Theme: Clinical Research Year: 2016
HIGH HEPATITIS C VIRUS REINFECTION RATE AFTER ACHIEVING SUSTAINED VIROLOGICAL RESPONSE (SVR) AMONG PEOPLE WHO INJECT DRUGS ACTIVELY: TACTIC COHORT
Deshaies,L; CIUSSS Capitale Nationale, Quebec City, Canada
Background: Availability and efficacy of new regimens to treat Hepatitis C (HCV) are appealing for treatment scale-up. Treating people who inject drugs (PWID) could prevent onward transmission however there are concerns about high costs and possible reinfections. In Quebec City, HCV prevalence (SurvUDI-cohort 2010) in PWID is 73% and cocaine is the most frequently injected drug (77%) followed by prescription opioids (63%).
Methods: 47 PWID (who injected drugs within 6 months prior treatment) were treated with Peginferon/ribavirine (+/- protease inhibitor) by a multidisciplinary team in a community setting with low threshold access to care.
To document reinfection, we performed HCV RNA testing every 12 months post-treatment. Reinfection was defined as positive HCV RNA after sustained virological response (SVR) or a positive RNA within 6 months post-treatment with different genotype.
Results: A total of 33 patients achieved SVR but 3 patients were lost to follow-up. Among the 30 eligible patients, there were 18 males, median age 38 and 3 HIV positive. We documented 10 reinfections in a mean of 2.6 years of follow-up. Reinfection rate was 12.8 per 100 person-years (95%CI 4.87, 20.77). 2 persons had reinfection early after treatment (6 and 9 months) but mean time for reinfection was 2.35 years after treatment (6-62 months).
Conclusion: Recent meta-analysis looking at reinfection among PWID described relatively low rates of reinfection but there were few studies included with small sample size and without clear distinction between former and current injecting drug users. Possible explanations for this high incidence of reinfection in our study are the high prevalence (73%) of HCV infection in our PWID population plus different drug practices related to cocaine and prescription opioids which differ by frequency of injections from heroin use.
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