Sarah Amele1, Anastasia Karachalia Sandri2, Alison Rodger1, Linos Vandekerckhove3, Thomas Benfield4, Ana Milinkovic5, Claudine Duvivier6, Hans-Jürgen Stellbrink7, Helen Sambatakou8, Nikoloz Chkhartishvili9, Luis Caldeira10, Monserrat Laguno11, Pere Domingo12, Gilles Wandeler13, Martin Gisinger14, Elena Kuzovatova15, Gordana Dragovic16, Brygida Knysz17, Raimonda Matulionyte18, Jürgen Kurt Rockstroh19, Jens Dilling Lundgren2, Amanda Mocroft1,2, Lars Peters2. 1. Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK. 2. CHIP, Rigshospitalet, Copenhagen, Denmark. 3. Ghent University Hospital, Ghent, Belgium. 4. Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark. 5. Chelsea and Westminster Hospital, London, UK. 6. AP-HP - Necker Enfants Malades Hospital, Infectious Diseases Department; Necker Pasteur Center for Infectious Diseases and Tropical Medicine; Université de Paris; IHU Imagine, Paris, France. 7. ICH Study Center, Hamburg, Germany. 8. Ippokration General Hospital, Athens, Greece. 9. Infectious Diseases, AIDS & Clinical Immunology Research Center, Tbilisi, Georgia. 10. Santa Maria University Hospital, University of Lisbon, Lisbon, Portugal. 11. Infectious Diseases Service, Hospital Clinic, Barcelona, Spain. 12. Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 13. Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland. 14. Medical University of Innsbruck, Innsbruck, Austria. 15. Nizhny Novgorod Scientific and Research Institute, Nizhny Novgorod, Russia. 16. Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Belgrade, Serbia. 17. Wroclaw Medical University, Wroclaw, Poland. 18. Department of Infectious Diseases and Dermatovenerology, Faculty of Medicine, Vilnius University; Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania. 19. Universitäts Klinik Bonn, Bonn, Germany.
Abstract
OBJECTIVES: Although direct-acting antivirals (DAAs) can clear HCV in nearly all HIV/HCV-coinfected individuals, high rates of reinfection may hamper efforts to eliminate HCV in this population. We investigated reinfection after sustained virological response (SVR) in HIV/HCV-coinfected individuals in Europe. METHODS: Factors associated with odds of reinfection by 2 years after SVR in EuroSIDA participants with one or more HCV-RNA test and 2 years follow-up were assessed using logistic regression. RESULTS: Overall, 1022 individuals were included. The median age was 50 (interquartile range: 43-54 years), and most were male (78%), injection drug users (52%), and received interferon (IFN)-free DAAs (62%). By 24 months, 75 [7.3%, 95% confidence interval (CI): 5.7-8.9%] individuals were reinfected. Among individuals treated prior to 2014, 16.1% were reinfected compared with 4.2% and 8.3%, respectively, among those treated during or after 2014 with IFN-free and IFN-based therapy. After adjustment, individuals who had started treatment during or after 2014 with IFN-free or IFN-based therapy had significantly lower odds of reinfection (adjusted odds ratio = 0.21, 95% CI: 0.11-0.38; 0.43, 95% CI: 0.22-0.83) compared with those who had received therapy before 2014. There were no significant differences in odds of reinfection according to age, gender, European region, HIV transmission risk group or liver fibrosis. CONCLUSIONS: Among HIV/HCV-coinfected individuals in Europe, 7.3% were reinfected with HCV within 24 months of achieving SVR, with evidence suggesting that this is decreasing over time and with use of newer HCV regimens. Harm reduction to reduce reinfection and surveillance to detect early reinfection with an offer of treatment are essential to eliminate HCV.
OBJECTIVES: Although direct-acting antivirals (DAAs) can clear HCV in nearly all HIV/HCV-coinfected individuals, high rates of reinfection may hamper efforts to eliminate HCV in this population. We investigated reinfection after sustained virological response (SVR) in HIV/HCV-coinfected individuals in Europe. METHODS: Factors associated with odds of reinfection by 2 years after SVR in EuroSIDA participants with one or more HCV-RNA test and 2 years follow-up were assessed using logistic regression. RESULTS: Overall, 1022 individuals were included. The median age was 50 (interquartile range: 43-54 years), and most were male (78%), injection drug users (52%), and received interferon (IFN)-free DAAs (62%). By 24 months, 75 [7.3%, 95% confidence interval (CI): 5.7-8.9%] individuals were reinfected. Among individuals treated prior to 2014, 16.1% were reinfected compared with 4.2% and 8.3%, respectively, among those treated during or after 2014 with IFN-free and IFN-based therapy. After adjustment, individuals who had started treatment during or after 2014 with IFN-free or IFN-based therapy had significantly lower odds of reinfection (adjusted odds ratio = 0.21, 95% CI: 0.11-0.38; 0.43, 95% CI: 0.22-0.83) compared with those who had received therapy before 2014. There were no significant differences in odds of reinfection according to age, gender, European region, HIV transmission risk group or liver fibrosis. CONCLUSIONS: Among HIV/HCV-coinfected individuals in Europe, 7.3% were reinfected with HCV within 24 months of achieving SVR, with evidence suggesting that this is decreasing over time and with use of newer HCV regimens. Harm reduction to reduce reinfection and surveillance to detect early reinfection with an offer of treatment are essential to eliminate HCV.