Reinfection with hepatitis C virus following sustained virological response in injection drug users.
OBJECTIVE
Despite that 60-90% of injection drug users (IDUs) are infected with hepatitis C virus (HCV) infection, IDUs are often denied therapy based on concerns of reinfection following treatment. However, there are little data in this regard. We evaluated HCV re-infection following sustained virologic response (SVR) among HCV-infected IDUs having received HCV treatment in a multidisciplinary program.


METHODS
Following treatment, participants were encouraged to return at follow-up intervals of 1 year and illicit drug use histories were obtained. In those with SVR, HCV RNA testing by PCR was performed to determine if relapse or reinfection occurred.


RESULTS
Among 58 receiving HCV treatment between January 2002 and December 2006, 60% (35 of 58) achieved an SVR. Patients were followed for a median of 2.0 years following SVR (range, 0.4-5.0 years), with ongoing illicit and injection drug use reported in 54% (19 of 35) and 46% (16 of 35). Of the 35 with SVR, 28 remained HCV RNA negative during follow-up (80%), with four lost to follow-up and one dying of hepatocellular carcinoma and two cases of reinfection were observed (2 of 35). The rates of reinfection were 3.2 per 100 p-y (95% CI:0.4, 11.5) overall and 5.3 per 100 p-y (95% CI:0.6, 19.0) among those reporting injecting following SVR (n = 16). One of two participants with HCV re-infection spontaneously cleared virus following reinfection.


CONCLUSIONS
The rate of reinfection following treatment for HCV infection among current and former IDUs engaged in a multidisciplinary program is low.
Grebely
Jason
J
National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Darlinghurst, New South Wales, Australia. jgrebely@nchecr.unsw.edu.au
Knight
Elizabeth
E
Ngai
Tyler
T
Genoway
Krista A
KA
Raffa
Jesse D
JD
Storms
Michelle
M
Gallagher
Lesley
L
Krajden
Mel
M
Dore
Gregory J
GJ
Duncan
Fiona
F
Conway
Brian
B
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D001955:British Columbia; D003151:Community Health Centers; D004359:Drug Therapy, Combination; D055030:Drug Users / Q000706:statistics & numerical data; D005260:Female; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000635:transmission; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D011994:Recombinant Proteins; D012008:Recurrence; D012075:Remission, Spontaneous; D012254:Ribavirin / Q000627:therapeutic use; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load
D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D012367:RNA, Viral; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C417083:peginterferon alfa-2b