Understanding and addressing hepatitis C reinfection in the oral direct‐acting antiviral era

Abstract

The availability of effective, simple, well-tolerated oral direct-acting antiviral (DAA) hepatitis C regimens has raised optimism for hepatitis C virus (HCV) elimination at the population level. HCV reinfection in key populations such as people who inject drugs (PWID) and HIV-infected men who have sex with men (MSM) however threatens the achievement of this goal from a patient, provider and population perspective. The goal of this review was to synthesize our current understanding of estimated rates and factors associated with HCV reinfection. This review also proposes interventions to aid understanding of and reduce hepatitis C reinfection among PWID and HIV-infected MSM in the oral direct-acting antiviral era.

Hepatitis C virus reinfection after successful treatment with direct-acting antiviral therapy in a large population-based cohort

“…Lastly, to date, this is the largest and only population-based study of HCV reinfection rates after SVR with all-oral, interferon-free therapies [11]. Using linked laboratory and administrative data has provided a strong foundation for population-level monitoring of HCV reinfection rates, which will help support the program planning required to achieve WHO HCV elimination goals.…”

“…However, as HCV infection does not result in sterilizing immunity, individuals with ongoing risk activities remain vulnerable to reinfection following cure of their initial infection [9]. Thus, reinfection after successful HCV treatment is an important public health issue and may impact efforts to control HCV transmission [10,11]. PWIDs have been shown to be adherent to DAA treatments and can be effectively cured [12,13].…”

“…As DAAs have mitigated concerns related to compliance and adherence among PWIDs with ongoing injection behaviours, it has been postulated that reinfection rates with DAAs may be higher than during the interferon era [21]. However, population-level data on reinfection following successful DAA treatment is scarce [11].…”

The Hepatitis C Virus Care Continuum: Linkage to Hepatitis C Virus Care and Treatment Among Patients at an Urban Health Network, Philadelphia, PA

“…Second, injection drug use, the predominant risk for HCV transmission, has increased in concert with the nation’s opioid epidemic . Moreover, among persons successfully treated and cured, active drug injection poses a major risk of reinfection …”

“…(8) Moreover, among persons successfully treated and cured, active drug injection poses a major risk of reinfection. (9) Since the development of direct-acting antiviral drugs (DAAs) that offer curative treatment to persons diagnosed with HCV infection, several studies have identified important gaps in the HCV care continuum, that is, the steps along the pathway from identifying persons with active infection through to cure. National estimates suggest that in 2013, among the estimated 3.2-3.5 million persons in the United States with chronic HCV infection, roughly 50% were aware of their diagnosis, up to 38% were referred to an HCV provider, between 20% and 27% received confirmatory HCV RNA testing, 17% underwent a liver biopsy, only 7%-16% were treated, and less than 10% achieved sustained virologic response (SVR) (i.e., cure).…”