Hepatitis C Virus Reinfection Following Treatment Among People Who Use Drugs

Abstract

Most new cases of hepatitis C virus (HCV) infections in the developed world are associated with injection drug use. However, treatment for people who inject drugs (PWID) is controversial, as successful treatment risks being followed by new infection. Reinfection after sustained virologic response has been reported, but is the risk so great that treatment should be withheld from this large HCV population? Preliminary evidence suggests that the reinfection incidence is low, but studies to date have been limited by small sample size and few cases of reinfection. In this review, we assess data from studies among PWID of HCV reinfection following treatment to give a reasonable estimate on how frequently reinfection appears and try to characterize those most at risk, The observation that spontaneous clearance of HCV reinfection following treatment occurs is suggestive of a partial protective immunity against persistent infection.

Molecular diagnosis of infectious diseases in São Miguel Island (Azores, Portugal): A hospital-based descriptive study

“…HCV coinfection has been documented in individuals with ongoing risk behaviors, with the phenomena being detected in 2%-10% [21]. We identified coinfection in five patients (3.4%), all with risk behaviors, namely injection-drug use.…”

“…Reinfection is defined as a case in which an initial infection is completely resolved prior to a subsequent infection [21]. This can be either a reinfection with a different genotype/subtype than to the initial infection, or with the same subtype but a different strain.…”

APASL consensus statements and recommendations for hepatitis C prevention, epidemiology, and laboratory testing

“…However, the rate of HCV reinfection might be as low as 0-5 cases per 100 person-years, even among persons who continue injected drug use during and after treatment [143,145,146]. Due to the low reinfection rate and potential clearance after reinfection, antiviral treatment should not be withheld for these populations.…”

Ten priorities for expanding access to HCV treatment for people who inject drugs in low- and middle-income countries

“…Documented rates of reinfection are low, subsequent to improved immune response to re-exposure, coupled with the impact of SVR on modifying risk practices, and should no hold back treatment. (Grady et al, 2013) The current very high cost of direct acting antivirals -at over $50,000 per treatment course in some countries -has led to strict rationing of these drugs to reduce the budgetary impact on health services. Rationing is a consequence of high drug prices, and every effort should be made to reduce their cost.…”