Abstract

Studies have shown that hepatitis C virus subtype 3a (HCV-3a) is likely to have been circulating in South Asia before its global spread. However, the time and route of this dissemination remain unclear. For the first time, we generated host and virus genome-wide data for more than 500 patients infected with HCV-3a from the UK, North America, Australia, and New Zealand. We used the host genomic data to infer the ancestry of the patients and used this information to investigate the epidemic history of HCV-3a. We observed that viruses from hosts of South Asian ancestry clustered together near the root of the tree, irrespective of the sampling country, and that they were more diverse than viruses from other host ancestries. We hypothesized that South Asian hosts are more likely to have been infected in South Asia and used the inferred host ancestries to distinguish between the location where the infection was acquired and where the sample was taken. Next, we inferred that three independent transmission events resulted in the spread of the virus from South Asia to the UK, North America, and Oceania. This initial spread happened during or soon after the end of World War II. This was subsequently followed by many independent transmissions between the UK, North America, and Oceania. Using both host and virus genomic information can be highly informative in studying the virus epidemic history, especially in the context of chronic infections where migration histories need to be accounted for.

Highlights

  • It is estimated that 71 million people are infected with the hepatitis C virus (HCV) worldwide, many in the developing world (WHO 2017)

  • For BOSON hosts with hepatitis C virus subtype 3a (HCV-3a) infection where genetic data were not available, host ancestries were designated as their self-reported ancestries

  • We report the first study that incorporates host genetic information to investigate the genetic epidemiology of a virus (HCV-3a)

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Summary

Introduction

It is estimated that 71 million people are infected with the hepatitis C virus (HCV) worldwide, many in the developing world (WHO 2017). Chronic HCV infection is one of the leading causes of liver cirrhosis and hepatocellular carcinoma (HCC) (El-Serag 2012). While there are currently no vaccines for HCV, the recently developed direct-acting antivirals have significantly improved the safety and efficacy of treatment regimens for HCV infection (Smith et al, 2021). HCV is highly diverse and is currently classified into eight major genotypes (denoted by numbers 1–8), each of which has been divided into many subtypes (denoted by lower case letters, e.g. 1a, 1b, etc.). The clinical outcomes of chronic HCV infection are influenced by viral genetics. It has been shown that HCV genotype 3 is associated with a higher risk of developing

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