Department of HIV and Sexual Health, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
Department of Zoology, University of Oxford, Oxford, UK.
J Viral Hepat. 2020 Jul;27(7):721-730. doi: 10.1111/jvh.13286. Epub 2020 Mar 12.
We sought to characterize risk factors and patterns of HCV transmission amongst men who have sex with men (MSM). MSM with recently acquired HCV (AHCV) were prospectively recruited ('clinic cohort') between January and September 2017. Clinical data and risk behaviours were identified and blood obtained for HCV whole genome sequencing. Phylogenetic analyses were performed, using sequences from this cohort and two other AHCV cohorts, to identify transmission clusters. Sixteen (40.0%) men in the clinic cohort were HIV-negative MSM. HIV-negative MSM were younger than HIV-positive MSM; most (81.3%) had taken HIV PrEP in the preceding year. Eighteen men (45.0%) reported injection drug use; most (34, 85.0%) reported noninjection drug use in the last year. Most in both groups reported condomless anal sex, fisting and sex in a group environment. Few (7, 17.5%) men thought partners may have had HCV. There were 52 sequences in the HCV genotype 1a phylogeny, 18 from the clinic cohort and 34 from other AHCV cohorts; 47 (90.4%) clustered with ≥1 other sequence. There were 7 clusters of 2-27 sequences; 6 clusters contained HIV-negative and HIV-positive MSM and 1 cluster only HIV-positive MSM. Four of these clusters were part of larger clusters first described in 2007. PrEP-using MSM are at risk of HCV, sharing similar risk factors to HIV-positive MSM. Phylogenetics highlights that PrEP-using and HIV-positive MSM are involved in the same HCV transmission networks. Few men demonstrated HCV awareness and risk reduction strategies should be expanded.
我们旨在描述男男性行为者（MSM）中丙型肝炎病毒（HCV）的传播风险因素和模式。2017 年 1 月至 9 月，前瞻性招募了新近感染 HCV（AHCV）的 MSM（“临床队列”）。确定了临床数据和风险行为，并采集血液进行 HCV 全基因组测序。使用该队列和另外两个 AHCV 队列的序列进行系统发育分析，以确定传播簇。临床队列中有 16 名（40.0%）男性为 HIV 阴性 MSM。HIV 阴性 MSM 比 HIV 阳性 MSM 年轻；大多数（81.3%）在过去一年中服用了 HIV 暴露前预防药物（PrEP）。18 名男性（45.0%）报告使用过注射毒品；大多数（34 名，85.0%）在过去一年中报告使用过非注射毒品。两组大多数人都报告了无保护的肛交、拳交和群体环境中的性行为。很少有（7 名，17.5%）男性认为伴侣可能患有 HCV。在 HCV 基因型 1a 系统发育中，有 52 个序列，其中 18 个来自临床队列，34 个来自其他 AHCV 队列；47 个（90.4%）与≥1 个其他序列聚类。有 7 个 2-27 个序列的簇；6 个簇包含 HIV 阴性和 HIV 阳性 MSM，1 个簇仅包含 HIV 阳性 MSM。其中 4 个簇是 2007 年首次描述的更大簇的一部分。使用 PrEP 的 MSM 存在感染 HCV 的风险，与 HIV 阳性 MSM 具有相似的风险因素。系统发育学强调，使用 PrEP 的和 HIV 阳性的 MSM 参与了相同的 HCV 传播网络。很少有男性表现出 HCV 意识，应扩大风险降低策略。
