Incidence, Risk factors and Prevention of Hepatitis C Reinfection Interview with:
Naveed Zafar Janjua, MBBS, MSc, DrPH
Senior Scientist, Clinical Prevention Services
BC Centre for Disease Control
Clinical Associate Professor, School of Population and Public Health
University of British Columbia What is the background for this study?

Response: Hepatitis C is a viral infection that affects the liver. About quarter of people infected with hepatitis C clear their infection spontaneously rest develop chronic infection. Left untreated, hepatitis C could results in scarring of liver (liver cirrhosis), liver cancer or death. New anti-viral drugs are highly effective in curing hepatitis C, about than 95 per cent of those treated can be cured. However, people who engage in high risk activities such as people who inject drugs (PWID) remain at risk of reinfection. As the cost of treatment is very high, re-infection is a concern among physicians and policy makers in Canada and around the world. What are the main findings?

Response: The Hepatitis Team at the BC Centre for Disease Control (BCCDC), using its landmark cohort, BC Hepatitis Testers Cohort (BC-HTC), conducted a study to assess the role of various interventions in preventing hepatitis C reinfection among PWID. In the largest study in the World on hepatitis C reinfection, we monitored reinfection among 5,915 cases of hepatitis C who cleared their first infection either spontaneously or after successful anti-viral therapy. People were followed up for a median of 5.4 years. Of 5915 individuals who cleared their primary infection, 452 (8%) developed reinfection.

People who cleared their infection spontaneously without treatment, those co-infected with HIV, and injection drug users had higher risk of reinfection.

Among cases with a history of current injection drug use, opioid substitution therapy reduces risk of reinfection by 27% while engagement with mental health counsellng services was associated with a 29% lower risk of reinfection. What should readers take away from your report?

Response: Risk of hepatitis C reinfection is high among those who spontaneously cleared infection, people who inject drugs and those co-infected with HIV. PWIDs and those co-infected with HIV were less likely to be treated with toxic, less tolerated older interferon-based treatments. Highly effective, short course and well tolerated direct acting agents have opened up opportunities for treatment of these groups. However, that also means, if they continue to engage in high risk activities, hepatitis C infection reinfection will increase in these groups. In this study, we have shown the value of opioid substitution therapy and mental health support in reducing the reinfection risk in people who inject drugs.

Thus, harm reduction interventions accompanying hepatitis C treatment could prevent hepatitis C reinfection and realize the goal of hepatitis C elimination. What recommendations do you have for future research as a result of this study?

Response: In this study, we were not able to assess reinfection in new drugs era that needs to be investigated. We were also not able to assess role of needle and syringe exchange/ distribution programs on reinfection risk along with other interventions. Opioid substitution therapy works for opioid related addictions, there is need for investigation of reinfection among those using stimulants such as cocaine and methamphetamine and impact of interventions on reducing reinfection among those using stimulants. Is there anything else you would like to add?

Response: Hepatitis C is a chronic viral infection of the liver affecting about 180 million people worldwide. Approximately one per cent of British Columbians are infected with hepatitis C. New infections mainly occur in PWID.

The BC Hepatitis Testers Cohort (BC-HTC) brings together data on all laboratory test results, doctor visits, hospital stays, cancer treatment, prescription drug information for people in BC who has been tested for hepatitis C (HCV), human immunodeficiency virus (HIV) or tested positive for tuberculosis or hepatitis B. Further details and research based on the BC-HTC available at: Thank you for your contribution to the community.


Islam N, Krajden M, Shoveller J, Gustafson P, Gilbert M, Wong J, Buxton JA, Tyndall MW, Janjua NZ. Incidence, risk factors, and prevention of hepatitis C reinfection: a population-based cohort study. Lancet Gastroenterology & Hepatology 2016

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on December 27, 2016 by Marie Benz MD FAAD