HIV Insight: Sustained Virological Response

Thursday, March 3, 2016

Risk of Late Relapse or Reinfection with Hepatitis C Virus After Achieving a Sustained Virological Response: A Systematic Review and Meta-analysis

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: Bryony Simmons,1 Jawaad Saleem,1 Andrew Hill,2 Richard D. Riley,3 and Graham S. Cooke1

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).

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Friday, January 22, 2016

Hepatitis C Reinfection Following Sustained Virological Response - Seven-Year Follow-Up of Patients Infected Through Injecting Drug Use

BACKGROUND AND AIMS:

On-going risk behaviour can lead to hepatitis C virus (HCV) reinfection following successful treatment. We aimed to assess the incidence of persistent HCV reinfection in a population of people who inject drugs (PWID) who had achieved sustained virological response (SVR) seven years earlier.

METHODS:

In 2004-2006 we conducted a multicentre treatment trial comprising HCV genotype 2 or 3 patients in Sweden, Norway and Denmark (NORTH-C). Six months of abstinence from injecting drug use (IDU) was required before treatment. All Norwegian patients who had obtained SVR (n=161) were eligible for participation in this long-term follow-up study assessing virological and behavioural characteristics.

RESULTS:

Follow-up data were available in 138 of 161 (86%) individuals. Persistent reinfection was identified in 10 of 94 (11%) individuals with a history of IDU prior to treatment (incidence rate 1.7/100 person-years (PY); 95% CI 0.8-3.1) and in 10 of 37 (27%) individuals who had relapsed to IDU after treatment (incidence rate 4.9/100 PY; 95% CI 2.3-8.9). Although relapse to IDU perfectly predicted reinfection, no baseline factor was associated with reinfection. Relapse to IDU was associated with age < 30 years (vs. ⩾ 40 years) at treatment (adjusted odds ratio [aOR] 7.03; 95% CI 1.78-27.8) and low education level (aOR 4.10; 95% CI 1.56-10.8).

CONCLUSIONS:

Over time, persistent HCV reinfection was common among individuals who had relapsed to IDU after treatment. Reinfection should be systematically addressed and prevented when providing HCV care for PWID.

Purchase full article at: http://goo.gl/fKlhz0

By: Midgard H1, Bjøro B2, Mæland A3, Konopski Z4, Kileng H5, Damås JK6, Paulsen J7, Heggelund L8, Sandvei PK9, Ringstad JO9, Karlsen LN10, Stene-Johansen K11, Pettersson JH11, Dorenberg DH11, Dalgard O12.

1Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway. Electronic address: havardmi@medisin.uio.no.
2Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.
3Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway.
4Department of Gastroenterology, Oslo University Hospital, Oslo, Norway.
5Section of Gastroenterology, University Hospital of North Norway, Tromsø, Norway.
6Centre of Molecular Inflammation Research, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Infectious Diseases, St. Olav's Hospital, Trondheim, Norway.
7Section of Gastroenterology, Telemark Hospital Trust, Skien, Norway.
8Section of Infectious Diseases, Vestre Viken Hospital Trust, Drammen, Norway.
9Department of Medicine, Østfold Hospital Trust, Grålum, Norway.
10Department of Medicine, Stavanger University Hospital, Stavanger, Norway.
11Department of Virology, The Norwegian Institute for Public Health, Oslo, Norway.
12Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.