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<title xml:lang="en">Evidence of a large, international network of international hepatitis C virus transmission in HIV-positive men who have sex with men</title>
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<name sortKey="Van De Laar, T" sort="Van De Laar, T" uniqKey="Van De Laar T" first="T" last="Van De Laar">T. Van De Laar</name>
<affiliation>
<nlm:aff id="A1">Cluster of Infectious Diseases, Health Service, Amsterdam, Netherlands</nlm:aff>
</affiliation>
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<author>
<name sortKey="Pybus, O" sort="Pybus, O" uniqKey="Pybus O" first="O" last="Pybus">O. Pybus</name>
<affiliation>
<nlm:aff id="A2">Department of Zoology, University of Oxford, UK</nlm:aff>
</affiliation>
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<author>
<name sortKey="Bruisten, S" sort="Bruisten, S" uniqKey="Bruisten S" first="S" last="Bruisten">S. Bruisten</name>
<affiliation>
<nlm:aff id="A1">Cluster of Infectious Diseases, Health Service, Amsterdam, Netherlands</nlm:aff>
</affiliation>
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<author>
<name sortKey="Brown, D" sort="Brown, D" uniqKey="Brown D" first="D" last="Brown">D. Brown</name>
<affiliation>
<nlm:aff id="A3">UCL Centre for Hepatology, Royal Free Hospital, London, UK</nlm:aff>
</affiliation>
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<author>
<name sortKey="Nelson, M" sort="Nelson, M" uniqKey="Nelson M" first="M" last="Nelson">M. Nelson</name>
<affiliation>
<nlm:aff id="A4">Department of HIV Medicine, Chelsea and Westminster Hospitals, London, UK</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Bhagani, S" sort="Bhagani, S" uniqKey="Bhagani S" first="S" last="Bhagani">S. Bhagani</name>
<affiliation>
<nlm:aff id="A5">Department of HIV Medicine, Royal Free and University College, London, UK</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Vogel, M" sort="Vogel, M" uniqKey="Vogel M" first="M" last="Vogel">M. Vogel</name>
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<nlm:aff id="A6">Medizinische Klinik und Poliklinik I, Bonn University, Bonn, Germany</nlm:aff>
</affiliation>
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<author>
<name sortKey="Baumgarten, A" sort="Baumgarten, A" uniqKey="Baumgarten A" first="A" last="Baumgarten">A. Baumgarten</name>
<affiliation>
<nlm:aff id="A7">Practice Dupke/Carganico/Baumgarten, Berlin, Germany</nlm:aff>
</affiliation>
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<author>
<name sortKey="Chaix, Ml" sort="Chaix, Ml" uniqKey="Chaix M" first="Ml" last="Chaix">Ml Chaix</name>
<affiliation>
<nlm:aff id="A8">University Paris Descartes EA3620, Virology CHU Necker AP-HP, Paris France</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Fisher, M" sort="Fisher, M" uniqKey="Fisher M" first="M" last="Fisher">M. Fisher</name>
<affiliation>
<nlm:aff id="A9">Department of HIV Medicine, Brighton and Sussex University Hospitals Trust, Brighton, UK</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="G Tz, H" sort="G Tz, H" uniqKey="G Tz H" first="H" last="G Tz">H. G Tz</name>
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<nlm:aff id="A10">Department of Infectious Diseases, Health Service, Rotterdam, Netherlands</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Matthews, G" sort="Matthews, G" uniqKey="Matthews G" first="G" last="Matthews">G. Matthews</name>
<affiliation>
<nlm:aff id="A11">National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney Australia</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Neifer, S" sort="Neifer, S" uniqKey="Neifer S" first="S" last="Neifer">S. Neifer</name>
<affiliation>
<nlm:aff id="A7">Practice Dupke/Carganico/Baumgarten, Berlin, Germany</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="White, P" sort="White, P" uniqKey="White P" first="P" last="White">P. White</name>
<affiliation>
<nlm:aff id="A12">School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, Australia</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Rawlinson, W" sort="Rawlinson, W" uniqKey="Rawlinson W" first="W" last="Rawlinson">W. Rawlinson</name>
<affiliation>
<nlm:aff id="A12">School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, Australia</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Pol, S" sort="Pol, S" uniqKey="Pol S" first="S" last="Pol">S. Pol</name>
<affiliation>
<nlm:aff id="A13">Hepatology Unit, Cochin hospital/University Paris-Descartes, Paris France</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Rockstroh, J" sort="Rockstroh, J" uniqKey="Rockstroh J" first="J" last="Rockstroh">J. Rockstroh</name>
<affiliation>
<nlm:aff id="A6">Medizinische Klinik und Poliklinik I, Bonn University, Bonn, Germany</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Coutinho, R" sort="Coutinho, R" uniqKey="Coutinho R" first="R" last="Coutinho">R. Coutinho</name>
<affiliation>
<nlm:aff id="A1">Cluster of Infectious Diseases, Health Service, Amsterdam, Netherlands</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A14">Centre for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, Netherlands</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Dore, G" sort="Dore, G" uniqKey="Dore G" first="G" last="Dore">G. Dore</name>
<affiliation>
<nlm:aff id="A11">National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney Australia</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Dusheiko, G" sort="Dusheiko, G" uniqKey="Dusheiko G" first="G" last="Dusheiko">G. Dusheiko</name>
<affiliation>
<nlm:aff id="A3">UCL Centre for Hepatology, Royal Free Hospital, London, UK</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Danta, M" sort="Danta, M" uniqKey="Danta M" first="M" last="Danta">M. Danta</name>
<affiliation>
<nlm:aff id="A3">UCL Centre for Hepatology, Royal Free Hospital, London, UK</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A16">St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Australia</nlm:aff>
</affiliation>
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<idno type="pmid">19422083</idno>
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<date when="2009">2009</date>
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<title xml:lang="en" level="a" type="main">Evidence of a large, international network of international hepatitis C virus transmission in HIV-positive men who have sex with men</title>
<author>
<name sortKey="Van De Laar, T" sort="Van De Laar, T" uniqKey="Van De Laar T" first="T" last="Van De Laar">T. Van De Laar</name>
<affiliation>
<nlm:aff id="A1">Cluster of Infectious Diseases, Health Service, Amsterdam, Netherlands</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Pybus, O" sort="Pybus, O" uniqKey="Pybus O" first="O" last="Pybus">O. Pybus</name>
<affiliation>
<nlm:aff id="A2">Department of Zoology, University of Oxford, UK</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Bruisten, S" sort="Bruisten, S" uniqKey="Bruisten S" first="S" last="Bruisten">S. Bruisten</name>
<affiliation>
<nlm:aff id="A1">Cluster of Infectious Diseases, Health Service, Amsterdam, Netherlands</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Brown, D" sort="Brown, D" uniqKey="Brown D" first="D" last="Brown">D. Brown</name>
<affiliation>
<nlm:aff id="A3">UCL Centre for Hepatology, Royal Free Hospital, London, UK</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Nelson, M" sort="Nelson, M" uniqKey="Nelson M" first="M" last="Nelson">M. Nelson</name>
<affiliation>
<nlm:aff id="A4">Department of HIV Medicine, Chelsea and Westminster Hospitals, London, UK</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Bhagani, S" sort="Bhagani, S" uniqKey="Bhagani S" first="S" last="Bhagani">S. Bhagani</name>
<affiliation>
<nlm:aff id="A5">Department of HIV Medicine, Royal Free and University College, London, UK</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Vogel, M" sort="Vogel, M" uniqKey="Vogel M" first="M" last="Vogel">M. Vogel</name>
<affiliation>
<nlm:aff id="A6">Medizinische Klinik und Poliklinik I, Bonn University, Bonn, Germany</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Baumgarten, A" sort="Baumgarten, A" uniqKey="Baumgarten A" first="A" last="Baumgarten">A. Baumgarten</name>
<affiliation>
<nlm:aff id="A7">Practice Dupke/Carganico/Baumgarten, Berlin, Germany</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Chaix, Ml" sort="Chaix, Ml" uniqKey="Chaix M" first="Ml" last="Chaix">Ml Chaix</name>
<affiliation>
<nlm:aff id="A8">University Paris Descartes EA3620, Virology CHU Necker AP-HP, Paris France</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Fisher, M" sort="Fisher, M" uniqKey="Fisher M" first="M" last="Fisher">M. Fisher</name>
<affiliation>
<nlm:aff id="A9">Department of HIV Medicine, Brighton and Sussex University Hospitals Trust, Brighton, UK</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="G Tz, H" sort="G Tz, H" uniqKey="G Tz H" first="H" last="G Tz">H. G Tz</name>
<affiliation>
<nlm:aff id="A10">Department of Infectious Diseases, Health Service, Rotterdam, Netherlands</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Matthews, G" sort="Matthews, G" uniqKey="Matthews G" first="G" last="Matthews">G. Matthews</name>
<affiliation>
<nlm:aff id="A11">National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney Australia</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Neifer, S" sort="Neifer, S" uniqKey="Neifer S" first="S" last="Neifer">S. Neifer</name>
<affiliation>
<nlm:aff id="A7">Practice Dupke/Carganico/Baumgarten, Berlin, Germany</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="White, P" sort="White, P" uniqKey="White P" first="P" last="White">P. White</name>
<affiliation>
<nlm:aff id="A12">School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, Australia</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Rawlinson, W" sort="Rawlinson, W" uniqKey="Rawlinson W" first="W" last="Rawlinson">W. Rawlinson</name>
<affiliation>
<nlm:aff id="A12">School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, Australia</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Pol, S" sort="Pol, S" uniqKey="Pol S" first="S" last="Pol">S. Pol</name>
<affiliation>
<nlm:aff id="A13">Hepatology Unit, Cochin hospital/University Paris-Descartes, Paris France</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Rockstroh, J" sort="Rockstroh, J" uniqKey="Rockstroh J" first="J" last="Rockstroh">J. Rockstroh</name>
<affiliation>
<nlm:aff id="A6">Medizinische Klinik und Poliklinik I, Bonn University, Bonn, Germany</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Coutinho, R" sort="Coutinho, R" uniqKey="Coutinho R" first="R" last="Coutinho">R. Coutinho</name>
<affiliation>
<nlm:aff id="A1">Cluster of Infectious Diseases, Health Service, Amsterdam, Netherlands</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A14">Centre for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, Netherlands</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Dore, G" sort="Dore, G" uniqKey="Dore G" first="G" last="Dore">G. Dore</name>
<affiliation>
<nlm:aff id="A11">National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney Australia</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Dusheiko, G" sort="Dusheiko, G" uniqKey="Dusheiko G" first="G" last="Dusheiko">G. Dusheiko</name>
<affiliation>
<nlm:aff id="A3">UCL Centre for Hepatology, Royal Free Hospital, London, UK</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Danta, M" sort="Danta, M" uniqKey="Danta M" first="M" last="Danta">M. Danta</name>
<affiliation>
<nlm:aff id="A3">UCL Centre for Hepatology, Royal Free Hospital, London, UK</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A16">St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Australia</nlm:aff>
</affiliation>
</author>
</analytic>
<series>
<title level="j">Gastroenterology</title>
<idno type="ISSN">0016-5085</idno>
<idno type="eISSN">1528-0012</idno>
<imprint>
<date when="2009">2009</date>
</imprint>
</series>
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<front>
<div type="abstract" xml:lang="en">
<sec id="S1">
<title>Background</title>
<p id="P1">Since 2000, there has been a marked rise in acute hepatitis C virus (HCV) in HIV-positive men who have sex with men (MSM). We conducted an international phylogenetic study to investigate the existence of an HCV transmission network among MSM.</p>
</sec>
<sec id="S2">
<title>Methods</title>
<p id="P2">HIV-positive MSM diagnosed with recent HCV (n=226) in England (107), Netherlands (58), France (12), Germany (25) and Australia (24) between 2000 and 2006 were enrolled into a molecular phylogenetic study. Using real-time PCR, the NS5B region of the HCV genome (436 bp) was amplified, sequenced and compared with unrelated NS5B sequences.</p>
</sec>
<sec id="S3">
<title>Results</title>
<p id="P3">NS5B sequences were obtained from 200 (89%) cases. Circulating HCV genotypes were 1a (59%); 4d (23%), 3a (11%), 1b (5%), and 2b/c (3%). Phylogenetic analysis revealed 156 (78%) sequences that formed 11 clusters (bootstrap value >70%) containing between 4 and 37 individual sequences. Country mixing was associated with larger cluster size (17 vs 4.5 sequences; p=0.03). ‘Molecular clock’ analysis indicated that the majority (85%) of transmissions occurred since 1996.</p>
</sec>
<sec id="S4">
<title>Discussion</title>
<p id="P4">Phylogenetic analysis revealed a large international network of HCV transmission among HIV-positive MSM. The rapid spread of HCV among neighboring countries is supported by the large proportion (74%) of European MSM infected with an HCV strain co-circulating in multiple European countries; the low evolutionary distances among HCV isolates from different countries; and the trend toward increased country mixing with increasing cluster size. Temporally, this epidemic coincides with the introduction of highly active anti-retroviral therapy and associated increases in sexual risk behaviors. International collaborative public health efforts are needed to mitigate HCV transmission among this population.</p>
</sec>
</div>
</front>
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<pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
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<front>
<journal-meta>
<journal-id journal-id-type="nlm-journal-id">0374630</journal-id>
<journal-id journal-id-type="pubmed-jr-id">3841</journal-id>
<journal-id journal-id-type="nlm-ta">Gastroenterology</journal-id>
<journal-id journal-id-type="iso-abbrev">Gastroenterology</journal-id>
<journal-title-group>
<journal-title>Gastroenterology</journal-title>
</journal-title-group>
<issn pub-type="ppub">0016-5085</issn>
<issn pub-type="epub">1528-0012</issn>
</journal-meta>
<article-meta>
<article-id pub-id-type="pmid">19422083</article-id>
<article-id pub-id-type="pmc">4260925</article-id>
<article-id pub-id-type="manuscript">NIHMS100381</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Article</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Evidence of a large, international network of international hepatitis C virus transmission in HIV-positive men who have sex with men</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>van de Laar</surname>
<given-names>T</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Pybus</surname>
<given-names>O</given-names>
</name>
<xref ref-type="aff" rid="A2">2</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Bruisten</surname>
<given-names>S</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Brown</surname>
<given-names>D</given-names>
</name>
<xref ref-type="aff" rid="A3">3</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Nelson</surname>
<given-names>M</given-names>
</name>
<xref ref-type="aff" rid="A4">4</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Bhagani</surname>
<given-names>S</given-names>
</name>
<xref ref-type="aff" rid="A5">5</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Vogel</surname>
<given-names>M</given-names>
</name>
<xref ref-type="aff" rid="A6">6</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Baumgarten</surname>
<given-names>A</given-names>
</name>
<xref ref-type="aff" rid="A7">7</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Chaix</surname>
<given-names>ML</given-names>
</name>
<xref ref-type="aff" rid="A8">8</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Fisher</surname>
<given-names>M</given-names>
</name>
<xref ref-type="aff" rid="A9">9</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Gőtz</surname>
<given-names>H</given-names>
</name>
<xref ref-type="aff" rid="A10">10</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Matthews</surname>
<given-names>G</given-names>
</name>
<xref ref-type="aff" rid="A11">11</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Neifer</surname>
<given-names>S</given-names>
</name>
<xref ref-type="aff" rid="A7">7</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>White</surname>
<given-names>P</given-names>
</name>
<xref ref-type="aff" rid="A12">12</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Rawlinson</surname>
<given-names>W</given-names>
</name>
<xref ref-type="aff" rid="A12">12</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Pol</surname>
<given-names>S</given-names>
</name>
<xref ref-type="aff" rid="A13">13</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Rockstroh</surname>
<given-names>J</given-names>
</name>
<xref ref-type="aff" rid="A6">6</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Coutinho</surname>
<given-names>R</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
<xref ref-type="aff" rid="A14">14</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Dore</surname>
<given-names>G</given-names>
</name>
<xref ref-type="aff" rid="A11">11</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Dusheiko</surname>
<given-names>G</given-names>
</name>
<xref ref-type="aff" rid="A3">3</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Danta</surname>
<given-names>M</given-names>
</name>
<xref ref-type="aff" rid="A3">3</xref>
<xref ref-type="aff" rid="A16">16</xref>
</contrib>
</contrib-group>
<aff id="A1">
<label>1</label>
Cluster of Infectious Diseases, Health Service, Amsterdam, Netherlands</aff>
<aff id="A2">
<label>2</label>
Department of Zoology, University of Oxford, UK</aff>
<aff id="A3">
<label>3</label>
UCL Centre for Hepatology, Royal Free Hospital, London, UK</aff>
<aff id="A4">
<label>4</label>
Department of HIV Medicine, Chelsea and Westminster Hospitals, London, UK</aff>
<aff id="A5">
<label>5</label>
Department of HIV Medicine, Royal Free and University College, London, UK</aff>
<aff id="A6">
<label>6</label>
Medizinische Klinik und Poliklinik I, Bonn University, Bonn, Germany</aff>
<aff id="A7">
<label>7</label>
Practice Dupke/Carganico/Baumgarten, Berlin, Germany</aff>
<aff id="A8">
<label>8</label>
University Paris Descartes EA3620, Virology CHU Necker AP-HP, Paris France</aff>
<aff id="A9">
<label>9</label>
Department of HIV Medicine, Brighton and Sussex University Hospitals Trust, Brighton, UK</aff>
<aff id="A10">
<label>10</label>
Department of Infectious Diseases, Health Service, Rotterdam, Netherlands</aff>
<aff id="A11">
<label>11</label>
National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney Australia</aff>
<aff id="A12">
<label>12</label>
School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, Australia</aff>
<aff id="A13">
<label>13</label>
Hepatology Unit, Cochin hospital/University Paris-Descartes, Paris France</aff>
<aff id="A14">
<label>14</label>
Centre for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, Netherlands</aff>
<aff id="A15">
<label>15</label>
Department of Human Retrovirology, Academic Medical Centre/University of Amsterdam, Amsterdam, the Netherlands</aff>
<aff id="A16">
<label>16</label>
St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Australia</aff>
<author-notes>
<corresp id="FN1">Corresponding author: Dr Mark Danta, St Vincent's Clinical School, Faculty of Medicine, UNSW, Darlinghurst, Sydney, Australia, T 612 8382 2352 F 612 8382 2794,
<email>m.danta@unsw.edu.au</email>
</corresp>
</author-notes>
<pub-date pub-type="nihms-submitted">
<day>11</day>
<month>4</month>
<year>2009</year>
</pub-date>
<pub-date pub-type="ppub">
<month>5</month>
<year>2009</year>
</pub-date>
<pub-date pub-type="pmc-release">
<day>09</day>
<month>12</month>
<year>2014</year>
</pub-date>
<volume>136</volume>
<issue>5</issue>
<fpage>1609</fpage>
<lpage>1617</lpage>
<abstract>
<sec id="S1">
<title>Background</title>
<p id="P1">Since 2000, there has been a marked rise in acute hepatitis C virus (HCV) in HIV-positive men who have sex with men (MSM). We conducted an international phylogenetic study to investigate the existence of an HCV transmission network among MSM.</p>
</sec>
<sec id="S2">
<title>Methods</title>
<p id="P2">HIV-positive MSM diagnosed with recent HCV (n=226) in England (107), Netherlands (58), France (12), Germany (25) and Australia (24) between 2000 and 2006 were enrolled into a molecular phylogenetic study. Using real-time PCR, the NS5B region of the HCV genome (436 bp) was amplified, sequenced and compared with unrelated NS5B sequences.</p>
</sec>
<sec id="S3">
<title>Results</title>
<p id="P3">NS5B sequences were obtained from 200 (89%) cases. Circulating HCV genotypes were 1a (59%); 4d (23%), 3a (11%), 1b (5%), and 2b/c (3%). Phylogenetic analysis revealed 156 (78%) sequences that formed 11 clusters (bootstrap value >70%) containing between 4 and 37 individual sequences. Country mixing was associated with larger cluster size (17 vs 4.5 sequences; p=0.03). ‘Molecular clock’ analysis indicated that the majority (85%) of transmissions occurred since 1996.</p>
</sec>
<sec id="S4">
<title>Discussion</title>
<p id="P4">Phylogenetic analysis revealed a large international network of HCV transmission among HIV-positive MSM. The rapid spread of HCV among neighboring countries is supported by the large proportion (74%) of European MSM infected with an HCV strain co-circulating in multiple European countries; the low evolutionary distances among HCV isolates from different countries; and the trend toward increased country mixing with increasing cluster size. Temporally, this epidemic coincides with the introduction of highly active anti-retroviral therapy and associated increases in sexual risk behaviors. International collaborative public health efforts are needed to mitigate HCV transmission among this population.</p>
</sec>
</abstract>
</article-meta>
</front>
</pmc>
</record>

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