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 O. 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
JournalLiver International
Early online date24 May 2019
DOIs
Publication statusE-pub ahead of print - 24 May 2019

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

Keywords

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

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
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 O. ; 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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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, OO, 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

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 O.; Aspinall, Esther; Hutchinson, Sharon; Hellard, Margaret E.; Sacks-Davis, Rachel.

In: Liver International, 24.05.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Staying hepatitis C negative: 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 - Acceptance in SAN AAM: 12m embargo

PY - 2019/5/24

Y1 - 2019/5/24

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 - substance abuse

KW - intravenous

KW - antiviral agents

KW - opiate substitution treatment

U2 - 10.1111/liv.14152

DO - 10.1111/liv.14152

M3 - Article

ER -

Latham NH, Doyle JS, Palmer AY, Vanhommerig JW, Agius P, Goutzamanis S et al. Staying hepatitis C negative: a systematic review and meta-analysis of cure and reinfection in people who inject drugs. Liver International. 2019 May 24. https://doi.org/10.1111/liv.14152