Author: Brendan Jacka, Stine Høj, Nanor Minoyan, Sahar Saeed, Joseph Cox, Erica EM Moodie, Andreea Adelina Artenie, Alexander Wong, Geng Zang, Mark Hull, Valerie Martel-Laferrière, M John Gill, Sharon Walmsley, Didier Jutras-Aswad, Marina Klein, Julie Bruneau

Theme: Epidemiology & Public Health Research Year: 2019

Background: Expanding uptake of hepatitis C virus (HCV) curative treatments increases the pool of
individuals susceptible to HCV reinfection, particularly among people who inject drugs (PWID) and
men who have sex with men (MSM). This study examined patterns of recent drug consumption and
sexual behaviour and their association with HCV reinfection (HCV RNA-positive following
spontaneous- or treatment-induced clearance) in at-risk men.
Methods: HCV antibody-positive/HCV RNA-negative participants were drawn from HEPCO (PWID;
Montreal, 2011-2017) and Canadian Coinfection Cohort (HIV-positive MSM and/or PWID; panCanadian, 2004-2018). Questionnaires and HCV RNA testing were completed 3-/6-monthly,
depending on the cohort. We employed latent class analysis to identify heterogeneous behavioural
clusters (based on ten/two indicators of drug use/gender of sexual partner). Time-to-event
methods were used to calculate HCV reinfection rates and associations with time-updated
behavioural cluster membership (adjusting for recruitment site, age, recent incarceration, and
unstable housing).
Result: Data from 3027 study visits involving 540 men (baseline median age: 48 yrs; 55% HIV-positive)
were analyzed. Latent class analysis derived six behavioural clusters: two based on gender of sexual
partner without injection (‘heterosexual’, and ‘MSM’), two based on the predominant drug injected
(‘cocaine’, and ‘heroin and opioid agonist therapy’) and two based on polydrug injection
(‘prescription opioid-dominant’, and ‘amphetamine-dominant’). Ninety-eight HCV reinfections
occurred in 1473 person-years (PY) [6.65 per 100py]. Compared to ‘heterosexual without
injection’, HCV reinfection was elevated for the ‘prescription opioid-dominant’ (adjusted HR: 7.93;
95% CI: 5.31, 11.83), ‘cocaine injection’ (aHR: 3.28; 1.66, 6.49), ‘heroin injection and opioid agonist
therapy’ (aHR: 2.96; 1.48, 5.92), and ‘amphetamine-dominant’ clusters (aHR: 2.77; 1.18, 6.49), but
not for the ‘MSM without injection’ cluster (aHR: 0.87; 0.57, 1.35).
In these Canadian cohorts of male PWID and MSM, HCV reinfection was associated with patterns
of recent drug injection, but not sex with men in those reporting no recent injecting.
Disclosure of Interest Statement
BJ, SH, NM, SS, EEMM, AAA, AW, GZ, and DJA declare that they have no conflicts of interest. JC
received consulting fees from ViiV Healthcare, Gilead, and Merck; grants from ViiV Healthcare,
Gilead, and Merck; and payment for lectures from Gilead. MH reports receiving honoraria for
advisory board representation and speaking engagements regarding HIV and HCV from BMS,
Gilead, Merck and ViiV Healthcare, paid to his institution. VML reports consulting fees from Merck
and Gilead; grants from Gilead and Abbvie; and lecture fees from AbbVie, Merck and Gilead. MJG
reports personal fees from Merck, ViiV Healthcare, and Gilead outside the submitted work. SW
received grants, consulting fees, lecture fees, nonfinancial support and fees for the development
of educational presentations from Merck, ViiV Healthcare, GlaxoSmithKline, Pfizer, Gilead, Abbvie,
Bristol-Myers Squibb and Janssen. MBK has received research grants for investigator-initiated trials
from Merck and ViiV Healthcare and consulting fees from ViiV Healthcare, Bristol-Meyers Squibb,
Merck, Gilead and AbbVie. JB received advisor fees from Gilead Sciences and Merck and a research
grant from Gilead Sciences, outside of this current work

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