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. 2009 Oct 15;200(8):1216-26.
doi: 10.1086/605947.

Acute hepatitis C virus infection in young adult injection drug users: a prospective study of incident infection, resolution, and reinfection

Kimberly Page  1 , Judith A Hahn, Jennifer Evans, Stephen Shiboski, Paula Lum, Eric Delwart, Leslie Tobler, William Andrews, Lia Avanesyan, Stewart Cooper, Michael P Busch
Affiliations

Acute hepatitis C virus infection in young adult injection drug users: a prospective study of incident infection, resolution, and reinfection

Kimberly Page et al. J Infect Dis. .

Abstract

Background: Hepatitis C virus (HCV) infection, clearance, and reinfection are best studied in injection drug users (IDUs), who have the highest incidence of HCV and are likely to represent most infections.

Methods: A prospective cohort of HCV-negative young IDUs was followed up from January 2000 to September 2007, to identify acute and incident HCV and prospectively study infection outcomes.

Results: Among 1,191 young IDUs screened, 731 (61.4%) were HCV negative, and 520 (71.1%) of the 731 were enrolled into follow-up. Cumulative HCV incidence was 26.7/100 person-years of observation (95% confidence interval [CI], 21.5-31.6). Of 135 acute/incident HCV infections, 95 (70.4%) were followed; 20 (21.1%) of the 95 infections cleared. Women had a significantly higher incidence of viral clearance than did men (age-adjusted hazard ratio, 2.91 [95% CI, 1.68-5.03]) and also showed a faster rate of early HCV viremia decline (P < .01). The estimated reinfection rate was 24.6/100 person-years of observation (95% CI, 11.7-51.6). Among 7 individuals, multiple episodes of HCV reinfection and reclearance were observed.

Conclusions: In this large sample of young IDUs, females show demonstrative differences in their rates of viral clearance and kinetics of early viral decline. Recurring reinfection and reclearance suggest possible protection against persistent infection. These results should inform HCV clinical care and vaccine development.

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Conflict of interest statement

Conflict of interest: William Andrews is employed by Novartis Vaccines & Diagnostics. No other authors have any financial conflicts of interest

Figures

Figure 1
Figure 1
Enrollment and prospective follow up of incident HCV infection, and infection outcome of young injection drug users in the UFO-3 Study
Figure 2
Figure 2
Estimated HCV viral persistence probability (in months) among young injection drug users with incident HCV infection. The shaded area shows the 95% confidence interval accounting for uncertainties in both time of infection and time of clearance.
Figure 3
Figure 3
Estimated HCV viral persistence probabilities (in months) among female and male young injection drug users with incident HCV infection.
Figure 4
Figure 4
HCV viral load declines (log iμ/ml/month) in the first 6 months after detection of incident HCV infection among female and male injection drug users by infection outcome (clearance or chronic infection).
Figure 5
Figure 5
Genotype (GT), HCV RNA and anti-HCV results showing acute HCV infection, reinfection and re-clearance among young injection drug users who have previously cleared HCV infection. Visit dates are shown in the lower boxes. Gray boxes (formula image) show new acute HCV infections and reinfections. Participants whose first infection serology was consistent with previously resolved infection (anti-HCV positive and HCV RNA negative) are shown with gray stippled boxes (formula image).
See this image and copyright information in PMC

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