Hepatitis C reinfection risk following successful therapy among people living with HIV: a global systematic review, meta-analysis, and meta-regression

BACKGROUND: Varied rates of HCV reinfection after treatment have been reported among people living with HIV (PLHIV), which could jeopardize elimination efforts in some populations. The aim of this systematic review was to assess HCV reinfection incidence and identify factors associated with reinfection among PLHIV.
METHODS: For studies evaluating post-treatment HCV reinfection among PLHIV, we searched bibliographic databases and conference abstracts. Meta-analysis was used to pool rates of reinfection and meta-regression was used to explore heterogeneity across studies.
RESULTS: A total of 37 studies were included (13,009 person-years [PY] of follow-up). The overall incidence of HCV reinfection was 3.85/100PY (95%CI 2.82'5.27). Reinfection rates were 5.89/100PY (95%CI 4.41' 7.87) among HIV-positive men who have sex with men (MSM) and 3.29/100PY (95%CI 2.01'5.39) among HIV-positive people who inject drugs (PWID). Among MSM, reinfection incidence was 4.75/100PY (95%CI 3.17'7.11) among those who had never injected drugs, 4.13/100PY (95%CI 2.21'7.69) among those who ever injected and 9.17/100PY (95%CI 5.93'14.17) among those for whom no injecting risk data were collected. Among PWID, reinfection rate among studies who restricted the study population to people with recent injecting drug use was 5.49/100PY (95%CI 2.08'14.48). Reinfection rates were comparable following interferon-based (4.45/100PY [95%CI 2.86'6.91]) and direct-acting antiviral treatment (3.95/100PY [95%CI 2.46'6.33]). Reinfection rate was higher among those treated for recent HCV (8.16/100PY [95%CI 5.77'11.54] compared to that among people treated for chronic HCV infection (2.87/100PY [95%CI 1.95'4.22]). In meta-regression analysis, incidence was significantly higher in studies with higher proportion of PWID in the study population (100% PWID vs <100% PWID; adjusted rate ratio [aRR] 4.94; 95%CI 1.96'12.44) and following treatment of recent HCV (recent HCV vs chronic HCV; aRR 2.61; 95%CI 1.03'6.59).
CONCLUSIONS: HCV reinfection risk following treatment among HIV-positive MSM is high irrespective of injecting status. This suggests that reinfection prevention services need to focus on a range of different modalities directed to possible sources of risk. Further, people with recent HCV are at higher risk of reinfection given likelihood of ongoing risk behaviour for transmission.