Abstract
BackgroundThere is currently no systematic screening for hepatitis C (HCV) reinfection in people who inject drugs (PWID) after treatment in Belgium. However, in a recent meta-analysis, the overall HCV reinfection rate was 5.9/100 person-years (PY) among PWID. Accordingly, this study was undertaken to investigate the reinfection rate in former and active PWID who achieved the end of treatment response after direct-acting antiviral (DAA) treatment in Belgium.MethodsThis observational cross-sectional study recruited individuals with a history of injecting drug use who had achieved the end of treatment response to any DAA treatment between 2015 and 2020. Participants were offered a post-treatment HCV RNA test.ResultsEighty-five potential participants were eligible to participate and contacted, of whom 60 participants were enrolled in the study with a median age of 51.0 (IQR 44.3–56.0) years; it was reported that 23.3% continued to inject drugs intravenously after DAA treatment. Liver cirrhosis was present in 12.9%. The majority had genotype 1a (51.7%) or genotype 3 (15.0%) infection. We detected no reinfections in this study population. The total time patients were followed up for reinfection in the study was 78.5 PY (median 1.0 years IQR 0.4–2.0).ConclusionReinfection after successful treatment with DAA initially appears to be very low in Belgian PWID. Therefore, efforts should be made to screen individuals with persistent risk behaviors for reinfection systematically. In addition, a national HCV registry should be established to accurately define the burden of HCV infection and reinfection in Belgium and support the elimination of viral hepatitis C in Europe.Trial registration clinicaltrials.gov NCT04251572, Registered 5 Feb 2020–Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04251572.
Highlights
There is currently no systematic screening for hepatitis C (HCV) reinfection in people who inject drugs (PWID) after treatment in Belgium
Study design and participants This observational cross-sectional study recruited individuals aged 18 years or older with a history of injecting drug use (IDU) who had achieved the end of treatment response to any interferon-free direct-acting antiviral (DAA) treatment between 2015 and 2020
All participants had a history of IDU, 71.7% (n = 43) received opioid agonist treatment (OAT), 21.7% (n = 13) injected drugs during treatment, and it was reported by 23.3% (n = 14) after DAA treatment (Table 2)
Summary
There is currently no systematic screening for hepatitis C (HCV) reinfection in people who inject drugs (PWID) after treatment in Belgium. This study was undertaken to investigate the reinfection rate in former and active PWID who achieved the end of treatment response after direct-acting antiviral (DAA) treatment in Belgium. The introduction of highly effective direct-acting antiviral (DAA) therapy has changed the HCV treatment paradigm. These changes led to progress toward achieving the World Health Organization’s stated goal of reducing HCV viral infections by 90% ( 80% reduction in new HCV cases) and mortality by 65% by 2030 [11, 12]. Treatment for HCV is only reimbursed if the patient has a chronic infection (> 6 months). DAA treatment can only be prescribed by a hepatologist and is only available in a hospital pharmacy [15]
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