Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
Division of Infectious Diseases, Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America.
PLoS One. 2020 Jul 15;15(7):e0235237. doi: 10.1371/journal.pone.0235237. eCollection 2020.
The epidemic of hepatitis C virus (HCV) infection among HIV-infected men who have sex with men (MSM) is in its second decade, but the routes of transmission remain poorly understood. We hypothesized that by pairing single genome sequencing (SGS), to enumerate infecting HCV genomes (viruses), with detailed sexual and drug histories, we could gain insight into the routes of transmission among MSM. We used SGS to analyze blood specimens from eight HIV-infected MSM who had 10 episodes of acute (seronegative) or early HCV infections. Seven of eight men reported condomless receptive anal intercourse (CRAI), six with rectal exposure to semen, and all eight denied rectal trauma or bleeding. Of the 10 HCV infections, eight resulted from transmission of a single virus; one infection resulted from transmission of either one or a few (three or four) closely-related viruses; and one infection resulted from transmission of >10 distinct viruses. The participant infected by >10 viruses reported sharing injection equipment for methamphetamine during sex. Two other participants also injected methamphetamine during sex but they did not share injection equipment and were infected by a single virus. Conclusions: Most HCV infections of HIV-infected MSM without a history of either rectal trauma or bleeding or shared injection equipment were caused by a single virus. Intra-rectal exposure to semen during CRAI is therefore likely sufficient for HCV transmission among MSM. Conversely, rectal trauma or bleeding or shared injection equipment are not necessary for HCV transmission among MSM. These results help clarify routes of HCV transmission among MSM and can therefore help guide the design of much-needed behavioral and other interventions to prevent HCV transmission among MSM.
丙型肝炎病毒（HCV）感染在男男性行为者（MSM）中的流行已经进入第二个十年，但传播途径仍不清楚。我们假设通过配对单基因组测序（SGS），以计数感染 HCV 基因组（病毒），并结合详细的性行为和药物使用史，我们可以深入了解 MSM 中的传播途径。我们使用 SGS 分析了 8 名 HIV 感染的 MSM 的血液样本，这些人有 10 次急性（血清阴性）或早期 HCV 感染。8 名男性中有 7 名报告了无保护的肛交（CRAI），6 名有直肠接触精液，所有 8 名均否认直肠创伤或出血。在 10 次 HCV 感染中，8 次是由单一病毒传播引起的；1 次感染是由一个或少数（3 或 4 个）密切相关的病毒传播引起的；1 次感染是由超过 10 个不同的病毒传播引起的。感染超过 10 个病毒的参与者报告在性行为中共享了用于吸食冰毒的注射设备。另外两名参与者也在性行为中注射了冰毒，但他们没有共享注射设备，并且只感染了一个病毒。结论：大多数没有直肠创伤或出血史或共享注射设备史的 HIV 感染 MSM 的 HCV 感染是由单一病毒引起的。在 CRAI 期间，直肠内接触精液很可能足以在 MSM 中传播 HCV。相反，直肠创伤或出血或共享注射设备不是 MSM 中 HCV 传播的必要条件。这些结果有助于阐明 MSM 中 HCV 的传播途径，因此可以帮助指导设计急需的行为和其他干预措施，以防止 MSM 中 HCV 的传播。
