Background.
Treatment
for hepatitis C virus (HCV) can lead to sustained virological response (SVR) in
over 90% of people. Subsequent recurrence of HCV, either from late relapse or
reinfection, reverses the beneficial effects of SVR.
Methods.
A
search identified studies analysing HCV recurrence post-SVR. The recurrence
rate for each study was calculated using events/person years of follow-up
(PYFU). Results were pooled using a random-effects model and used to calculate
5-year recurrence risk. Three patient groups were analysed: (1) Mono-HCV
infected “low-risk” patients; (2) Mono-HCV infected “high-risk” patients
(injecting drug users or prisoners); (3) human immunodeficiency virus (HIV)/HCV
coinfected patients. Recurrence was defined as confirmed HCV RNA detectability
post-SVR.
Results.
In
the 43 studies of HCV mono-infected “low-risk” patients (n = 7969) the pooled
recurrence rate was 1.85/1000 PYFU (95% confidence interval [CI], .71–3.35; I2 = 73%) leading to a summary 5-year
recurrence risk of 0.95% (95% CI, .35%–1.69%). For the 14 studies of HCV
monoinfected “high-risk” patients (n = 771) the pooled recurrence rate was
22.32/1000 PYFU (95% CI, 13.07–33.46; I2 =
27%) leading to a summary 5-year risk of 10.67% (95% CI, 6.38%–15.66%). For the
4 studies of HIV/HCV coinfected patients the pooled recurrence rate was
32.02/1000 PYFU (95% CI, .00–123.49; I2 =
96%) leading to a summary 5-year risk of 15.02% (95% CI, .00%–48.26%). The
higher pooled estimates of recurrence in the high-risk and coinfected cohorts
were driven by an increase in reinfection rather than late relapse.
Conclusions.
SVR
appears durable in the majority of patients at 5 years post-treatment. The
large difference in 5 year event rate by risk group is driven mainly by an
increased reinfection risk.
Below: Summary 5-year risk (95%
confidence interval) of recurrence post-sustained virological response (SVR),
by risk group. Presented are the pooled estimates for the 5-year risk of
recurrence after achieving an SVR. Also shown are the number of studies that were
included to derive each estimate. Abbreviations: HCV, hepatitis C virus; HIV,
human immunodeficiency virus.
Full article at: http://goo.gl/7iLF2K
By:
1Division of Medicine, Imperial College
London
2Pharmacology and Therapeutics, Liverpool
University
3Research Institute of Primary Care and
Health Sciences, Keele University, Staffordshire, United Kingdom
Correspondence: B. Simmons, St Mary's Campus, Imperial
College London, Norfolk Place, London W2 1PG, UK (Email:ku.ca.lairepmi.inmula@31snommis.ynoyrb).
More at: https://twitter.com/hiv insight
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