Treatment of Hepatitis C Virus Infection Among People Who Are Actively Injecting Drugs: A Systematic Review and Meta-analysis

被引:259
作者
Aspinall, Esther J. [1 ,2 ]
Corson, Stephen [2 ]
Doyle, Joseph S. [3 ,4 ,5 ]
Grebely, Jason [6 ]
Hutchinson, Sharon J. [1 ,2 ]
Dore, Gregory J. [6 ]
Goldberg, David J. [1 ]
Hellard, Margaret E. [3 ,4 ,5 ]
机构
[1] Univ Strathclyde, Natl Serv Scotland, Hlth Protect Scotland, Glasgow, Lanark, Scotland
[2] Univ Strathclyde, Dept Math & Stat, Glasgow, Lanark, Scotland
[3] Monash Univ, Burnet Inst, Ctr Populat Hlth, Melbourne, Vic 3004, Australia
[4] Monash Univ, Alfred Hosp, Infect Dis Unit, Melbourne, Vic 3181, Australia
[5] Monash Univ, Sch Publ Hlth & Prevent Med, Melbourne, Vic 3004, Australia
[6] Univ New S Wales, Kirby Inst, Sydney, NSW, Australia
基金
英国医学研究理事会; 澳大利亚国家健康与医学研究理事会;
关键词
hepatitis C; treatment; people who inject drugs; SUSTAINED VIROLOGICAL RESPONSE; COMBINATION THERAPY; USERS; REINFECTION; ADHERENCE; RIBAVIRIN; MODEL; CARE;
D O I
10.1093/cid/cit306
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. Although guidelines recommend that people who inject drugs (PWID) should not be excluded from hepatitis C (HCV) treatment, some services remain reluctant to treat PWID. The aim of this review was to investigate sustained virologic response (SVR), adherence, discontinuation, and HCV reinfection among PWID. Methods. A search of Medline, Embase, and Cochrane databases (between 2002 and January 2012) was conducted for primary articles/conference abstracts examining HCV treatment outcomes in PWID. Meta-analysis was used to obtain pooled estimates of SVR, adherence, discontinuation, and HCV reinfection. Results. Ten primary articles and 1 conference abstract met the inclusion criteria. Across 6 studies (comprising 314 drug users, of whom 141 [45%] were PWID), pooled SVR was 56% (95% confidence interval [CI], 50%-61%) for all genotypes, 37% (95% CI, 26%-48%) for genotypes 1/4, and 67% (95% CI, 56%-78%) for genotypes 2/3. Pooled 80/80/80 adherence was 82% (95% CI, 74%-89%) across 2 studies, and pooled treatment discontinuation was 22% (95% CI, 16%-27%) across 4 studies. Across 5 studies (comprising 131 drug users) examining reinfection, pooled risk was 2.4 (95% CI, .9-6.1) per 100 person-years. Conclusions. HCV treatment outcomes are acceptable in PWID, supporting treatment guidelines. The pooled estimate of HCV reinfection risk was low, but there was considerable uncertainty around this estimate. Further studies on the risk of reinfection are needed to assess the long-term effectiveness of HCV treatment in PWID.
引用
收藏
页码:S80 / S89
页数:10
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