Infrequent Reinfection after Successful Treatment for Hepatitis C Virus Infection in Injection Drug Users

Cornell University, Итак, New York, United States
Clinical Infectious Diseases (Impact Factor: 8.89). 12/2004; 39(10):1540-3. DOI: 10.1086/425361
Source: PubMed


We followed-up 18 injection drug users for a mean of 33.8 months (range, 4-55 months) after successful treatment for hepatitis C virus (HCV) infection. Fifteen (83%) of the patients remained HCV RNA-negative, 1 patient was not tested, and 2 patients had test results positive for HCV RNA. The estimated rate of reinfection as a result of injection drug use was 0-4.1 cases per 100 person-years (cumulative incidence, 0%-12.6% at 48 months after completion of treatment). Of 50 patients originally treated, 15 (30%) were HCV RNA-negative 3 years later.

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    • "It also highlights the potential health risks associated with HCV reinfection, raising the importance of public health initiatives to educate PWID about the risks of HCV reinfection following spontaneous HCV clearance. Moreover, although HCV reinfection following successful antiviral treatment has occurred infrequently in the past [16,33-38], with the advent of new highly effective treatments [39] and potential increases in the number of PWID being treated, reinfection following antiviral treatment may become common and will require close study. "
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    ABSTRACT: Hepatitis C virus reinfection and spontaneous clearance of reinfection were examined in a highly characterised cohort of 188 people who inject drugs over a five-year period. Nine confirmed reinfections and 17 possible reinfections were identified (confirmed reinfections were those genetically distinct from the previous infection and possible reinfections were used to define instances where genetic differences between infections could not be assessed due to lack of availability of hepatitis C virus sequence data). The incidence of confirmed reinfection was 28.8 per 100 person-years (PY), 95%CI: 15.0-55.4; the combined incidence of confirmed and possible reinfection was 24.6 per 100 PY (95%CI: 16.8-36.1). The hazard of hepatitis C reinfection was approximately double that of primary hepatitis C infection; it did not reach statistical significance in confirmed reinfections alone (hazard ratio [HR]: 2.45, 95%CI: 0.87-6.86, p=0.089), but did in confirmed and possible hepatitis C reinfections combined (HR: 1.93, 95%CI: 1.01-3.69, p=0.047) and after adjustment for the number of recent injecting partners and duration of injecting. In multivariable analysis, shorter duration of injection (HR: 0.91; 95%CI: 0.83-0.98; p=0.019) and multiple recent injecting partners (HR: 3.12; 95%CI: 1.08-9.00, p=0.035) were independent predictors of possible and confirmed reinfection. Time to spontaneous clearance was shorter in confirmed reinfection (HR: 5.34, 95%CI: 1.67-17.03, p=0.005) and confirmed and possible reinfection (HR: 3.10, 95%CI: 1.10-8.76, p-value=0.033) than primary infection. Nonetheless, 50% of confirmed reinfections and 41% of confirmed or possible reinfections did not spontaneously clear. Conclusions: Hepatitis C reinfection and spontaneous clearance of hepatitis C reinfection were observed at high rates, suggesting partial acquired natural immunity to hepatitis C virus. Public health campaigns about the risks of hepatitis C reinfection are required.
    PLoS ONE 11/2013; 8(11):e80216. DOI:10.1371/journal.pone.0080216 · 3.23 Impact Factor
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    • "Provider reticence is documented as stemming from: concerns about treatment adherence among PWID [49,50]; the impact of psychiatric co-morbidities [51], HIV co-infection [37,52] and/or current alcohol and drug consumption [13,53,54]; as well as potential HCV re-infection [55,56]; and a presumption of a lack of interest from clients [39]. A growing body of literature evidences that many of these provider concerns should not preclude consideration for HCV treatment, with: adherence among cohorts of PWID equalling that of other patient groups [14,16,57]; low re-infection occurrences [55,56,58]; treatment successes among current drug and alcohol users [13,14,16,22,53,59-61]; as well as those with psychiatric co-morbidities [51,62,63] and HIV [64-66]. While HCV treatment can be complicated by HIV comorbidity, including antiretroviral drug-drug interactions and co-occurring antiviral toxicity [65,67,68], a 48 week treatment with peginterferon plus ribavirin for all genotypes has been found to be effective in co-infected individuals, including for PWID [65,69]. "
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    ABSTRACT: Background Evidence documents successful hepatitis C virus (HCV) treatment outcomes for people who inject drugs (PWID) and interest in HCV treatment among this population. Maximising HCV treatment for PWID can be an effective HCV preventative measure. Yet HCV treatment among PWID remains suboptimal. This review seeks to map social factors mediating HCV treatment access. Method We undertook a review of the social science and public health literature pertaining to HCV treatment for PWID, with a focus on barriers to treatment access, uptake and completion. Medline and Scopus databases were searched, supplemented by manual and grey literature searches. A two step search was taken, with the first step pertaining to literature on HCV treatment for PWID and the second focusing on social structural factors. In total, 596 references were screened, with 165 articles and reports selected to inform the review. Results Clinical and individual level barriers to HCV treatment among PWID are well evidenced. These include patient and provider concerns regarding co-morbidities, adherence, and side effect management. Social factors affecting treatment access are less well evidenced. In attempting to map these, key barriers fall into the following domains: social stigma, housing, criminalisation, health care systems, and gender. Key facilitating factors to treatment access include: combination intervention approaches encompassing social as well as biomedical interventions, low threshold access to opiate substitution therapy, and integrated delivery of multidisciplinary care. Conclusion Combination intervention approaches need to encompass social interventions in relation to housing, stigma reduction and systemic changes in policy and health care delivery. Future research needs to better delineate social factors affecting treatment access.
    Harm Reduction Journal 05/2013; 10(1):7. DOI:10.1186/1477-7517-10-7 · 1.26 Impact Factor
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    • "Few studies have conducted a systematic follow-up of the participants after HCV treatment, and those studies have shown low rates of reinfection [27]. Although there are cases of posttreatment reinfection in the literature [28][29][30], the incidence of such cases is less frequent than the incidence of HCV infection[31] or reinfection [32][33] in community-based studies. "
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    ABSTRACT: Alcohol consumption, current injecting drug use, and pre-existing mental illness have been identified as 3 of the main reasons for excluding patients from treatment for hepatitis C. We reviewed the literature to obtain an evidence base for these common exclusion criteria. We reviewed original research and meta-analyses investigating the effects of alcohol consumption, current injecting drug use, and pre-existing mental illness. We identified 66 study reports relevant to the review, but found only limited evidence to support withholding of treatment on the basis of the 3 previously mentioned exclusion criteria. Currently, there is a lack of evidence for many of the barriers faced by patients in availing treatment for hepatitis C. Adherence to treat routine was found to be a better predictor of sustained virological response than injecting drug or alcohol consumption during treatment period or the presence of a pre-existing mental disorder. Although several challenges remain, we need to ensure that treatment decisions are based on the best available evidence and the treatment is performed appropriately on a case-by-case basis.
    Hepatitis Monthly 07/2011; 11(7):513-8. · 1.93 Impact Factor
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