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Thématique :
- Foie
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Docteur Jean-Louis PAYEN
Coup de coeur :
 
 
Journal of Hepatology
  2018/11  
 
  2018 Nov;69(5):1007-1014.  
  doi: 10.1016/j.jhep.2018.07.025  
 
  Hepatitis C virus reinfection after successful treatment with direct-acting antiviral therapy in a large population-based cohort  
 
  Rossi C, Butt ZA, Wong S, Buxton JA, Islam N, Yu A, Darvishian M, Gilbert M, Wong J, Chapinal N, Binka M, Alvarez M, Tyndall MW, Krajden M, Janjua NZ; BC Hepatitis Testers Cohort Team.  
  https://www.ncbi.nlm.nih.gov/pubmed/30142429  
 
 

Abstract

BACKGROUND & AIMS:

Direct-acting antiviral therapies (DAA) are an important tool for hepatitis C virus (HCV) elimination. However, reinfection among people who inject drugs (PWID) may hamper elimination targets. Therefore, we estimated HCV reinfection rates among DAA-treated individuals, including PWID.

METHODS:

We analyzed data from the British Columbia Hepatitis Testers Cohort which included ∼1.7 million individuals screened for HCV in British Columbia, Canada. We followed HCV-infected individuals treated with DAAs who achieved a sustained virologic response (SVR) and had ≥1 subsequent HCV RNA measurement to April 22nd, 2018. Reinfection was defined as a positive RNA measurement after SVR. PWID were identified using a validated algorithm and classified based on recent (<3 years) or former (≥3 years before SVR) use. Crude reinfection rates per 100 person-years (PYs) were calculated. Poisson regression was used to model adjusted incidence rate ratios (IRRs) and 95% CIs.

RESULTS:

Of 4,114 individuals who met the inclusion criteria, most were male (n = 2,692, 65%), born before 1965 (n = 3,411, 83%) and were either recent (n = 875, 21%) or former PWID (n = 1,793, 44%). Opioid-agonist therapy (OAT) was received by 19% of PWID. We identified 40 reinfections during 2,767 PYs. Reinfection rates were higher among recent (3.1/100 PYs; IRR 6.7; 95% CI 1.9-23.5) and former PWID (1.4/100 PYs; IRR 3.7; 95% CI 1.1-12.9) than non-PWID (0.3/100 PYs). Among recent PWID, reinfection rates were higher among individuals born after 1975 (10.2/100 PYs) and those co-infected with HIV (5.7/100 PYs). Only one PWID receiving daily OAT developed reinfection.

CONCLUSIONS:

Population-level reinfection rates remain elevated after DAA therapy among PWID because of ongoing exposure risk. Engagement of PWID in harm-reduction and support services is needed to prevent reinfections.

LAY SUMMARY:

Direct-acting antivirals are an effective tool for the treatment of hepatitis C virus, enabling the elimination of the virus. However, some patients who have been successfully treated with direct-acting antivirals are at risk of reinfection. Our findings showed that the risk of reinfection was highest among people with recent injection drug use. Among people who inject drugs, daily use of opioid-agonist therapy was associated with a lower risk of reinfection.

 
Question posée
 
Réinfection par le virus de l'hépatite C après un traitement efficace par une thérapie à action directe dans une large cohorte.
 
Question posée
 
Les taux de réinfection étaient plus élevés chez les patients récemment infectés (3,1 / 100 AP; RIR 6,7; IC à 95% de 1,9-23,5,5) en comparaison avec les patients anciennement contaminés (1,4 / 100 AP; RI 3,7; IC à 95% 1,1 à 12,9). Parmi les patients ayant une consommation de drogues IV récente, les taux de réinfection étaient plus élevés chez les personnes nées après 1975 (10,2 / 100 AP) et les personnes co-infectées par le VIH (5,7 / 100 AP).
 
Commentaires

Cette étude confirme le risque élevé de re-contamination comme déjà observé dans des travaux antérieurs, avec des chiffres proches. Ces travaux justifient un travail de prise en charge de ces patients pas uniquement hépatologique mais également sur la prise en charge des conduites addictives.

 
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