The risk of hepatitis C virus recurrence in hepatitis C virus‐infected patients treated with direct‐acting antivirals after achieving a sustained virological response: A comprehensive analysis

• Published in: Liver international Vol. 41; no. 10; pp. 2341 - 2357
• Main Authors: Huang, Peng, Wang, Yan, Yue, Ming, Ge, Zhijun, Xia, Xueshan, Jeyarajan, Andre J., Holmes, Jacinta A., Yu, Rongbin, Zhu, Chuanwu, Yang, Sheng, Lin, Wenyu, Chung, Raymond T.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc 01-10-2021
• Subjects: Antiviral agents; Confidence intervals; direct‐acting antivirals; Eradication; Health risks; Hepatitis; Hepatitis C; hepatitis C virus; HIV; Human immunodeficiency virus; Infections; Populations; reinfection; relapse; Risk taking; sustained virological response; Viruses
• ISSN: 1478-3223; 1478-3231
• DOI: 10.1111/liv.14976

Background & Aims
The risk for hepatitis C virus (HCV) recurrence persists after HCV eradication with direct‐acting antivirals (DAAs), particularly in patients with ongoing high‐risk behaviours. Our aim was to assess the risk of HCV recurrence (late relapse and/or reinfection) post‐sustained virological response (SVR).
Methods
We searched the literature for studies reporting HCV recurrence rates post‐SVR in PubMed, Web of Science and the Cochrane Library. Identified publications were divided into groups based on patient risk for HCV reinfection: low‐risk HCV mono‐infection, high‐risk HCV mono‐infection and a human immunodeficiency virus (HIV)/HCV coinfection. The HCV recurrence rate for each study was calculated by using events divided by the person‐years of follow‐up (PYFU). HCV recurrence was defined as confirmed, detectable HCV RNA post‐SVR.
Results
In the 16 studies of low‐risk patients, the pooled recurrence rate was 0.89/1000 PYFU (95% confidence interval [CI], 0.16‐2.03). For the 19 studies of high‐risk patients, the pooled recurrence rate was 29.37/1000 PYFU (95% CI, 15.54‐46.91). For the eight studies of HIV/HCV‐coinfected patients, the pooled recurrence rate was 23.25/1000 PYFU (95% CI, 4.24‐53.39). The higher pooled estimates of recurrence in the high‐risk and HIV/HCV‐coinfected populations were predominantly driven by an increase in reinfection rather than late relapse.
Conclusions
The HCV recurrence risk after achieving SVR with all‐oral DAAs therapy is low, and the risk of HCV recurrence in high‐risk and HIV/HCV‐coinfected populations was driven by an increase in reinfection rather than late relapse.