Reinfection incidence and risk among people treated for recent hepatitis C virus infection: the react study.

Martinello, Marianne; Carson, Joanne M; Van Der Valk, Marc; Rockstroh, Jürgen K; Ingiliz, Patrick; Hellard, Margaret; Nelson, Mark; Lutz, Thomas; Bhagani, Sanjay; Kim, Arthur Y; Hull, Mark; Cordes, Christiane; Moon, Juhi; Feld, Jordan J; Gane, Ed; Rauch, Andri; Bruneau, Julie; Tu, Elise; Applegate, Tanya; Grebely, Jason; ... (2023). Reinfection incidence and risk among people treated for recent hepatitis C virus infection: the react study. AIDS, 37(12), pp. 1883-1890. Wolters Kluwer Health 10.1097/QAD.0000000000003651

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OBJECTIVE

Reinfection poses a challenge to HCV elimination. This analysis assessed incidence of, and factors associated with reinfection among people treated for recent HCV (duration of infection <12 months).

METHODS

Participants treated for recent HCV (primary infection or reinfection) in an international randomised trial were followed at three-monthly intervals for up to two years to assess for reinfection. Reinfection incidence was calculated using person-time of observation. Factors associated with HCV reinfection were assessed using Cox proportional hazards regression analysis.

RESULTS

Of 222 participants treated for recent HCV, 196 (62% primary infection, 38% reinfection) were included in the cohort at risk for reinfection, of whom 87% identified as gay or bisexual men, 71% had HIV, and 20% injected drugs in the month prior to enrolment. During 198 person-years of follow-up, 28 cases of HCV reinfection were identified among 27 participants, for an incidence of 14.2 per 100 person-years (95%CI 9.8, 20.5). Reinfection was associated with prior HCV reinfection (aHR 2.42; 95%CI 1.08, 5.38), injection drug use post-treatment (aHR 2.53; 95%CI 1.14, 5.59), condomless anal intercourse with casual male partners (aHR 3.32; 95%CI 1.14, 9.65) and geographic region (United Kingdom, aHR 0·21; 95% CI 0.06, 0.75). Among gay and bisexual men, reinfection was also associated with sexualised drug use involving injecting post-treatment (aHR 2.97; 95%CI 1.10, 8.02).

CONCLUSION

High reinfection incidence following treatment for recent HCV among people with ongoing sexual and drug use risk behaviour highlights the need for post-treatment surveillance, rapid retreatment of reinfection, and targeted harm reduction strategies.

CLINICAL TRIAL REGISTRATION

clinicaltrials.gov Identifier NCT02625909.

FUNDING

National Institutes of Health (R01DA040506). Study medication - Gilead Sciences Inc.

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