Reinfection by HCV following effective all-oral DAA therapy in HIV/HCV-coinfected individuals

OBJECTIVES:We analyzed HCV reinfection among participants in a prospective registry of HIV/HCV-coinfected patients treated with all-oral DAA-based therapy in the region of Madrid. DESIGN:Observational cohort study. METHODS:The study period started on the date SVR was confirmed. The censoring date was December 31, 2017. SVR was defined as negative HCV-RNA 12 weeks after completion of treatment. Reinfection was defined as a positive HCV-RNA test result after achievement of SVR. RESULTS:Reinfections were detected in 17 of 2,359 HIV/HCV-coinfected patients (0.72%) overall, in 12 of 177 (6.78%) men who have sex with men MSM, and in 5 of 1,459 (0.34%) people who inject drugs (PWID). The incidence of reinfection (95% CI) per 100 person-years was 0.48 (0.30–0.77) overall, 5.93 (3.37–10.44) for MSM, and 0.21 (0.09–0.52) for PWID. Reinfections were detected a median of 14.86 weeks (IQR 13.43–25.71) after SVR. In 10 (58.82%) patients, the reinfection was caused by a different HCV genotype. All 12 MSM with reinfection acknowledged unprotected anal intercourse with several partners, 7 used chemsex, 6 reported fisting, and 4 practiced slamming. A concomitant STI was detected in 5 patients. Four IDU with reinfection reported injecting drugs following SVR. CONCLUSIONS:HCV reinfection is a matter of concern in HIV-positive MSM treated with all-oral DAA therapy in the region of Madrid. Our data suggest that prevention strategies and frequent testing with HCV-RNA should be applied following SVR in MSM who engage in high-risk practices.