Sexually-transmitted hepatitis C virus reinfections among people living with HIV in Taiwan: the emerging role of genotype 6

Abstract

Hepatitis C virus (HCV) reinfections after successful treatment with direct-acting antivirals (DAAs) pose a significant challenge to HCV elimination, especially among high-risk people living with HIV (PLWH). In this study, PLWH who had achieved HCV viral clearance with DAAs were included between January 2018 and June 2021. PLWH having acquired HCV infections after 2017 were classified as “recent-infection group,” and those before 2017 as “remote-infection group,” and the incidences of HCV reinfection were compared between two groups. Clinical and behavioural characteristics were evaluated to identify associated factors with HCV reinfection. A total of 284 PLWH were included: 179 in the recent-infection group and 105 in the remote-infection group. After a median follow-up of 2.32 years (interquartile range [IQR], 0.13–3.94), the overall incidence of HCV reinfection was 5.8 per 100 person-years of follow-up (PYFU). The incidence in the recent-infection group was significantly higher than that in the remote-infection group (9.8 vs. 0.4 per 100 PYFU, p < 0.001). The leading HCV genotypes before DAA treatment were genotypes 2 (31.0%), 1b (26.8%), and 6 (21.8%); however, genotype 6 (58.8%) became predominant upon reinfection. Younger age (adjusted odds ratio [aOR] per 1-year increase, 0.95; 95% CI, 0.90–0.99), condomless receptive anal sex (aOR, 14.5; 95% CI, 2.37–88.8), rimming (aOR, 3.87; 95% CI, 1.14–13.1), and recent syphilis (aOR, 2.73; 95% CI, 1.26–5.91) were linked to HCV reinfections. In conclusion, PLWH acquiring HCV after 2017 had a significantly higher risk for sexually-transmitted HCV reinfections. The predominance of HCV genotype 6 reinfections suggests possible on-going clustered HCV infections among at-risk PLWH.

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

“…Increasing trends of recently acquired HCV infections had been noted among PLWH who were predominantly MSM and HCV seronegative at baseline in Taiwan during 1994 to 2018, with an HCV seroincidence rate reaching 28.10 per 1,000 person-years of follow-up (PYFU) in 2018 ( 25 , 26 ). The rate of HCV reinfection was estimated to be 82 per 1,000 PYFU ( 27 , 28 ). Syphilis was consistently found to be statistically significantly associated with HCV infections in all these studies ( 25 – 28 ).…”

“…The rate of HCV reinfection was estimated to be 82 per 1,000 PYFU ( 27 , 28 ). Syphilis was consistently found to be statistically significantly associated with HCV infections in all these studies ( 25 – 28 ). In Taiwan, DAAs have been reimbursed by the National Health Insurance (NHI) since 2017 ( 29 , 30 ).…”

Determining reinfection rates by hepatitis C testing interval among key populations: A systematic review and meta‐analysis

“…The 38 studies included in the pooled HCV reinfection incidence estimate comprised 8931 participants at risk of reinfection (Table S1). Berenguer et al, 19 and Chen et al 20 included two study population arms (PWID and MSM) and HCV reinfection incidence rates were extracted for each arm and assigned to each key population meta‐analysis separately. The pooled incidence estimate from all included studies was 4.13 per 100 py (95% confidence interval [CI]: 3.45–4.81) with HCV reinfection incidence ranging from 0.00 per 100 py to 31.00 per 100 py across studies.…”

“…Twenty-seven studies reported reinfection among PWID, 9 among MSM and 3 among people in custodial settings (two studies reported on both PWID and MSM 19,20 ). No studies reporting reinfection among transgender people were identified.…”