1 Disease Elimination Program, Burnet Institute, Melbourne, Australia.
2 School of Medicine, Monash University, Melbourne, Australia.
3 Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, Australia.
4 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
5 School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
6 Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
7 Division of Infectious Diseases, Landspitali University Hospital, Reykjavik, Iceland.
8 Department of Science, Landspitali University Hospital, Reykjavik, Iceland.
9 Médecins du Monde, Paris, France.
10 The International Charitable Foundation Alliance for Public Health, Kyiv, Ukraine.
11 Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore.
12 Section of Infectious Diseases, Yale University School of Medicine, New Haven.
13 Division of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven.
14 Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.
15 Department of Medicine, McGill University Health Centre, Montreal, Canada.
16 Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore.
17 School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom.
18 Health Protection Scotland, National Services Scotland, Glasgow, United Kingdom.
19 Doherty Institute, University of Melbourne, Melbourne, Australia.
20 Department of Medicine, University of Melbourne, Australia.
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).
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.
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).
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.