Hepatitis C Reinfection Following Sustained Virological Response - Seven-Year Follow-Up of Patients Infected Through Injecting Drug Use

BACKGROUND AND AIMS:

On-going risk behaviour can lead to hepatitis C virus (HCV) reinfection following successful treatment. We aimed to assess the incidence of persistent HCV reinfection in a population of people who inject drugs (PWID) who had achieved sustained virological response (SVR) seven years earlier.

METHODS:

In 2004-2006 we conducted a multicentre treatment trial comprising HCV genotype 2 or 3 patients in Sweden, Norway and Denmark (NORTH-C). Six months of abstinence from injecting drug use (IDU) was required before treatment. All Norwegian patients who had obtained SVR (n=161) were eligible for participation in this long-term follow-up study assessing virological and behavioural characteristics.

RESULTS:

Follow-up data were available in 138 of 161 (86%) individuals. Persistent reinfection was identified in 10 of 94 (11%) individuals with a history of IDU prior to treatment (incidence rate 1.7/100 person-years (PY); 95% CI 0.8-3.1) and in 10 of 37 (27%) individuals who had relapsed to IDU after treatment (incidence rate 4.9/100 PY; 95% CI 2.3-8.9). Although relapse to IDU perfectly predicted reinfection, no baseline factor was associated with reinfection. Relapse to IDU was associated with age < 30 years (vs. ⩾ 40 years) at treatment (adjusted odds ratio [aOR] 7.03; 95% CI 1.78-27.8) and low education level (aOR 4.10; 95% CI 1.56-10.8).

CONCLUSIONS:

Over time, persistent HCV reinfection was common among individuals who had relapsed to IDU after treatment. Reinfection should be systematically addressed and prevented when providing HCV care for PWID.

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By:  Midgard H1, Bjøro B2, Mæland A3, Konopski Z4, Kileng H5, Damås JK6, Paulsen J7, Heggelund L8, Sandvei PK9, Ringstad JO9, Karlsen LN10, Stene-Johansen K11, Pettersson JH11, Dorenberg DH11, Dalgard O12.

• 1Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway. Electronic address: havardmi@medisin.uio.no.
• 2Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.
• 3Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway.
• 4Department of Gastroenterology, Oslo University Hospital, Oslo, Norway.
• 5Section of Gastroenterology, University Hospital of North Norway, Tromsø, Norway.
• 6Centre of Molecular Inflammation Research, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Infectious Diseases, St. Olav's Hospital, Trondheim, Norway.
• 7Section of Gastroenterology, Telemark Hospital Trust, Skien, Norway.
• 8Section of Infectious Diseases, Vestre Viken Hospital Trust, Drammen, Norway.
• 9Department of Medicine, Østfold Hospital Trust, Grålum, Norway.
• 10Department of Medicine, Stavanger University Hospital, Stavanger, Norway.
• 11Department of Virology, The Norwegian Institute for Public Health, Oslo, Norway.
• 12Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway. 

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