Determinants of hepatitis C virus treatment completion and efficacy in drug users assessed by meta-analysis

Rositsa B. Dimova, Marija Zeremski, Ira M. Jacobson, Holly Hagan, Don Des Jarlais, Andrew H. Talal

Research output: Contribution to journalArticle

Abstract

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 virologic 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 test) and investigated (meta-regression), and pooled rates were estimated (random effects).Results. Thirty-six studies comprising 2866 patients were retrieved. The treatment completion rate among DUs was 83.4% (95% confidence interval [CI], 77.1%-88.9%). Among 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 <. 0001). After adjusting for human immunodeficiency virus (HIV)/HCV coinfection, sex, and treatment of addiction, support services during antiviral therapy increased treatment completion (P <. 0001). The pooled SVR rate was 55.5% (95% CI, 50.6%-60.3%). Genotype 1/4 (P =. 0012) and the proportion of HIV-coinfected DUs (P =. 0173) influenced the SVR rate. After adjusting for HCV genotype 1/4 and HIV/HCV coinfection, the SVR rate was positively correlated with involvement of a multidisciplinary team (P <. 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.

Original languageEnglish (US)
Pages (from-to)806-816
Number of pages11
JournalClinical Infectious Diseases
Volume56
Issue number6
DOIs
StatePublished - Mar 15 2013

Fingerprint

Drug Users
Hepacivirus
Meta-Analysis
Therapeutics
Coinfection
Antiviral Agents
Genotype
HIV
Confidence Intervals
Ribavirin
Interferons
Sustained Virologic Response
HIV-1
Demography

Keywords

  • drug users
  • hepatitis C virus
  • meta-analysis
  • SVR
  • treatment completion

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)

Cite this

Determinants of hepatitis C virus treatment completion and efficacy in drug users assessed by meta-analysis. / Dimova, Rositsa B.; Zeremski, Marija; Jacobson, Ira M.; Hagan, Holly; Des Jarlais, Don; Talal, Andrew H.

In: Clinical Infectious Diseases, Vol. 56, No. 6, 15.03.2013, p. 806-816.

Research output: Contribution to journalArticle

Dimova, Rositsa B. ; Zeremski, Marija ; Jacobson, Ira M. ; Hagan, Holly ; Des Jarlais, Don ; Talal, Andrew H. / Determinants of hepatitis C virus treatment completion and efficacy in drug users assessed by meta-analysis. In: Clinical Infectious Diseases. 2013 ; Vol. 56, No. 6. pp. 806-816.
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abstract = "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 virologic 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 test) and investigated (meta-regression), and pooled rates were estimated (random effects).Results. Thirty-six studies comprising 2866 patients were retrieved. The treatment completion rate among DUs was 83.4{\%} (95{\%} confidence interval [CI], 77.1{\%}-88.9{\%}). Among 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 <. 0001). After adjusting for human immunodeficiency virus (HIV)/HCV coinfection, sex, and treatment of addiction, support services during antiviral therapy increased treatment completion (P <. 0001). The pooled SVR rate was 55.5{\%} (95{\%} CI, 50.6{\%}-60.3{\%}). Genotype 1/4 (P =. 0012) and the proportion of HIV-coinfected DUs (P =. 0173) influenced the SVR rate. After adjusting for HCV genotype 1/4 and HIV/HCV coinfection, the SVR rate was positively correlated with involvement of a multidisciplinary team (P <. 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.",
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T1 - Determinants of hepatitis C virus treatment completion and efficacy in drug users assessed by meta-analysis

AU - Dimova, Rositsa B.

AU - Zeremski, Marija

AU - Jacobson, Ira M.

AU - Hagan, Holly

AU - Des Jarlais, Don

AU - Talal, Andrew H.

PY - 2013/3/15

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N2 - 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 virologic 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 test) and investigated (meta-regression), and pooled rates were estimated (random effects).Results. Thirty-six studies comprising 2866 patients were retrieved. The treatment completion rate among DUs was 83.4% (95% confidence interval [CI], 77.1%-88.9%). Among 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 <. 0001). After adjusting for human immunodeficiency virus (HIV)/HCV coinfection, sex, and treatment of addiction, support services during antiviral therapy increased treatment completion (P <. 0001). The pooled SVR rate was 55.5% (95% CI, 50.6%-60.3%). Genotype 1/4 (P =. 0012) and the proportion of HIV-coinfected DUs (P =. 0173) influenced the SVR rate. After adjusting for HCV genotype 1/4 and HIV/HCV coinfection, the SVR rate was positively correlated with involvement of a multidisciplinary team (P <. 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.

AB - 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 virologic 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 test) and investigated (meta-regression), and pooled rates were estimated (random effects).Results. Thirty-six studies comprising 2866 patients were retrieved. The treatment completion rate among DUs was 83.4% (95% confidence interval [CI], 77.1%-88.9%). Among 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 <. 0001). After adjusting for human immunodeficiency virus (HIV)/HCV coinfection, sex, and treatment of addiction, support services during antiviral therapy increased treatment completion (P <. 0001). The pooled SVR rate was 55.5% (95% CI, 50.6%-60.3%). Genotype 1/4 (P =. 0012) and the proportion of HIV-coinfected DUs (P =. 0173) influenced the SVR rate. After adjusting for HCV genotype 1/4 and HIV/HCV coinfection, the SVR rate was positively correlated with involvement of a multidisciplinary team (P <. 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.

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