Phylogenetic analysis of acute hepatitis C virus genotype 4 infections among human immunodeficiency virus-positive men who have sex with men in Germany.
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.
Vogel
Martin
M
Department of Internal Medicine I, University of Bonn, Bonn, Germany. martin.vogel@ukb.uni-bonn.de
van de Laar
Thijs
T
Kupfer
Bernd
B
Stellbrink
Hans-Jürgen
HJ
Kümmerle
Tim
T
Mauss
Stefan
S
Knecht
Gaby
G
Berger
Annemarie
A
Bruisten
Sylvia
S
Rockstroh
Jürgen K
JK
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
D017361:Viral Nonstructural Proteins; C087036:NS-5 protein, hepatitis C virus; D012324:RNA-Dependent RNA Polymerase