Recurrence of Hepatitis C After Treatment Studied

A multi-study analysis shows that a majority of patients with hepatitis C maintained sustained virological response (SVR) five years after they were treated but researchers found higher risk of reinfection among patients in two subgroups.

Researchers set out to systematically review evidence from a number of studies that examined the durability of treatment-induced SVR in patients with chronic hepatitis C virus and conduct a meta-analysis to provide summary estimates of the recurrence rate by risk group. The findings were published online January 19 in the journal Clinical Infectious Diseases.

Hepatitis C treatment is considered successful if a patient achieves SVR, an indication that HCV RNA is no longer detectable in his or her blood 12-to-24 weeks after treatment ends. This cure marker is associated with improved prognosis compared to patients who aren’t treated or fail therapy, with benefits that include “improved histology, reduced risk of hepatocellular carcinoma, and improved overall survival,” the authors note.

The three patient groups analyzed included low risk mono-HCV infected patients, high risk mono-HCV-infected patients who were injection drug users or prisoners and patients who were coinfected with HCV and human immunodeficiency virus (HIV). Researchers defined recurrence of the virus as confirmed HCV RNA detectability post-SVR.

The majority of studies reviewed by the researchers involved recurrence of HCV after interferon-based treatments, which has lost favor in the past few years over newly approved direct-acting antiviral drugs that don’t require interferon. All studies included in the analysis evaluated SVR at 24 weeks post-treatment.

Researchers calculated the recurrence rate for each study using events/person years of follow-up (PYFU). Using a random-effects model, they pooled the results and used them to calculate the 5-year recurrence risk for each of the three groups.

For the low risk group, researchers reviewed 43 studies and found that HCV returned in 108 of 7,969 patients and determined a pooled recurrence rate of 1.85/1000 PYFU.

For the high risk group, 14 studies were reviewed, including 12 that evaluated risk among injection drug users and two studies among prisoners. Out of a total of 771 patients, HCV returned in 42, amounting to a pooled recurrence rate of 22.32/1000 PYFU.

The researchers also evaluated four studies of people who were coinfected with HIV/HCV and found that 31 out of 309 patients experienced a recurrence of hepatitis C, a pooled recurrence rate of 32.02/1000 PYFU, according to the article.

“These incidence rates led to estimated 5-year recurrence rates of 0.95%, 10.67%, and 15.02% in the low-risk, high-risk, and coinfection groups, respectively,” the article states. “Thus, despite higher recurrence rates in those with identified ongoing risk behaviors and/or HIV infection, SVR is durable, and the great majority of patients have SVR at 5 years post-treatment.”

Because the meta-analysis involved recurrence post-treatment and cases of spontaneous clearance were excluded, the findings indicate that the greater risk of recurrence in the high-risk and HIV coninfected groups is fueled by an increased likelihood of reinfection, state the authors. They call for more prevention campaigns aimed at people at high-risk of re-exposure to HCV.