Hepatitis C Reinfection Rates Drop for Drug Users Over Time

TOPLINE: 
Hepatitis C virus (HCV) reinfection rates among people who inject drugs are high immediately after treatment in community settings, particularly among those reporting recent injection drug use and sharing of injection paraphernalia, but they decrease significantly over time.
METHODOLOGY:
The Hepatitis C Real Options (HERO) study was a randomized clinical trial in which people who injected drugs within 90 days of study entry received either modified directly observed therapy or patient navigation at opioid treatment programs and community health centers in the United States, as well as sofosbuvir and velpatasvir once daily for 12 weeks.
In this secondary analysis, researchers looked at the subset of participants from the HERO study with HCV infection who achieved a sustained virologic response (SVR) and had one or more post-SVR assessments for HCV RNA.
The primary outcome was the rate of HCV reinfection, with changes in the reinfection rates.
TAKEAWAY:
Among the 415 participants (mean age, 44.7 years; 72.8% men; 61.8% White), the overall reinfection rate was 11.4 per 100 person-years at risk over a follow-up period of 518 person-years.
Reinfection rates varied significantly across sites, ranging from 3.3% to 27.6%.
Reinfection rates decreased significantly over time, from 15.5 per 100 person-years in follow-up weeks 0-24 to 4.3 per 100 person-years in weeks 73-144 (P = .008).
Significantly higher reinfection rates were observed in participants who reported recent injection drug use and the sharing of injection paraphernalia.
Reinfection rates were lower in participants aged ≥ 40 years vs < 40 years (adjusted incidence rate ratio [IRR], 0.32), Black participants vs those of other races (adjusted IRR, 0.24), and those with negative vs positive urine toxicology results for methamphetamine (adjusted IRR, 0.41).
IN PRACTICE:
“Our results reinforce previous reports showing that most reinfections occur within 24 weeks of SVR, emphasizing the need to offer effective interventions early to prevent reinfection,” the authors wrote.
The authors of an invited commentary that accompanied the article wrote that rather than view the high reinfection rate as a cause of alarm, “a successful HCV elimination strategy must anticipate this, and both clinicians and policymakers should not be discouraged but be prepared to push on incorporating surveillance, prevention, and management of reinfection in their approach.”
SOURCE:
The study, led by Alain H. Litwin, MD, MPH, School of Health Research, Clemson University, Clemson, South Carolina, and Judith I. Tsui, MD, MPH, Department of Medicine, University of Washington, Seattle, was published online in JAMA Network Open.
LIMITATIONS: 
The study was predominantly conducted in an urban setting, and there was a notable heterogeneity in reinfection rates across different sites. The lack of phylogenetic testing prevented differentiation between relapse and reinfection. The exclusion of participants who were lost to follow-up, representing a high-risk group, may have resulted in an underestimation of true reinfection rates.
DISCLOSURES:
The study was supported by the Patient-Centered Outcomes Research Institute, with additional support from Gilead Sciences, Quest Diagnostics, Monogram Biosciences, and OraSure Technologies. Some authors declared receiving personal fees, support for diagnostic materials, and grants from various pharmaceutical companies and foundations.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
 
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