Can Hepatitis C Virus (HCV) Reinfection Be Predicted And Prevented Among People Who Currently Inject Drugs (PCID)? The Potential Importance Of Understanding And Intervening Upon Injection Networks To Achieve Sustained Aviremia

Author: Eckhardt BJ, Davis L, Edlin BR, Marks KM

Theme: Clinical Research Year: 2018

Limiting reinfection remains a challenge when treating active PCID for HCV. Modeling
suggests that a network treatment strategy which involves treating HCV-infected injection
partners concurrently may reduce rates of reinfection and consequently community HCV
prevalence. Using viral phylogenetic as well as quantitative and qualitative injection network
data, we sought to explore whether a network treatment strategy could have prevented HCV
Beginning in June 2014, PCID recruited in a syringe service program (SSP) were offered onsite treatment for HCV. Pre- and on-treatment quantitative data was collected on
participants’ injection networks and sharing behavior. Next-generation sequencing (NGS)
was performed on virus from most participants to provide a background library. Individuals
with viremia post treatment participated in a qualitative interview about their injection
practices, including names of others who injected near them (“proximity partners”). Global
Health Outbreak and Surveillance Technology (GHOST), was used to compare viral
sequences with the background library to evaluate for linked transmission pairs.
Eighty HCV-infected SSP participants were seen by an HCV provider, and 53 participants
started treatment. Pre-treatment virus from 31 were analyzed by NGS. None had infection
with mixed genotypes Forty-eight (91%) achieved a sustained virologic response 12 weeks
after treatment completion, while 3 patients had post-treatment viremia. Standardized
surveys of the three patients captured no sharing events pre-, or on-treatment. Two of three
samples could be sequenced. Both clustered phylogenetically with virus from the library
suggesting transmission links. In both of these cases, post-treatment qualitative interview
failed to capture sharing events, but did identify the transmission network seen in GHOST
results, through proximity partner naming.
In an HCV treatment program in a SSP, proximity partner naming aligned with phylogenetic
transmission links. Further study is warranted to determine if a network treatment strategy
will prevent HCV reinfection in high risk PWID.
Disclosure of Interest Statement: See example below:
This project was partially funded by a research grant from BMS. Dr. Eckhardt has
received research grants to New York University from Gilead Sciences Inc and to
Weill Cornell from BMS. Dr. Marks has received research grants to Weill Cornell
from Gilead Sciences Inc, Merck, and BMS.

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