Recent abstinence at the moment to initiate HCV treatment is no guarantee to avoid HCV reinfections

Author: Valencia J, Gutiérrez J, Moreno S, Alvatro-Meca A, Troya J, Cuevas G, Alvarez J, Pulido L, Ryan P

Theme: Clinical Research Year: 2019

Introduction: The perception by many providers is that “people who injected drugs (PWID)
actively will simply get re-infected after HCV treatment”. As such, HCV treatment of PWID in
active consumption is often not considered worthwhile, and they are not offered these
Methods: This study was based on data from a follow-up cohort of HCV-infected people who
consumed heroin and/or cocaine (smoked or injected) during the previous 6 months and
received DAA at 2 low threshold harm reduction mobile unit (LTMHRUs) located in Madrid
(Spain). Participants received HCV treatment while in active consumption or recent abstinence.
Cox proportional hazard regression analysis was used.
Results: 165 individuals-initiated DAA at the 2 LTMHRUs. Notably, 120 patients (72.7%) were
homeless and 71 (43%) started therapy in recent abstinence. Of those who started therapy in
recent abstinence, 39 (55%) relapsed in drugs during follow-up. Total time at risk for
reinfection was 101.1-PY (median, 0.6 years; IQR, 0.3-1.3). We identified 10 reinfections. Five
participants reported use of injected drugs (IDU) at initiation of HCV treatment, and another 5
initiated HCV treatment during recent abstinence. Median estimated time to HCV reinfection
was 7.2 (IQR, 4.2-18) months after the end of treatment. Median time to reinfection was
shorter in those who reported IDU at initiation of HCV treatment (5.9 months; IQR, 4.3-7.8).
The incidence of reinfection was not statistically different according to IDU at baseline (recent
abstinence at baseline 9.1 [95% CI, 2.9; 21.3] per 100 PY compared with active consumption at
baseline 10.8 [95% CI, 3.5; 25.2] per 100 PY, p 0.79).
Conclusions: Our study shows that, owing to the chronic nature and high frequency of relapses
to drug addiction, the incidence of reinfection is similar between PWID who initiate HCV
treatment in recent abstinence or active consumption. Also, these findings highlight the need
to frequent testing following successful treatment to detect early reinfections.
Disclosure of interest: This project received funds of Gilead and Abbie

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