Staying hepatitis C negative: A systematic review and meta‐analysis of cure and reinfection in people who inject drugs

Abstract

Background and Aims: Direct-acting antivirals (DAAs) are highly effective in treating hepatitis C. However, there is concern that cure rates may be lower, and reinfection rates higher, among people who inject drugs. We conducted a systematic review of treatment outcomes achieved with DAAs in people who inject drugs (PWID).Hepatitis C (HCV) is a blood-borne virus, which in high-income countries is primarily transmitted amongst people who inject drugs (PWID). 1,2 Curing HCV reduces mortality and improves quality of life. 3,4 Treating PWID also reduces the risk of transmission, and is an essential component of achieving the World Health Organization HCV elimination targets. 5 Despite recommendations that PWID receive treatment, 6-8 this population continues to be excluded; both by individual practitioners, 9 and at a systemic level. 10,11 Our 2013 systematic review of interferon/ribavirin therapy found that PWID receiving treatment had high levels of adherence (82%, 95% CI 74%-89%), low-treatment discontinuation (22%, 95% CI 16%-27%), and similar SVR rates (56%, 95% CI 50%-61%) to non-PWID in realworld settings. 12 A systematic review of treatment outcomes in people reporting recent drug use, including a subgroup of people who inject drugs, found that this population achieves relatively high rates of cure with DAAs. 13 Despite the effectiveness of DAAs, concerns about reinfection in PWID have been raised and may partially account for practitioner unwillingness to prescribe DAA therapy to this population. 9Low rates of reinfection were observed among those PWID treated with interferon-based therapies, 12,14 but this may be different in the DAA era. Indeed, given that DAA treatments are significantly more effective and tolerable than interferon-based therapies, it is possible that the availability of DAA treatment may result in an increase in the number of people with ongoing risk behaviour who achieve cure, and in turn increase the total population at risk of reinfection.Several studies have investigated DAA therapy outcomes amongst PWID, including reinfection, but the number of recent PWID included in each study is small (range: 23-163). [15][16][17][18][19][20][21][22][23][24][25][26][27] We conducted a systematic review and meta-analysis to measure SVR, treatment discontinuation, adherence, and reinfection amongst recent PWID and OST recipients treated with DAAs.Methods: A search strategy was used to identify studies that reported sustained viral response (SVR), treatment discontinuation, adherence or reinfection in recent PWID and/or opioid substitution therapy (OST) recipients. Study quality was assessed using the Newcastle-Ottawa Scale. Meta-analysis of proportions was used to estimate pooled SVR and treatment discontinuation rates. The pooled relative risk of achieving SVR and pooled reinfection rate were calculated using generalized mixed effects linear models. Results:The search identified 8075 references; 26 were eligible for inclusion. The pooled SVR for recent PWID was 88% (95% CI, 83%-92%) and 91% (95% C...

Socio-demographic and ecological factors associated with anti-HCV prevalence in people who inject drugs: A systematic review

“…Unlike HIV, anti-HCV prevalence among PWID does not seem to be associated with national-level factors such as income or population blood borne virus prevalence. Also, despite strong evidence that the implementation of needle-syringe programs and OAT results in a reduction in HCV transmission and reinfection (Des Jarlais et al, 2013;Hagan et al, 2011;Latham et al, 2019;Platt et al, 2017), we did not find an association between country-level coverage of these harm reduction strategies and study-level anti-HCV prevalence. Unfortunately, there was insufficient data to determine whether study-level OAT engagement was associated with anti-HCV prevalence, which may have been a more effective method to answer this question.…”

Development of an Interdisciplinary Telehealth Model of Provider Training and Comprehensive Care for Hepatitis C and Opioid Use Disorder in a High-Burden Region

“…These patients had rates of progression along the cascade similar to those of patients not receiving MAT. This findings support recent studies demonstrating that patients receiving MAT have success in HCV treatment comparable to that of patients not receiving MAT [ 46 ]. Although we offer referrals to and receive referrals from a CHR program, patients who participated in CHR were not specifically tracked.…”

Hepatitis C Reinfection in People Who Inject Drugs in Resource-Limited Countries: A Systematic Review and Analysis

“…No report included background information on recruitment methods (e.g., flyer, bus ad, outreach in clinics) or sampling methodologies (e.g., consecutive patients); inquiries for supplemental information yielded one result. Testing intervals ranged from varied or not delineated in three studies [ 21 , 22 , 25 ] to a single testing time point in three studies [ 20 , 23 , 26 ]; only two studies delineated multiple testing time points over a significant follow-up period (2–6 years).…”