New Study: High HCV Re-Infection Rates in People Who Inject Drugs

Injection drug use
Injection drug use
The study showed that while it is feasible to recruit people who inject drugs from a community-based needle and syringe program into HCV treatment and achieve SVR-12, re-infection and mortality rates were high.

Hepatitis C virus (HCV) treatment can be successfully delivered to people who inject drugs via community needle and syringe programs, according to study results published in the Journal of Viral Hepatology. However, the findings also indicated that this population had a higher rate of re-infection compared with existing estimates.

The study included participants who were HCV RNA-positive recruited from the largest needle and syringe program in Dundee, Scotland, over 42 months. The researchers assessed sustained virologic response at 12 weeks and rates of re-infection.

Of 105 participants, 94 initiated treatment. Participant mean age was 34.0 (standard deviation [SD] 6.9), and 71.3% were men. In addition, 1 in 5 (20/94) participants were homeless and 68.1% were on opiate substitution therapy at the time of study enrollment. Levels of significant fibrosis (F2-F4) were low (18.1%). All participants were HIV- and hepatitis B-negative.

Participants with genotype 1 (n=37) were treated with peg-interferon plus ribavirin and simepravir/telaprevir and participants with genotype 2/3 (n=57) were treated with peg-interferon plus ribavirin.

The results indicated that 71.3% of participants had ≥80% treatment adherence. The researchers did not find any difference in sustained virologic response rates at 12 weeks by genotype, with 81.0% for genotype 1 and 82.5% for genotype 2/3.

At 18 months post-treatment, 15 of 77 participants were re-infected after 69.8 person-years of follow-up, giving a re-infection rate of 21.5/100 person-years (95% CI, 13.00-35.65).

Due to the small sample size of the study, there was insufficient power to identify independent predictors of adherence, sustained virologic response at 12 weeks, and re-infection.

“Scaling-up the intensity of harm reduction and HCV treatment provision is needed to minimize re-infection and reduce HCV transmission in the population,” concluded the researchers.

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Disclosure: Janssen Pharmaceuticals in part funded this study. Multiple authors disclosed affiliations with pharmaceutical companies. See the reference for complete disclosure information.


Schulkind J, Stephens B, Ahmad F, et al. High response and re-infection rates among people who inject drugs treated for hepatitis C in a community needle and syringe programme [published online November 13, 2018]. J Viral Hepatol. doi:10.1111/jvh.13035