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Assessing hepatitis C spontaneous clearance and understanding associated factors—A systematic review and meta‐analysis

Aisyah, DN; Shallcross, L; Hully, AJ; O'Brien, A; Hayward, A; (2018) Assessing hepatitis C spontaneous clearance and understanding associated factors—A systematic review and meta‐analysis. Journal of Viral Hepatitis , 25 (6) pp. 680-698. 10.1111/jvh.12866. Green open access

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Abstract

New advances in the treatment of hepatitis C provide high levels of sustained viral response but their expense limits availability in publicly funded health systems. The aim of this review was to estimate the proportion of patients who will spontaneously clear HCV, to identify factors that are associated with clearance and to support better targeting of directly acting antivirals. We searched Ovid EMBASE, Ovid MEDLINE and PubMed from 1 January 1994 to 30 June 2015 for studies reporting hepatitis C spontaneous clearance and/or demographic, clinical and behavioural factors associated with clearance. We undertook meta‐analyses to estimate the odds of clearance for each predictor. Forty‐three studies met the inclusion criteria, representing 20 110 individuals, and 6 of these studies included sufficient data to estimate spontaneous clearance. The proportion achieving clearance within 3, 6, 12 and 24 months following infection were, respectively, 19.8% (95% CI: 2.6%‐47.5%), 27.9% (95% CI: 17.2%‐41.8%), 36.1% (95% CI: 23.5%‐50.9%) and 37.1% (95% CI: 23.7%‐52.8%). Individuals who had not spontaneously cleared by 12 months were unlikely to do so. The likelihood of spontaneous clearance was lower in males and individuals with HIV co‐infection, the absence of HBV co‐infection, asymptomatic infection, black or nonindigenous race, nongenotype 1 infection, older age and alcohol or drug problems. This study suggests that patients continue to spontaneously clear HCV for at least 12 months following initial infection. However, injecting drug users are comparatively less likely to achieve clearance; thus, they should be considered a priority for early treatment given the continuing risks that these individuals pose for onwards transmission.

Type: Article
Title: Assessing hepatitis C spontaneous clearance and understanding associated factors—A systematic review and meta‐analysis
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/jvh.12866
Publisher version: https://doi.org/10.1111/jvh.12866
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: behaviour, clinical, demographic factor, hepatitis C virus, predictors
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inst for Liver and Digestive Hlth
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Epidemiology and Public Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics
URI: https://discovery.ucl.ac.uk/id/eprint/10042289
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