Amanda Weir1, Allan McLeod2, Hamish Innes3, Heather Valerio4, Esther J Aspinall5, David J Goldberg6, Stephen T Barclay7, John F Dillon8, Ray Fox9, Andrew Fraser10, Peter C Hayes11, Nicholas Kennedy12, Peter R Mills13, Adrian J Stanley14, Celia Aitken15, Rory Gunson16, Kate Templeton17, Alison Hunt18, Paul McIntyre19, Sharon J Hutchinson20. 1. School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK. Electronic address: amanda.weir@nhs.net. 2. Health Protection Scotland, Glasgow, UK. Electronic address: allan.mcleod@nhs.net. 3. School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK. Electronic address: hamish.innes@nhs.net. 4. School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK. Electronic address: heather.valerio@nhs.net. 5. School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK. Electronic address: esther.aspinall@nhs.net. 6. School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK. Electronic address: david.goldberg2@nhs.net. 7. Glasgow Royal Infirmary, Glasgow, UK. Electronic address: stephenbarclay@nhs.net. 8. Ninewells Hospital and Medical School, Dundee, UK. Electronic address: j.dillon@nhs.net. 9. Gartnavel General Hospital, Glasgow, UK. Electronic address: Ray.Fox2@ggc.scot.nhs.uk. 10. Aberdeen Royal Infirmary, Aberdeen, UK. Electronic address: a.fraser2@nhs.net. 11. Royal Infirmary Edinburgh, Edinburgh, UK. Electronic address: peter.hayes@nhslothian.scot.nhs.uk. 12. Monklands Hospital, Lanarkshire, UK. Electronic address: nicholas.kennedy@lanarkshire.scot.nhs.net. 13. Gartnavel General Hospital, Glasgow, UK. Electronic address: peter.mills@glasgow.ac.uk. 14. Glasgow Royal Infirmary, Glasgow, UK. Electronic address: Adrian.Stanley@ggc.scot.nhs.uk. 15. West of Scotland Specialist Virology Centre, Glasgow, UK. Electronic address: Celia.Aitken@ggc.scot.nhs.uk. 16. West of Scotland Specialist Virology Centre, Glasgow, UK. Electronic address: rory.gunson@nhs.net. 17. East of Scotland Specialist Virology Centre, Edinburgh, UK. Electronic address: kate.templeton@nhs.net. 18. Aberdeen Royal Infirmary, Aberdeen, UK. Electronic address: alison.hunt@nhs.net. 19. Ninewells Hospital and Medical School, Dundee, UK. Electronic address: paul.mcintyre@nhs.net. 20. School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK. Electronic address: sharon.hutchinson2@nhs.net.
Abstract
BACKGROUND: Although people who inject drugs (PWID) are an important group to receive Hepatitis C Virus (HCV) antiviral therapy, initiation onto treatment remains low. Concerns over reinfection may make clinicians reluctant to treat this group. We examined the risk of HCV reinfection among a cohort of PWID (encompassing all those reporting a history of injecting drug use) from Scotland who achieved a sustained virological response (SVR). METHODS: Clinical and laboratory data were used to monitor RNA testing among PWID who attained SVR following therapy between 2000 and 2009. Data were linked to morbidity and mortality records. Follow-up began one year after completion of therapy, ending on 31st December, 2012. Frequency of RNA testing during follow-up was calculated and the incidence of HCV reinfection estimated. Cox proportional hazards regression was used to examine factors associated with HCV reinfection. RESULTS: Among 448 PWID with a SVR, 277 (61.8%) were tested during follow-up, median 4.5 years; 191 (69%) received one RNA test and 86 (31%) received at least two RNA tests. There were seven reinfections over 410 person years generating a reinfection rate of 1.7/100py (95% CI 0.7-3.5). For PWID who have been hospitalised for an opiate or injection related cause post SVR (11%), the risk of HCV reinfection was greater [AHR=12.9, 95% CI 2.2-76.0, p=0.002] and the reinfection rate was 5.7/100py (95% CI 1.8-13.3). CONCLUSION: PWID who have been tested, following SVR, for HCV in Scotland appear to be at a low risk of reinfection. Follow-up and monitoring of this population are warranted as treatment is offered more widely.
BACKGROUND: Although people who inject drugs (PWID) are an important group to receive Hepatitis C Virus (HCV) antiviral therapy, initiation onto treatment remains low. Concerns over reinfection may make clinicians reluctant to treat this group. We examined the risk of HCV reinfection among a cohort of PWID (encompassing all those reporting a history of injecting drug use) from Scotland who achieved a sustained virological response (SVR). METHODS: Clinical and laboratory data were used to monitor RNA testing among PWID who attained SVR following therapy between 2000 and 2009. Data were linked to morbidity and mortality records. Follow-up began one year after completion of therapy, ending on 31st December, 2012. Frequency of RNA testing during follow-up was calculated and the incidence of HCV reinfection estimated. Cox proportional hazards regression was used to examine factors associated with HCV reinfection. RESULTS: Among 448 PWID with a SVR, 277 (61.8%) were tested during follow-up, median 4.5 years; 191 (69%) received one RNA test and 86 (31%) received at least two RNA tests. There were seven reinfections over 410 person years generating a reinfection rate of 1.7/100py (95% CI 0.7-3.5). For PWID who have been hospitalised for an opiate or injection related cause post SVR (11%), the risk of HCV reinfection was greater [AHR=12.9, 95% CI 2.2-76.0, p=0.002] and the reinfection rate was 5.7/100py (95% CI 1.8-13.3). CONCLUSION: PWID who have been tested, following SVR, for HCV in Scotland appear to be at a low risk of reinfection. Follow-up and monitoring of this population are warranted as treatment is offered more widely.
Authors: Emma Day; Margaret Hellard; Carla Treloar; Julie Bruneau; Natasha K Martin; Anne Øvrehus; Olav Dalgard; Andrew Lloyd; John Dillon; Matt Hickman; Jude Byrne; Alain Litwin; Mojca Maticic; Philip Bruggmann; Havard Midgard; Brianna Norton; Stacey Trooskin; Jeffrey V Lazarus; Jason Grebely Journal: Liver Int Date: 2018-09-22 Impact factor: 5.828
Authors: M Martinello; J Grebely; K Petoumenos; E Gane; M Hellard; D Shaw; J Sasadeusz; T L Applegate; G J Dore; G V Matthews Journal: J Viral Hepat Date: 2017-01-23 Impact factor: 3.728
Authors: Jason Grebely; Julie Bruneau; Jeffrey V Lazarus; Olav Dalgard; Philip Bruggmann; Carla Treloar; Matthew Hickman; Margaret Hellard; Teri Roberts; Levinia Crooks; Håvard Midgard; Sarah Larney; Louisa Degenhardt; Hannu Alho; Jude Byrne; John F Dillon; Jordan J Feld; Graham Foster; David Goldberg; Andrew R Lloyd; Jens Reimer; Geert Robaeys; Marta Torrens; Nat Wright; Icro Maremmani; Brianna L Norton; Alain H Litwin; Gregory J Dore Journal: Int J Drug Policy Date: 2017-07-03