Persistent Transmission of HCV among Men Who Have Sex with Men despite Widespread Screening and Treatment with Direct-Acting Antivirals
Stephanie Popping,
Lize Cuypers,
Mark A. A. Claassen,
Guido E. van den Berk,
Anja De Weggheleire,
Joop E. Arends,
Anne Boerekamps,
Richard Molenkamp,
Marion P. G. Koopmans,
Annelies Verbon,
Charles A. B. Boucher,
Bart Rijnders,
David A. M. C. van de Vijver
Affiliations
Stephanie Popping
Department of Viroscience, Erasmus Medical Center, 3015 CA Rotterdam, The Netherlands
Lize Cuypers
Laboratory of Clinical and Epidemiological Virology, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, 3000 Leuven, Belgium
Mark A. A. Claassen
Department of Internal Medicine and Infectious Diseases, Rijnstate Ziekenhuis, 6815 AD Arnhem, The Netherlands
Guido E. van den Berk
Department of Internal Medicine and Infectious Diseases, OLVG, 1091 AC Amsterdam, The Netherlands
Anja De Weggheleire
Department of Clinical Science, Institute of Tropical Medicine Antwerp, 2000 Antwerp, Belgium
Joop E. Arends
Department of Internal Medicine and Infectious Diseases, Universitair Medisch Centrum Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands
Anne Boerekamps
Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, 3015 CA Rotterdam, The Netherlands
Richard Molenkamp
Department of Viroscience, Erasmus Medical Center, 3015 CA Rotterdam, The Netherlands
Marion P. G. Koopmans
Department of Viroscience, Erasmus Medical Center, 3015 CA Rotterdam, The Netherlands
Annelies Verbon
Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, 3015 CA Rotterdam, The Netherlands
Charles A. B. Boucher
Department of Viroscience, Erasmus Medical Center, 3015 CA Rotterdam, The Netherlands
Bart Rijnders
Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, 3015 CA Rotterdam, The Netherlands
David A. M. C. van de Vijver
Department of Viroscience, Erasmus Medical Center, 3015 CA Rotterdam, The Netherlands
Background: In the Netherlands, unrestricted access to direct-acting antivirals (DAAs) halved the incidence of acute hepatitis C virus (HCV) infections among HIV-infected men who have sex with men (MSM). To develop strategies that can further reduce the spread of HCV, it is important to understand the transmission dynamics of HCV. We used phylogenetic analysis of a dense sample of MSM to provide insight into the impact of unrestricted access to DAAs on HCV transmission in the Netherlands and in Belgium. Methods: We included 89 MSM that were recently infected with HCV genotype 1a in ten Dutch and one Belgian HIV treatment centers. Sequences were generated using next gene sequencing and Sanger sequencing. Maximum likelihood phylogenetic analysis (general time reversible model) was performed on concatenated NS5A and NS5B sequences and a reference set of 389 highly similar control sequences selected from GenBank. A cluster was based on a minimum bootstrap support of 90% and a 3% genetic distance threshold. Results: We found that 78 (88%) of individuals were part of seven major clusters. All clusters included individuals from across the study region, however, different cities were part of different clusters. In three clusters, HIV-negative MSM clustered with sequences from HIV-positive MSM. All clusters that were observed before the introduction of DAAs persisted after unrestricted access to DAAs became available. Conclusion: Recently acquired HCV infections among MSM in the Netherlands and Belgium are strongly clustered and therefore highly suitable for targeted prevention strategies, such as contact tracing and partner notification. Importantly, despite an HCV incidence reduction after high DAA uptake and continuously monitoring, HCV transmission persisted in the same clusters.
