HCV reinfection rates after cure or spontaneous clearance among HIV‐infected and uninfected men who have sex with men

Abstract

Background & Aims Hepatitis C virus (HCV) reinfection among high‐risk groups threatens HCV elimination goals. We assessed HCV reinfection rates among men who have sex with men (MSM) in British Columbia (BC), Canada. Methods We used data from the BC Hepatitis Testers Cohort, which includes nearly 1.7 million individuals tested for HCV or HIV in BC. MSM who had either achieved sustained virologic response (SVR) after successful HCV treatment, or spontaneous clearance (SC) and had ≥1 subsequent HCV RNA measurement, were followed from the date of SVR or SC until the earliest of reinfection, death, or last HCV RNA measurement. Predictors of reinfection were identified by Cox proportional modelling. The earliest study start date was 6 November 1997 and latest end date was 13 April 2018. Results Of 1349 HCV‐positive MSM who met the inclusion criteria, 493 had SC while 856 achieved SVR. 349 (25.65%) had HIV coinfection. We identified 98 reinfections during 5203 person‐years (PYs) yielding a reinfection rate of 1.88/100PYs. The reinfection rate among SC (2.74/100PYs) was more than twice that of those with SVR (1.03/100 PYs). Problematic alcohol use (aHR 1.73, 95% CI 1.003‐2.92), injection drug use (aHR 2.60, 95% CI 1.57‐4.29) and HIV coinfection (aHR 2.04, 95% CI 1.29‐3.23) were associated with increased risk of HCV reinfection. Mental health counselling history (aHR 0.24, 95% CI 0.13‐0.46) was associated with reduced HCV reinfection risk. Conclusions There is the need to engage MSM in harm reduction and prevention services following treatment to reduce reinfection risk.

Impact of extending direct antiviral agents (DAA) availability in France: an observational cohort study (2015-2019) of data from French administrative healthcare databases (SNDS).

“…However, HIV+ patients accounted for 23·2% of patients retreated twice versus 11% in the treated population, consistent with the higher risk of HCV reinfection in cases of HIV coinfection, especially in MSM. 19 …”

Performance of Hepatitis C Virus (HCV) Core Antigen Assay in the Diagnosis of Recently Acquired HCV Infection among High-Risk Populations

“…With the advances of direct-acting antivirals (DAAs) against hepatitis C virus (HCV) ( 1 , 2 ), timely diagnosis of HCV infection and linkage to HCV treatment can never be overemphasized to curb its onward transmission and avoid subsequent hepatic and extrahepatic complications. The populations at higher risk for repeat infections who contribute to most HCV infections, such as sexually active men who have sex with men (MSM) and people who inject drugs ( 3 – 6 ), will benefit most from this treatment-as-prevention strategy. In real-world settings, this strategy has effectively led to declines in HCV incidence and prevalence among people living with HIV (PLWH) in several developed countries ( 7 – 10 ).…”

Pangenotypic and Genotype-Specific Antivirals in the Treatment of HCV Genotype 4 Infected Patients with HCV Monoinfection and HIV/HCV Coinfection

“…Unfortunately, our study did not assess adherence, so we cannot confirm this hypothesis. Moreover, HCV reinfection during the post-treatment follow-up period in these patients cannot be ruled out since such a phenomenon was demonstrated previously [32,33].…”