Hepatitis C Virus Reinfection in People With HIV in Taiwan After Achieving Sustained Virologic Response With Antiviral Treatment: The RECUR Study

Abstract

Background

Data on hepatitis C virus (HCV) reinfection in East Asian people with HIV after treatment-induced sustained virologic response (SVR) are limited.

Methods

HIV/HCV-coinfected patients in Taiwan who achieved SVR ₁₂ with interferon (IFN) or direct-acting antivirals (DAAs) between 2005 and 2021 underwent HCV RNA measurements at SVR ₂₄ and then biannually. HCV reinfection was defined as the detection of different HCV strains beyond SVR ₁₂. HIV-negative, low-risk individuals with SVR ₁₂ served as reference patients. Crude reinfection rates and secular trends were assessed. Multivariate Cox regression analysis was performed to identify baseline factors associated with HCV reinfection.

Results

A total of 216 HIV-positive and 1589 reference patients were recruited, with median follow-up durations of 3.0 and 6.0 years, respectively. During a total of 772 person-years of follow-up (PYFU), the HCV reinfection rate in HIV-positive patients was 4.02 per 100 PYFU (95% CI, 2.85–5.65), while the HCV reinfection rate in reference patients was 0.14 per 100 PYFU (95% CI, 0.09–0.23) during 10 862 PYFU. HIV-positive patients had a higher risk of HCV reinfection than reference patients (hazard ratio [HR], 17.63; 95% CI, 7.10–43.80; P < .001). No baseline factors were predictive of HCV reinfection in HIV-positive patients. The incidence of HCV reinfection in HIV-positive patients increased after 2015, when DAAs were made available in Taiwan.

Conclusions

The risk of HCV reinfection remains high in HIV/HCV-coinfected patients with treatment-induced SVR ₁₂. In addition to mass screening and treatment scale-up, strategies to reduce reinfection are needed for HCV microelimination in HIV-positive patients in Taiwan.