HCV reinfection after HCV therapy among HIV/HCV co-infected individuals in Europe. HIV Medicine
Amele et al. on behalf of the EuroSIDA study group aimed to evaluate the 2-year prevalence of HCV reinfection after Interferon (IFN-) based or IFN-free direct acting agents (DAA) HCV therapy among HIV/HCV-coinfected individuals from the pan- European EuroSIDA cohort study.
The authors assessed factors associated with odds of reinfection by 2 years after sustained virological response (SVR) in EuroSIDA participants with one or more HCV- RNA test and 2 years follow-up.
Overall, 1’022 individuals were included. The median age was 50 (interquartile range: 43–54 years), and most were male (78%), injection drug users (52%), and received IFN-free DAAs (62%). By 24 months, 75 [7.3%, 95% confidence interval (CI): 5.7–8.9%] individuals were reinfected. Among individuals treated prior to 2014, 16.1% were reinfected compared with 4.2% and 8.3%, respectively, among those treated during or after 2014 with IFN-free and IFN-based therapy. After adjustment, individuals who had started treatment during or after 2014 with IFN-free or IFN-based therapy had significantly lower odds of reinfection (adjusted odds ratio = 0.21, 95% CI: 0.11–0.38; 0.43, 95% CI: 0.22–0.83) compared with those who had received therapy before 2014. There were no significant differences in odds of reinfection according to age, gender, European region, HIV transmission risk group or liver fibrosis.
In conclusion, this study of 1’022 HIV/HCV-coinfected people from all regions of Europe found that the HCV reinfection rate in the first 2 years after SVR was 7.3%, but with lower odds of reinfection among those treated in recent years or using IFN-free DAA therapy. Lower odds of reinfection among those treated in recent years can possibly be explained by a lower prevalence of HCV infection in the population due to the scale-up of DAA since 2014. The study found no differences in odds of reinfection when comparing IFN-treated (±DAAs) in 2014 or later with those who had received IFN-free DAA therapy in the same period. Hence, this data do not indicate that the ease of short, well-tolerated and effective DAA therapy compared with IFN-based therapy leads to increased risk of disinhibition and high rates of HCV reinfection after DAA therapy in this population.