Evan B Cunningham1, Behzad Hajarizadeh1, Janaki Amin1,2, Margaret Hellard3,4, Julie Bruneau5, Jordan J Feld6, Curtis Cooper7, Jeff Powis8, Alain H Litwin9, Philippa Marks1, Olav Dalgard10, Brian Conway11, Alberto Moriggia12,13, Catherine Stedman14, Phillip Read1,15, Philip Bruggmann16, Karine Lacombe17, Adrian Dunlop18, Tanya L Applegate1, Gail V Matthews1,19, Chris Fraser20, Gregory J Dore1,19, Jason Grebely1. 1. The Kirby Institute, University of New South Wales Sydney, Sydney, Australia. 2. Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia. 3. The Burnet Institute, Melbourne, Australia. 4. Department of Infectious Disease, The Alfred Hospital, Melbourne, Australia. 5. Centre Hospitalier de l'Université de Montréal, Montreal, Canada. 6. Toronto General Hospital, Toronto, Canada. 7. Ottawa Hospital Research Institute, Ottawa, Canada. 8. South Riverdale Community Health Centre, Toronto, Canada. 9. Albert Einstein College of Medicine, New York, New York, USA. 10. Akershus University Hospital, Oslo, Norway. 11. Vancouver Infectious Diseases Center, Vancouver, Canada. 12. Fondazione Epatocentro Ticino, Lugano, Switzerland. 13. Ingrado Addiction Services, Lugano, Switzerland. 14. Christchurch Hospital and University of Otago, Christchurch, New Zealand. 15. Kirketon Road Centre, Sydney, Australia. 16. Arud Centres for Addiction Medicine, Zurich, Switzerland. 17. Inserm UMR-S1136, Sorbonne Université, Hôpital Saint-Antoine, Paris, France. 18. Newcastle Pharmacotherapy Service, Newcastle, Australia. 19. St Vincent's Hospital, Sydney, Australia. 20. Coolaid Community Health Centre, Victoria, Canada.
Abstract
BACKGROUND: The aim of this analysis was to calculate the incidence of hepatitis C virus (HCV) reinfection and associated factors among 2 clinical trials of HCV direct-acting antiviral treatment in people with recent injecting drug use or currently receiving opioid agonist therapy (OAT). METHODS: Participants who achieved an end-of-treatment response in 2 clinical trials of people with recent injecting drug use or currently receiving OAT (SIMPLIFY and D3FEAT) enrolled between March 2016 and February 2017 in 8 countries were assessed for HCV reinfection, confirmed by viral sequencing. Incidence was calculated using person-time of observation and associated factors were assessed using Cox proportional hazard models. RESULTS: Seventy-three percent of the population at risk of reinfection (n = 177; median age, 48 years; 73% male) reported ongoing injecting drug use. Total follow-up time at risk was 254 person-years (median, 1.8 years; range, 0.2-2.8 years). Eight cases of reinfection were confirmed for an incidence of 3.1/100 person-years (95% confidence interval [CI], 1.6-6.3) overall and 17.9/100 person-years (95% CI, 5.8-55.6) among those who reported sharing needles/syringes. Younger age and needle/syringe sharing were associated with HCV reinfection. CONCLUSIONS: These data demonstrate the need for ongoing monitoring and improved strategies to prevent HCV reinfection following successful treatment among people with ongoing injecting drug use to achieve HCV elimination. CLINICAL TRIALS REGISTRATION: NCT02336139 and NCT02498015.
BACKGROUND: The aim of this analysis was to calculate the incidence of hepatitis C virus (HCV) reinfection and associated factors among 2 clinical trials of HCV direct-acting antiviral treatment in people with recent injecting drug use or currently receiving opioid agonist therapy (OAT). METHODS:Participants who achieved an end-of-treatment response in 2 clinical trials of people with recent injecting drug use or currently receiving OAT (SIMPLIFY and D3FEAT) enrolled between March 2016 and February 2017 in 8 countries were assessed for HCV reinfection, confirmed by viral sequencing. Incidence was calculated using person-time of observation and associated factors were assessed using Cox proportional hazard models. RESULTS: Seventy-three percent of the population at risk of reinfection (n = 177; median age, 48 years; 73% male) reported ongoing injecting drug use. Total follow-up time at risk was 254 person-years (median, 1.8 years; range, 0.2-2.8 years). Eight cases of reinfection were confirmed for an incidence of 3.1/100 person-years (95% confidence interval [CI], 1.6-6.3) overall and 17.9/100 person-years (95% CI, 5.8-55.6) among those who reported sharing needles/syringes. Younger age and needle/syringe sharing were associated with HCV reinfection. CONCLUSIONS: These data demonstrate the need for ongoing monitoring and improved strategies to prevent HCV reinfection following successful treatment among people with ongoing injecting drug use to achieve HCV elimination. CLINICAL TRIALS REGISTRATION: NCT02336139 and NCT02498015.
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