Hepatitis C virus reinfection after successful treatment with direct-acting antiviral therapy in a large population-based cohort
Author(s): ,
Naveed Z. Janjua
Affiliations:
School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
Corresponding author. Address: Clinical Prevention Services, BC Centre for Disease Control, University of British Columbia, 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada. Tel.: 604-707-2514; fax: 604-707-2401.
,
Mel Krajden
Affiliations:
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
,
Mark W. Tyndall
Affiliations:
School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
,
Maria Alvarez
Affiliations:
British Columbia Centre for Disease Control, Vancouver, BC, Canada
,
Mawuena Binka
Affiliations:
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
,
Nuria Chapinal
Affiliations:
British Columbia Centre for Disease Control, Vancouver, BC, Canada
,
Jason Wong
Affiliations:
School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
,
Mark Gilbert
Affiliations:
School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
,
Maryam Darvishian
Affiliations:
School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
,
Amanda Yu
Affiliations:
British Columbia Centre for Disease Control, Vancouver, BC, Canada
,
Nazrul Islam
Affiliations:
MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Cambridge, UK
,
Jane A. Buxton
Affiliations:
School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
,
Stanley Wong
Affiliations:
British Columbia Centre for Disease Control, Vancouver, BC, Canada
,
Zahid A. Butt
Affiliations:
School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
Carmine Rossi
Affiliations:
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
EASL LiverTree™. Janjua N. Nov 1, 2018; 234535
Dr. Naveed Janjua
Dr. Naveed Janjua

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Graphical abstract

Graphical abstract

DAA therapies are an important component of HCV elimination strategies. Larger population-level reports of reinfection rates after DAA therapy are lacking. HCV reinfection rates remain elevated among people who recently injected drugs. Opioid-agonist therapy mitigates reinfection risk.

Background & Aims

Direct-acting antiviral therapies (DAA) are an important tool for hepatitis C virus (HCV) elimination. However, reinfection among people who inject drugs (PWID) may hamper elimination targets. Therefore, we estimated HCV reinfection rates among DAA-treated individuals, including PWID.

Methods

We analyzed data from the British Columbia Hepatitis Testers Cohort which included ∼1.7 million individuals screened for HCV in British Columbia, Canada. We followed HCV-infected individuals treated with DAAs who achieved a sustained virologic response (SVR) and had ≥1 subsequent HCV RNA measurement to April 22nd, 2018. Reinfection was defined as a positive RNA measurement after SVR. PWID were identified using a validated algorithm and classified based on recent (<3 years) or former (≥3 years before SVR) use. Crude reinfection rates per 100 person-years (PYs) were calculated. Poisson regression was used to model adjusted incidence rate ratios (IRRs) and 95% CIs.

Results

Of 4,114 individuals who met the inclusion criteria, most were male (n = 2,692, 65%), born before 1965 (n = 3,411, 83%) and were either recent (n = 875, 21%) or former PWID (n = 1,793, 44%). Opioid-agonist therapy (OAT) was received by 19% of PWID. We identified 40 reinfections during 2,767 PYs. Reinfection rates were higher among recent (3.1/100 PYs; IRR 6.7; 95% CI 1.9–23.5) and former PWID (1.4/100 PYs; IRR 3.7; 95% CI 1.1–12.9) than non-PWID (0.3/100 PYs). Among recent PWID, reinfection rates were higher among individuals born after 1975 (10.2/100 PYs) and those co-infected with HIV (5.7/100 PYs). Only one PWID receiving daily OAT developed reinfection.

Conclusions

Population-level reinfection rates remain elevated after DAA therapy among PWID because of ongoing exposure risk. Engagement of PWID in harm-reduction and support services is needed to prevent reinfections.

Lay summary

Direct-acting antivirals are an effective tool for the treatment of hepatitis C virus, enabling the elimination of the virus. However, some patients who have been successfully treated with direct-acting antivirals are at risk of reinfection. Our findings showed that the risk of reinfection was highest among people with recent injection drug use. Among people who inject drugs, daily use of opioid-agonist therapy was associated with a lower risk of reinfection.

Keyword(s)
Hepatitis C, Direct-Acting Antiviral, Reinfection, Injection Drug Use, Epidemiology, Canada
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