Individuals who have completed hepatitis C virus (HCV) treatment should be screened regularly for ongoing injection drug use, according to a study published in Clinical Infectious Diseases.

Direct-acting antiviral (DAA) therapy is highly effective in people who inject drugs (PWID); however, rates, specific injection behaviors, and social determinants of drug use associated with HCV reinfection following DAA therapy among PWID on opioid agonist therapy (OAT) are not well known. Therefore, researchers assessed the rate of HCV reinfection in 141 PWID on OAT in the Bronx, New York, and explored the risk factors associated with HCV reinfection in this population. Injection drug use after sustained virologic response at 24 weeks after treatment was reported in 19% (n=22) of participants and HCV reinfection was observed in 3 participants. Thus, after 246 person-years of follow-up, the incidence of reinfection was 1.22/100 person-years. However, all reinfections occurred among participants reporting ongoing injection drug use, therefore the incidence of reinfection in participants reporting ongoing injection drug use was 7.4/100 person-years. The researchers found that reinfection was associated with reporting ongoing injection drug use in the follow-up period, a lack of confidence in the ability to avoid contracting HCV, homelessness, and living with a PWID.

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“Our study is among the first to identify a rate of reinfection and specific risk factors for HCV reinfection among PWID on OAT,” stated the authors. They added that, “We provide further evidence that HCV reinfection rates are low among PWID; however, our data strongly indicate that reinfection is driven by ongoing [injection drug use] after HCV treatment even among PWID on OAT.”

Reference
Akiyama MJ, Lipsey D, Heo M, et al. Low hepatitis C reinfection following direct-acting antiviral therapy among people who inject drugs on opioid agonist therapy [published online July 26, 2019]. Clin Infect Dis. doi:10.1093/cid/ciz693.