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Risk of late relapse or re-infection with Hepatitis C after Sustained Virological Response: meta-analysis of 66 studies in 11,071 patients
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Reported by Jules Levin
CROI 2015 Feb 23-26, Seattle, WA
Andrew Hill1, Bryony Simmons2, Jawaad Saleem2, and Graham Cooke2 1 St Stephens AIDS Trust, Chelsea and Westminster Hospital, London, United Kingdom, 2 Faculty of Medicine, Imperial College London, London, United Kingdom
from Jules: Reported by Andrew Hill 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. There are concerns regarding reinfection with IDUs but that should not be an excuse not to treat them, education regarding reinfection prior to treatment is a better approach and can I think be effective. Studies find meth maintenance, opoid substitution and needle exchange can reduce risk for reinfection. These types of programs are plentiful throughout the USA & in other countries. HCV eradication cannot be accomplished without treating IDUs systematically, "Test & Treat" programs are essential in HCV & to eradication, as in HIV where "Test & Treat" has become useful. Of importance, curing HCV in IDUs can reduce the rate of HCV transmission & modeling studies report how this could be accomplished (see links to these studies below). This subsequent report at CROI is an updated analysis where he makes note regarding HIV/HCV coinfected reinfections: "For the studies of HIV/HCV co-infected patients, five-year rates of HCV recurrence were significantly lower for patients followed up after randomised clinical trials, compared to unselected patients cohorts (1.44% [95%CI 0.05-7.82] vs. 24.57% [95%CI 20.79-28.72]). Further exploration is required to determine whether recurrence rates in this population are due to HIV co-infection or risk behaviours, or an interaction between both."
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)
Modeling studies:
New antiviral treatment could significantly reduce global burden of hepatitis C.....http://www.natap.org/2013/HCV/051313_08.htm
EASL/2014: IMPACT OF NEW DAA-CONTAINING REGIMENS ON HCV TRANSMISSION AMONG INJECTING DRUG USERS (IDUS): A MODEL-BASED ANALYSIS (ANRS 12376)...."Test & Treat", Eliminating HCV.......http://www.natap.org/2014/EASL/EASL_87.htm.....
Can antiviral therapy for hepatitis C reduce the prevalence of HCV among injecting drug user populations? A modeling analysis of its prevention utility.......http://www.natap.org/2011/HCV/052311_01.htm........AUTHORS Conclude: Despite the possibility of re-infection, modest rates of hepatitis C treatment among active injecting drug users could effectively reduce transmission. Evaluating and extending strategies to treat hepatitis C among active injectors are warranted. Journal of Hepatology (June 2011). Natasha K. Martin12, Peter Vickerman12, Graham R. Foster3, Sharon J. Hutchinson45, David J. Goldberg4, Matthew Hickman1
Cost-effectiveness of hepatitis C virus antiviral treatment for injection drug user populations......Hepatology January 2012
Natasha K. Martin,1,2 Peter Vickerman,1,2 Alec Miners,2 Graham R. Foster,3
Sharon J. Hutchinson,4,5
David J. Goldberg,4 and Matthew Hickman1.........AUTHORS Conclude: Despite the possibility of reinfection, the model suggests providing antiviral treatment to IDUs is the most cost-effective policy option in chronic prevalence scenarios less than 60%. Further research on how HCV treatment for injectors can be scaled up and its impact on prevalence is warranted.
at IDSA/2014 Shruti Mehta Professor at Johns Hopkins in a slide talk presented a plan/strategy to Eradicate HCV & to Treat IDUs.....HCV Treatment Cascade: Is Eradication Possible?
http://www.natap.org/2014/HCV/101014_01.htm
Eradication of hepatitis C infection:
The importance of targeting people who inject drugs.......http://www.natap.org/2014/HCV/012414_04.htm ....AUTHORS say: To combine an improvement of testing, link to care, adherence to treatment and change in recommendations to treat as soon as possible was the only strategy that led to a high decrease of prevalence and of the number of complications; because 1) Infected people are quickly diagnosed and linked to care (before reaching advanced fibrosis stages); 2) When linked to care, they are immediately treated (before transmitting the infection to a lot of injecting partners) and 3) a high adherence to treatment ensures a high SVR rate
In a published study by the CDC in May 2014 in PLOS ONE called Estimating the Number of Persons Who Inject Drugs in the United States by Meta-Analysis to Calculate National Rates of HIV and Hepatitis C Virus Infections: "we estimated that persons who ever injected drugs comprised 2.6% (CI: 1.8%-3.3%) of the U.S. population......[http://www.natap.org/2014/HCV/053014_01.htm] we estimate that approximately 774,434 adults and adolescents (range: 494,605-1,054,263) injected drugs in the past year in the United States......This represents approximately 6,612,488 million PWID (range: 4,583,188-8,641,788) aged 13 years or older in 2011.......Although PWID comprise 3% or less of the U.S. population, they account for 22% of all persons living with HIV infection.....HCV Infection Rate among PWID in the U.S: The prevalence rate of HCV infection among PWID aged 40-65 years was 43,126 per 100,000 PWID (CI: 34,024-58,875). In Table 4 in this study: Based on a 2013 US population of about 316 million, 13% are Black or African-American but this study reports in Table 4 similar percentages of PWIDs who are White (3.8%) & African-American/Black (3.4%)."
Reported by Jules Levin
CROI 2015 Feb 23-26, Seattle, WA
Andrew Hill1, Bryony Simmons2, Jawaad Saleem2, and Graham Cooke2 1 St Stephens AIDS Trust, Chelsea and Westminster Hospital, London, United Kingdom, 2 Faculty of Medicine, Imperial College London, London, United Kingdom
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