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J Hepatol. 2019 Nov 27. pii: S0168-8278(19)30699-3. doi: 10.1016/j.jhep.2019.11.012. [Epub ahead of print]

Hepatitis C reinfection after successful antiviral treatment among people who inject drugs: A meta-analysis.

Author information

1
The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia. Electronic address: bhajarizadeh@kirby.unsw.edu.au.
2
The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
3
British Columbia Centre for Disease Control, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
4
Department of Gastroenterology, Oslo University Hospital, Oslo, Norway.
5
Akershus University Hospital, Oslo, Norway.
6
Ninewells Hospital and Medical School, University of Dundee, Dundee, The United Kingdom.
7
Population Health Sciences, University of Bristol, Bristol, The United Kingdom.
8
Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.

Abstract

BACKGROUND:

/Aims: HCV reinfection following successful treatment can compromise treatment outcome. This systematic review assessed the rate of HCV reinfection following treatment among people with recent drug use and those receiving opioid agonist therapy (OAT).

METHODS:

Bibliographic databases and conference abstracts were searched for studies assessing post-treatment HCV reinfection rate among people with recent drug use (injecting or non-injecting) or those receiving OAT. Meta-analysis was used to cumulate reinfection rates and meta-regression to explore heterogeneity.

RESULTS:

Thirty-six studies were included (person-years follow-up=6,311). The overall rate of HCV reinfection was 5.9/100 person-years (95%CI: 4.1-8.5) among people with recent drug use (injecting or non-injecting), 6.2/100 person-years (95%CI: 4.3-9.0) among people recently injecting drugs, and 3.8/100 person-years (95%CI: 2.5-5.8) among those receiving OAT. Reinfection rates were comparable following interferon-based (5.4/100 person-years; 95%CI: 3.1-9.5), and direct-acting antiviral therapy (3.9/100 person-years; 95%CI: 2.5-5.9). In stratified analysis, reinfection rate was 1.4/100 person-years (95%CI: 0.8-2.6) among people receiving OAT with no recent drug use, 5.9/100 person-years (95%CI: 4.0-8.6) among people receiving OAT with recent drug use, and 6.6/100 person-years (95%CI: 3.4-12.7) among people with recent drug use, not receiving OAT. In meta-regression analysis, longer follow-up was associated with lower reinfection rate [adjusted Rate Ratio (aRR) per year increase in mean/median follow-up: 0.77, 95%CI: 0.69-0.86]. Compared with people receiving OAT with no recent drug use, those with recent drug use, receiving OAT (aRR: 3.50, 95%CI: 1.62-7.53), and those with recent drug use, not receiving OAT (aRR: 3.96, 95%CI: 1.82-8.59) had higher reinfection rates.

CONCLUSION:

HCV reinfection risk following treatment increased among people with recent drug use compared to those receiving OAT. Lower rates in studies with longer follow-up suggested higher reinfection risk early post-treatment.

KEYWORDS:

DAA; HCV; OAT; SVR; follow-up; meta-regression; opioid agonist therapy; recent drug use; reinfection; sustained virologic response; systematic review

PMID:
31785345
DOI:
10.1016/j.jhep.2019.11.012

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