Background
The timing of the initial spread of hepatitis C genotype 1a in North America is controversial. In particular how and when HCV reached extraordinary prevalence in specific demographic groups remains unclear. We sought to quantify, using all available HCV sequence data and phylodynamic methods the timing of the spread of HCV genotype 1a in North America.
Methods
We screened 45,316 publicly available HCV genotype 1a sequences for location and genotype then conducted phylogenetic analyses of available North American sequences from five HCV genes (E1, E2, NS2, NS4B, NS5B), with an emphasis on including as many sequences with early collection dates as possible. We inferred the historical population dynamics of this regional epidemic for all five HCV gene regions using Bayesian skyline plots.
Findings
Our analyses suggest that the bulk of the early spread of genotype 1a in North America occurred prior to 1965, and that the HCV epidemic has undergone relatively little expansion since 1965. Furthermore, our results indicate that the HCV epidemic has stabilized as of the early 1990’s. These results were robust across all five HCV gene regions analyzed.
Interpretation
Our results reveal the early HCV epidemic dynamics in North America. Importantly, the expansion of genotype 1a prior to 1965 suggests that nosocomial or iatrogenic factors rather than past sporadic behavioral risk (i.e.: experimentation with injection drug use, unsafe tattooing, high risk sex, travel to high endemic areas) were key contributors to the HCV epidemic in North America. Our results may also reduce stigmatization around HCV screening and diagnosis, potentially increasing rates of HCV screening and treatment.