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REINFECTION FOLLOWING SUCCESSFUL TREATMENT FOR HEPATITIS C VIRUS INFECTION WITH EITHER INTERFERON ALPHA OR PEGYLATED INTERFERON/RIBAVIRIN COMBINATION THERAPY
JD Farley, Y Al-Khafaji, T Mikami
Dr John Farley Inc; Department of Epidemiology, University of British Columbia, Vancouver, BC
Treatment of intravenous drug users (IVDU) for hepatitis C virus (HCV) infection has been discouraged because of their purported high possibility of reinfection. Under current treatment recommendations, HCV infections are not monitored for Sustained Virological Response (SVR) beyond six months following the End of Treatment (EOT). We investigated how HCV reinfection occurs and how effectively the reinfected patients can be treated. We reviewed the medical charts of 180 patients (IVDUs and non-IVDUs) who were treated at our clinic between August 1999 and April 2007, and identified 15 IVDU patients who were reinfected after successful treatment (HCV RNA was undetectable at least six months after completing the recommended treatment (SVR), or if the SVR was not available, a new reinfection. Based on 135 who likely acquired their initial infection through IVDU in the cohort, the reinfection rate was 8.8 cases per 100 person-years. The time of occurrence of reinfection had a mean of 75.0 weeks after the scheduled EOT and a standard deviation of 53.8 weeks. Reinfection may occur well after the six-month post-treatment date, and the most likely causes included intravenous drug use, blood contact, and tattooing. Reinfection occurred only in IVDUs and is not insignificant. We recommend that IVDUs should have ongoing counseling regarding reinfection and should be monitored for HCV Viremia for longer than the currently recommended six months post completion of treatment. Those who are regularly followed-up, if reinfected, will be detected earlier and can be intervened more appropriately.