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Reinfection by HCV following effective all-oral DAA therapy in HIV/HCV-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
CONCISE COMMUNICATION (CLINICAL): PDF Only

Objectives: We analyzed HCV reinfection among participants in a prospective registry of HIV/HCV-coinfected patients treated with all-oral DAA-based therapy in the region of Madrid.

Design: Observational cohort study.

Methods: The study period started on the date SVR was confirmed. The censoring date was December 31, 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 2,359 HIV/HCV-coinfected patients (0.72%) overall, in 12 of 177 (6.78%) men who have sex with men MSM, and in 5 of 1,459 (0.34%) people who inject drugs (PWID). The incidence of reinfection (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 14.86 weeks (IQR 13.43–25.71) 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, 7 used chemsex, 6 reported fisting, and 4 practiced slamming. A concomitant STI was detected in 5 patients. Four IDU with reinfection reported injecting drugs following SVR.

Conclusions: 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, Madrid, Spain

bSubdirección General de Farmacia y Productos Sanitarios/SERMAS, Madrid, Spain

cInstituto de Salud Carlos III, Madrid, Spain

dHospital Universitaro La Paz/IdiPAZ, Madrid, Spain

eHospital Universitario 12 de Octubre/i+12, Madrid, Spain

fHospital Clínico Universitario San Carlos, Madrid, Spain

gHospital Universitario de la Princesa, Madrid, Spain

hHospital Universitario Infanta Leonor, Madrid, Spain

iFundación Hospital de Alcorcón, Alcorcón, Spain

jHospital del Henares, Coslada, Spain.

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, 28007 Madrid, Spain. Tel: +34 91 586 8592; fax: +34 91 426 5177; e-mail: jbb4@me.com

Received 17 September, 2018

Accepted 30 October, 2018

Copyright © 2019 Wolters Kluwer Health, Inc.