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

Behzad Hajarizadeh, Evan B. Cunningham, Heather Valerio, Marianne Martinello, Matthew Law, Naveed Janjua, Håvard Midgard, Olav Dalgard, John Dillon, Matthew Hickman, Julie Bruneau, Gregory J. Dore, Jason Grebely

Research output: Contribution to journalArticle (Academic Journal)

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, Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation 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.
Original languageEnglish
JournalJournal of Hepatology
Early online date27 Nov 2019
DOIs
Publication statusE-pub ahead of print - 27 Nov 2019

Keywords

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

Fingerprint Dive into the research topics of 'Hepatitis C reinfection after successful antiviral treatment among people who inject drugs: A meta-analysis'. Together they form a unique fingerprint.

  • Cite this

    Hajarizadeh, B., Cunningham, E. B., Valerio, H., Martinello, M., Law, M., Janjua, N., Midgard, H., Dalgard, O., Dillon, J., Hickman, M., Bruneau, J., Dore, G. J., & Grebely, J. (2019). Hepatitis C reinfection after successful antiviral treatment among people who inject drugs: A meta-analysis. Journal of Hepatology. https://doi.org/10.1016/j.jhep.2019.11.012