title: Hepatitis C genotype distribution and homology among geographically disparate injecting drug users in Afghanistan.
abstract: Hepatitis C virus (HCV) prevalence is high among injecting drug users in Afghanistan, but transmission dynamics are poorly understood. Samples from HCV-infected injecting drug users were sequenced to determine circulating genotypes and potential transmission linkages. Serum samples were obtained from injecting drug user participants in Hirat, Jalalabad, and Mazar-i-Sharif between 2006 and 2008 with reactive anti-HCV rapid tests. Specimens with detected HCV viremia were amplified and underwent sequence analysis. Of 113 samples evaluated, 25 samples (35.2%) were only typeable in NS5B, nine samples (12.7%) were only typeable in CE1, and 37 samples (52.1%) were genotyped in both regions. Of those with typeable HCV, all were Afghan males with a mean age of 31.1 (standard deviation [SD] ± 8.0) years and mean duration of injecting of 3.9 (SD ± 4.3) years. Most reported residence outside Afghanistan in the last decade (90.1%) and prior incarceration (76.8%). HCV genotypes detected were: 1a, (35.2%, n = 25), 3a (62.0%, n = 44), and 1b (2.8%, n = 2). Cluster formation was detected in NS5B and CE1 and were generally from within the same city. All participants within clusters reported being a refugee in Iran compared to 93.5% of those outside clusters. Only 22.2% (4/11) of those within clusters had been refugees in Pakistan and these four individuals had also been refugees in Iran. Predominance of genotype 3a and the association between HCV viremia and having been a refugee in Iran potentially reflects migration between Afghanistan and Iran among IDUs from Mazar-i-Sharif and Hirat and carry implications for harm reduction programs for this migratory population.
authors.affiliation: Department of Molecular Virology and Pathogenesis, United States Military HIV Research Program (MHRP), Walter Reed Army Institute of Research, Silver Spring, MD, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Sanders-Buell
authors.forename: Wiriya
authors.initials: W
authors.lastname: Rutvisuttinunt
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Todd
authors.forename: Abdul
authors.initials: A
authors.lastname: Nasir
authors.forename: Andrea
authors.initials: A
authors.lastname: Bradfield
authors.forename: Esther
authors.initials: E
authors.lastname: Lei
authors.forename: Kultida
authors.initials: K
authors.lastname: Poltavee
authors.forename: Hathairat
authors.initials: H
authors.lastname: Savadsuk
authors.forename: Jerome H
authors.initials: JH
authors.lastname: Kim
authors.forename: Paul T
authors.initials: PT
authors.lastname: Scott
authors.forename: Mark
authors.initials: M
authors.lastname: de Souza
authors.forename: Sodsai
authors.initials: S
authors.lastname: Tovanabutra
mesh_terms: D000328:Adult; D000346:Afghanistan; D016000:Cluster Analysis; D004279:DNA, Viral / Q000737:chemistry / Q000235:genetics; D005838:Genotype; D016174:Hepacivirus / Q000145:classification* / Q000235:genetics* / Q000302:isolation & purification; D006526:Hepatitis C / Q000635:transmission / Q000821:virology*; D006801:Humans; D007492:Iran; D008297:Male; D017720:Molecular Epidemiology; D008969:Molecular Sequence Data; D010154:Pakistan / Q000453:epidemiology; D017422:Sequence Analysis, DNA; D044967:Serum / Q000821:virology; D015819:Substance Abuse, Intravenous / Q000150:complications*; D055815:Young Adult
chemical_list: D004279:DNA, Viral
keywords: HCV Type 3a; hepatitis C genotype; linkage cluster; molecular epidemiology