Sexual and drug use risk behaviour trajectories among people treated for recent HCV infection: the REACT study

Joanne M Carson; Sebastiano Barbieri; Evan Cunningham; Eric Mao; Marc van der Valk; Jürgen K Rockstroh; Margaret Hellard; Arthur Kim; Sanjay Bhagani; Jordan J Feld; Ed Gane; Maria C Thurnheer; Julie Bruneau; Elise Tu; Gregory J Dore; Gail V Matthews; Marianne Martinello; REACT study group

doi:10.1002/jia2.26168

Sexual and drug use risk behaviour trajectories among people treated for recent HCV infection: the REACT study

J Int AIDS Soc. 2023 Sep;26(9):e26168. doi: 10.1002/jia2.26168.

Authors

Joanne M Carson¹, Sebastiano Barbieri², Evan Cunningham¹, Eric Mao¹, Marc van der Valk^{3

4}, Jürgen K Rockstroh⁵, Margaret Hellard^{6

7}, Arthur Kim⁸, Sanjay Bhagani⁹, Jordan J Feld¹⁰, Ed Gane¹¹, Maria C Thurnheer¹², Julie Bruneau¹³, Elise Tu¹, Gregory J Dore¹, Gail V Matthews¹, Marianne Martinello¹; REACT study group¹

Affiliations

¹ Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.
² The Centre for Big Data Research in Health, UNSW Sydney, Sydney, New South Wales, Australia.
³ Division of Infectious Diseases, Amsterdam Infection and Immunity Institute, University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
⁴ Stichting HIV Monitoring, Amsterdam, The Netherlands.
⁵ University Hospital Bonn, Bonn, Germany.
⁶ Burnet Institute, Melbourne, Victoria, Australia.
⁷ The Alfred Hospital, Melbourne, Victoria, Australia.
⁸ Massachusetts General Hospital, Boston, Massachusetts, USA.
⁹ Royal Free Hospital, London, UK.
¹⁰ Toronto Centre for Liver Diseases, Toronto General Hospital, Toronto, Ontario, Canada.
¹¹ Auckland City Hospital, Auckland, New Zealand.
¹² Department of Infectious Diseases, Bern Inselspital, Bern, Switzerland.
¹³ Research Center, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada.

Abstract

Introduction: Exploration of sexual and drug use behaviours following treatment for recent hepatitis C virus (HCV) is limited. This analysis modelled behavioural trajectories following treatment for recent HCV and assessed reinfection.

Methods: Participants treated for recent HCV in an international trial (enrolled 2017-2019) were followed at 3-monthly intervals for up to 2 years to assess longitudinal behaviours. Population-averaged changes were assessed using generalized estimating equations. Distinct behavioural trajectories were identified using group-based trajectory modelling. HCV reinfection incidence was calculated using person-years (PY) of observation.

Results: During the follow-up of 212 participants (84% gay and bisexual men [GBM]; 69% HIV; 26% current injecting drug use [IDU]), behavioural trajectories for IDU and stimulant use (past month) did not change. However, population-averaged decreases in the likelihood of daily IDU (adjusted odds ratio [AOR] 0.83; 95% CI 0.72, 0.95) and opioid use (AOR 0.84; 95% CI 0.75, 0.93) were observed. Among GBM, behavioural trajectories for chemsex did not change. Population-averaged decreases in condomless anal intercourse with casual male partners (CAI-CMP) (AOR 0.95; 95% CI 0.90, 0.99) and group-sex (AOR 0.86; 95% CI 0.80, 0.93) were observed, but masked distinct trajectories. While a proportion had a decreased probability of CAI-CMP (23%) and group-sex (59%) post-treatment, a substantial proportion retained a high probability of these behaviours. High HCV reinfection incidence was observed for the sustained high probability IDU (33.0/100 PY; 95% CI 17.7, 61.3) and chemsex (23.3/100 PY; 95% CI 14.5, 37.5) trajectories.

Conclusions: Limited sexual and drug use behavioural change was observed following treatment for recent HCV, supporting access to surveillance and (re)treatment.

Trial registration: ClinicalTrials.gov NCT02625909.

Keywords: GBM; HCV; HIV; PWID; STI; reinfection.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

HIV Infections*
Hepacivirus
Hepatitis C* / drug therapy
Hepatitis C* / epidemiology
Humans
Male
Opioid-Related Disorders*
Reinfection
Risk-Taking

Associated data

ClinicalTrials.gov/NCT02625909

Grants and funding

NH/NIH HHS/United States