Montefiore Medical Center/Albert Einstein College of Medicine.
Centers for Disease Control, Division of Viral Hepatitis.
J Infect Dis. 2020 Jul 6;222(3):488-498. doi: 10.1093/infdis/jiaa100.
Understanding hepatitis C virus (HCV) transmission among people who inject drugs (PWID) is essential for HCV elimination. We aimed to differentiate reinfections from treatment failures and to identify transmission linkages and associated factors in a cohort of PWID receiving opioid agonist therapy (OAT).
We analyzed baseline and follow-up specimens from 150 PWID from 3 OAT clinics in the Bronx, New York. Next-generation sequencing data from the hypervariable region 1 of HCV were analyzed using Global Hepatitis Outbreak and Surveillance Technology.
There were 3 transmission linkages between study participants. Sustained virologic response (SVR) was not achieved in 9 participants: 7 had follow-up specimens with similar sequences to baseline, and 2 died. In 4 additional participants, SVR was achieved but the participants were viremic at later follow-up: 2 were reinfected with different strains, 1 had a late treatment failure, and 1 was transiently viremic 17 months after treatment. All transmission linkages were from the same OAT clinic and involved spousal or common-law partnerships.
This study highlights the use of next-generation sequencing as an important tool for identifying viral transmission and to help distinguish relapse and reinfection among PWID. Results reinforce the need for harm reduction interventions among couples and those who report ongoing risk factors after SVR.
了解注射吸毒者（PWID）中的丙型肝炎病毒（HCV）传播对于 HCV 消除至关重要。我们旨在区分再感染和治疗失败，并确定接受阿片类激动剂治疗（OAT）的一组 PWID 中的传播联系和相关因素。
我们分析了来自纽约布朗克斯 3 个 OAT 诊所的 150 名 PWID 的基线和随访标本。使用全球肝炎爆发和监测技术对 HCV 高变区 1 的下一代测序数据进行了分析。
研究参与者之间有 3 个传播联系。9 名参与者未达到持续病毒学应答（SVR）：7 名有与基线相似序列的随访标本，2 名死亡。在另外 4 名参与者中，SVR 达到，但参与者在后续随访中仍有病毒血症：2 人感染了不同的毒株，1 人发生晚期治疗失败，1 人在治疗后 17 个月出现短暂病毒血症。所有的传播联系都来自同一个 OAT 诊所，涉及配偶或事实伴侣关系。
本研究强调了使用下一代测序作为识别病毒传播的重要工具，并有助于区分 PWID 中的复发和再感染。研究结果强调了在 SVR 后，需要对夫妇和那些报告持续存在风险因素的人进行减少伤害干预。
