Reinfection incidence and risk among people treated for recent hepatitis C virus infection: the react study

Abstract

Objective: Reinfection poses a challenge to HCV elimination. This analysis assessed incidence of, and factors associated with reinfection among people treated for recent HCV (duration of infection <12 months). Methods: Participants treated for recent HCV (primary infection or reinfection) in an international randomised trial were followed at three-monthly intervals for up to two years to assess for reinfection. Reinfection incidence was calculated using person-time of observation. Factors associated with HCV reinfection were assessed using Cox proportional hazards regression analysis. Results: Of 222 participants treated for recent HCV, 196 (62% primary infection, 38% reinfection) were included in the cohort at risk for reinfection, of whom 87% identified as gay or bisexual men, 71% had HIV, and 20% injected drugs in the month prior to enrolment. During 198 person-years of follow-up, 28 cases of HCV reinfection were identified among 27 participants, for an incidence of 14.2 per 100 person-years (95%CI 9.8, 20.5). Reinfection was associated with prior HCV reinfection (aHR 2.42; 95%CI 1.08, 5.38), injection drug use post-treatment (aHR 2.53; 95%CI 1.14, 5.59), condomless anal intercourse with casual male partners (aHR 3.32; 95%CI 1.14, 9.65) and geographic region (United Kingdom, aHR 0·21; 95% CI 0.06, 0.75). Among gay and bisexual men, reinfection was also associated with sexualised drug use involving injecting post-treatment (aHR 2.97; 95%CI 1.10, 8.02). Conclusion: High reinfection incidence following treatment for recent HCV among people with ongoing sexual and drug use risk behaviour highlights the need for post-treatment surveillance, rapid retreatment of reinfection, and targeted harm reduction strategies. Clinical trial registration: clinicaltrials.gov Identifier NCT02625909 Funding: National Institutes of Health (R01DA040506). Study medication - Gilead Sciences Inc.

Low Hepatitis C Virus Prevalence among Men Who Have Sex with Men Attending Public Health Services in The Netherlands

“…However, untreated HCV can rapidly spread in the MSM community, resulting in increasing incidences. An alternative would be to focus on subgroups of people with continuous high-risk behavior who had a previous HCV infection, as reinfections remain high in the MSM population [12,17,19,20]. Additionally, the HCV epidemic among MSM in general should be tracked and extended to an international scale, as phylogenetic studies show a clear linkage between local HCV infections and European HCV clusters [21][22][23].…”

“…Furthermore, the incidence of HCV has continued to decline ever since, which was also seen in countries like the United Kingdom and Australia [9,10]. Nevertheless, HCV reinfections are common among MSM [4,11,12].…”

A framework for approaching hepatitis C reinfection in people who use drugs

“…People experiencing homelessness have lower rates of SVR with initial treatment and higher rates of reinfection 6,15,19 . This may be attributed to their unique challenges with medication retention, including frequent relocation and high rates of property theft, as well as the association of homelessness and injection risk behaviors 17,28 . Efforts should be made to link people with unstable housing to social services and to design tailored interventions to improve their access to HCV and drug use treatment.…”

“…[10] Several additional studies have since been published, with reinfection rates ranging from 1.8/100 PY (95% CI: 0.6-5.6) in a UK cohort treated at an addiction center to 28.7/100 PY (95% CI: 16.3-50.6) among persons in an Australian prison who reported recent IDU and sharing of needles/syringes (Table 1). [11][12][13][14][15][16][17][18][19][20] In addition to IDU, factors associated with higher rates of reinfection include younger age, experiencing unstable housing or homelessness, receipt of HCV treatment while in prison, and recent needle or syringe sharing. [11,13,15,19] Notably, much of this research has been conducted outside of the United States.…”

Coordinated expansion of memory T follicular helper and B cells mediates spontaneous clearance of HCV reinfection

“…Hepatitis C virus (HCV) infection represents an ideal model to study this question with two dichotomous outcomes where approximately 30% of acutely infected individuals resolve spontaneously while the rest develop chronic infection. Despite the resolution of primary HCV infection, people who inject drugs (PWID) remain at high risk of HCV exposure and reinfection (4)(5)(6)(7)(8), thus representing a natural experimental rechallenge framework to study memory immune responses against human viral infection. Spontaneous resolution of primary HCV is associated with both Tcell and antibody responses.…”