Understanding hepatitis C virus reinfections in England in the context of eliminating viral hepatitis as a public health concern

Background

There is a need to understand how hepatitis C virus (HCV) reinfection may influence achievement of eliminating HCV as a public health concern. We aimed to understand how the rate of HCV reinfection is changing over time, and factors associated with HCV reinfection, when including people who experience multiple reinfections.

Methods

Data pertaining to individuals treated for HCV and subsequent HCV-RNA testing were extracted from surveillance systems in England. Rates of reinfection were calculated per 100 person-years (PY) between 2018 and 2023, disaggregated by people who had a history of injecting drug use (≥3 years) at first treatment, and recently injected drugs (<3 years), and by time since treatment. Poisson regression was used to understand sociodemographic factors associated with experiencing HCV reinfection.

Results

Among 29,448 individuals (74 % men, 84 % White), the reinfection rate was 6.44 (95 %CI:6.25–6.92)/100 PY. Reinfection rates appeared to decrease between 2018–2023, most notably among people who recently injected drugs. Rates among those less than one-year post-treatment remained consistently high. Poisson regression analyses found significantly higher reinfection rates among those one-year post-treatment (61.91 [57.62–66. 51]/100 PY), people who recently injected drugs (11.53 [11.11–11.95]/100 PY), and men (9.91 [9.38–10.46]/100 PY) and women (10.58 [9.36–11.96]/100 PY) who had been in prison.

Conclusions

HCV reinfection appeared to decrease over the study period, but people were most at risk in the year post-treatment, which remained constant over time. Harm reduction services should be accessible to people who inject drugs and people who have been in prison, particularly soon after treatment.