A Prospective Study to Examine Persistent HCV Reinfection in Injection Drug Users Who Have Previously Cleared the Virus

Due to the risk of perceived reinfection, many persons with hepatitis C virus (HCV) with a recent or continuing history of injection drug use (IDU) do not receive treatment for the virus. However, few prospective studies have been conducted to investigate HCV reinfection among the IDU population.

In the current study, 224 persons with past or continuing IDU were followed from 1997 to 2007. Data -- including demographics and IDU and sexual behaviors -- were collected at baseline and every six months. Serum was tested for the presence of HCV antibody and serially for HCV RNA. Resolvers were defined as HCV antibody and RIBA positive and RNA negative at two consecutive time points, or as becoming HCV RNA negative after HCV antiviral treatment. The presence of HCV RNA at two or more visits was classified as reinfection.

Among the participants, 186 had chronic HCV, and 38 had resolved HCV. Resolvers were followed for a total of 214 person-years. Ongoing IDU was reported by 42 percent of resolvers, representing 58 person-years of IDU. Among the resolvers just one reinfection occurred -- a reinfection rate of 0.47 cases/100 person-years of follow-up. The reinfection occurred in a person who continued to inject drugs -- a reinfection rate of 1.75 cases/100 person-years of IDU.

"These data suggest that despite ongoing IDU, persistent HCV reinfection is lower than previously published," the authors concluded. "This can be attributed to a more clinically relevant definition of reinfection. This information will better help clinicians make informed decisions regarding HCV treatment options for patients who may continue to inject illicit drugs."

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