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). 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.
| Original language | English (US) |
|---|---|
| Journal | Liver International |
| DOIs | |
| State | Published - Jan 1 2019 |
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Keywords
- antiviral agents
- Hepatitis C
- intravenous
- opiate substitution treatment
- substance abuse
ASJC Scopus subject areas
- Hepatology
Cite this
Staying hepatitis C negative : A systematic review and meta-analysis of cure and reinfection in people who inject drugs. / Latham, Ned H.; Doyle, Joseph S.; Palmer, Anna Y.; Vanhommerig, Joost W.; Agius, Paul; Goutzamanis, Stelliana; Li, Zinia; Pedrana, Alisa; Gottfredsson, Magnus; Bouscaillou, Julie; Luhmann, Niklas; Mazhnaya, Alyona; Altice, Frederick L.; Saeed, Sahar; Klein, Marina; Falade-Nwulia, Oluwaseun; Aspinall, Esther; Hutchinson, Sharon; Hellard, Margaret E.; Sacks-Davis, Rachel.
In: Liver International, 01.01.2019.Research output: Contribution to journal › Article
}
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
AU - Aspinall, Esther
AU - Hutchinson, Sharon
AU - Hellard, Margaret E.
AU - Sacks-Davis, Rachel
PY - 2019/1/1
Y1 - 2019/1/1
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 - antiviral agents
KW - Hepatitis C
KW - intravenous
KW - opiate substitution treatment
KW - substance abuse
UR - http://www.scopus.com/inward/record.url?scp=85067344494&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85067344494&partnerID=8YFLogxK
U2 - 10.1111/liv.14152
DO - 10.1111/liv.14152
M3 - Article
JO - Liver International
JF - Liver International
SN - 1478-3223
ER -