Reinfection Following Successful Direct-acting Antiviral Therapy for Hepatitis C Virus Infection Among People Who Inject Drugs
Reinfection Following Successful Direct-acting Antiviral Therapy for Hepatitis C Virus Infection Among People Who Inject Drugs
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DOI：
10.1093/cid/ciaa253
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发表时间：
2021-04-15
影响因子：
11.8
通讯作者：
Grebely, Jason
中科院分区：
文献类型：
--
作者：
Cunningham, Evan B.;Hajarizadeh, Behzad;Grebely, Jason
背景。本分析的目的是计算最近注射吸毒或正在接受阿片类激动剂治疗（OAT）的人群中丙型肝炎病毒（HCV）直接抗病毒治疗的2项临床试验中丙型肝炎病毒（HCV）再感染的发生率及其相关因素。2016年3月至2017年2月期间，在8个国家的2项临床试验中，近期注射吸毒或目前正在接受OAT （SIMPLIFY和D3FEAT）治疗的参与者获得了治疗结束反应，通过病毒测序评估了HCV再感染情况。发生率采用观察人数计算，相关因素采用Cox比例风险模型评估。73%有再感染风险的人群（n = 177；中位年龄48岁；73%为男性）报告持续注射吸毒。总随访时间为254人年（中位1.8年，范围0.2-2.8年）。共确认8例再感染，总体发生率为3.1/100人-年（95%可信区间[CI]， 1.6-6.3），报告共用针头/注射器者的再感染发生率为17.9/100人-年（95% CI, 5.8-55.6）。年龄较小和共用针头/注射器与丙型肝炎病毒再感染有关。这些数据表明，需要持续监测和改进策略，以防止持续注射吸毒者在成功治疗后再次感染丙型肝炎病毒，以实现消除丙型肝炎病毒。
Background. The aim of this analysis was to calculate the incidence of hepatitis C virus (HCV) reinfection and associated factors among 2 clinical trials of HCV direct-acting antiviral treatment in people with recent injecting drug use or currently receiving opioid agonist therapy (OAT).Methods. Participants who achieved an end-of-treatment response in 2 clinical trials of people with recent injecting drug use or currently receiving OAT (SIMPLIFY and D3FEAT) enrolled between March 2016 and February 2017 in 8 countries were assessed for HCV reinfection, confirmed by viral sequencing. Incidence was calculated using person-time of observation and associated factors were assessed using Cox proportional hazard models.Results. Seventy-three percent of the population at risk of reinfection (n = 177; median age, 48 years; 73% male) reported ongoing injecting drug use. Total follow-up time at risk was 254 person-years (median, 1.8 years; range, 0.2-2.8 years). Eight cases of reinfection were confirmed for an incidence of 3.1/100 person-years (95% confidence interval [CI], 1.6-6.3) overall and 17.9/100 person-years (95% CI, 5.8-55.6) among those who reported sharing needles/syringes. Younger age and needle/syringe sharing were associated with HCV reinfection.Conclusions. These data demonstrate the need for ongoing monitoring and improved strategies to prevent HCV reinfection following successful treatment among people with ongoing injecting drug use to achieve HCV elimination.