Author: Hajarizadeh B, Cunningham EB, Valerio H, Martinello M, Law M, Reid H, Janjua N, Midgard H, Dalgard O, Dillon J, Hickman M, Bruneau J, Dore GJ, Grebely J

Theme: Clinical Research Year: 2019

Background: Among individuals with ongoing injecting drug use, HCV reinfection following
successful therapy can compromise treatment outcome. This systematic review assessed posttreatment HCV reinfection rate among people with recent drug use and those receiving opioid
substitution therapy (OST).
Methods: Bibliographic databases and conference abstracts were searched for studies assessing HCV
reinfection rate after treatment among people with recent drug use (injecting or non-injecting) or
those receiving OST. Meta-analysis was used to cumulate reinfection rates and meta-regression to
explore heterogeneity across studies.
Results: Thirty-five eligible studies were included [total person-years follow-up (PYFU)=6,306],
including sub-population data of people with recent injecting or non-injecting drug use (31 studies,
PYFU=5,017), people with recent injecting drug use (28 studies, PYFU=4,502), and people receiving
OST (25 studies, PYFU=2,482). HCV reinfection rate was 5.7 per 100 PYFU (95%CI: 4.0-8.2) among
people with recent drug use, 5.9 per 100 PYFU (95%CI: 4.0-8.7) among people with recent injecting
drug use, and 3.8 per 100 PYFU (95%CI: 2.5-5.8) among those receiving OST. Reinfection rate was
comparable between post-interferon-containing therapy (5.5 per 100 PYFU; 95%CI: 3.1-9.7), and
post-DAA therapy (3.5 per 100 PYFU; 95%CI: 2.4-5.1). In stratified analysis, reinfection rate was 1.4
per 100 PYFU (95%CI: 0.8-2.6) among people receiving OST with no recent drug use, 6.1 per 100
PYFU (95%CI: 4.0-9.2) among those with recent drug use who also received OST, and 6.2 per 100
PYFU (95%CI: 3.1-12.3) among those with recent drug use, not receiving OST. In meta-regression
analysis, longer follow-up was significantly associated with lower reinfection rate [adjusted Rate
Ratio (aRR) for each year increase in mean/median follow-up: 0.81, 95%CI: 0.73-0.89; P<0.001], while recent drug use (with/without OST), compared to OST (no recent drug use) was significantly associated with higher reinfection rate (aRR: 3.81, 95%CI: 2.05-7.06; P<0.001). Conclusion: Post-treatment HCV reinfection risk was increased among individuals with recent drug use compared to those on OST. Lower rate in studies with longer follow-up suggested higher risk of reinfection early post-treatment. Harm reduction services are required to reduce reinfection risk while regular post-treatment HCV assessment is required to detect and treat reinfection early. Disclosure of Interest Statement: JG reports grants and personal fees from AbbVie, Cepheid, Gilead Sciences, and Merck. GD reports grants, personal fees, and non-financial support from AbbVie, Merck, Bristol-Myers Squibb, and Roche; grants and personal fees from Janssen; personal fees and non-financial support from Gilead Sciences; and personal fees from GlaxoSmithKline and Abbott Diagnostics. OD reports grants from Gilead Sciences during this study and grants from Gilead Sciences, Merck, and AbbVie. JBr reports consultant fees from Gilead Sciences and Merck. AHL reports grants and personal fees from Gilead Sciences and Merck. MH reports grants from Gilead Sciences, Bristol-Myers Squibb, and AbbVie. JD reports grants and personal fees from Gilead, Merck Sharp & Dohme, Janssen, and AbbVie. All other authors declare no competing interests.HM has held sponsored lectures for Roche, Medivir and Abbvie.ML has received research support from Merck, Bristol-Myers Squibb, Boehringer Ingelheim, Janssen-Cilag, Gilead Sciences, and ViiV HealthCare. ML has received consultancy and workshop fees from Gilead Sciences. ML has received Data Safety Monitoring Board Committee fees from Sirtex Pty Ltd.

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