observed in the majority of patients. Impact and Implications: We evaluated the occurrence and transmission of recently acquired HCV infections (RAHCs) over a period of 10 years. Our data demonstrate that the presence of RAHC was mainly found in HIV-coinfected MSM, with internationally connected transmission networks being observed in the majority of patients. Spontaneous clearance rates were low, and reinfection rates increased mainly driven by a small subset of MSM patients with high-risk behaviour.
