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: 9.42). 12/2004; 39(10):1540-3. DOI: 10.1086/425361
Source: PubMed

ABSTRACT 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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Available from: Brian R Edlin, Jul 29, 2015
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    • "The number of new infections per year is therefore given by so that per year. There is debate about the rate of reinfection in those that have previously cleared infection with estimates ranging from 2% to 47% per year (Aitken et al., 2008a; Backmund et al., 2004; Grebely et al., 2006). We assume a reinfection rate, of 5% per year thus but acknowledge that new research suggests it is higher than this. "
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    ABSTRACT: This work used mathematical modelling to explore effective policy for Hepatitis C virus (HCV) treatment in Australia in the context of methadone maintenance treatment (MMT). We consider two models to depict HCV in the population of injecting drug users (IDU) within Australia. The first model considers the IDU population as a whole. The second model includes separate components for those that are or are not enrolled in MMT. The impact of different levels of HCV treatment and its allocation dependent on MMT status were then determined in terms of the steady state levels of each of these models. Although increasing levels of HCV treatment decrease chronic infection prevalence, initially numbers of acutely infected can rise. This is caused by the high rate of reinfection. We find that no matter the extent of HCV treatment, HCV prevalence cannot be eliminated without limiting risk behaviour. Assuming equal adherence to HCV therapy between MMT and non-MMT, over 84% of HCV treatment should be allocated to those not in MMT. Only if adherence to HCV therapy in non-MMT patients falls below 44% of that in MMT then treatment should be preferentially directed to those in MMT. Contrary to generally held beliefs regarding HCV treatment the majority of therapy should be allocated to those that are still actively injecting. This is due to rates of reinfection and to the high turnover of individuals in MMT. Higher adherence to HCV therapy in MMT would need to be achieved before this changed.
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    • "Unstable accommodation and lack of safe, refrigerated facilities for HCV therapies; limited or cost-prohibitive transportation options; and conflict with the law (Cooper & Mills, 2006; Fischer et al., 2004; Strathdee et al., 2005) also present as potential barriers. Despite these barriers, recent evidence suggests that IDUs can be treated effectively for HCV infection, particularly when treatment programs involve a multidisciplinary team (Backmund, Meyer, Von Zielonka, & Eichenlaub, 2001; Backmund et al., 2004; Crofts, Jolley, Kaldor, van Beek, & Wodak, 1997; Matthews et al., 2005; Sylvestre, 2005), which manage patients on a case-by-case basis (Edlin, 2002; Fischer et al., 2004). Unlike chronic HCV infection, high treatment responses for acute HCV infection are obtained with interferon monotherapy, including more recently with pegylatedinterferon (PEG-IFN) (Jaeckel et al., 2001; Kamal et al., 2004, 2006; Wiegand et al., 2006). "
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