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Clin Infect Dis. 2017 May 1;64(9):1154-1162. doi: 10.1093/cid/cix126.

Risk Factors for Hepatitis C Virus Reinfection After Sustained Virologic Response in Patients Coinfected With HIV.

Author information

1
Department of Medicine, Division of Infectious Diseases, McGill University Health Centre, Montreal, Canada.
2
Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Switzerland.
3
Southern Alberta HIV Clinic, Calgary, Alberta, Canada.
4
University Health Network, University of Toronto, Toronto, Canada.
5
CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada.
6
Department of Medicine, University of Ottawa, Ottawa, Canada
7
Department of Microbiology and Infectious Diseases, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada.
8
Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada.
9
Division of Infectious Diseases, Oak Tree Clinic, BC Women's Hospital, Vancouver, British Columbia, Canada.
10
Division of Infectious Diseases, Laval University, Québec City, Canada.

Abstract

Background:

Highly effective hepatitis C virus (HCV) therapies have spurred a scale-up of treatment to populations at greater risk of reinfection after sustained virologic response (SVR). Reinfection may be higher in HIV-HCV coinfection, but prior studies have considered small selected populations. We assessed risk factors for reinfection after SVR in a representative cohort of Canadian coinfected patients in clinical care.

Methods:

All patients achieving SVR after HCV treatment were followed with HCV RNA measurements every 6 months in a prospective cohort study. We used Bayesian Cox regression to estimate reinfection rates according to patient reported injection drug use (IDU) and sexual activity among men who have sex with men (MSM).

Results:

Of 497 patients treated for HCV, 257 achieved SVR and had at least 1 subsequent RNA measurement. During 589 person-years of follow-up (PYFU) after SVR, 18 (7%) became HCV RNA positive. The adjusted reinfection rate (per 1000 PYFU) in the first year after SVR was highest in those who reported high-frequency IDU (58; 95% credible interval [CrI], 18-134) followed by MSM reporting high-risk sexual activity (26; 95% CrI, 6-66) and low-frequency IDU (22; 95% CrI, 4-68). The rate in low-risk MSM (16; 95% CrI, 4-38) was similar to that in reference patients (10; 95% CrI, 4-20). Reinfection rates did not diminish with time.

Conclusions:

HCV reinfection rates varied according to risk. Measures are needed to reduce risk behaviors and increase monitoring in high-risk IDU and MSM if HCV elimination targets are to be realized.

KEYWORDS:

HIV; hepatitis C virus; reinfection; sustained virologic response; hepatitis C treatment

PMID:
28199495
PMCID:
PMC5399935
DOI:
10.1093/cid/cix126
[Indexed for MEDLINE]
Free PMC Article

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