Risk of hepatitis C virus reinfection after direct-acting antiviral treatment among HIV-positive men who have sex with men and people who inject drugs: a systematic review and meta-analysis

The incidence of hepatitis C virus (HCV) reinfection following successful direct-acting antiviral therapy in HIV/HCV co-infected individuals remains a significant public health concern. This study aimed to estimate the reinfection incidence in high-risk groups, particularly people who inject drugs and men who have sex with men (MSM). A systematic review and meta-analysis was conducted by searching PubMed, Embase, and the Cochrane Library through March 2022. Studies reporting HCV reinfection following sustained virologic response after direct-acting antiviral therapy among HIV/HCV co-infected patients were included. Ten studies involving 5,632 individuals were analyzed. The incidence rate ratio of reinfection was significantly higher in MSM (n = 1,681) than in people who inject drugs (n = 2,490) (incidence rate ratio = 3.56; 95% CI: 1.26-10.09; I² = 77%). Subgroup and meta-regression analyses showed a higher reinfection rate in MSM from studies published on or before 2020 and among individuals with chronic HCV infection. Additionally, time to reinfection was shorter in MSM, with a pooled mean difference of -0.57 years. These findings highlight a consistently higher reinfection risk in HIV-positive MSM. Targeted behavioral counseling and routine HCV RNA surveillance are essential strategies to detect reinfection early and to support long-term control of HCV.