The risk for hepatitis C virus (HCV) reinfection among individuals with with HIV infection was most increased among men who have sex with men (MSM), according to results of a study published in The Lancet HIV.
Publication databases were searched through January 2022 for studies that assessed the incidence of HCV reinfection following successful therapy in patients with HIV. Previous treatments for HCV included interferon-based therapy, direct-acting antiviral (DAA) therapy, or a combination of both therapies. A total of 41 studies were included in the analysis, and the primary outcome was incident HCV reinfections between 12 and 24 weeks following successful therapy.
This analysis included a total of 9024 patients representing 14,263 person-years (py) of follow-up. Of the 41 studies, 18 included 4802 py of follow-up for HIV-positive MSM, 19 included 5511 py of follow-up for those who were HIV-positive with a history of injection drug use, and 4 included 402 py of follow-up for those who were HIV-positive who had recently used injectable drugs.
The pooled incidence rate (IR) of HCV reinfection per 100 py was estimated for each patient cohort. The incidence of HCV reinfection was most increased among MSM (IR, 6.01; 95% CI, 4.54-7.95; I2= 74.1%), followed by those who recently used injection drugs (IR, 5.49; 95% CI, 2.08-14.38; I2= 72.1%), and those with a history of injection drug use (IR, 3.29; 95% CI, 2.01-5.39; I2= 83.9%). Of note, the pooled IR of HCV reinfection was 3.76 (95% CI, 2.80-5.05; I2= 85.9%) among the entire study population.
Further analysis was performed among patients in the HIV-positive MSM cohort. Of these patients, the estimated pooled incidence of HCV reinfection was most increased among those with an unknown history of injection drug use (IR, 7.81; 95% CI, 4.35-14.00; I2= 52.6%), followed by those with no history of injection drug use (IR, 4.13; 95% CI, 2.21-7.69; I2= 58.5%), and those with a known history of injection drug use (IR, 4.75; 95% CI, 3.17-7.11; I2= 68.2%).
Stratified by HCV treatment type, the rate of reinfection was similar between patients who received combined treatment with interferon-based and DAA therapy (IR, 3.41; 95% CI, 1.77-6.59) compared with those who received DAA therapy alone (IR, 3.88; 95% CI, 2.51-6.01). The most significantly increased risk for HCV reinfection was observed among patients previously treated with interferon-based therapy alone (IR, 4.92; 95% CI, 3.30-7.32).
The researchers conducted an additional analysis that adjusted for the number of MSM within each study’s patient population, as well as the length of follow-up following successful treatment for initial HCV infection. Results showed that studies in which MSM comprised a majority of the overall population, there was a significantly increased risk for HCV reinfection (adjusted rate ratio [aRR], 2.66; 95% CI, 1.37-5.15; P =.0049).
Limitations included that most studies (n=33) were conducted among patients from high-income countries countries, and the majority of patients were men. It remains unclear whether these results are generalizable to individuals residing in low-income countries.
In regard to patients with HIV infection recently infected with HCV, “these findings highlight the importance of addressing contemporary sexual and drug use behaviors,” the researchers concluded.
Disclosure: Multiple authors declared affiliations with industry. Please see the original reference for a full list of disclosures.
Hosseini-Hooshyar S, Hajarizadeh B, Bajis S, et al. Risk of hepatitis C reinfection following successful therapy among people living with HIV: a global systematic review, meta-analysis, and meta-regression. Lancet HIV. 2022;9(6):e414-e427. doi:10.1016/S2352-3018(22)00077-7