TY - JOUR
T1 - Staying hepatitis C negative
T2 - A systematic review and meta-analysis of cure and reinfection in people who inject drugs
AU - Latham, Ned H.
AU - Doyle, Joseph S.
AU - Palmer, Anna Y.
AU - Vanhommerig, Joost W.
AU - Agius, Paul
AU - Goutzamanis, Stelliana
AU - Li, Zinia
AU - Pedrana, Alisa
AU - Gottfredsson, Magnus
AU - Bouscaillou, Julie
AU - Luhmann, Niklas
AU - Mazhnaya, Alyona
AU - Altice, Frederick L.
AU - Saeed, Sahar
AU - Klein, Marina
AU - Falade-Nwulia, Oluwaseun O.
AU - Aspinall, Esther
AU - Hutchinson, Sharon
AU - Hellard, Margaret E.
AU - Sacks-Davis, Rachel
N1 - Funding Information:
The authors acknowledge the authors of primary studies who provided additional information and data for this review. The authors also acknowledge the Victorian Operational Infrastructure Support Program received by the Burnet Institute. Joseph Doyle, Alisa Pedrana, Rachel Sacks-Davis and Margaret Hellard receive fellowship support from the Australian National Health and Medical Research Council.
Funding Information:
The authors acknowledge the authors of primary studies who pro‐ vided additional information and data for this review. The authors also acknowledge the Victorian Operational Infrastructure Support Program received by the Burnet Institute. Joseph Doyle, Alisa Pedrana, Rachel Sacks‐Davis and Margaret Hellard receive fellow‐ ship support from the Australian National Health and Medical Resea rch Council.
Funding Information:
The authors acknowledge the contribution to this work of the Victorian Operational Infrastructure Support Program received by the Burnet Institute. Joseph Doyle, Alisa Pedrana, Rachel Sacks‐ Davis and Margaret Hellard receive fellowship support from the Australian National Health and Medical Research Council.
Funding Information:
Joseph Doyle receives funding from Abbvie, Gilead Sciences, Bristol Myers Squibb and Merck for investigator initiated research grants, and consultancy from Abbvie, Gilead Sciences, Bristol Myers Squibb and Merck. Alisa Pedrana receives funding from Merck for investigator initiated research grants. Sharon Hutchinson receives honoraria from Gilead Sciences. Margaret Hellard receives fund‐ ing from Gilead Sciences Abbvie and GSK for investigator initi‐ ated research. All the other authors declare no potential conflict of interest.
Publisher Copyright:
© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
PY - 2019/12/1
Y1 - 2019/12/1
N2 - 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). 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% CI 88%-95%) for OST recipients. The relative risk of achieving SVR for recent PWID compared to non-recent PWID was 0.99 (95% CI, 0.94-1.06). The pooled treatment discontinuation was 2% (95% CI, 1%-4%) for both recent PWID and OST recipients. Amongst recent PWID, the pooled incidence of reinfection was 1.94 per 100 person years (95% CI, 0.87-4.32). In OST recipients, the incidence of reinfection was 0.55 per 100 person years (95% CI, 0.17-1.76). Conclusions: Treatment outcomes were similar in recent PWID compared to non-PWID treated with DAAs. People who report recent injecting or OST recipients should not be excluded from hepatitis C treatment.
AB - 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). 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% CI 88%-95%) for OST recipients. The relative risk of achieving SVR for recent PWID compared to non-recent PWID was 0.99 (95% CI, 0.94-1.06). The pooled treatment discontinuation was 2% (95% CI, 1%-4%) for both recent PWID and OST recipients. Amongst recent PWID, the pooled incidence of reinfection was 1.94 per 100 person years (95% CI, 0.87-4.32). In OST recipients, the incidence of reinfection was 0.55 per 100 person years (95% CI, 0.17-1.76). Conclusions: Treatment outcomes were similar in recent PWID compared to non-PWID treated with DAAs. People who report recent injecting or OST recipients should not be excluded from hepatitis C treatment.
KW - Hepatitis C
KW - antiviral agents
KW - intravenous
KW - opiate substitution treatment
KW - substance abuse
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U2 - 10.1111/liv.14152
DO - 10.1111/liv.14152
M3 - Review article
C2 - 31125496
AN - SCOPUS:85067344494
VL - 39
SP - 2244
EP - 2260
JO - Liver International
JF - Liver International
SN - 1478-3223
IS - 12
ER -