Hepatitis C reinfection following treatment induced viral clearance among people who have injected drugs

Amanda Weir; Allan McLeod; Hamish Innes; Heather Valerio; Esther J Aspinall; David J Goldberg; Stephen T Barclay; John F Dillon; Ray Fox; Andrew Fraser; Peter C Hayes; Nicholas Kennedy; Peter R Mills; Adrian J Stanley; Celia Aitken; Rory Gunson; Kate Templeton; Alison Hunt; Paul McIntyre; Sharon J Hutchinson

doi:10.1016/j.drugalcdep.2016.05.012

Hepatitis C reinfection following treatment induced viral clearance among people who have injected drugs

Amanda Weir (Lead / Corresponding author), Allan McLeod, Hamish Innes, Heather Valerio, Esther J Aspinall, David J Goldberg, Stephen T Barclay, John F Dillon, Ray Fox, Andrew Fraser, Peter C Hayes, Nicholas Kennedy, Peter R Mills, Adrian J Stanley, Celia Aitken, Rory Gunson, Kate Templeton, Alison Hunt, Paul McIntyre, Sharon J Hutchinson

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Abstract

BACKGROUND: Although people who inject drugs (PWID) are an important group to receive Hepatitis C Virus (HCV) antiviral therapy, initiation onto treatment remains low. Concerns over reinfection may make clinicians reluctant to treat this group. We examined the risk of HCV reinfection among a cohort of PWID (encompassing all those reporting a history of injecting drug use) from Scotland who achieved a sustained virological response (SVR).

METHODS: Clinical and laboratory data were used to monitor RNA testing among PWID who attained SVR following therapy between 2000 and 2009. Data were linked to morbidity and mortality records. Follow-up began one year after completion of therapy, ending on 31st December, 2012. Frequency of RNA testing during follow-up was calculated and the incidence of HCV reinfection estimated. Cox proportional hazards regression was used to examine factors associated with HCV reinfection.

RESULTS: Among 448 PWID with a SVR, 277 (61.8%) were tested during follow-up, median 4.5 years; 191 (69%) received one RNA test and 86 (31%) received at least two RNA tests. There were seven reinfections over 410 person years generating a reinfection rate of 1.7/100py (95% CI 0.7-3.5). For PWID who have been hospitalised for an opiate or injection related cause post SVR (11%), the risk of HCV reinfection was greater [AHR=12.9, 95% CI 2.2-76.0, p=0.002] and the reinfection rate was 5.7/100py (95% CI 1.8-13.3).

CONCLUSION: PWID who have been tested, following SVR, for HCV in Scotland appear to be at a low risk of reinfection. Follow-up and monitoring of this population are warranted as treatment is offered more widely.

Original language	English
Pages (from-to)	53-60
Number of pages	8
Journal	Drug and Alcohol Dependence
Volume	165
Early online date	28 May 2016
DOIs	https://doi.org/10.1016/j.drugalcdep.2016.05.012
Publication status	Published - 1 Aug 2016

Keywords

Hepatitis C virus
People who inject drugs
Reinfection
Sustained viral response
Record linkage

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.drugalcdep.2016.05.012

Weir_JHep_HCVReinfectionSVRPWIDScotland_v2.2
© 2016. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
Accepted author manuscript, 305 KBLicence: CC BY-NC-ND
Weir_JHep_HCVReinfectionSVRPWIDScotland_tblfig_v2.2
© 2016. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
Accepted author manuscript, 311 KBLicence: CC BY-NC-ND

Cite this

Weir, A., McLeod, A., Innes, H., Valerio, H., Aspinall, E. J., Goldberg, D. J., Barclay, S. T., Dillon, J. F., Fox, R., Fraser, A., Hayes, P. C., Kennedy, N., Mills, P. R., Stanley, A. J., Aitken, C., Gunson, R., Templeton, K., Hunt, A., McIntyre, P., & Hutchinson, S. J. (2016). Hepatitis C reinfection following treatment induced viral clearance among people who have injected drugs. Drug and Alcohol Dependence, 165, 53-60. https://doi.org/10.1016/j.drugalcdep.2016.05.012

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title = "Hepatitis C reinfection following treatment induced viral clearance among people who have injected drugs",

abstract = "BACKGROUND: Although people who inject drugs (PWID) are an important group to receive Hepatitis C Virus (HCV) antiviral therapy, initiation onto treatment remains low. Concerns over reinfection may make clinicians reluctant to treat this group. We examined the risk of HCV reinfection among a cohort of PWID (encompassing all those reporting a history of injecting drug use) from Scotland who achieved a sustained virological response (SVR).METHODS: Clinical and laboratory data were used to monitor RNA testing among PWID who attained SVR following therapy between 2000 and 2009. Data were linked to morbidity and mortality records. Follow-up began one year after completion of therapy, ending on 31st December, 2012. Frequency of RNA testing during follow-up was calculated and the incidence of HCV reinfection estimated. Cox proportional hazards regression was used to examine factors associated with HCV reinfection.RESULTS: Among 448 PWID with a SVR, 277 (61.8%) were tested during follow-up, median 4.5 years; 191 (69%) received one RNA test and 86 (31%) received at least two RNA tests. There were seven reinfections over 410 person years generating a reinfection rate of 1.7/100py (95% CI 0.7-3.5). For PWID who have been hospitalised for an opiate or injection related cause post SVR (11%), the risk of HCV reinfection was greater [AHR=12.9, 95% CI 2.2-76.0, p=0.002] and the reinfection rate was 5.7/100py (95% CI 1.8-13.3).CONCLUSION: PWID who have been tested, following SVR, for HCV in Scotland appear to be at a low risk of reinfection. Follow-up and monitoring of this population are warranted as treatment is offered more widely.",

keywords = "Hepatitis C virus, People who inject drugs, Reinfection, Sustained viral response, Record linkage",

author = "Amanda Weir and Allan McLeod and Hamish Innes and Heather Valerio and Aspinall, {Esther J} and Goldberg, {David J} and Barclay, {Stephen T} and Dillon, {John F} and Ray Fox and Andrew Fraser and Hayes, {Peter C} and Nicholas Kennedy and Mills, {Peter R} and Stanley, {Adrian J} and Celia Aitken and Rory Gunson and Kate Templeton and Alison Hunt and Paul McIntyre and Hutchinson, {Sharon J}",

year = "2016",

month = aug,

day = "1",

doi = "10.1016/j.drugalcdep.2016.05.012",

language = "English",

volume = "165",

pages = "53--60",

journal = "Drug and Alcohol Dependence",

issn = "0376-8716",

publisher = "Elsevier",

}

Weir, A, McLeod, A, Innes, H, Valerio, H, Aspinall, EJ, Goldberg, DJ, Barclay, ST, Dillon, JF, Fox, R, Fraser, A, Hayes, PC, Kennedy, N, Mills, PR, Stanley, AJ, Aitken, C, Gunson, R, Templeton, K, Hunt, A, McIntyre, P & Hutchinson, SJ 2016, 'Hepatitis C reinfection following treatment induced viral clearance among people who have injected drugs', Drug and Alcohol Dependence, vol. 165, pp. 53-60. https://doi.org/10.1016/j.drugalcdep.2016.05.012

TY - JOUR

T1 - Hepatitis C reinfection following treatment induced viral clearance among people who have injected drugs

AU - Weir, Amanda

AU - McLeod, Allan

AU - Innes, Hamish

AU - Valerio, Heather

AU - Aspinall, Esther J

AU - Goldberg, David J

AU - Barclay, Stephen T

AU - Dillon, John F

AU - Fox, Ray

AU - Fraser, Andrew

AU - Hayes, Peter C

AU - Kennedy, Nicholas

AU - Mills, Peter R

AU - Stanley, Adrian J

AU - Aitken, Celia

AU - Gunson, Rory

AU - Templeton, Kate

AU - Hunt, Alison

AU - McIntyre, Paul

AU - Hutchinson, Sharon J

PY - 2016/8/1

Y1 - 2016/8/1

N2 - BACKGROUND: Although people who inject drugs (PWID) are an important group to receive Hepatitis C Virus (HCV) antiviral therapy, initiation onto treatment remains low. Concerns over reinfection may make clinicians reluctant to treat this group. We examined the risk of HCV reinfection among a cohort of PWID (encompassing all those reporting a history of injecting drug use) from Scotland who achieved a sustained virological response (SVR).METHODS: Clinical and laboratory data were used to monitor RNA testing among PWID who attained SVR following therapy between 2000 and 2009. Data were linked to morbidity and mortality records. Follow-up began one year after completion of therapy, ending on 31st December, 2012. Frequency of RNA testing during follow-up was calculated and the incidence of HCV reinfection estimated. Cox proportional hazards regression was used to examine factors associated with HCV reinfection.RESULTS: Among 448 PWID with a SVR, 277 (61.8%) were tested during follow-up, median 4.5 years; 191 (69%) received one RNA test and 86 (31%) received at least two RNA tests. There were seven reinfections over 410 person years generating a reinfection rate of 1.7/100py (95% CI 0.7-3.5). For PWID who have been hospitalised for an opiate or injection related cause post SVR (11%), the risk of HCV reinfection was greater [AHR=12.9, 95% CI 2.2-76.0, p=0.002] and the reinfection rate was 5.7/100py (95% CI 1.8-13.3).CONCLUSION: PWID who have been tested, following SVR, for HCV in Scotland appear to be at a low risk of reinfection. Follow-up and monitoring of this population are warranted as treatment is offered more widely.

AB - BACKGROUND: Although people who inject drugs (PWID) are an important group to receive Hepatitis C Virus (HCV) antiviral therapy, initiation onto treatment remains low. Concerns over reinfection may make clinicians reluctant to treat this group. We examined the risk of HCV reinfection among a cohort of PWID (encompassing all those reporting a history of injecting drug use) from Scotland who achieved a sustained virological response (SVR).METHODS: Clinical and laboratory data were used to monitor RNA testing among PWID who attained SVR following therapy between 2000 and 2009. Data were linked to morbidity and mortality records. Follow-up began one year after completion of therapy, ending on 31st December, 2012. Frequency of RNA testing during follow-up was calculated and the incidence of HCV reinfection estimated. Cox proportional hazards regression was used to examine factors associated with HCV reinfection.RESULTS: Among 448 PWID with a SVR, 277 (61.8%) were tested during follow-up, median 4.5 years; 191 (69%) received one RNA test and 86 (31%) received at least two RNA tests. There were seven reinfections over 410 person years generating a reinfection rate of 1.7/100py (95% CI 0.7-3.5). For PWID who have been hospitalised for an opiate or injection related cause post SVR (11%), the risk of HCV reinfection was greater [AHR=12.9, 95% CI 2.2-76.0, p=0.002] and the reinfection rate was 5.7/100py (95% CI 1.8-13.3).CONCLUSION: PWID who have been tested, following SVR, for HCV in Scotland appear to be at a low risk of reinfection. Follow-up and monitoring of this population are warranted as treatment is offered more widely.

KW - Hepatitis C virus

KW - People who inject drugs

KW - Reinfection

KW - Sustained viral response

KW - Record linkage

U2 - 10.1016/j.drugalcdep.2016.05.012

DO - 10.1016/j.drugalcdep.2016.05.012

M3 - Article

C2 - 27268294

SN - 0376-8716

VL - 165

SP - 53

EP - 60

JO - Drug and Alcohol Dependence

JF - Drug and Alcohol Dependence

ER -

Hepatitis C reinfection following treatment induced viral clearance among people who have injected drugs

Abstract

Keywords

UN SDGs

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