Determinants of Hepatitis C Virus Treatment Completion and Efficacy in Drug Users Assessed by Meta-analysis

Dimova RB, Zeremski M, Jacobson IM, Hagan H, Jarlais DC, Talal AH

Background.?Hepatitis C virus (HCV)-infected drug users (DUs) have largely been excluded from HCV care. We conducted a systematic review and meta-analysis of the literature on treatment completion and sustained virological response (SVR) rates in DUs. We assessed the effects of different treatment approaches and services to promote HCV care among DUs as well as demographic and viral characteristics.

Methods.?Studies of at least 10 DUs treated with pegylated-interferon/ribavirin that reported SVR were analyzed. Heterogeneity was assessed (Cochran's test), investigated (meta-regression), and pooled rates estimated (random effects).

Results.?Thirty-six studies including 2866 patients were retrieved. The treatment completion rate among DUs was 83.4% (95%CI: 77.1%; 88.9%). From studies that included addiction-treated and untreated patients during HCV therapy, the higher the proportion of addiction-treated patients, the higher the HCV treatment completion rate (p<0.0001). After adjusting for HIV/HCV co-infection, gender, and treatment of addiction, support services during antiviral therapy increased treatment completion (p<0.0001). The pooled SVR rate was 55.5% (95%CI: 50.6%; 60.3%). Genotype 1/4 (p=0.0012) and the proportion of HIV co-infected DUs (p=0.0173) influenced the SVR rate. After adjusting for HCV genotype 1/4 and HIV/HCV co-infection, the SVR rate was positively correlated with involvement of a multidisciplinary team (p<0.0001).

Conclusions.?Treatment of addiction during HCV therapy results in higher treatment completion. Our pooled SVR rate is similar to that obtained in registration trials in the general population. Treatment of addiction during HCV therapy will likely be important for HCV-infected DUs undergoing treatment with more complex regimens including direct acting antivirals.