Hepatitis C virus reinfection in patients on haemodialysis after achieving sustained virologic response with antiviral treatment

Background: Data are limited regarding the risk of hepatitis C virus (HCV) reinfection after treatment-induced sustained virologic response (SVR) in patients on haemodialysis. Aims: To assess the risk of HCV reinfection among patients on haemodialysis with treatment-induced SVR. Methods: Patients on haemodialysis patients who achieved SVR₁₂ with interferon (IFN) or direct-acting antiviral (DAA)-based treatment received follow-up at SVR₂₄ and then biannually with HCV RNA measurements. HCV reinfection was defined as the resurgence of viremia by different viral strains beyond SVR₁₂. The low-risk general population who achieved SVR₁₂ and who underwent the same post-SVR₁₂ surveillance served as the reference group. Crude reinfection rates per 100 person-years (PYs) were calculated. Multivariate Cox regression analysis was performed to estimate the relative risk of HCV reinfection between the two groups. Results: We recruited 374 patients on haemodialysis and 1571 reference patients with a mean post-SVR₁₂ follow-up of 4.7 and 6.1 years. All haemodialysis patients who achieved SVR₁₂ also achieved SVR₂₄. The incidence rates of HCV reinfection were 0.23 per 100 PYs (95% confidence interval [CI]: 0.09-0.59) in haemodialysis patients and 0.16 per 100 PYs (95% CI: 0.10-0.26) in the reference group. The risk of HCV reinfection in patients on haemodialysis was comparable to that in the reference patients (hazard ratio [HR]: 1.39; 95% CI: 0.44-4.38, P = 0.57). Conclusions: The risk of HCV reinfection in patients on haemodialysis who achieve SVR₁₂ is low and comparable to that in the low-risk general population. HCV microelimination in this special population is feasible once universal screening and scaled-up treatment are implemented.