Factors associated with phylogenetic clustering of hepatitis C among people who inject drugs in Baltimore

Oluwaseun Falade-Nwulia,Oliver Laeyendecker,David Thomas,Mark Sulkowski,Stuart C Ray,Sean D Mccormick,Carl Latkin,Shruti H Mehta,Gregory D Kirk,Jada Hackman

doi:10.1186/s12879-020-05546-x

Oluwaseun Falade-Nwulia, Oliver Laeyendecker + Show 8 more

Open Access

https://doi.org/10.1186/s12879-020-05546-x

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Abstract

BackgroundThe availability of effective, oral direct acting antivirals (DAAs) for hepatitis C virus (HCV) treatment has put elimination of HCV as a public health challenge within reach. However, little is known about the characteristics of transmission networks of people who inject drugs (PWID).MethodsSequencing of a segment of the HCV genome was performed on samples collected from a community-based cohort of PWID between August 2005 and December 2016. Phylogenetic trees were inferred, and clusters were identified (70% bootstrap threshold; 0.04 maximum genetic distance threshold). We describe sex, race, age difference, and HIV infection status of potential transmission partners. Logistic regression was used to assess factors associated with being in an HCV cluster.ResultsOf 508 HCV genotype 1 viremic PWID, 8% (n = 41) were grouped into 20 clusters, consisting of 19 pairs and 1 triad. In adjusted analyses, female sex (odds ratio [OR] 2.3 [95% confidence interval (CI) 1.2–4.5]) and HIV infection (OR 5.7 [CI 2.7–11.9]) remained independently associated with being in an HCV infection cluster.ConclusionsMolecular epidemiological analysis reveals that, in this cohort of PWID in Baltimore, HIV infection and female sex were associated with HCV clustering. Combination HCV prevention interventions targeting HIV infected PWID and addressing HCV infection prevention needs of women have potential to advance HCV elimination efforts.

Highlights

Hepatitis C virus (HCV) infection is a major public health challenge that disproportionately affects people who inject drugs (PWID) with a prevalence of 50–80% [1]
Study population and design Data and specimens for this study were from participants enrolled in the AIDS Linked to the Intravenous Experience (ALIVE) study, a prospective communityrecruited cohort of former and current PWID residing in Baltimore, Maryland [16]
Study population characteristics A total of 2312 PWID were enrolled in the ALIVE cohort between 2005 and 2016 of which 1873 (81%) were hepatitis C virus (HCV) antibody positive

Summary

Introduction

Hepatitis C virus (HCV) infection is a major public health challenge that disproportionately affects people who inject drugs (PWID) with a prevalence of 50–80% [1]. Shared use of drug preparation equipment (including cotton, cookers, and water) is the major route of HCV transmission among PWID [2]. Recent phylogenetic analyses suggested dense networks of HIV transmission in a rural community in Indiana, United States linked to injection use of oxymorphone [12]. This analysis demonstrated that HIV spreads rapidly through existing HCV transmission networks [15]; highlighting the importance of understanding HCV transmission networks for prevention of HCV and HIV transmission among PWID. The availability of effective, oral direct acting antivirals (DAAs) for hepatitis C virus (HCV) treatment has put elimination of HCV as a public health challenge within reach. Little is known about the characteristics of transmission networks of people who inject drugs (PWID)

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