Transmission of hepatitis C virus infection among younger and older people who inject drugs in Vancouver, Canada

详细信息    查看全文

• 作者：Brendan Jacka¹ ; ^{bjacka@kirby.unsw.edu.au" class="auth_mail" title="E-mail the corresponding author} ; Tanya Applegate¹ ; Art F. Poon² ; ³ ; Jayna Raghwani⁴ ; P. Richard Harrigan² ; ³ ; Kora DeBeck² ; ⁵ ; M.-J. Milloy² ; ⁶ ; Mel Krajden⁷ ; Andrea Olmstead⁷ ; Jeffrey B. Joy² ; Brandon D.L. Marshall⁸ ; Kanna Hayashi² ; Oliver G. Pybus⁴ ; Viviane Dias Lima² ; ³ ; Gkikas Magiorkinis⁴ ; ⁹ ; Julio Montaner² ; ³ ; Francois Lamoury¹ ; Gregory J. Dore¹ ; Evan Wood² ; ³ ; Jason Grebely¹
• 关键词：HCV ; hepatitis C virus ; PWID ; people who inject drugs ; NSP ; needle and syringe programs ; OST ; opioid substitution therapy ; HIV ; human immunodeficiency virus ; ARYS ; At Risk Youth Study ; VIDUS ; Vancouver Injection Drug Users Study ; RNA ; ribonucleic acid ; PCR ; polymerase chain reaction ; E2 ; envelope-2 ; MCMC ; Markov Chain Monte Carlo ; BaTS ; Bayesian association of tip significance ; tMRCA ; time to most common recent ancestor
• 刊名：Journal of Hepatology
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：64
• 期：6
• 页码：1247-1255
• 全文大小：923 K

文摘

Understanding HCV transmission among people who inject drugs (PWID) is important for designing prevention strategies. This study investigated whether HCV infection among younger injectors occurs from few or many transmission events from older injectors to younger injectors among PWID in Vancouver, Canada.

Methods

HCV antibody positive participants at enrolment or follow-up (1996–2012) were tested for HCV RNA and sequenced (Core-E2). Time-stamped phylogenetic trees were inferred using Bayesian Evolutionary Analysis Sampling Trees (BEAST). Association of age with phylogeny was tested using statistics implemented in the software Bayesian Tip Significance (BaTS) testing. Factors associated with clustering (maximum cluster age: five years) were identified using logistic regression.

Results

Among 699 participants with HCV subtype 1a, 1b, 2b and 3a infection (26% female, 24% HIV+): 21% were younger (<27 years), and 10% had recent HCV seroconversion. When inferred cluster age was limited to <5 years, 15% (n = 108) were in clusters/pairs. Although a moderate degree of segregation was observed between younger and older participants, there was also transmission between age groups. Younger age (<27 vs. >40, AOR: 3.14; 95% CI: 1.54, 6.39), HIV (AOR: 1.97; 95% CI: 1.22, 3.18) and subtype 3a (AOR: 2.12; 95% CI: 1.33, 3.38) were independently associated with clustering.

Conclusions

In this population of PWID from Vancouver, HCV among young injectors was seeded from many transmission events between HCV-infected older and younger injectors. Phylogenetic clustering was associated with younger age and HIV. These data suggest that HCV transmission among PWID is complex, with transmission occurring between and among older and younger PWID.