HCV: reinfection rates highest with recent IDU

  • Rossi C & al.
  • J Hepatol
  • 21 Aug 2018

  • curated by Yael Waknine
  • Univadis Clinical Summaries
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Takeaway

  • Recent injection drug use (IDU) is associated with higher odds of HCV reinfection after sustained virologic response (SVR) to direct-acting antivirals (DAAs).

Why this matters

  • Opioid agonist therapy (OAT) appears to mitigate reinfection risk among people who inject drugs (PWID), highlighting the need for harm-reduction measures.

Study design

  • Data for 4114 participants in the British Columbia Hepatitis Testers cohort with DAA-achieved SVR and ≥1 subsequent viral load assessment.
  • IDU defined as recent (
  • Funding: British Columbia Centre for Disease Control; Canadian Institutes of Health Research.

Key results

  • Patients were primarily male (65%) and recent (21%) or former PWID (44%); 83% were born before 1965 (median age, 60 years).
  • Of 513 PWID receiving OAT, only 1 developed reinfection.
  • 40 cases of HCV reinfection occurred over 2766.8 patient-years (PY, 1.44/100 PY); 33 cases (83%) were persistent.
  • Reinfection rate was highest with recent IDU (3.11/100 PY; adjusted incident rate ratio [IRR]=6.7; 95% CI, 1.9-23.5).
    • Rates were higher among subgroups born after 1975 (10.2/100 PY) or with HIV coinfection (5.67/100 PY).
  • Among former PWID, the reinfection rate was 1.41/100 PY (IRR=3.7; 95% CI, 1.1-12.9%) vs non-PWID (0.3/100 PY).

Limitations

  • Late relapse and spontaneous clearance not captured.

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