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

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Hepatitis C reinfection after successful antiviral treatment among people who inject drugs: A meta-analysis
Journal of Hepatology ( IF 26.8 ) Pub Date : 2020-04-01 , DOI: 10.1016/j.jhep.2019.11.012
Behzad Hajarizadeh ₁ , Evan B Cunningham ₁ , Heather Valerio ₁ , Marianne Martinello ₁ , Matthew Law ₁ , Naveed Z Janjua ₂ , Håvard Midgard ₃ , Olav Dalgard ₄ , John Dillon ₅ , Matthew Hickman ₆ , Julie Bruneau ₇ , Gregory J Dore ₁ , Jason Grebely ₁

Affiliation

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.

中文翻译：

注射吸毒者抗病毒治疗成功后丙型肝炎再感染：荟萃分析

背景/目的：成功治疗后 HCV 再感染会影响治疗结果。该系统评价评估了近期吸毒者和接受阿片类药物激动剂治疗 (OAT) 患者治疗后 HCV 再感染的发生率。方法搜索书目数据库和会议摘要，以评估近期吸毒（注射或非注射）或接受 OAT 的人的治疗后 HCV 再感染率的研究。荟萃分析用于累积再感染率和荟萃回归以探索异质性。结果纳入了 36 项研究（人年随访 = 6,311）。近期吸毒（注射或非注射）人群中 HCV 再感染的总体率为 5.9/100 人年（95%CI：4.1-8.5），6.2/100 人年（95%CI：4.3-9） . 0) 在最近注射毒品的人群中，在接受 OAT 的人群中为 3.8/100 人年 (95% CI：2.5-5.8)。在基于干扰素（5.4/100 人年；95%CI：3.1-9.5）和直接作用抗病毒治疗（3.9/100 人年；95%CI：2.5-5.9）后，再感染率相当。在分层分析中，接受 OAT 治疗且近期未吸毒的患者的再感染率为 1.4/100 人年（95%CI：0.8-2.6），接受 OAT 治疗的患者的再感染率为 5.9/100 人年（95%CI：4.0-8.6）。近期吸毒的 OAT，以及近期吸毒但未接受 OAT 的人群中 6.6/100 人年（95%CI：3.4-12.7）。在荟萃回归分析中，较长的随访时间与较低的再感染率相关 [平均/中位随访的调整后比率 (aRR) 每年增加：0.77，95% CI：0.69-0.86]。与最近没有吸毒的接受 OAT 的人相比，近期吸毒并接受 OAT 的患者 (aRR: 3.50, 95%CI: 1.62-7.53) 和近期吸毒但未接受 OAT 的患者 (aRR: 3.96, 95%CI: 1.82-8.59) 的再感染率较高。结论与接受 OAT 的人相比，近期吸毒的人在治疗后 HCV 再感染的风险增加。随访时间较长的研究中较低的发生率表明治疗后早期再感染的风险较高。

更新日期：2020-04-01

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