Hcv Reinfection in Active Drug Users from Facts to Explanations and Possible Solutions
Authors:   Mobile Hepatitis Team, Perpignan Hospital, France, AJ Remy , Monte J Del , J Hervet , H Bouchkira , S Djazouli 
Published: March 2024

Background and Aims: Perpignan (in south of France) was 600 000 people very low-income area. Main sociological characteristics associated, many homeless and drugs users local insecurity therefore low-price cocaine, national attractiveness for consumers and traffickers, overconsumption with these lower price, local manufacture of cannabis and road transport effects redistribution of drugs purchased in Spain. This was the only place where coke rail was sold under 5 dollars, 50% lower than the price in the rest of France. Mobile hepatitis team (MHT) was created in 2013 and cured about 1000 HCV patients in an outreach and test to cure approach. MHT used HCV POCT, HCV real time viral load, liver fibrosis measure by FIBROSCAN and nurse DAA prescription. For 2 years, MHT observed increase of reinfections. Method: Observational and Sociological Study of HCV Reinfections. Results: In 2023, MHT (nurses (44%) and hepatologist (56%) prescriptions) treated 89 HCV patients: men 68%, mean age 46 years, reinfection rate 21%. This rate was higher (31%) in patients treated by nurses. They were younger, more often homeless, and active drugs users. A clinical psychological study by patients’ interview showed than reinfected patients were younger, lower educational level, more often homeless, with history of psychiatric illnesses and prison. There was no correlation with precariousness score. More the patient thinks that he was responsible for his illness, the more impulsive he was (dimension urgency emotional impulsiveness). More the patient was aware of the consequences of his illness, the more impulsive he was (dimension urgency emotional impulsivity). The more impulsive the patient was (total score, emergency emotional impulsivity dimension), higher the neuroticism score (negativist personality trait). We individualized 2 specific groups of reinfected patients : gypsies in prison and homeless in the city. More the patient participates in harm reduction workshops, the more he feels responsible for his illness and the consequences of his illness, with magical thoughts about his contamination. The paradoxical outcome was people reinfected had more risk and harm reduction sessions after first infection. There was no fear about DAA treatment as HCV interferon and ribavirin treatment. DAA are always well tolerated and efficient, even in reinfection. Conclusion: Direct-acting antivirals are an effective tool for the treatment of hepatitis C virus, enabling the elimination of the virus. However, some patients who have been successfully treated with direct-acting antivirals are at risk of reinfection. Our findings showed that the risk of reinfection was highest among people with ractive injection drug use..In low-income population exposed to cocaine and other low price drugs, HCV reinfection was a trivialized life event. For reduce it, MHT had set up 3 specific projects: 1. home screening in gypsy women and neighborhood 2. Peers fingersticks HCV screening in homeless people and orientation of HCV positive patients to MHT 3. Prison zero hepatitis program with all HCV inmates same time treatment. Combination of these projects reduced to 22% rate of HCV reinfection in active drugs users during first quarter of their deployment.