Hepatitis C Virus Reinfection Following Direct-Acting Antiviral Treatment in the Prison Setting: The SToP-C Study.

Abstract

BACKGROUND:

Injection drug use (IDU) following treatment for hepatitis C virus (HCV) infection may lead to reinfection, particularly if access to harm reduction services is suboptimal. This study assessed HCV reinfection risk following direct-acting antiviral therapy within Australian prisons that had opioid agonist therapy (OAT) programs but did not have needle and syringe programs (NSPs).

METHODS:

The Surveillance and Treatment of Prisoners With Hepatitis C (SToP-C) study enrolled people incarcerated in 4 prisons between 2014 and 2019. Participants treated for HCV were followed every 3-6 months to identify reinfection (confirmed by sequencing). Reinfection incidence and associated factors were evaluated.

RESULTS:

Among 388 participants receiving treatment, 161 had available posttreatment follow-up and were included in analysis (92% male; median age, 33 years; 67% IDU in prison; median follow-up 9 months). Among those with recent (in the past month) IDU (n = 71), 90% had receptive needle/syringe sharing. During 145 person-years (PY) of follow-up, 18 cases of reinfection were identified. Reinfection incidence was 12.5/100 PY (95% confidence interval [CI]: 7.9-19.8) overall, increasing to 28.7/100 PY (95% CI: 16.3-50.6) among those with recent IDU and needle/syringe sharing. In adjusted analysis, recent IDU with needle/syringe sharing was associated with increased reinfection risk (adjusted hazard ratio [aHR], 4.74 [95% CI: 1.33-16.80]; P = .016) and longer HCV testing interval with decreased risk (ie, chance of detection; aHR, 0.41 per each month increase [95% CI: .26-.64]; P < .001).

CONCLUSIONS:

A high rate of HCV reinfection was observed within prison. Posttreatment surveillance and retreatment are -essential to limit the impact of reinfection. High-coverage OAT and NSPs should be considered within prisons.

CLINICAL TRIALS REGISTRATION:

NCT02064049.

• Authors: Joanne M Carson, Gregory J Dore, Andrew R Lloyd, Jason Grebely, Marianne Byrne, Evan Cunningham, Janaki Amin, Peter Vickerman, Natasha K Martin, Carla Treloar, Marianne Martinello, Gail V Matthews, Behzad Hajarizadeh, Surveillance and Treatment of Prisoners With Hepatitis C (SToP-C) Study Group
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 75 Issue 10 Pg. 1809-1819 (11 14 2022) ISSN: 1537-6591 [Electronic] United States
• PMID: 35362522 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © The Author(s) 2022. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected].

Chemical References

• Antiviral Agents

Topics

• Humans
• Male
• Adult
• Female
• Hepacivirus
• Antiviral Agents (therapeutic use)
• Prisons
• Substance Abuse, Intravenous (complications, epidemiology)
• Reinfection
• Hepatitis C, Chronic (drug therapy, epidemiology, complications)
• Recurrence
• Australia (epidemiology)
• Hepatitis C (drug therapy, epidemiology, etiology)