High rates of hepatitis C virus reinfection and spontaneous clearance of reinfection in people who inject drugs: a prospective cohort study

• Published in: PloS one Vol. 8; no. 11; p. e80216
• Main Authors: Sacks-Davis, Rachel, Aitken, Campbell K, Higgs, Peter, Spelman, Tim, Pedrana, Alisa E, Bowden, Scott, Bharadwaj, Mandvi, Nivarthi, Usha K, Suppiah, Vijayaprakash, George, Jacob, Grebely, Jason, Drummer, Heidi E, Hellard, Margaret
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 07.11.2013; Public Library of Science (PLoS)
• Subjects: Adult; Analysis; Cohort analysis; Drug abuse; Drug use; Drugs; Female; Health aspects; Health risk assessment; Health risks; Hepacivirus - immunology; Hepatitis; Hepatitis C; Hepatitis C - etiology; Hepatitis C - immunology; Hepatitis C - transmission; Hepatitis C - virology; Hepatitis C virus; Humans; Immunity; Immunity, Innate; Incidence; Infection; Infections; Interferon; Laboratories; Male; Medical research; Preventive medicine; Proportional Hazards Models; Prospective Studies; Public health; Recurrence; Remission, Spontaneous; Risk Factors; RNA, Viral - immunology; Studies; Substance Abuse, Intravenous - complications; Substance Abuse, Intravenous - immunology; Substance Abuse, Intravenous - virology; Viruses; Australia; Victoria Australia; New South Wales Australia
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0080216

Hepatitis C virus reinfection and spontaneous clearance of reinfection were examined in a highly characterised cohort of 188 people who inject drugs over a five-year period. Nine confirmed reinfections and 17 possible reinfections were identified (confirmed reinfections were those genetically distinct from the previous infection and possible reinfections were used to define instances where genetic differences between infections could not be assessed due to lack of availability of hepatitis C virus sequence data). The incidence of confirmed reinfection was 28.8 per 100 person-years (PY), 95%CI: 15.0-55.4; the combined incidence of confirmed and possible reinfection was 24.6 per 100 PY (95%CI: 16.8-36.1). The hazard of hepatitis C reinfection was approximately double that of primary hepatitis C infection; it did not reach statistical significance in confirmed reinfections alone (hazard ratio [HR]: 2.45, 95%CI: 0.87-6.86, p=0.089), but did in confirmed and possible hepatitis C reinfections combined (HR: 1.93, 95%CI: 1.01-3.69, p=0.047) and after adjustment for the number of recent injecting partners and duration of injecting. In multivariable analysis, shorter duration of injection (HR: 0.91; 95%CI: 0.83-0.98; p=0.019) and multiple recent injecting partners (HR: 3.12; 95%CI: 1.08-9.00, p=0.035) were independent predictors of possible and confirmed reinfection. Time to spontaneous clearance was shorter in confirmed reinfection (HR: 5.34, 95%CI: 1.67-17.03, p=0.005) and confirmed and possible reinfection (HR: 3.10, 95%CI: 1.10-8.76, p-value=0.033) than primary infection. Nonetheless, 50% of confirmed reinfections and 41% of confirmed or possible reinfections did not spontaneously clear. Hepatitis C reinfection and spontaneous clearance of hepatitis C reinfection were observed at high rates, suggesting partial acquired natural immunity to hepatitis C virus. Public health campaigns about the risks of hepatitis C reinfection are required.