Theme: Clinical Research Year: 2018
Background: Direct acting antiviral (DAA) therapy is highly effective in PWID;
however, little is known about rates and factors associated with HCV reinfection
following DAA therapy among PWID on opioid agonist therapy (OAT).
Methods: PREVAIL is a randomized control trial that assessed models of HCV care
for 150 PWID on OAT in the Bronx, NY. Those who achieved SVR12 (n=141) were
eligible for this extension study. Interviews and assessments of recurrent HCV
viremia occurred at 6-month intervals for up to 24 months post-SVR24. We used logrank tests to analyze variables associated with time to reinfection at a two-sided
significance level of p<.05. Next generation sequencing of HCV hypervariable region
(HVR1) differentiated relapse from reinfection.
Results: Of 141 who achieved SVR, 114 had a least one visit in the follow-up study
(62% male, mean age 52). At treatment initiation, 75% (n=85) reported ever
injecting. Injection drug use (IDU) after SVR24 was reported in 19% (n=22). HCV
reinfection was observed in three participants. Over 203.1 person-years (py) of
follow-up, the incidence of reinfection was 1.48/100 py (95% CI 0.30-4.32). All
reinfections occurred among participants with ongoing IDU. The incidence of
reinfection in participants reporting ongoing IDU (18.2 py of follow-up) was 16.5/100
py (95% CI 3.4-48.3). Factors associated with reinfection were homelessness
(p=0.002), alcohol/drug treatment in the last 6 months (p=0.003), and living with
someone who injects drugs (p=0.007). Risk behaviors associated with reinfection
were injecting heroin with speed (p=0.014), speed alone (p<0.0001), and crack
(p=0.007), sharing: rigs (p<0.0001), cotton (p<0.0001), cookers (p=0.002), rinse
water (p=0.016), splitting drug solution with a previously used syringe (p=0.0001),
injecting with multiple partners (p=0.035), and lack of confidence in the ability to
avoid contracting HCV (p=0.019).
Conclusion: HCV reinfection was low overall, but more common among people with
ongoing injecting drug use following DAA therapy.
Disclosure of Interest Statement: This study was funded by the National Institute
of Drug Abuse (R01 DA034086) and a pilot grant from the Albert Einstein College of
Medicine Liver Research Center P30DK41296.