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*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

15 Citations (Scopus)


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
Pages (from-to)2244-2260
Number of pages17
JournalLiver International
Issue number12
Publication statusPublished - 1 Dec 2019

Bibliographical note

Publisher Copyright:
© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

Other keywords

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


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