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Higher Risk of Incident Hepatitis C Virus Coinfection Among Men Who Have Sex With Men, in Whom the HIV Genetic Bottleneck at Transmission Was Wide


Kouyos, R D; Rauch, A; Braun, D L; Yang, W-L; Böni, J; Yerly, S; Klimkait, T; Aubert, V; Shah, C; Kovari, H; Calmy, A; Cavassini, M; Battegay, M; Vernazza, P L; Bernasconi, E; Ledergerber, B; Gunthard, H F (2014). Higher Risk of Incident Hepatitis C Virus Coinfection Among Men Who Have Sex With Men, in Whom the HIV Genetic Bottleneck at Transmission Was Wide. Journal of Infectious Diseases, 210(10):1555-1561.

Abstract

Background: High-risk sexual behaviors have been suggested as drivers of the recent dramatic increase of sexually transmitted hepatitis C virus (HCV) among human immunodeficiency virus (HIV)–infected men who have sex with men (MSM).
Methods: We assessed the association between the genetic bottleneck of HIV at transmission and the prevalence and incidence of HCV coinfection in HIV-infected MSM from the Swiss HIV Cohort Study (SHCS). As a proxy for the width of the transmission bottleneck, we used the fraction of ambiguous nucleotides detected by genotypic resistance tests sampled during early HIV infection. We defined a broad bottleneck as a fraction of ambiguous nucleotides exceeding a previously established threshold (0.5%).
Results: From the SHCS, we identified 671 MSM with available results of HCV serologic tests and with an HIV genotypic resistance test performed during early HIV infection. Of those, 161 (24.0%) exhibited a broad HIV transmission bottleneck, 38 (5.7%) had at least 1 positive HCV test result, and 26 (3.9%) had an incident HCV infection. Individuals with broad HIV transmission bottlenecks exhibited a 2-fold higher odds of having ever experienced an HCV coinfection (odds ratio, 2.2 [95% confidence interval {CI}, 1.1–4.3]) and a 3-fold higher hazard of having an incident HCV infection (hazard ratio, 3.0 [95% CI, 1.4–6.6]) than individuals with narrow HIV transmission bottlenecks.
Conclusions: Our results indicate that the currently occurring sexual spread of HCV is focused on MSM who are prone to exhibit broad HIV transmission bottlenecks. This is consistent with an important role of high-risk behavior and mucosal barrier impairment in the transmission of HCV among MSM.

Background: High-risk sexual behaviors have been suggested as drivers of the recent dramatic increase of sexually transmitted hepatitis C virus (HCV) among human immunodeficiency virus (HIV)–infected men who have sex with men (MSM).
Methods: We assessed the association between the genetic bottleneck of HIV at transmission and the prevalence and incidence of HCV coinfection in HIV-infected MSM from the Swiss HIV Cohort Study (SHCS). As a proxy for the width of the transmission bottleneck, we used the fraction of ambiguous nucleotides detected by genotypic resistance tests sampled during early HIV infection. We defined a broad bottleneck as a fraction of ambiguous nucleotides exceeding a previously established threshold (0.5%).
Results: From the SHCS, we identified 671 MSM with available results of HCV serologic tests and with an HIV genotypic resistance test performed during early HIV infection. Of those, 161 (24.0%) exhibited a broad HIV transmission bottleneck, 38 (5.7%) had at least 1 positive HCV test result, and 26 (3.9%) had an incident HCV infection. Individuals with broad HIV transmission bottlenecks exhibited a 2-fold higher odds of having ever experienced an HCV coinfection (odds ratio, 2.2 [95% confidence interval {CI}, 1.1–4.3]) and a 3-fold higher hazard of having an incident HCV infection (hazard ratio, 3.0 [95% CI, 1.4–6.6]) than individuals with narrow HIV transmission bottlenecks.
Conclusions: Our results indicate that the currently occurring sexual spread of HCV is focused on MSM who are prone to exhibit broad HIV transmission bottlenecks. This is consistent with an important role of high-risk behavior and mucosal barrier impairment in the transmission of HCV among MSM.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Institute of Medical Virology
04 Faculty of Medicine > University Hospital Zurich > Clinic for Infectious Diseases
Dewey Decimal Classification:570 Life sciences; biology
610 Medicine & health
Uncontrolled Keywords:HIV; hepatitis C virus; coinfection; transmission bottleneck; sexual transmission
Language:English
Date:18 June 2014
Deposited On:28 Nov 2014 11:30
Last Modified:05 Apr 2016 18:33
Publisher:Oxford University Press
ISSN:0022-1899
Funders:Swiss National Science Foundation (grants 33CS30-134277 and 33CS30-148522 to the Swiss HIV Cohort Study [SHCS]), SHCS projects 470, 528, and 569, SHCS Research Foundation, Swiss National Science Foundation (grants 324730-130865 [to H. F. G.] and PZ00P3-142411 [to R. D. K.]), Yvonne-Jacob Foundation (to H. F. G.), Union Bank of Switzerland (grant to H. F. G., in the name of an anonymous donor), Gilead Switzerland (unrestricted grant to the SHCS research foundation), University of Zurich’s Clinical Research Priority Program “ Viral infectious diseases: Zurich Primary HIV Infection Study” (to H. F. G.)
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1093/infdis/jiu315
Related URLs:http://jid.oxfordjournals.org/content/210/10/1555.full.pdf+html?sid=1deeb2a5-01fc-4509-ba85-d001986bfa21 (Publisher)
PubMed ID:24943723

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