Is Injection Drug Use Associated with HCV Reinfection Among People Receiving Medications for Opioid Use Disorder?

Treatment of hepatitis C virus (HCV) with elbasvir–grazoprevir is safe and effective in people with injection drug use (IDU) who are receiving medications for opioid use disorder (MOUD; methadone, buprenorphine, or buprenorphine–naloxone). However, the likelihood of HCV reinfection in this population—and whether continued IDU following HCV treatment completion affects this likelihood—are not well understood. Researchers examined a cohort of adults with HCV receiving MOUD who completed elbasvir–grazoprevir treatment to examine the rate of HCV reinfection over a 3-year period. Participants were recruited from 13 countries, including the US.

• Among the 286 participants (604 person-years) included in analyses, the rate of HCV reinfection was 1.7 per 100-person years. Among participants who reported IDU in the last month (n=91; 212 person-years), the reinfection rate was higher (1.9 per 100 person-years).
• Risk for HCV reinfection was highest within 6 months of HCV treatment completion.
• More than 50 percent of participants had urine drug tests positive for substances other than MOUD, and approximately 20 percent reported IDU throughout the study period.

Comments: Among people who completed elbasvir–grazoprevir treatment for HCV, and received MOUD, HCV reinfection rates were low overall, despite the relatively high prevalence of continued IDU among participants. Risk of HCV reinfection was highest within 6 months of HCV treatment completion, suggesting that this period may be key for optimizing MOUD and ensuring access to needle and syringe services programs for people who complete HCV treatment and have IDU.

Carrie Mintz, MD

Reference: Grebely J, Dore GJ, Altice, FL et al. Reinfection and risk behaviors after treatment of hepatitis C virus infection in persons receiving opioid agonist therapy: a cohort study. Ann Intern Med. 2022;175(9):1221–1229.