title: High rate of hepatitis C virus (HCV) recurrence in HIV-infected individuals with spontaneous HCV RNA clearance.
abstract: OBJECTIVE
  Following resolution of hepatitis C virus (HCV) infection, recurrence has been shown to occur in some persons with repeated exposure to HCV. We aimed to investigate the rate and factors associated with HCV RNA recurrence among HIV-1-infected patients with prior spontaneous HCV RNA clearance in the EuroSIDA cohort.
  
  
  METHODS
  All HIV-infected patients with documented prior spontaneous HCV clearance, and at least one subsequently collected plasma sample, were examined. The last sample was tested for HCV RNA and those with HCV RNA ≥ 615 IU/mL were defined as having HCV recurrence and their characteristics were compared with those of patients who were still aviraemic. Logistic regression was used to identify factors associated with HCV recurrence.
  
  
  RESULTS
  Of 191 eligible patients, 35 [18.3%; 95% confidence interval (CI) 12.8-23.8%] had HCV recurrence. Thirty-three (94.3%) were injecting drug users (IDUs). The median time between the first and last samples was 3.6 years (interquartile range 2.0-5.8 years). After adjustment, those on combination antiretroviral therapy [odds ratio (OR) 0.44; 95% CI 0.20-0.99; P = 0.046] and older persons (OR 0.51 per 10 years older; 95% CI 0.28-0.95; P = 0.033) were less likely to have HCV RNA recurrence, whereas IDUs were over 6 times more likely to have HCV RNA recurrence compared with non-IDUs (OR 6.58; 95% CI 1.48-29.28; P = 0.013).
  
  
  CONCLUSIONS
  Around 1 in 5 HIV-infected patients with prior spontaneous HCV RNA clearance had detectable HCV RNA during follow-up. Our findings underline the importance of maintaining focus on preventive measures to reduce IDU and sharing of contaminated needles. Clinicians should maintain a high degree of vigilance to identify patients with new HCV infection early.
authors.affiliation: CHIP - Department of Infectious Diseases and Rheumatology, section 2100, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: L
authors.initials: L
authors.lastname: Peters
authors.forename: A
authors.initials: A
authors.lastname: Mocroft
authors.forename: V
authors.initials: V
authors.lastname: Soriano
authors.forename: J K
authors.initials: JK
authors.lastname: Rockstroh
authors.forename: N
authors.initials: N
authors.lastname: Kirkby
authors.forename: P
authors.initials: P
authors.lastname: Reiss
authors.forename: C
authors.initials: C
authors.lastname: Katlama
authors.forename: N
authors.initials: N
authors.lastname: Zakharova
authors.forename: R
authors.initials: R
authors.lastname: Flisiak
authors.forename: J D
authors.initials: JD
authors.lastname: Lundgren
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage; D001118:Argentina / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D015497:HIV-1; D016174:Hepacivirus / Q000235:genetics* / Q000302:isolation & purification; D006526:Hepatitis C / Q000150:complications* / Q000453:epidemiology / Q000821:virology; D006801:Humans; D007557:Israel / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D012008:Recurrence; D012075:Remission, Spontaneous; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000150:complications; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D012367:RNA, Viral
keywords: HCV; HCV RNA recurrence; HIV; injection drug use