Reinfection following successful direct-acting antiviral therapy for hepatitis C virus infection among people with recent injecting drug use: the SHARP-C study

Joshua Ang¹, Behzad Hajarizadeh¹, Shane Tillakeratne¹, Gregory J Dore¹, Carla Treloar², Janaki Amin³, Jodi van Dyk¹, Louisa Degenhardt⁴, Tanya Applegate¹, Adrian Dunlop⁵, Chris Fraser⁶, Brian Conway⁷, Alexander Wong⁸, Dennaye Fuchs⁹, Jeff Powis¹⁰, Kate Mason¹¹, Edward J Gane¹², Martin Weltman¹³, Phillip Read¹⁴, Marianne Martinello¹⁵, Emily Rowe¹⁶, David A Baker¹⁷, Alexandra Wade¹⁸, Gail Matthews¹, Lise Lafferty¹, Andrew Lloyd¹, Jason Grebely¹, Evan B Cunningham¹⁹

Affiliations

¹ Kirby Institute, UNSW, Sydney, NSW, Australia.
² Centre for Social Research in Health, UNSW, Sydney, 2052, NSW, Australia.
³ Macquarie University, Sydney, NSW, Australia.
⁴ National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.
⁵ Drug & Alcohol Clinical Services, Hunter New England Health, & University of Newcastle, Newcastle, NSW, Australia; Drug & Alcohol Clinical Research & Improvement, St Leonards, NSW, Australia.
⁶ Cool Aid Community Health Center, Victoria, BC, Canada.
⁷ Vancouver Infectious Diseases Centre, Vancouver, BC, Canada.
⁸ Department of Medicine, University of Saskatchewan, Regina, SK, Canada.
⁹ ID Clinic, Saskatchewan Health Authority, Regina, SK, Canada.
¹⁰ Michael Garron Hospital, Toronto, ON, Canada.
¹¹ South Riverdale Community Health Centre, Toronto, ON, Canada.
¹² University of Auckland, Auckland, New Zealand.
¹³ Department of Gastroenterology and Hepatology, Nepean Hospital, Kingswood, Australia; Nepean Clinical School, University of Sydney, Kingswood, Australia.
¹⁴ Kirby Institute, UNSW, Sydney, NSW, Australia; Kirketon Road Centre, South Eastern Local Health District, Sydney, Australia.
¹⁵ Kirby Institute, UNSW, Sydney, NSW, Australia; Blacktown and Mt Druitt Hospital, Western Sydney Local Health District, Blacktown, NSW, Australia.
¹⁶ Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia; The University of Adelaide, Adelaide, SA, Australia.
¹⁷ East Sydney Doctors, Sydney, Australia.
¹⁸ Mid North Coast Liver Clinic, Mid North Coast Local Health District, Coffs Harbour, 2450, NSW, Australia; Drug and Alcohol Services, Mid North Coast Local Health District, Coffs Harbour, 2450, NSW, Australia.
¹⁹ Kirby Institute, UNSW, Sydney, NSW, Australia. Electronic address: ecunningham@kirby.unsw.edu.au.

PMID: 40554239
DOI: 10.1016/j.drugpo.2025.104859

Free article

Observational Study

Reinfection following successful direct-acting antiviral therapy for hepatitis C virus infection among people with recent injecting drug use: the SHARP-C study

Joshua Ang et al. Int J Drug Policy. 2025 Sep.

Free article

. 2025 Sep:143:104859.

doi: 10.1016/j.drugpo.2025.104859. Epub 2025 Jun 18.

Authors

Affiliations

¹ Kirby Institute, UNSW, Sydney, NSW, Australia.
² Centre for Social Research in Health, UNSW, Sydney, 2052, NSW, Australia.
³ Macquarie University, Sydney, NSW, Australia.
⁴ National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.
⁵ Drug & Alcohol Clinical Services, Hunter New England Health, & University of Newcastle, Newcastle, NSW, Australia; Drug & Alcohol Clinical Research & Improvement, St Leonards, NSW, Australia.
⁶ Cool Aid Community Health Center, Victoria, BC, Canada.
⁷ Vancouver Infectious Diseases Centre, Vancouver, BC, Canada.
⁸ Department of Medicine, University of Saskatchewan, Regina, SK, Canada.
⁹ ID Clinic, Saskatchewan Health Authority, Regina, SK, Canada.
¹⁰ Michael Garron Hospital, Toronto, ON, Canada.
¹¹ South Riverdale Community Health Centre, Toronto, ON, Canada.
¹² University of Auckland, Auckland, New Zealand.
¹³ Department of Gastroenterology and Hepatology, Nepean Hospital, Kingswood, Australia; Nepean Clinical School, University of Sydney, Kingswood, Australia.
¹⁴ Kirby Institute, UNSW, Sydney, NSW, Australia; Kirketon Road Centre, South Eastern Local Health District, Sydney, Australia.
¹⁵ Kirby Institute, UNSW, Sydney, NSW, Australia; Blacktown and Mt Druitt Hospital, Western Sydney Local Health District, Blacktown, NSW, Australia.
¹⁶ Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia; The University of Adelaide, Adelaide, SA, Australia.
¹⁷ East Sydney Doctors, Sydney, Australia.
¹⁸ Mid North Coast Liver Clinic, Mid North Coast Local Health District, Coffs Harbour, 2450, NSW, Australia; Drug and Alcohol Services, Mid North Coast Local Health District, Coffs Harbour, 2450, NSW, Australia.
¹⁹ Kirby Institute, UNSW, Sydney, NSW, Australia. Electronic address: ecunningham@kirby.unsw.edu.au.

PMID: 40554239
DOI: 10.1016/j.drugpo.2025.104859

Abstract

Background: Injecting drug use following treatment for hepatitis C virus (HCV) may result in reinfection, potentially reversing individual, and population benefits of HCV treatment. The aim of this study was to evaluate the incidence of HCV reinfection following successful direct acting antiviral (DAA) therapy among people with recent injecting drug use.

Methods: This analysis used data from an observational cohort study of people with recent injecting drug use (previous six months) following successful DAA treatment in Australia, Canada, and New Zealand. Participants were either recruited prior to commencing DAA therapy or after a documented sustained virological response (SVR). Participants were assessed three-monthly for HCV reinfection. Reinfection was defined as recurrence of virus distinct from the initial infecting strain or recurrence after confirmed cure at or after 12 weeks post-treatment. Person-time of observation and Cox proportional hazard models were used to calculate reinfection incidence and associated factors.

Results: Among 112 participants who contributed follow-up time at risk of reinfection (113 person-years of follow-up time), the median age was 43 years, 34 % were female, and 86 % reported injecting drug use in the month prior to enrolment. Eleven cases of reinfection were observed for an incidence of 9.7/100 person-years (95 % confidence interval [CI], 5.4-17.4) overall, 11.1/100 person-years (95 % CI, 6.1-20.0) among people who reported injecting drugs during follow-up, and 24.3/100 person-years (95 % CI, 7.8-75.3) among those who reported sharing needles/syringes during follow-up. All cases of HCV reinfection occurred among people reporting injecting drug use during the study.

Conclusions: The relatively high incidence of reinfection seen in this study underscores the importance of targeted harm reduction measures and monitoring for HCV reinfections within the first year following successful treatment among people who inject drugs. Additional research into integrated models of care incorporating harm reduction and supporting reducing risk of reinfection and HCV treatment are needed.

Keywords: Drug use; HCV; Injecting; Re-infection; Reinfection; Sequencing.

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Conflict of interest statement

Declaration of competing interest JG reports grants and personal fees from AbbVie, Abbott, bioLytical, Cepheid, Gilead Sciences, Hologic, and Roche. GJD has received research grants from AbbVie and Gilead Sciences. GM reports grants from ViiV and Janssen, received honororia from ViiV and Gilead and participated on a Data Safety Monitoring Board for ViiV. CT has received speakers’ fees from Abbvie and Gilead and research funding from Merck for research unrelated to this work. LL has received speaker fees from AbbVie Pty Ltd. ARL is supported by an NHMRC Practitioner Fellowship (1137587) and has received investigator-initiated research grants from Gilead Sciences and AbbVie Pty Ltd. LD has received investigator-initiated untied educational grants from Indivior, Mundipharma and Seqirus. AJD has received grants from Camurus AB and Indivior to Hunter New England Health who employ AJD for clinical research studies. CF has received honoraria from Indivior, Gilead, and ViiV; is on the speaker’s bureau for Master Clinician Alliance, which receives funding for CME activities from Indivior, and has received research grants from Abbvie, Canadian HIV Trials Network, Gilead, Merck, and ViiV. BC has received grants, honoraria, and consulting fees from AbbVie, Astra Zeneca, Gilead Sciences, GSK, Indivior Canada, Merck, Moderna, Sanofi Pasteur, Seqirus, and ViiV Healthcare. AW has received grants/honoraria from AbbVie, Gilead, Merck, and ViiV Healthcare. DF has received advisory fees from Gilead Sciences, Merck, and Abbvie. EJG received speaking fees from AbbVie and Gilead Sciences and participated in advisory boards for AbbVie, Aligos, Assembly, Gilead Sciences, GSK, Intellia, Janssen, Roche, Vir Biotechnology, Virion, and Vaccitech. MW has participated in ad boards and as a speaker for Abbvie, Roche, and MSD. PR has received research funding from Gilead Sciences, as well as institutional and individual honoraria from Gilead Sciences, Abbvie, and MSD. DAB. reports trial funding from Viiv Healthcare and MSD; participation on an Advisory Board for Gilead Sciences and AbbVie; and a leadership or fiduciary role as an advisor to Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM). All other authors have no potential conflicts to declare.

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Reinfection following successful direct-acting antiviral therapy for hepatitis C virus infection among people with recent injecting drug use: the SHARP-C study

Affiliations

Reinfection following successful direct-acting antiviral therapy for hepatitis C virus infection among people with recent injecting drug use: the SHARP-C study

Authors

Affiliations

Abstract

Conflict of interest statement

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Full Text Sources

Medical