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

Abstract

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EASL recommendations on treatment of hepatitis C: Final update of the series☆

“…A recent meta-analysis of 36 studies reported a follow-up of 6,311 person-years. 303 The overall rate of HCV reinfection was 5.9/100 person-years among people with recent injecting or non-injecting drug use, 6.2/100 person-years among people recently injecting drugs, and 3.8/100 person-years among those receiving OST. Reinfection rates were comparable following IFN-based and DAA-based therapy (5.4/100 personyears vs. 3.9/100 person-years, respectively).…”

“…Reported rates of reinfection following successful HCV treatment among patients at high risk, such as PWIDs or men who have sex with men with high-risk behaviour, are of the order of 1-8% per year. 303,[379][380][381][382][383][384][385][386][387][388] The ease of pangenotypic DAA-based therapy may increase the likelihood of reinfection, as recently suggested. 389 To maximize the benefit of therapy, the risks of reinfection should be emphasised to patients at risk, and behavioural modifications should be positively reinforced.…”

“…In meta-regression analysis, longer follow-up was associated with a lower reinfection rate, suggesting higher reinfection risk early post-treatment. 303 Thus, patients who injected drugs during the year preceding treatment should be offered ideally bi-annual, at least annual testing for reinfection after DAA-induced SVR. In addition, testing should be offered after risk behaviour.…”

High dropout rate from aftercare program of antihepatitis C therapy for patients with history of injection drug use

“…Meta-analysis clearly showed that HCV reinfection risk after DAA treatment was higher in patients with recent IDU compared to those receiving opioid agonist therapy (OAT). 24 We could not dismiss the possibility of HCV reinfection among dropout patients. A recent randomized control study showed that the intensive interventions resulted in greater adherence and higher SVR rate than self-administered treatment in PWIDs who were treated with DAA.…”

Opportunistic treatment of hepatitis C virus infection (OPPORTUNI-C): study protocol for a pragmatic stepped wedge cluster randomized trial of immediate versus outpatient treatment initiation among hospitalized people who inject drugs

“…The introduction of highly efficient DAA therapy has changed the HCV treatment paradigm, leading to cure in > 95% of individuals after an 8-12-week course of oral treatment [7]. Although DAA therapy is shown to be effective in clinical trials and cohort studies of selected PWID [8,9], HCV care in this group may be challenging due to risks of suboptimal treatment adherence [10], loss to follow-up [9], and reinfection after successful treatment [11,12]. Suboptimal adherence could increase the risk of selection of resistanceassociated substitutions in the viral genome [13], but the clinical importance of this among PWID is unknown.…”