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.
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 language | English |
|---|---|
| Journal | Journal of Hepatology |
| Early online date | 27 Nov 2019 |
| DOIs | |
| Publication status | E-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
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Professor Matt Hickman
- Bristol Medical School (PHS) - Professor in Public Health and Epidemiology
- Bristol Population Health Science Institute
- Health Protection Research Unit (HPRU)
- Centre for Academic Mental Health
- Infection and Immunity
- Centre for Academic Primary Care
Person: Academic , Member, Group lead