High rates of hepatitis C virus reinfection and spontaneous clearance of reinfection in people who inject drugs: a prospective cohort study.
Hepatitis C virus reinfection and spontaneous clearance of reinfection were examined in a highly characterised cohort of 188 people who inject drugs over a five-year period. Nine confirmed reinfections and 17 possible reinfections were identified (confirmed reinfections were those genetically distinct from the previous infection and possible reinfections were used to define instances where genetic differences between infections could not be assessed due to lack of availability of hepatitis C virus sequence data). The incidence of confirmed reinfection was 28.8 per 100 person-years (PY), 95%CI: 15.0-55.4; the combined incidence of confirmed and possible reinfection was 24.6 per 100 PY (95%CI: 16.8-36.1). The hazard of hepatitis C reinfection was approximately double that of primary hepatitis C infection; it did not reach statistical significance in confirmed reinfections alone (hazard ratio [HR]: 2.45, 95%CI: 0.87-6.86, p=0.089), but did in confirmed and possible hepatitis C reinfections combined (HR: 1.93, 95%CI: 1.01-3.69, p=0.047) and after adjustment for the number of recent injecting partners and duration of injecting. In multivariable analysis, shorter duration of injection (HR: 0.91; 95%CI: 0.83-0.98; p=0.019) and multiple recent injecting partners (HR: 3.12; 95%CI: 1.08-9.00, p=0.035) were independent predictors of possible and confirmed reinfection. Time to spontaneous clearance was shorter in confirmed reinfection (HR: 5.34, 95%CI: 1.67-17.03, p=0.005) and confirmed and possible reinfection (HR: 3.10, 95%CI: 1.10-8.76, p-value=0.033) than primary infection. Nonetheless, 50% of confirmed reinfections and 41% of confirmed or possible reinfections did not spontaneously clear.


CONCLUSIONS
Hepatitis C reinfection and spontaneous clearance of hepatitis C reinfection were observed at high rates, suggesting partial acquired natural immunity to hepatitis C virus. Public health campaigns about the risks of hepatitis C reinfection are required.
Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia ; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia ; Centre for Excellence into Injecting Drug Use, Burnet Institute, Melbourne, Victoria, Australia.
Rachel
R
Sacks-Davis
Campbell K
CK
Aitken
Peter
P
Higgs
Tim
T
Spelman
Alisa E
AE
Pedrana
Scott
S
Bowden
Mandvi
M
Bharadwaj
Usha K
UK
Nivarthi
Vijayaprakash
V
Suppiah
Jacob
J
George
Jason
J
Grebely
Heidi E
HE
Drummer
Margaret
M
Hellard
D000328:Adult; D005260:Female; D016174:Hepacivirus / Q000276:immunology*; D006526:Hepatitis C / Q000209:etiology / Q000276:immunology* / Q000635:transmission / Q000821:virology; D006801:Humans; D007113:Immunity, Innate; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012367:RNA, Viral / Q000276:immunology*; D012008:Recurrence; D012075:Remission, Spontaneous; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000276:immunology* / Q000821:virology
D012367:RNA, Viral