August 09, 2019
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HCV reinfection rates low among PWID on opioid agonist therapy

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Results from an extension study of the PREVAIL trial showed that hepatitis C virus reinfection rates were low among people who inject drugs on opioid agonist therapy and higher among those reporting ongoing injection drug use, or IDU.

“There is urgency to better understand rates and risk factors associated with reinfection since HCV causes more than 18,000 deaths annually in the [United States] and is the leading cause of end-stage liver disease, hepatocellular carcinoma, and liver transplantation,” Matthew J. Akiyama, MD, MSc, assistant professor of medicine at Albert Einstein College of Medicine, and colleagues wrote. “Curing HCV can lead to regression of cirrhosis, improve quality of life and reduce [hepatocellular carcinoma] risk as well as HCV-related and all-cause mortality.

“The goals of this study were to assess the rate of HCV reinfection among a cohort of [people who inject drugs (PWID)] on [opioid agonist therapy (OAT)] in the Bronx, New York, and explore risk factors associated with HCV reinfection in this population.”

To do this, Akiyama and colleagues recruited eligible extension participants from PREVAIL, a randomized controlled trial that assessed models of HCV care among 150 PWID on OAT. They conducted interviews and assessments of recurrent HCV viremia at 6-month intervals for up to 24 months.

Overall, of the 141 eligible participants who achieved SVR in PREVAIL, 114 had a least one visit in the extension study, according to Akiyama and colleagues. Injection drug use after SVR24 was reported in 19% of participants, and three were reinfected, an incidence of 1.22 reinfections per 100 person-years (95% CI, 0.25-3.57). All reinfections occurred in participants reporting ongoing IDU, and reinfection was associated with a lack of confidence in the ability to avoid contracting HCV, homelessness and living with a PWID, Akiyama and colleagues reported.

“Our study is among the first to identify a rate of reinfection and specific risk factors for HCV reinfection among PWID on OAT. We provide further evidence that HCV reinfection rates are low among PWID; however, our data strongly indicate that reinfection is driven by ongoing IDU after HCV treatment even among PWID on OAT. For this reason, individuals who have completed HCV treatment should be screened regularly for ongoing IDU,” the authors concluded.

“Future work should focus on further characterizing specific risk factors with consideration for a standardized, reproducible reinfection visit checklist, which may be used for harm reduction efforts among those at highest risk for HCV reinfection, as well as efforts to address social determinants of health.” – by Caitlyn Stulpin

Disclosures: Akiyama reports serving on an advisory board for Gilead Sciences. Please see the study for all other authors’ relevant financial disclosures.