High Re-Infection Rates Among People Who Inject Drugs Successfully Treated For Hepatitis C In A Community Needle And Syringe Programme

Author: Schulkind J, Stephens B, Johnston L, Ahmad F, Ward Z, Hickman M, Dillon JF

Theme: Epidemiology & Public Health Research Year: 2018

Treating people who inject drugs (PWIDs) has the potential to reduce HCV transmission, a
concept known as ‘treatment as prevention’ (TasP). Latest international guidelines now
recommend direct acting antiviral (DAA) treatment for all HCV-infected PWIDs. However, reinfection following treatment in this population remains a concern. Here we present reinfection data from a pilot of a novel HCV treatment pathway for PWIDs in a community
needle and syringe programme (NSP). Primary study results have been presented
This prospective study recruited 104 HCV RNA positive participants over 42 months from the
largest NSP in Dundee. 94/104 individuals commenced treatment. Individuals were treated
with peg-interferon+ribavirin+/- Simepravir/Telaprevir. Weekly study visits took place within
the NSP. Individuals will be followed up for a 5-year period post-treatment to determine reinfection. Here we present latest re-infection data at 18-months.
Mean age of participants was 34.0 years (SD 6.9), 71.3% (61/94) were male. 1 in 5 (20/94)
participants were homeless. Baseline data showed high rates of injecting: participants
injected median 6.5 times/week. In terms of harm reduction; 68.1% (64/94) were on opiate
substitution therapy (OST) at start of treatment; 82.4% (75/94) had 100% NSP coverage.
Overall sustained virological response at 12 weeks (SVR12) was 82.0% (77/92). 2
participants died prior to 3-month follow-up. Re-infection rates were 12.6/100 person-years
(95% CI 5.3-30.4) at 6-months (n=5) and 17.1 per 100 person-years (95% CI 10.28-28.29)
(n=15) at 18-months post-treatment. Univariable poisson regression found weak association
between increasing age and lower re-infection rates (p=0.063 p=0.14). No convincing
evidence of correlation between other hypothesised factors.
PWIDs were successfully recruited, treated and followed-up from a community NSP.
However, we also report higher rates of re-infection than many other studies. Scaling-up the
intensity of harm reduction and HCV treatment provision should be pursued to minimize reinfection and reduce HCV transmission in the population.
Disclosure of Interest Statement:
This study was funded with support from Janssen and Roche.
MH has received honoraria unrelated to this work from Merck, Abbvie and Gilead.
JD has received grants and honoraria from Gilead, Abbvie, Merck, Roche, Janssen.

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