title: Phylogenetic analysis of acute hepatitis C virus genotype 4 infections among human immunodeficiency virus-positive men who have sex with men in Germany.
abstract: BACKGROUND
  An ongoing HCV epidemic currently affects a growing proportion of HIV-positive men who have sex with men (MSM) in Europe. Recently in the North-Rhine region of Germany, we have observed an increase in acute HCV infections of genotype 4 (HCV-4).
  
  
  OBJECTIVE
  To characterize the current spread of HCV-4 among German MSM using a molecular epidemiological approach.
  
  
  METHODS
  Patient characteristics and sera were collected for HIV-positive MSM diagnosed with acute HCV-4 infections in the North-Rhine region (n=14), Hamburg (n=14), Frankfurt (n=4) and Berlin (n=4). Part of the HCV NS5B region (436 bp) was amplified, sequenced and compared with HCV-4 sequences from HIV-positive Dutch, English and French MSM (n=50) as well as unrelated HCV risk groups (n=61).
  
  
  RESULTS
  NS5B sequences were obtained from 35/36 (97%) of German cases, all of which were HCV subtype 4d (HCV-4d). The phylogenetic analysis of HCV sequences revealed two MSM-specific HCV-4d clusters of 71 and 12 sequences. All except one of the German MSM belonged to a large MSM-specific HCV cluster containing MSM from all four different European countries. None of the HCV-4 strains circulating among injecting drug users or in HCV-4 endemic areas were part of the MSM-specific clusters.
  
  
  CONCLUSIONS
  HCV rapidly spreads among European HIV-positive MSM through a joint international transmission network, separate from that of injecting drug users. In order to contain this epidemic, non-parenteral routes of transmission, such as unsafe sex, must be taken into consideration and prevention measures should be refocused accordingly.
authors.affiliation: Department of Internal Medicine I, University of Bonn, Bonn, Germany. martin.vogel@ukb.uni-bonn.de
authors.forename: Martin
authors.initials: M
authors.lastname: Vogel
authors.forename: Thijs
authors.initials: T
authors.lastname: van de Laar
authors.forename: Bernd
authors.initials: B
authors.lastname: Kupfer
authors.forename: Hans-Jürgen
authors.initials: HJ
authors.lastname: Stellbrink
authors.forename: Tim
authors.initials: T
authors.lastname: Kümmerle
authors.forename: Stefan
authors.initials: S
authors.lastname: Mauss
authors.forename: Gaby
authors.initials: G
authors.lastname: Knecht
authors.forename: Annemarie
authors.initials: A
authors.lastname: Berger
authors.forename: Sylvia
authors.initials: S
authors.lastname: Bruisten
authors.forename: Jürgen K
authors.initials: JK
authors.lastname: Rockstroh
mesh_terms: D000328:Adult; D001483:Base Sequence; D019295:Computational Biology; D005858:Germany / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications*; D016174:Hepacivirus / Q000235:genetics*; D006526:Hepatitis C / Q000150:complications* / Q000453:epidemiology* / Q000821:virology*; D018451:Homosexuality, Male; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D008957:Models, Genetic; D008969:Molecular Sequence Data; D010802:Phylogeny; D017422:Sequence Analysis, DNA; D017361:Viral Nonstructural Proteins / Q000235:genetics; D012324:RNA-Dependent RNA Polymerase
chemical_list: D017361:Viral Nonstructural Proteins; C087036:NS-5 protein, hepatitis C virus; D012324:RNA-Dependent RNA Polymerase