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LOW RATE OF HEPATITIS C VIRUS (HCV) RE-INFECTION AMONG INJECTION DRUG USERS (IDUS) FOLLOWING SUSTAINED VIROLOGIC RESPONSE (SVR) AFTER TREATMENT FOR HCV INFECTION
J Grebely1,3, JD Raffa2, KA Genoway1, G Showler4, F Duncan3, M Viljoen3, M Khara3, S de Vlaming3, C Fraser4, B Conway1,3
1Department of Anesthesiology, Pharmacology and Therapeutics; 2Department of Statistics and Actuarial Science, University of Waterloo; 3Pender Community Health Centre, Vancouver Coastal Health, Vancouver; 4Cool-Aid Community Health Centre, Victoria
AIM: Little is known about HCV re-infection following successful treatment among IDUs. We sought to evaluate HCV re-infection following SVR among IDUs having received directly observed IFN alpha-2b or PEG-IFN alpha-2a/b in combination with self-administered ribavirin in a directly observed therapy program.
METHODS: Viremic HCV-infected IDUs, with ALT >1.5x ULN, received 24 or 48 week therapy (based on HCV genotype) with ribavirin and interferon alpha-2b, replaced by PEG-interferon alpha-2a/2b. Following treatment, subjects were encouraged to return to the clinic at follow-up intervals of ~1 year and were asked about their use of illicit drugs. HCV RNA testing by PCR was performed and positive results were genotyped.
RESULTS: Overall, 28/51 subjects (55%) receiving IFN alpha-2b (n=12), PEG-IFN alpha-2b (n=32) or PEG-IFN alpha-2a (n=7) achieved an SVR. Illicit drugs were used by 21/51 (41%) in the 6 months preceding therapy and by 29/51 (57%) during treatment. In total, 28 subjects were followed for a mean of 1.1 years (range, 0-3.2 years) following SVR. In this period, 13/28 (46%) reported using illicit drugs (3 – injection heroin/cocaine and crack cocaine, 2 – injection heroin and crack cocaine, 1 - injection cocaine and crack cocaine, 3 – injection cocaine, 2 – injection heroin, 2 – crack cocaine). Eleven subjects (39%) reported injection drug use. Overall, 25/28 (89%) remained HCV RNA negative, 1 died of hepatocellular carcinoma, 1 was lost to follow-up and 1 was positive for HCV RNA. This subject received 17 weeks of PEG-IFN alpha-2b therapy and had viral reoccurrence with the same genotype (G1), consistent with re-infection or viral relapse. Therefore, viremia re-occurred in 1/28 (3.6%), providing an estimated rate of re-occurrence of 4.0 cases per 100 person-years.
CONCLUSIONS: These data demonstrate a low rate of HCV re-infection among IDUs successfully treated for HCV and provides a rationale for expanding treatment in this group. Research is required to understand if this is associated with protective immunity against HCV re-infection or reduced risk behaviors for acquisition following successful treatment.