HCV Reinfection After Successful Antiviral Treatment Among People who Inject Drugs

Although reinfection with hepatitis C virus (HCV) may occur following successful treatment in people with recent drug use, reinfection risk should not be used as a reason to withhold therapy from people with ongoing injecting drug use, according to a systematic review published in the Journal of Hepatology.

HCV reinfection following successful treatment can compromise treatment outcomes. Further, because direct-acting antiviral (DAA) therapy is expensive, data on the magnitude of post-treatment HCV reinfection risk is crucial to guide clinical decision making and policy in this area. Therefore, researchers searched bibliographic databases and conference abstracts to assess the rate of HCV reinfection after treatment among people who recently used drugs and those receiving opioid agonist therapy.

Of the 36 studies that were included in this meta-analysis and meta-regression, researchers found that the rate of HCV reinfection after treatment was lowest among people receiving opioid agonist therapy with no recent drug use. They also found that the rate of reinfection was comparable after interferon therapy or DAA therapy. A higher rate of HCV reinfection was observed in studies with a shorter follow-up.

The pooled estimates of reinfection rates were 5.9 per 100 person-years (95% CI, 4.1–8.5) among people with recent injecting or non-injecting drug use, 6.2 per 100 person-years (95% CI, 4.3–9.0) among people with recent injecting drug use, and 3.8 per 100 person-years (95% CI, 2.5, 5.8) among those receiving opioid agonist therapy. The pooled estimates of persistent HCV reinfection demonstrated a similar pattern.

Thus, these data demonstrated that harm reduction services are required to reduce the reinfection risk, and regular post-treatment hepatitis C assessment is required for early detection and retreatment. Researchers also highlighted that the finding of significantly lower reinfection risk among people receiving opioid agonist therapy who did not use drugs, indicated the importance of enhancing access to such therapy as a strategy to prevent reinfection. These data can be used to inform HCV clinical guidelines, public health policy decisions around treatment access, and national strategies to guide HCV elimination efforts globally.

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The study authors concluded that, “Monitoring HCV reinfection following successful HCV treatment in people who inject drugs will be crucial to HCV elimination efforts.” They added that, “Further studies are required to evaluate innovative strategies and models of care to enhance engagement in post-treatment care and prevent HCV reinfection among people who inject drugs.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Hajarizadeh B, Cunningham EB, Valerio H, et al. Hepatitis C reinfection after successful antiviral treatment among people who inject drugs: A meta-analysis. J Hepatol. 2020;72:643–657.