Incidence and spontaneous clearance of hepatitis C (HCV) in PWID at the Stockholm needle exchange - importance for HCV elimination

Article: Incidence and spontaneous clearance of hepatitis C (HCV) in PWID at the Stockholm needle exchange – importance for HCV elimination—M. Kaberg, et. al.

Source: J Viral Hepat. 2018 Jul 11. doi: 10.1111/jvh.12969. [Epub ahead of print]

Study Aims and Results: The aim of the study was to understand the incidence, spontaneous viral clearance, predictors of new and re-infection of hepatitis C (HCV) among people who inject drugs (PWID) in Sweden.

The trial enrolled 2,320 patients between 2013 and 2016. The people were tested at baseline and answered questions regarding sociodemographic and injection risk behavior. Testing for HCV was repeated every 3 to 6 months.

At the beginning of the study, there were 100 study participants, 77% were HCV antibody positive, and 54% were HCV RNA (viral load) positive. Twenty-four percent (24%) were HCV antibody positive but HCV viral load negative indicating spontaneously HCV viral load clearance.

There was a high incidence of new HCV infections noted. The high rate of new infections was due to the sharing of needles and drug use equipment.

There were no significant differences between the two groups who became infected with HCV. However, there was a significant difference in the spontaneous clearance of HCV in the naïve (never been infected) group (20%) compared to the group who had previously spontaneously cleared the virus (44%).

Conclusions: In this study, there was a high rate of new infections. The authors noted that HCV infections among PWIDs would continue to rise. They also noted that increased harm reduction measures, more comprehensive needle exchange programs, effective drug treatment programs, and scaling up HCV treatment are needed to eliminate HCV.

Editorial Comments: The authors’ conclusions are not surprising. They pointed out that more treatment and services are needed to eliminate or even greatly reduce the prevalence of HCV in Sweden.

Note: the higher rate of spontaneous clearance of HCV among the people who had previously spontaneously cleared the virus has been noted in previous studies.