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Analyses of HCV Strains
Approximately 71 million people worldwide are infected with the hepatitis C virus (HCV). Injectable drug use represents the most common route of transmission in Europe and other developed countries. We studied the molecular characteristics of the HCV infection among mono-infected people who used drugs (PWUD) in Italy. Among 208 PWUD with anti-HCV antibodies, 101 (48.6%) were HCV RNA-positive, the majority (47%) were infected with the HCV genotype (Gt)1a, followed by Gt3a (34.9%), Gt4 (9.1%), Gt1b (4.5%), and Gt2 (4.5%). Bayesian phylogenetic analyses of clustered HCV NS5B sequences from 66 HCV-positive PWUDs with available plasma samples indicated age and neighborhood proximity as the most common characteristics between closely related HCV strains. Population dynamics, as measured by a coalescent Bayesian skyline analysis, revealed an increase in HCV Gt1a infections from the mid-1980s to mid-1990s. While HCV Gt3a infections were first detected in the 1980s, patient numbers with this genotype subtype remained relatively constant. For both Gt1a and Gt3a, Birth–Death Bayesian Skyline analyses produced higher reproduction numbers post 2014. For earlier time intervals, slow growths were observed for both Gt1a and Gt3a with reproduction numbers (Re) of approximately 1. The evolutionary rates for Gt1a and Gt3a were estimated as 2.23 × 10−4 and 3.85 × 10−4, respectively.
1. IntroductionThe WHO estimated that approximately 71 million people worldwide are infected with the hepatitis C virus (HCV), with 1.75 million new infections being reported every year . This virus is a blood-borne pathogen. Before the screening for anti-HCV antibodies was introduced in 1990, blood transfusion was the main risk factor for HCV infection . In 1993, Western countries started using a nucleic acid amplification (NAT) test to detect the presence of HCV RNA. The availability of more sensitive tests led to a reduction in HCV prevalence. In Italy in 2013, the HCV RNA incidence rate in first-time blood donors was 2.5 per 100,000 . Illicit drug users (IDUs) have been the predominant HCV-infected population since the early 2000s . The WHO estimated that nearly 13 million individuals worldwide are IUDs, of which 67% are living with HCV . Despite the route of transmission being similar for HCV and HIV, the transmission rates appear to vary. The HCV is estimated to be approximately ten times more transmissible than HIV, as only 30% of infected IDUs have HIV. Seroprevalence of HCV antibodies is very high among people who inject drugs (PWID); up to 90% of PWID have HCV antibodies compared with approximately 10% with HIV seroprevalence . Preventive strategies, such as the reduction of syringe exchange with better aseptic technique compliance, have facilitated the reduction of HCV transmission by drug injection. However, numerous studies have shown that the sharing of drug paraphernalia is responsible for the spread of HCV among both IDUs and non-IDUs . Specifically, the sharing of a sniffer device is a relevant factor in the spread of HCV among non-IDUs . Changes in drug consumption and the awareness of safer drug injection practices have reduced the incidence of HCV transmission. In France, for instance, the cumulative incidence of HCV infection in IDUs was 40–50% over the last five years with the implementation of safer drug practices; this is compared with 90% in the early 1990s . In Italy, in 2016, a national surveillance analysis at the Italian Centers for substance dependence indicated that approximately half a million of the population were people who use drugs (PWUD) and 30% tested positive for HCV . The HCV status of these patients remains poorly understood, especially the variability in HCV transmission dynamics among this special population. As reported for other Western countries , genotypes 1a (Gt1a) and 3 (Gt3) are the most prevalent among PWID. HCV Gt4 prevalence is also increasing and drug use seems to be a key factor for the spread of this genotype , combined with people emigrating from African and Asian countries. To date, no phylogenetic or phylodynamic studies have been performed that focus on the correlation of drug use with the HCV genotype and the age of the patient.
2. Current Analysis on HCV Infection
|Characteristics||Total (n)||HCV Genotype|
|Age (years), mean ± SD||50 ± 8.9 (n = 66)||49 ± 9.4 (n = 31)||57 ± 3.5 (n = 3)||61 ± 5.3 (n = 3)||48 ± 9.1 (n = 23)||52 ± 2.3 (n = 6)|
|Gender||(n = 66)||(n = 31)||(n = 3)||(n = 3)||(n = 23)||(n = 6)|
|Estimated year of HCV infection||(n = 66)||(n = 31)||(n = 3)||(n = 3)||(n = 23)||(n = 6)|
|Assumption for infection||(n = 66)||(n = 31)||(n = 3)||(n = 3)||(n = 23)||(n = 6)|
|Inhal and Intrav||55||23||3||3||21||5|
|Most commonly injected drug at recruitment||(n = 66)||(n = 31)||(n = 3)||(n = 3)||(n = 23)||(n = 6)|
|Heroin and Cocaine||45||21||3||1||15||5|
The entry is from 10.3390/microorganisms9071432
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