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Reinfection by hepatitis C virus following effective all-oral direct-acting antiviral drug therapy in HIV/hepatitis C virus coinfected individuals

Berenguer, Juana; Gil-Martin, Ángelab; Jarrin, Inmaculadac; Montes, María L.d; Domínguez, Lourdese; Aldámiz-Echevarría, Teresaa; Téllez, María J.f; Santos, Ignaciog; Troya, Jesúsh; Losa, Juan E.i; Serrano, Reginoj; De Guzmán, María T.k; Calvo, María J.b; González-García, Juan J.d the Madrid-CoRe Study Group

doi: 10.1097/QAD.0000000000002103

Objectives: We analysed hepatitis C virus (HCV) reinfection among participants in a prospective registry of HIV/HCV-coinfected patients treated with all-oral direct-acting antiretroviral (DAA)-based therapy in the region of Madrid.

Design: An observational cohort study.

Methods: The study period started on the date sustained viral response (SVR) was confirmed. The censoring date was 31 December 2017. SVR was defined as negative HCV-RNA 12 weeks after completion of treatment. Reinfection was defined as a positive HCV-RNA test result after achievement of SVR.

Results: Reinfections were detected in 17 of 2359 HIV/HCV-coinfected patients (0.72%) overall, in 12 out of 177 (6.78%) MSM and in five out of 1459 (0.34%) people who inject drugs (PWID). The incidence of reinfection [95% confidence interval (95% CI)] per 100 person-years was 0.48 (0.30–0.77) overall, 5.93 (3.37–10.44) for MSM and 0.21 (0.09–0.52) for PWID. Reinfections were detected a median of 15 weeks (interquartile range 13–26) after SVR. In 10 (58.82%) patients, the reinfection was caused by a different HCV genotype. All 12 MSM with reinfection acknowledged unprotected anal intercourse with several partners, seven used chemsex, six reported fisting and four practiced slamming. A concomitant STI was detected in five patients. Four IDU with reinfection reported injecting drugs following SVR.

Conclusion: HCV reinfection is a matter of concern in HIV-positive MSM treated with all-oral DAA therapy in the region of Madrid. Our data suggest that prevention strategies and frequent testing with HCV-RNA should be applied following SVR in MSM who engage in high-risk practices.

aHospital General Universitario Gregorio Marañón/IiSGM

bSubdirección General de Farmacia y Productos Sanitarios/SERMAS

cInstituto de Salud Carlos III

dHospital Universitaro La Paz/IdiPAZ

eHospital Universitario 12 de Octubre/i+12

fHospital Clínico Universitario San Carlos

gHospital Universitario de la Princesa

hHospital Universitario Infanta Leonor, Madrid

iFundación Hospital de Alcorcón, Alcorcón

jHospital del Henares, Coslada

kHospital Infanta Cristina, Parla, Spain.

Correspondence to Juan Berenguer, MD, PhD, Unidad de Enfermedades Infecciosas/VIH (4100), Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Doctor Esquerdo 46, Madrid 28007, Spain. Tel: +34 91 586 8592; fax: +34 91 426 5177; e-mail:

Received 17 September, 2018

Accepted 30 October, 2018

Copyright © 2019 Wolters Kluwer Health, Inc.