2229. Low Hepatitis C Virus Reinfection Rates After Sustained Viral Response in HIV Co-infected Patients in Houston, Texas

Abstract

Background. Hepatitis C Virus (HCV) infection is a signifcant public health problem associated with a high morbidity and mortality. HCV recurrence is a particular concern in patients with ongoing high-risk behaviors. Previous studies have shown a wide variation in HCV reinfection rates, but have considered small selected populations. The aim of our study was to estimate the HCV reinfection rates in a representative real-world cohort of HCV/HIV co-infected patients in Houston, Texas and to compare it with published data. Methods. Retrospective cohort study of HCV/HIV co-infected patients treated between January 2004 to July 2016 at a freestanding HIV clinic that serves indigent and minority patients. HCV reinfection was defned as a single detectable HCV RNA level afer achieving SVR 12. We reviewed demographic data, risk behaviors, laboratory tests and treatment outcomes. Cox proportional hazards regression was used to estimate reinfection rates. A meta-analysis was performed to calculate the reinfection rates reported in the literature in diferent patient populations. Results. Of 288 patients treated, 187 (65%) achieved SVR12 by the end of the study. Follow-up data were available in 151 (81%) patients. Median follow-up time afer SVR12 was 1.26 (0.66, 2.13) years. Afer achieving SVR12, two patients became reinfected, with a reinfection rate of 10.8 (1.3-39.1) per 1,000 PYFU. Our meta analysis demonstrated higher reinfection rates in diferent populations (87.8 (60.9-127) per 1,000 PYFU in MSM; 65.6 (34.1-126) per 1,000 PYFU in IVDU and 13.5 (10.4-17.5) per 1,000 PYFU in non-IVDU). In our patient population, the mean time from SVR12 to reinfection was 52.5 weeks, and reinfection was with the same HCV genotype. Both patients were MSM and reported high-risk sexual behavior; one patient also developed syphilis. Both patients have been retreated. One has achieved SVR12 and the other has successfully completed treatment and is awaiting SVR12 check-up in the following weeks. Conclusion. The reinfection rate in our diverse cohort of HIV/HCV treated patients is very low compared with others studies. Eforts to reduce risk behaviors are important if HCV elimination is to be achieved.