Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.
J Hepatol. 2016 May;64(5):1020-1026. doi: 10.1016/j.jhep.2016.01.001. Epub 2016 Jan 11.
BACKGROUND & AIMS: On-going risk behaviour can lead to hepatitis C virus (HCV) reinfection following successful treatment. We aimed to assess the incidence of persistent HCV reinfection in a population of people who inject drugs (PWID) who had achieved sustained virological response (SVR) seven years earlier.
In 2004-2006 we conducted a multicentre treatment trial comprising HCV genotype 2 or 3 patients in Sweden, Norway and Denmark (NORTH-C). Six months of abstinence from injecting drug use (IDU) was required before treatment. All Norwegian patients who had obtained SVR (n=161) were eligible for participation in this long-term follow-up study assessing virological and behavioural characteristics.
Follow-up data were available in 138 of 161 (86%) individuals. Persistent reinfection was identified in 10 of 94 (11%) individuals with a history of IDU prior to treatment (incidence rate 1.7/100 person-years (PY); 95% CI 0.8-3.1) and in 10 of 37 (27%) individuals who had relapsed to IDU after treatment (incidence rate 4.9/100 PY; 95% CI 2.3-8.9). Although relapse to IDU perfectly predicted reinfection, no baseline factor was associated with reinfection. Relapse to IDU was associated with age <30 years (vs. ⩾40 years) at treatment (adjusted odds ratio [aOR] 7.03; 95% CI 1.78-27.8) and low education level (aOR 3.64; 95% CI 1.44-9.18).
Over time, persistent HCV reinfection was common among individuals who had relapsed to IDU after treatment. Reinfection should be systematically addressed and prevented when providing HCV care for PWID.
持续的风险行为可能导致丙型肝炎病毒（HCV）在成功治疗后再次感染。本研究旨在评估 7 年前获得持续病毒学应答（SVR）的吸毒人群（PWID）中持续 HCV 再感染的发生率。
2004-2006 年，我们在瑞典、挪威和丹麦（NORTH-C）进行了一项多中心治疗试验，纳入 HCV 基因型 2 或 3 的患者。治疗前需戒断 6 个月的静脉吸毒（IDU）。所有获得 SVR 的挪威患者（n=161）均有资格参加这项长期随访研究，以评估病毒学和行为特征。
161 例患者中有 138 例（86%）可获得随访数据。在治疗前有 IDU 史的 94 例患者中有 10 例（11%）发生持续性再感染（发病率为 1.7/100 人年；95%CI 0.8-3.1），在治疗后重新开始 IDU 的 37 例患者中有 10 例（27%）发生再感染（发病率为 4.9/100 人年；95%CI 2.3-8.9）。尽管 IDU 的复发可以完美预测再感染，但没有基线因素与再感染相关。IDU 的复发与治疗时年龄<30 岁（vs. ⩾40 岁）（校正比值比[aOR] 7.03；95%CI 1.78-27.8）和低教育程度（aOR 3.64；95%CI 1.44-9.18）相关。
随着时间的推移，在治疗后重新开始 IDU 的患者中，持续的 HCV 再感染很常见。在为 PWID 提供 HCV 护理时，应系统地解决和预防再感染。
