@article {619878,
	title = {Hepatitis C Virus Reinfection after Successful Treatment with Direct-Acting Antiviral Therapy in a Large Population-Based Cohort},
	journal = {Journal of Hepatology},
	volume = {69},
	number = {5},
	year = {2018},
	note = {[[{"fid":"691898","view_mode":"default","type":"media","attributes":{"height":"100","width":"100","style":"float: left;","class":"wysiwyg-placeholder media-element file-default "}}]]},
	pages = {1007-14},
	publisher = {Elsevier},
	abstract = {Background \&amp; AimsDirect-acting antiviral therapies (DAA) are an important tool for hepatitis C virus (HCV) elimination. However, reinfection among people who inject drugs (PWID) may hamper elimination targets. We therefore estimated HCV reinfection rates among DAA-treated individuals, including PWIDs.MethodsWe analyzed data from the BC Hepatitis Testers Cohort which included \~{}1.7 million individuals screened for HCV in British Columbia, Canada. We followed HCV-infected individuals treated with DAAs who achieved a sustained virologic response (SVR) and had >=1 subsequent HCV RNA measurement to April 22nd, 2018. Reinfection was defined as a positive RNA measurement after SVR. PWIDs were identified using a validated algorithm and classified based on recent (\&lt;3 years) or former (>=3 years before SVR) use. Crude reinfection rates per 100 person-years (PYs) were calculated. Poisson regression was used to model adjusted incidence rate ratios (IRRs) and 95\% confidence intervals (CI).ResultsOf 4,114 individuals who met inclusion, most were male (n=2,692, 65\%), born before 1965 (n=3,411, 83\%) and were either recent (n=875, 21\%) or former PWIDs (n=1,793, 44\%). Opioid-agonist therapy (OAT) was observed in 19\% of PWIDs. We identified 40 reinfections during 2,767 PYs. Reinfection rates were higher among recent (3.1/100 PYs; IRR: 6.7, 95\% CI: 1.9, 23.5) and former PWIDs (1.4/100 PYs; IRR: 3.7, 95\% CI: 1.1, 12.9) than non-PWIDs (0.3/100 PYs). Among recent PWIDs, reinfection rates were higher among individuals born after 1975 (10.2/100 PYs) and those with co-infected with HIV (5.7/100 PYs). Only one PWID receiving daily OAT developed reinfection.ConclusionsPopulation-level reinfection rates remain elevated after DAA therapy among PWIDs because of ongoing exposure risk. Engagement of PWIDs in harm-reduction and support services is needed to prevent reinfections.Lay SummaryWe estimated HCV reinfection rates after successful treatment with direct-acting antiviral therapies. Our findings showed that the risk of reinfection was highest among people with recent injection drug use. Among people who inject drugs, daily use of opioid-agonist therapy was associated with a lower risk of reinfection.Keywords:Hepatitis C,\&nbsp;Direct-Acting Antiviral,\&nbsp;Reinfection,\&nbsp;Injection Drug Use,\&nbsp;Epidemiology,\&nbsp;Canada},
	isbn = {0168-8278},
	url = {https://www.journal-of-hepatology.eu/article/S0168-8278(18)32288-8/fulltext},
	author = {Rossi, Carmine and Butt, Zahid and Wong, Stanley and Buxton, Jane and Islam, Nazrul and Yu, Amanda and Darvishian, Maryam and Gilbert, Mark and Wong, Jason and Chapinal, Nuria and Binka, Mawuena and Alvarez, Maria and Tyndall, Mark and Krajden, Mel and Janjua, Naveed}
}
