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  • br Material and methods br Results br Discussion In this

    2022-08-11


    Material and methods
    Results
    Discussion In this paper, an HCV molecular epidemiological study was conducted in DU sentinel surveillance sites in 20 prefecture-level cities across Guangdong Province, and the different subtype distributions between IDU and NIDU were compared. Owing to the lack of representative research on the distribution of HCV subtypes among DU in Guangdong Province in the past, we compared the results with our research in 2015 (Kuang et al., 2015) and found that the main subtypes are basically the same, but we did make four new findings. Firstly, the prevalence of 6a is significantly higher than it was in 2015 (43.6% versus 63.0%). Secondly, the HCV subtypes 1b, 3a, 3b and 6a are significantly different between the four regions. Our third finding is that, HCV subtypes 3b and 6a are significantly different between Guangdong residents and non-Guangdong residents in DU. Lastly, The HCV subtype distribution has no significant difference between NIDU and IDU. Since 6a had been found to be the second most abundant subtype in three cities within Guangdong in 2005 (Lu et al., 2005), it was estimated that Guangdong had become the second epidemic source of 6a (Fu et al., 2012) and 6a would spread to other provinces of China. Our study confirmed that hypothesis. HCV Aclacinomycin A 6 is mainly prevalent in Southeast Asia, with 22 subtypes of 6a-6v named (Akkarathamrongsin et al., 2010; Wang et al., 2009). Subtype 6a is prevalent in southern China and other northern countries in Southeast Asia. In this study, the proportion of 6a is much higher than that of the 2013 study (Kuang et al., 2015) Subtype 6a was also the main subtype in all 20 cities in Guangdong, thereby confirming the rapid spread of 6a. The recently discovered 6e, 6u, and 6n were mainly prevalent in Southeast Asia, and found in the southwestern region of China, and scattered in other province (Cui et al., 2017; Lu et al., 2018). Subtype 6e was the second largest subtype of Vietnam followed by 6a (Li et al., 2014), and the third largest subtype among Guangxi IDU (Tian et al., 2012). Subtype 6n is the most important subtype in northern Myanmar (Lwin et al., 2007) and the second largest subtype among Yunnan IDU (Li et al., 2017). Subtype 6u was first discovered in Myanmar, but was named in Dehong, Yunnan (Wan et al., 2016). In this study, very few cases of 6e, 6u and 6n were found in a few cities of PRD and the western region. Since the first infector of the human immunodeficiency virus (HIV) was detected in DU in 1996 (Lin et al., 2001), drug use had been the main route of HIV transmission in Guangdong until 2009, when the main transmission pattern shifted from drug use to sexual transmission. From then on, the incidence of HIV infection among DU had been maintained at a low level (unpublished data), which reflects the more than decade long intervention efforts in DU in Guangdong Province. HCV has the same transmission route as HIV. In our study, the rapid spread of 6a in DU and the emergence of 6 new subtypes (i.e. 6e, 6u, and 6n) illustrate the fact that the risk factors still exist. Consequently, DU must be educated more around this. The four regions in Guangdong have their own specificities in dialects and cultures. We found that HCV subtypes are significantly different in all four regions. In the PRD region, 3a is significantly higher compared to other regions. As we know, subtype 3a is common globally, but it is mainly prevalent in India, Pakistan and South Asia (e.g. Thailand) (Esmaeilzadeh et al., 2014). In China, subtype 3a is mainly concentrated in the southwest region (Huang et al., 2018). Located in the central of Guangdong Province, the PRD has the densest and fastest growing population. The mix and flow of these international and inter-provincial populations may be why 3a is significantly more common than in other regions. However, we found it strange that subtype 3b in the PRD is significantly less common (8.7%) than in other regions. Subtype 3b is mainly prevalent in Southeast Asia and is one of the major subtypes of IDU in Yunnan and Guangxi in southwestern China (Li et al., 2017; Wan et al., 2016). In recent years, 3b has been reported in DU in Anhui (Cui et al., 2017) and Jiangsu Provinces (Lu et al., 2018). Further research is required to reveal the reason behind this mystery. Since 2010, the prevalence of HCV type 3 has increased rapidly in southwestern and southern China (Du et al., 2019). The monitoring of HCV type 3 should be strengthened because type 3 is not sensitive enough to the most effective drug for hepatitis C Direct-active Antiviral Agent (DAA) (Zanaga et al., 2016) and because it accelerate cirrhosis (Bochud et al., 2009) leading to liver cancer (Nkontchou et al., 2011).