Reinfection with the hepatitis C virus (HCV) has been described in patients with ongoing risk behaviour. Among men who have sex with men (MSM), users of intravenous (IDU) and non-intravenous drugs (mainly methamphetamine) for sexual enhancement (Chemsex) have been identified as a main risk group for HCV acquisition. The frequency of HCV reinfections after treatment with direct-acting antivirals (DAA) is not known. Here, we analysed the reinfection incidence rate in HCV mono-infected and HIV/HCV co-infected MSM or patients with IDU from the German hepatitis C cohort (GECCO).
Until September 2017, 2364 DAA treatment courses of HIV/HCV co-infected and HCV mono-infected patients from 9 hepatitis centers have been included in the GECCO database since February 2014. All patients who completed HCV antiviral therapy were included in our current analysis. A reinfection was diagnosed in patients with a detectable HCV viral load who previously achieved a sustained virological response 12 weeks after the end of treatment, or with evidence for a genotype switch.
In total, 32/1960 patients (0.02%) had an HCV reinfection. The follow-up time for the entire cohort was 1141 person-years (median follow-up time 26 weeks per patient; range 4-205 weeks), indicating an HCV reinfection incidence of 2.8 per 100 person-years. All patients with an HCV reinfection were male, the mean age was 48 years (standard deviation 8.6 years), 3 (9.4%) suffered from liver cirrhosis, 26/32 (81.25%) had an HCV/HIV co-infection, 25 patients (78.1%) were MSM and 7 patients reported IDU (21.9%). Importantly, 8/25 (32%) MSM were occasional IDU. The median time from end of anti-HCV treatment to the diagnosis of the HCV reinfection was 53 weeks (range 2-115). A genotype switch occurred in 14/32 patients (44%). The reinfection rate in patients with IDU was 1.0% (7/710) during 390 person-years. Thus, the incidence of an HCV reinfection in patients with IDU was 1.8 per 100 person years. The reinfection rate in patients with MSM was 11.2% (25/223) during 175 person-years, indicating an incidence for an HCV reinfection of 14.3 per 100 person-years.
The overall incidence of an HCV reinfection in our large multicenter cohort remained low. However, patients with ongoing risk behaviour displayed an increased incidence for an HCV reinfection, in particular men who have sex with men.