Abstract
Chronic hepatitis C cases diagnosed in Romania were mostly related to unsafe parenteral treatments and blood transfusions; HCV genotype 1b was prevalent. During the last decade, an increasing number of HCV infections was reported among people who inject drugs (PWID). The aim of the current study was to test if this epidemiological shift triggered a diversification of the circulating viral strains. HCV genotypes were determined by reverse hybridization in 130 HCV-infected PWID (87.7% males; mean age 27.9 ± 6.7 years, injecting drugs for 8.1 ± 4.8 years). HIV-HCV co-infection was diagnosed in 80.8% of the subjects and 26.9% were HIV-HCV-HBV triple infected. Active HCV viral replication was present in 104 PWID (80%), more frequently in those HIV-co-infected (91.4% vs. 52% in HCV mono-infected, and 77.148.5% in HIV-HCV-HBV triple-infected, p = 0.0001). Non-1b genotypes were prevalent (54.8%), with subtype 1a the most commonly detected (24%), followed by genotypes 3a (14.4%) and 4 (7.7%). Mixed infections with genotypes 1a and 1b were found in nine subjects (8.7%). There was no difference in the genotypes frequencies based on HIV or HBV co-infection status, length of drug usage, or associated risk factors (tattoos, piercing, detention). The continuous surveillance of HCV genotypes in PWID from Romania will add valuable information to the overall European epidemiological picture, with important therapeutic implications.
Highlights
Chronic hepatitis C cases diagnosed in Romania were mostly related to unsafe parenteral treatments and blood transfusions; hepatitis C virus (HCV) genotype 1b was prevalent
In Europe, hepatitis C virus (HCV) transmission is mainly related to injecting drug use; in Romania, a country with a high HCV seroprevalence (3.3% in the general population), the majority of the diagnosed cases have been attributed to unsafe surgical procedures, parenteral treatments, and blood transfusions received before 1990 [1]
A change in this epidemiological picture occurred in the last decade, with an increasing trend of HCV infections reported among people who inject drugs (PWID): seroprevalence rates mounted from 47.6% in 2004 to 82.4% in 2012 [2]
Summary
Chronic hepatitis C cases diagnosed in Romania were mostly related to unsafe parenteral treatments and blood transfusions; HCV genotype 1b was prevalent. A change in this epidemiological picture occurred in the last decade, with an increasing trend of HCV infections reported among people who inject drugs (PWID): seroprevalence rates mounted from 47.6% in 2004 to 82.4% in 2012 [2]. This rise was driven both by the replacement of heroin with new psychoactive substances (NPS), traded as legal until 2011, and by the low coverage of harm-reduction measures. The aim of the current study was to identify if the continuous increase of PWID as a new risk-group for HCV infection in Romania has triggered a change in the circulating viral genotypes Human immunodeficiency virus (HIV) and hepatitis B virus (HBV) infections were scarcely detected in PWID in Romania until 2011, when an explosive increase in blood-borne viral infections (multiple hepatitis and HIV co-infection) was reported in drug users hospitalized as medical emergencies, mainly caused by acute intoxication or systemic infections secondary to druginduced immunosuppression [3].
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