Hepatitis C reinfection after sustained virological response

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• 作者：Hå ; vard Midgard¹ ; ² ; ^{havardmi@medisin.uio.no" class="auth_mail" title="E-mail the corresponding author} ; Benedikte Bjø ; ro³ ; Arild Mæ ; land⁴ ; Zbigniew Konopski⁵ ; Hege Kileng⁶ ; Jan K. Damå ; s⁷ ; ⁸ ; Jø ; rn Paulsen⁹ ; Lars Heggelund¹⁰ ; Per K. Sandvei¹¹ ; Jetmund O. Ringstad¹¹ ; Lars N. Karlsen¹² ; Kathrine Stene-Johansen¹³ ; John H.-O. Pettersson¹³ ; Dagny H. Dorenberg¹³ ; Olav Dalgard¹ ; ²
• 关键词：HCV ; hepatitis C virus ; PWID ; people who inject drugs ; SVR ; sustained virological response ; IDU ; injecting drug use ; DAAs ; direct-acting antivirals ; RNA ; ribonucleic acid ; OST ; opioid substitution treatment ; RVR ; rapid virological response ; E1 ; envelope 1 ; HVR1 ; hypervariable region 1 ; E2 ; envelope 2 ; RT ; reverse transcriptase ; PCR ; polymerase chain reaction ; IQR ; interquartile range ; CI ; confidence interval ; PY ; person-years ; HR ; hazard ratio ; OR ; odds ratio ; HIV ; human immunodeficiency virus
• 刊名：Journal of Hepatology
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：64
• 期：5
• 页码：1020-1026
• 全文大小：722 K

文摘

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 3.64; 95% CI 1.44–9.18).

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.