# Implications of reinfection for Hepatitis C elimination among HIV-infected and uninfected people who inject drugs

> **NIH NIH R36** · JOHNS HOPKINS UNIVERSITY · 2020 · $53,675

## Abstract

PROJECT SUMMARY / ABSTRACT
Hepatitis C virus (HCV) infection and HCV-HIV coinfections are significant causes of morbidity and mortality
among people who inject drugs (PWID). HCV prevalence among PWID can exceed 90% in high burden settings,
and incidence remains high in the US following the changing epidemiology of substance use disorders. Highly
effective, curative treatment for HCV is available, and calls have been made for the expansion of treatment-as-
prevention and harm reduction programs to eliminate HCV globally. While modeling studies have indicated
moderate to high treatment coverage may achieve elimination targets among PWID by 2030, such models often
do not fully account for individual heterogeneity and longitudinal patterns in HCV risk. Even low rates of HCV
reinfection can lead to pathogen persistence, a phenomenon that may be particularly important when considering
micro-elimination among PWID living with HIV. However, traditional methods to measure HCV risk result in
substantial misclassification when long testing intervals lead to frequent unobserved HCV exposure events (e.g.,
clearance-reinfection events occurring between study visits classified as a single chronic infection).
Here, we will leverage rich epidemiologic and molecular data from a 30-year cohort of HIV-infected and
uninfected PWID in Baltimore, MD USA (the ALIVE study) to explore the feasibility of HCV elimination in a high
burden setting. We will use hidden Markov models which account for unobserved exposures to estimate HCV
risk across individuals' injection careers. We will use next-generation genetic sequencing data to quantify risk of
reinfection and treatment failure among individuals known to have received directly acting antiviral therapy and
returned with post-treatment viremia. In both aims, we will consider the role of HIV coinfection as a modifier of
HCV risk. Together, these aims will allow for identification of individuals and time periods within injection careers
in which expected HCV reinfection risk is high. With this improved understanding of the individual and temporal
variance in HCV reinfection risk, we will generate evidence-based assessments of various policies and strategies
for delivering HCV treatment and harm reduction using dynamic transmission models, including targeted
strategies among HIV-infected PWID. This project will provide critical guidance for policymakers and public
health officials on the design and implementation of effective HCV elimination strategies among HIV-infected
and uninfected PWID.

## Key facts

- **NIH application ID:** 10080970
- **Project number:** 1R36DA052224-01
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Kyra H Grantz
- **Activity code:** R36 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $53,675
- **Award type:** 1
- **Project period:** 2020-07-01 → 2022-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10080970

## Citation

> US National Institutes of Health, RePORTER application 10080970, Implications of reinfection for Hepatitis C elimination among HIV-infected and uninfected people who inject drugs (1R36DA052224-01). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10080970. Licensed CC0.

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