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HCV recurrence after SVR 20 times more frequent
with HIV/HCV than HCV alone
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CROI 2015, February 23-26, 2015, Seattle, Washington
from Jules: my recollection from what I think was a previous oral presentation by Hill was at AASLD where he reported similar data on re-infection, and he mentioned that the high rate may be due to MSM reinfection rates due to risky behavior after SVR:
AASLD: Effects of Sustained Virological Response on the risk of liver transplant, hepatocellular carcinoma, death and re-infection: meta-analysis of 129 studies in 34,563 patients with Hepatitis C infection - (12/01/14)
Mark Mascolini
Only 1% of low-risk HCV-monoinfected people in an 11,000-person 66-study meta-analysis had HCV recurrence (late relapse or reinfection) after achieving a sustained virologic response (SVR) to HCV therapy [1]. In contrast, 22% of HIV/HCV-coinfected people had a recurrence within 5 years of attaining SVR. Most of the studies analyzed focused on SVR after pegylated interferon plus ribavirin.
Relapse or reinfection--typically rare after SVR--reverses the beneficial effects of SVR, noted Andrew Hill and colleagues from Chelsea and Westminster Hospital and the Imperial College London. To assess recurrence rates in people with and without HIV, and in injection drug users (IDUs) and prisoners, they conducted a systematic review and meta-analysis. Most of the studies analyzed tested pegylated interferon and ribavirin. Whether recurrence rates will also be higher with HIV/HCV after SVR following direct-acting antiviral (DAA) therapy remains to be determined when more experience accumulates. DAA regimens have transformed the management of HCV infection, with SVR rates of 90% or higher in people with and without HIV.
Hill and workers defined SVR as undetectable HCV RNA 24 weeks after treatment ended. All studies included had more than 6 months of follow-up after SVR. The researchers divided studies into three groups: (1) low-risk populations of HCV-monoinfected people not including IDUs or prisoners, (2) high-risk populations including IDUs and prisoners, and (3) HIV/HCV-coinfected populations with or without other risk factors. The researchers excluded studies of liver transplant patients. They defined recurrence as confirmed detectable HCV RNA after SVR resulting from late relapse or reinfection.
The investigators calculated recurrence as number of relapses or reinfections per 100 person-years. They pooled estimates of reinfection for each of the three study group and used pooled estimates to determine the 5-year recurrence rate for each group.
Hill and colleagues found 43 studies including 9419 low-risk people, 16 studies with 819 IDUs or prisoners, and 7 studies of 833 HIV/HCV-coinfected people. Follow-up averaged 4.1 years in low-risk populations, 2.9 years in IDUs and prisoners, and 3.1 years in coinfected people. All studies in the IDU/prisoner and HIV/HCV groups took place in Western Europe, North America, or Australia. The low-risk studies also included Bangladesh, Brazil, India, Japan, Russia, South Korea, Thailand, and Turkey.
Five-year post-SVR recurrence rates were markedly lower in the HCV-monoinfected low-risk group:
-- Low risk: 1.1% recurrence (95% confidence interval [CI] 0.9% to 1.4%)
-- IDUs/prisoners: 13.2% recurrence (95% CI 9.9% to 17.2%)
-- HIV/HCV coinfection: 21.7% recurrence (95% CI 18.3% to 25.5%)
Pooled recurrence estimates were substantially lower in low-risk monoinfected populations:
-- Low risk: 0.23 per 100 person-years (95% CI 0.18 to 0.28)
-- IDUs/prisoners: 2.80 per 100 person-years (95% CI 2.06 to 3.71)
-- HIV/HCV coinfection: 4.78 per 100 person-years (95% CI 3.97 to 5.71)
A recurrence estimate of 4.78 per 100 person-years means about 5 of every 100 people had a recurrence every year.
In the HIV/HCV studies, 5-year HCV recurrence rates proved significantly lower among patients followed after randomized clinical trials than in those enrolled in cohort studies: 1.44% (95% CI 0.05% to 7.82%) versus 24.57% (95% CI 20.79% versus 28.72%). The researchers noted that further study is needed to determine whether the high recurrence rates in the HIV/HCV groups reflect HIV coinfection, risk behaviors, or an interaction between the two factors.
Reference
1. Hill AM, Simmons B, Saleem J Cooke G. Five-year risk of late relapse or reinfection with hepatitis C after sustained virological response: meta-analysis of 49 studies in 8534 patients. CROI 2015. February 23-26, 2015. Seattle, Washington. Abstract 654.
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