Persistent Hepatitis C Reinfection in Injection Drug Users Who Have Cleared the Virus

Previous retrospective studies of injection drug users who resolved their hepatitis C infection (HCV) have reported high rates of acute reinfection. But the rate of clinically relevant persistent reinfection (i.e., more than one consecutive positive test for HCV RNA in people with resolved HCV) has not been measured prospectively.

To determine this rate, researchers in this study prospectively examined 224 people with hepatitis C infection, a history of injection drug use, and serial hepatitis C viral loads.

• Of 224 subjects followed for 1391 person-years, 38 resolved their infection.

• Of these 38 subjects, 29 resolved their infection spontaneously, and 9 resolved their infection after receiving HCV treatment.

• Fourteen of the spontaneous resolvers and 2 of the treatment-associated resolvers continued to inject drugs during follow-up.

• Only 1 of the 38 subjects with a resolved infection (a subject who had spontaneous resolution, continued to inject drugs, and also had HIV) had persistent hepatitis C reinfection.

Comments:

Persistent reinfection with hepatitis C in people who have resolved the infection, even in those with ongoing injection drug use, appears to be less common than suggested by previously published reports. However, determining a more certain rate of hepatitis C reinfection among injection drug users will require larger studies.

Alexander Y. Walley, MD, MSc

Reference:

Currie SL, Ryan JC, Tracy D, et al. A prospective study to examine persistent HCV reinfection in injection drug users who have previously cleared the virus. Drug Alcohol Depend. 2008:93:(1-2):148–154.