More
than one in ten HIV-positive people in the large EuroSIDA cohort who
were cured of hepatitis C were reinfected within two years, according to
a report last month at the 10th International AIDS Society Conference on HIV Science (IAS 2019) in Mexico City.
These findings underscore the need for education and harm reduction
services in an effort to reach the goal of eliminating hepatitis C virus
(HCV) as a public health threat, according to presenter Sarah Amele of
the University College London Centre for Global Health.
Almost everyone, regardless of HIV status, can easily be cured of
hepatitis C with direct-acting antivirals (DAAs). However, initial
infection does not confer immunity and it is possible to become
reinfected if ongoing risk behavior occurs.
Amele and colleagues conducted a study of HCV reinfection
rates among participants in EuroSIDA, a prospective observational cohort
study with over 22,000 HIV-positive participants in more than 30
countries in Europe, as well as Russia.
Although the overall risk of HCV reinfection is generally low, higher
rates have been observed among HIV-positive people who inject drugs and
men who have sex with men, Amele noted as background.
For example, a previous analysis
from the European AIDS Treatment Network saw a reinfection rate among
gay men of 24.6%, albeit with considerable variation among countries. An earlier study
of HIV-positive men receiving care at Chelsea and Westminster Hospital
in London saw a reinfection rate of 8 cases per 100 person-years.
The present analysis included 585 people living with HIV
who had achieved sustained virologic response (SVR), or continued
undetectable HCV RNA after completing hepatitis C treatment using either
DAAs (18.8%) or the older interferon-based therapy (81.2%). Just over
three-quarters were men, most were white and the median age was 47 years
at the time of SVR. Nearly a third (30.3%) were men who have sex with
men and 48.0% had a history of injecting drugs. More than 90% were on
antiretroviral therapy (ART) and the median CD4 count was 514 cells/mm3.
The largest proportion were from western Europe (43.8%), followed by
southern Europe (24.3%), northern Europe (17.4%) and eastern Europe
(14.5%); central European countries were allocated to either the western
or eastern group.
Overall, 78 people, or 13.3%, were reinfected, defined as testing
positive for HCV RNA or receiving subsequent hepatitis C treatment
within two years after having achieved SVR. Men were about twice as
likely as women to be reinfected (15.0 vs 7.6%, respectively). The
reinfection rate was highest in western Europe (18.0%), followed by
eastern Europe (15.3%), northern Europe (11.8%) and southern Europe
(4.9%).
The HCV reinfection rate was a bit higher for men who have sex with
men (16.4%) compared with people who inject drugs (13.5%), but this
difference was not statistically significant. There were no differences
according to HCV genotype or treatment with DAAs versus interferon,
although those successfully treated after the availability of DAAs in
2014 had a lower reinfection rate (9.9 vs 16.3%). The CD4 counts were
546 cells/mm3 among those who were reinfected and 503 cells/mm3 among
those who were not.
After adjusting for other factors, individuals from western and
eastern Europe, those with a CD4 count above 500 cells/mm3 and those
with advanced liver fibrosis or cirrhosis had increased odds of
reinfection, the researchers reported.
"Active surveillance to detect early HCV reinfection (with an offer
of early treatment) is essential" and "harm reduction services for
people who inject drugs are crucial to reduce rates of reinfection,"
they concluded. "Reducing the rate of HCV reinfection is urgently needed
to reach the goal of elimination by 2030, especially among marginalised
groups."