Abstract
Infection with hepatitis C virus (HCV) does not induce protective immunity, and re-exposure to HCV can reinfect the population engaging in high-risk behavior. An increasing incidence of acute hepatitis C infection in people living with HIV (PLWH) has been described in recent years. This retrospective cohort study was conducted in PLWH who completed HCV therapy between June 2009 and June 2020 at an HIV care hospital, to analyze their basic characteristics and risky behavior. Of 2419 patients, 639 were diagnosed with HCV infection and 516 completed the HCV therapy with a sustained virologic response. In total, 59 patients (11.4%) were reinfected with acute hepatitis C, and the median time to reinfection was 85.3 weeks (IQR: 57–150). The incidence of reinfection was 6.7 cases/100 person-years. The factors associated with reinfection were being male (AHR, 8.02; 95% CI 1.08–59.49), DAA (direct-acting antiviral) treatment (AHR, 2.23; 95% CI 1.04–4.79), liver cirrhosis (AHR, 3.94; 95% CI 1.09–14.22), heroin dependency (AHR: 7.41; 95% CI 3.37–14.3), and HIV viral loads <50 copies/mL at the follow-up (AHR: 0.47, 95% CI 0.24–0.93) in the subgroup of people who inject drugs (PWID). Amphetamine abuse (AHR: 20.17; 95% CI 2.36–172.52) was the dominant factor in the subgroup of men who have sex with men (MSM). Our study suggests that education and behavioral interventions are needed in this population to prevent reinfection.
Highlights
An estimated 71 million people have chronic hepatitis C virus (HCV) infection, and a significant number of these people develop cirrhosis of the liver or liver cancer as a result [1]
HCV infection remains a major cause of liver-related morbidity and mortality among people living with HIV (PLWH), especially the people who inject drugs (PWID) [2,3]
The treatment uptake with interferonbased therapy has generally been high in the population of HIV-positive men who have sex with men (MSM), and high sustained virological response (SVR) rates have been reported, but there are relatively low SVR rates in the population of PWID [4]
Summary
An estimated 71 million people have chronic HCV infection, and a significant number of these people develop cirrhosis of the liver or liver cancer as a result [1]. 1.34 million deaths are caused by viral hepatitis, which is comparable to the deaths caused by tuberculosis and higher than those by HIV infection. HCV infection remains a major cause of liver-related morbidity and mortality among people living with HIV (PLWH), especially the people who inject drugs (PWID) [2,3]. Oral direct antiviral agent (DAA)-based treatment trials have demonstrated very high efficacy (SVR > 95%) among PLWH with HCV coinfection, even in the population of PWID [5,6]. Some studies have predicted that scaling-up DAA treatment will substantially reduce the HCV prevalence [7,8]
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