Hepatitis C Virus Reinfection Among People Who Inject Drugs
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Published:2024-08-26
Issue:8
Volume:7
Page:e2430024
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ISSN:2574-3805
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Container-title:JAMA Network Open
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language:en
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Short-container-title:JAMA Netw Open
Author:
Litwin Alain H.123, Tsui Judith I.4, Heo Moonseong5, Mehta Shruti H.6, Taylor Lynn E.7, Lum Paula J.8, Feinberg Judith910, Kim Arthur Y.11, Norton Brianna L.12, Pericot-Valverde Irene13, Arnsten Julia12, Meissner Paul14, Karasz Alison15, McKee M. Diane15, Ward John W.16, Johnson Nirah17, Agyemang Linda12, Stein Ellen S.8, Thomas Aurielle7, Borsuk Courtney6, Blalock Kendra L.4, Wilkinson Samuel18, Wagner Katherine19, Carty Jillian11, Murray-Krezan Cristina20, Anderson Jessica19, Jacobsohn Vanessa21, Luetkemeyer Anne F.8, Falade-Nwulia Oluwaseun22, Groome Megan3, Davies Suzanne23, Costello Kevin23, Page Kimberly19, , James Jocelyn R24, Kim Nina24, Peavy Michelle24, Ramchandani Meena S24, King Ashley24, Dickerson Brian24, Fingerhood Michael24, Haselhuhn Taryn24, Mason Angela24, Moon Juhi24, Olsen Yngvild24, Walters Vickie24, Schmitt William24, Lijewski Virginia24, Pitts Anita24, Raji Syeda24, Silva Taniya24, Evans Fiona24, Koene Hope24, Brown Joelle24, Aneja Jasneet24, Lora Kiara24, Hidalgo Jennifer24, Soloway Irene24, Jefferson Karen24, Wong Joyce24, Kermack Andrea24, Stein Melissa24, Joseph Giliane24, London Karyn24, Allen Lincoln24, Marte Venecia24, Vera Tatiana24, Alvarez Romy24, Cullen Caycee24, Gill Gurjot24, Tierney Hannah24, Shapiro Scott24, Azari Soraya24, Eveland Joanna24, Berrner Daniel24, Grey Pauli24, Akerley Jordan24, Davis Herbert24, Tashima Karen24, Sprecht-Walsh Sophie24, Hordes Melissa24, McGregor Danielle24, Duryea Patrick24, Weenig Kathryn24, Grekin Paul24, Ninburg Michael24, Kelley Lacey24, Calkins Andrea24, Henry Gabrielle24, Thomas Danielle24, Ashler Alice24, Teshale Eyasu24, Seiguer Sebastian24, Rios Katrina24, Brown Lauren24, Spellman James24, Raymond Daniel24, Beane Susan24, Kapoor Hema24
Affiliation:
1. School of Health Research, Clemson University, Clemson, South Carolina 2. Department of Medicine, University of South Carolina School of Medicine, Greenville 3. Department of Medicine, Prisma Health, Greenville, South Carolina 4. Department of Medicine, University of Washington, Seattle 5. Department of Public Health Sciences, Clemson University, Clemson, South Carolina 6. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 7. Department of Pharmacy Practice and Clinical Research, University of Rhode Island, Kingston 8. Department of Medicine, University of California, San Francisco 9. Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown 10. Department of Medicine, Section of Infectious Diseases, West Virginia University School of Medicine, Morgantown 11. Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston 12. Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York 13. Department of Psychology, College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, South Carolina 14. Department of Family and Social Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York 15. Department of Family Medicine & Community Health, University of Massachusetts Chan Medical School, Worcester 16. Coalition for Global Hepatitis Elimination, The Task Force for Global Health, Decatur, Georgia 17. New York City Department of Health and Mental Hygiene, New York, New York 18. Office of Research Program Management, West Virginia University, Morgantown 19. Department of Internal Medicine, University of New Mexico Health Sciences Center, University of New Mexico, Albuquerque 20. Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 21. Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque 22. Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland 23. Center for Health Law & Policy Innovation, Harvard Law School, Cambridge, Massachusetts 24. for the HERO Study Group
Abstract
IMPORTANCEHepatitis C virus (HCV) reinfection after curative treatment remains a concern for people who inject drugs.OBJECTIVETo assess the incidence of HCV reinfection and associated risk factors.DESIGN, SETTING, AND PARTICIPANTSThis cohort study is a secondary analysis of a randomized clinical trial that was conducted across opioid treatment programs and community health centers in the US between September 2016 and August 2018. The current analyses were performed in March 2022. People who inject drugs who achieved sustained virologic response (SVR) were followed for up to 42 months.ExposurePatients were randomly assigned to receive modified directly observed therapy or patient navigation.MAIN OUTCOMES AND MEASURESThe primary outcome was rate of HCV reinfection. Change in reinfection rates over time was assessed using a Poisson regression model.RESULTSA total of 415 participants (mean [SD] age, 44.7 [11.5] years; 302 male [72.8%]) achieved a SVR and had 1 or more post-SVR assessments for HCV RNA. Overall, 302 (72.8%) reported recent injection drug use, 192 (46.3%) were living in unstable housing, and 313 (75.4%) had received recent methadone or buprenorphine for opioid use disorder. The overall reinfection rate was 11.4 per 100 person-years at risk (95% CI, 8.7-14.7 per 100 person-years at risk) over 518 person-years of follow-up. Reinfection rates varied significantly across sites, ranging from 2.9 per 100 person-years at risk (95% CI, 0.1-16.3 per 100 person-years) to 25.2 per 100 person-years at risk (95% CI, 15.6-38.5 per 100 person-years at risk) (P = .006). There was a significant decrease in incident reinfection with increasing post-SVR follow-up (weeks 0-24, 15.5 per 100 person-years; 95% CI, 10.3-22.3 per 100 person-years; weeks 73-144, 4.3 per 100 person-years; 95% CI, 0.9-12.5 per 100 person-years; P = .008). Reinfection rates were lower for participants aged 40 years or older than for younger participants (adjusted incidence rate ratio, 0.32; 95% CI, 0.18-0.57) and for participants for whom methamphetamine was not detected in urinary drug screening compared with participants for whom methamphetamine was detected (adjusted incidence rate ratio, 0.41; 95% CI, 0.21-0.82). Participants who reported injection drug use within the preceding 3 months had higher risk of reinfection than those who did not have recent injection drug use (adjusted incidence rate ratio, 3.33; 95% CI, 1.86-5.97).CONCLUSIONS AND RELEVANCEIn this cohort study of people who injected drugs and were treated for HCV infection in community settings, reinfection was high in the period immediately after SVR but decreased significantly over time. These findings highlight the importance of early intervention to prevent reinfection.Trial RegistrationClinicalTrials.gov Identifier: NCT02824640
Publisher
American Medical Association (AMA)
Reference36 articles.
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