Hep-C Reinfection Rates Double Among Unhoused Population

Researchers found the homeless population to be at an increased risk of hepatitis C virus (HCV) reinfection rates. This risk increased even more among patients who were experiencing homelessness at the time of treatment. The findings of their research are published in the Clinical Infectious Diseases.

“We found high HCV reinfection rates in a homeless-experienced population, with increased risk among those homeless at treatment,” the authors said. “Tailored strategies to address the individual and systems factors impacting marginalized populations are required to prevent HCV reinfection and to enhance engagement in post-treatment HCV care.”

Lead author Marguerite E Beiser, NP, of the HCV Services at the Boston Health Care for the Homeless Program, and colleagues studied recurrent HCV infection at 12 weeks post-treatment with HCV genotype switch or any recurrent HCV reinfection following sustain virologic response. The team collected information from 535 adults in this real-world cohort of homeless-experienced individuals. Among the study group, 81% were men with median age 49 years; 70% did not have a permanent housing solution or were homeless at the time of treatment.

Overall, the HCV reinfection rate was 12/100 person-years (95% CI, 9.5-15.1). The reinfection rate was 18.9/100 person-years (95% CI, 13.3-26.7) among patients with unstable housing, and 14.6/100 person-years (95% CI, 10-21.3) among patients who were homeless.

“In adjusted analysis, experiencing homelessness (vs. stable housing, adjusted HR 2.14, 95% CI 1.09-4.20, p=0.026) and drug use within six months prior to treatment (adjusted HR 5.23, 95%CI 2.25-12.13, p<0.001) were associated with increased reinfection risk,” the authors said.

With a total of 74 HCV reinfections, which included 5 second reinfections, the study pushed for more targeted strategies to closely integrate with routine health care structure to address the social determinants of health.

—Priyam Vora

Reference:
Beiser M, Shaw L, Shores S, Carson J and Hajarizadeh B. Hepatitis C virus reinfection in a real-world cohort of homeless-experienced individuals in Boston. Clin Infect Dis. 2023. DOI: https://doi.org/10.1093/cid/ciad127