Reinfection Following HCV DAA Therapy Among People Who Inject Drugs on Opioid Agonist Thearpy: The Prevail Study

Author: Akiyama MJ, Lipsey D, Heo M, Agyemang L, Hidalgo J, Lora K, Litwin AH

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.

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