Staying hepatitis C negative

A systematic review and meta-analysis of cure and reinfection in people who inject drugs

Ned H. Latham, Joseph S. Doyle, Anna Y. Palmer, Joost W. Vanhommerig, Paul Agius, Stelliana Goutzamanis, Zinia Li, Alisa Pedrana, Magnus Gottfredsson, Julie Bouscaillou, Niklas Luhmann, Alyona Mazhnaya, Frederick L. Altice, Sahar Saeed, Marina Klein, Oluwaseun Falade-Nwulia, Esther Aspinall, Sharon Hutchinson, Margaret E. Hellard, Rachel Sacks-Davis

Research output: Contribution to journalArticle

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 languageEnglish (US)
JournalLiver International
DOIs
StatePublished - Jan 1 2019

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Hepatitis C
Opiate Substitution Treatment
Meta-Analysis
Pharmaceutical Preparations
Antiviral Agents
Drug Substitution
Incidence
Therapeutics
Linear Models

Keywords

  • antiviral agents
  • Hepatitis C
  • intravenous
  • opiate substitution treatment
  • substance abuse

ASJC Scopus subject areas

  • Hepatology

Cite this

Latham, N. H., Doyle, J. S., Palmer, A. Y., Vanhommerig, J. W., Agius, P., Goutzamanis, S., ... Sacks-Davis, R. (2019). Staying hepatitis C negative: A systematic review and meta-analysis of cure and reinfection in people who inject drugs. Liver International. https://doi.org/10.1111/liv.14152

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 journalArticle

Latham, NH, Doyle, JS, Palmer, AY, Vanhommerig, JW, Agius, P, Goutzamanis, S, Li, Z, Pedrana, A, Gottfredsson, M, Bouscaillou, J, Luhmann, N, Mazhnaya, A, Altice, FL, Saeed, S, Klein, M, Falade-Nwulia, O, Aspinall, E, Hutchinson, S, Hellard, ME & Sacks-Davis, R 2019, 'Staying hepatitis C negative: A systematic review and meta-analysis of cure and reinfection in people who inject drugs', Liver International. https://doi.org/10.1111/liv.14152
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. / Staying hepatitis C negative : A systematic review and meta-analysis of cure and reinfection in people who inject drugs. In: Liver International. 2019.
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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.",
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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

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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.

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