Andrés Marco1, Rafael A Guerrero2, Mercedes Vergara3, Carlos Gallego4, Concepció Solé5, Ramón Planella6, M Elisa Vaz7, Núria Teixidó8, Ana Sastre9, Carlos Touzón10, Antonio da Silva11, Guido Almada12, Ana Ruíz13, Joan A Caylà14, Elisabet Turu15. 1. Prison Health Program, Catalan Institute of Health, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain. Electronic address: amarco@gencat.cat. 2. Prison Health Program, Catalan Institute of Health, Spain. Electronic address: rguerrero@gencat.cat. 3. Hepatology Unit, Digestive Disease Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain; CIBERehd, Instituto Carlos III, Madrid, Spain. Electronic address: mvergara@tauli.cat. 4. Health Services of Quatre Camins Penitentiary Centre, Barcelona, Spain. Electronic address: 27929cgc@comb.cat. 5. Health Services of Puig de les Basses Penitentiary Centre, Girona, Spain. Electronic address: csole@gencat.cat. 6. Health Services of Ponent Penitentiary Centre, Lleida, Spain. Electronic address: rplanella.lleida.ics@gencat.cat. 7. Health Services of Mas d'Enric Penitentiary Centre, Tarragona, Spain. Electronic address: mevaz@gencat.cat. 8. Health Services of Brians-1 Penitentiary Centre, Barcelona, Spain. Electronic address: nteixidop@gencat.cat. 9. Health Services of Brians-2 Penitentiary Centre, Barcelona, Spain. Electronic address: amsastre@gencat.cat. 10. Health Services of Lledoners Penitentiary Centre, Barcelona, Spain. Electronic address: ctouzon.cc.ics@gencat.cat. 11. Health Services of Quatre Camins Penitentiary Centre, Barcelona, Spain. Electronic address: 14999asm@comb.cat. 12. Health Services of Brians-1 Penitentiary Centre, Barcelona, Spain. 13. Health Services of Brians-2 Penitentiary Centre, Barcelona, Spain. Electronic address: ana.m.ruiz@gencat.cat. 14. Foundation of Tuberculosis Research Unit of Barcelona, Spain. Electronic address: joan.cayla@uitb.cat. 15. Prison Health Program, Catalan Institute of Health, Spain. Electronic address: eturu@gencat.cat.
Abstract
BACKGROUND: Prisoners and other high-risk patients who show a sustained virological response (SVR) after treatment for hepatitis C virus (HCV) can become reinfected. We aimed to calculate the rate of HCV reinfection in a large cohort of inmates with SVR and to determine factors that predict reinfection. METHODS: We included all inmates treated for hepatitis C in Catalonia (Spain) from January 2002 to December 2016 who achieved SVR and in whom viral load was subsequently determined. The incidence rate was calculated per 100 person-years (100 py) of follow up. Risk factors associated with reinfection were evaluated by bivariate log-rank test and multivariate Cox regression. Hazard ratio (HR) and their 95% confidence intervals (CI) were calculated. RESULTS: 602 patients were included, with a mean age of 37.9 years: 95% were men, 74.1% had a history of intravenous drug use (IDU) and 28.7% were HIV-infected. Patients were followed for a total of 2154.9 years (average 3.58 ± 3.1 years). 63 (10.5%) had HCV reinfection. 41 (65.1%) presented different genotype/subgenotype, 8 the initial genotype/subgenotype, and in 14 (22.2%) the genotype could not be determined. Of the 21 reinfected patients who were interviewed, 20 (95.2%) reported IDU after antiviral treatment, and 7 (33.3%) during treatment. The overall incidence of reinfection was 2.9 cases per 100 py. All reinfections occurred in patients with IDU history. At multivariate level, HIV infection was associated with reinfection (HR = 3.03; CI:1.82-5.04). CONCLUSION: In HIV-infected inmates with IDU history, the rate of reinfection of HCV post-SVR is very high. Prisons play a key role in the detection and treatment of infection and reinfection by HCV and in the post-treatment monitoring in these patients, which should be combined with counseling and the optimization of the harm reduction programs. Effective control of these vulnerable groups favours the elimination of the HCV infection.
BACKGROUND: Prisoners and other high-risk patients who show a sustained virological response (SVR) after treatment for hepatitis C virus (HCV) can become reinfected. We aimed to calculate the rate of HCV reinfection in a large cohort of inmates with SVR and to determine factors that predict reinfection. METHODS: We included all inmates treated for hepatitis C in Catalonia (Spain) from January 2002 to December 2016 who achieved SVR and in whom viral load was subsequently determined. The incidence rate was calculated per 100 person-years (100 py) of follow up. Risk factors associated with reinfection were evaluated by bivariate log-rank test and multivariate Cox regression. Hazard ratio (HR) and their 95% confidence intervals (CI) were calculated. RESULTS: 602 patients were included, with a mean age of 37.9 years: 95% were men, 74.1% had a history of intravenous drug use (IDU) and 28.7% were HIV-infected. Patients were followed for a total of 2154.9 years (average 3.58 ± 3.1 years). 63 (10.5%) had HCV reinfection. 41 (65.1%) presented different genotype/subgenotype, 8 the initial genotype/subgenotype, and in 14 (22.2%) the genotype could not be determined. Of the 21 reinfected patients who were interviewed, 20 (95.2%) reported IDU after antiviral treatment, and 7 (33.3%) during treatment. The overall incidence of reinfection was 2.9 cases per 100 py. All reinfections occurred in patients with IDU history. At multivariate level, HIV infection was associated with reinfection (HR = 3.03; CI:1.82-5.04). CONCLUSION: In HIV-infected inmates with IDU history, the rate of reinfection of HCV post-SVR is very high. Prisons play a key role in the detection and treatment of infection and reinfection by HCV and in the post-treatment monitoring in these patients, which should be combined with counseling and the optimization of the harm reduction programs. Effective control of these vulnerable groups favours the elimination of the HCV infection.