Frequent HCV reinfection and superinfection in a cohort of injecting drug users in Amsterdam☆

Background/Aims

This study investigates the occurrence of HCV reinfection and superinfection among HCV seroconverters participating in the Amsterdam Cohort Studies among drug users from 1985 through 2005.

Methods

HCV seroconverters (n=59) were tested for HCV RNA at five different time points: the last visit before seroconversion (t=−1), the first visit after seroconversion (t=1), six months after (t=2) and one year after (t=3) seroconversion, and the last visit prior to November 2005 (t=4). If HCV RNA was present, part of the NS5B region was amplified and sequenced. Additional phylogenetic analysis and cloning was performed to establish HCV reinfection and superinfection.

Results

Multiple HCV infections were detected in 23/59 (39%) seroconverters; 7 had HCV reinfections, 14 were superinfected, and 2 had reinfection followed by superinfection. At the moment of HCV reinfection, 7/9 seroconverters were HIV-negative: persistent HCV reinfection developed in both HIV-positive cases but also in 4/7 HIV-negative cases. In total, we identified 93 different HCV infections, varying from 1 to 4 infections per seroconverter. Multiple HCV infections were observed in 10/24 seroconverters with spontaneous HCV clearance (11 reinfections, 3 superinfections) and in 13/35 seroconverters without viral clearance (20 superinfections).

Conclusions

HCV reinfection and superinfection are common among actively injecting drug users. This might further complicate the development of an effective HCV vaccine.

Abbreviations: ACS, Amsterdam cohort studies, DU, drug users, HCV, hepatitis C virus, HIV, human immunodeficiency virus, PCR, polymerase chain reaction, PY, person years

Keywords: HCV, Reinfection, Superinfection, Epidemiology, Phylogeny, Injecting drug use, Immune protection