Reinfection Following Successful HCV DAA Therapy Among People with Recent Injecting Drug Use: The SIMPLIFY and D3FEAT Studies

Author: Cunningham EB , Grebely J, Dalgard O, Hajarizadeh B, Conway B, Powis J, Bruneau J, Feld JJ, Read P, Cooper C, Amin J, Bruggmann P, Lacombe K, Stedman C, Hellard ME, Marks P, Dunlop A, Quiene S, Moriggia A, Applegate TL, Litwin AH, Matthews GV,Dore GJ

Theme: Clinical Research Year: 2018

Background: HCV direct acting antiviral (DAA) therapy is effective in people who
inject drugs however, little is known about HCV reinfection following DAA therapy
among people who have recently injected drugs and/or people on opioid substitution
therapy (OST).
SIMPLIFY and D3FEAT are phase IV clinical trials to trial DAA therapy among people
with recent injecting drug use (IDU; last six months) or those receiving OST, through
a network of 25 international sites (SIMPLIFY: sofosbuvir/velpatasvir for 12 weeks in
people with recent injecting; D3FEAT: paritaprevir/ritonavir/dasabuvir/
ombitasvir±ribavirin for 12 weeks in people with recent injecting or receiving OST).
This analysis assessed HCV recurrence from end of treatment response (ETR)
through 24 weeks post-ETR (SVR24).
Results: Overall, 179 participants (72% male, median age 48 years) had an ETR and
at least one subsequent follow-up visit in SIMPLIFY (n=97) and D3FEAT (n=82). At
treatment initiation, 80% (n=144) reported IDU in the past 6 months, 54% (n=97)
reported IDU in the past month, and 60% (n=108) were receiving OST. IDU between
ETR and follow-up was reported in 70% (n=125). HCV recurrence was observed in
nine participants including three cases of HCV relapse and six cases of reinfection.
Over 168 person-years (py) of follow-up, the incidence of reinfection was 3.6/100 py
(95% CI 1.6-7.9). There were no cases of reinfection among those who did not report
ongoing injecting drug use after ETR. The incidence of reinfection in those with
ongoing injecting after ETR (124 py of follow-up) was 4.8/100 py (95% CI 2.2-10.7/100
Conclusion: HCV reinfection can occur following HCV DAA therapy among people
with ongoing injecting drug use following DAA therapy.
Disclosure of Interest Statement:
The conference collaborators recognise the considerable contribution that industry
partners make to professional and research activities. We also recognise the need for
transparency of disclosure of potential conflicts of interest by acknowledging these
relationships in publications and presentations.

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