Hepatitis C reinfection following treatment induced viral clearance among people who have injected drugs. (1st August 2016)

• Record Type: Journal Article
• Authors: Weir, Amanda; McLeod, Allan; Innes, Hamish; Valerio, Heather; Aspinall, Esther J.; Goldberg, David J.; Barclay, Stephen T.; Dillon, John F.; Fox, Ray; Fraser, Andrew; Hayes, Peter C.; Kennedy, Nicholas; Mills, Peter R.; Stanley, Adrian J.; Aitken, Celia; Gunson, Rory; Templeton, Kate; Hunt, Alison; McIntyre, Paul; Hutchinson, Sharon J.
• Is Part Of: Drug and alcohol dependence. Volume 165(2016)
• Page Start: 53
• Page End: 60
• Publication Date: 2016-08-01
• Subjects: Hepatitis C virus -- People who inject drugs -- Reinfection -- Sustained viral response -- Record linkage; Drug abuse -- Periodicals; Alcoholism -- Periodicals; 616.86
• DOI: 10.1016/j.drugalcdep.2016.05.012
• Languages: English
• ISSNs: 0376-8716

Abstract

Highlights: A novel record-linkage approach is applied to examine the incidence of HCV reinfection. More frequent HCV RNA testing post SVR is required to identify HCV reinfections in a timely manner. HCV reinfection among PWID, on the whole, is low. Reinfection should not be seen as a barrier to treating PWID with antiviral therapy. Abstract: Background: Although people who inject drugs (PWID) are an important group to receive Hepatitis C Virus (HCV) antiviral therapy, initiation onto treatment remains low. Concerns over reinfection may make clinicians reluctant to treat this group. We examined the risk of HCV reinfection among a cohort of PWID (encompassing all those reporting a history of injecting drug use) from Scotland who achieved a sustained virological response (SVR). Methods: Clinical and laboratory data were used to monitor RNA testing among PWID who attained SVR following therapy between 2000 and 2009. Data were linked to morbidity and mortality records. Follow-up began one year after completion of therapy, ending on 31st December, 2012. Frequency of RNA testing during follow-up was calculated and the incidence of HCV reinfection estimated. Cox proportional hazards regression was used to examine factors associated with HCV reinfection. Results: Among 448 PWID with a SVR, 277 (61.8%) were tested during follow-up, median 4.5 years; 191 (69%) received one RNA test and 86 (31%) received at least two RNA tests. There were seven reinfections over 410 person years generating a reinfection rate of 1.7/100 py (95% CI 0.7–3.5). For PWID who have been hospitalised for an opiate or injection related cause post SVR (11%), the risk of HCV reinfection was greater [AHR = 12.9, 95% CI 2.2–76.0, p = 0.002] and the reinfection rate was 5.7/100 py (95% CI 1.8–13.3). Conclusion: PWID who have been tested, following SVR, for HCV in Scotland appear to be at a low risk of reinfection. Follow-up and monitoring of this population are warranted as treatment is offered more widely.