Determining reinfection rates by hepatitis C testing interval among key populations: A systematic review and meta-analysis

Liver Int. 2023 Dec;43(12):2625-2644. doi: 10.1111/liv.15705. Epub 2023 Oct 10.


Background & aims: Detecting hepatitis C virus (HCV) reinfection among key populations helps prevent ongoing transmission. This systematic review aims to determine the association between different testing intervals during post-SVR follow-up on the detection of HCV reinfection among highest risk populations.

Methods: We searched electronic databases between January 2014 and February 2023 for studies that tested individuals at risk for HCV reinfection at discrete testing intervals and reported HCV reinfection incidence among key populations. Pooled estimates of reinfection incidence were calculated by population and testing frequency using random-effects meta-analysis.

Results: Forty-one single-armed observational studies (9453 individuals) were included. Thirty-eight studies (8931 individuals) reported HCV reinfection incidence rate and were included in meta-analyses. The overall pooled estimate of HCV reinfection incidence rate was 4.13 per 100 per person-years (py) (95% confidence interval [CI]: 3.45-4.81). The pooled incidence estimate among people who inject drugs (PWID) was 2.84 per 100 py (95% CI: 2.19-3.50), among men who have sex with men (MSM) 7.37 per 100 py (95% CI: 5.09-9.65) and among people in custodial settings 7.23 per 100 py (95% CI: 2.13-16.59). The pooled incidence estimate for studies reporting a testing interval of ≤6 months (4.26 per 100 py; 95% CI: 2.86-5.65) was higher than studies reporting testing intervals >6 months (5.19 per 100 py; 95% CI: 3.92-6.46).

Conclusions: HCV reinfection incidence was highest in studies of MSM and did not appear to change with retesting interval. Shorter testing intervals are likely to identify more reinfections, help prevent onward transmission where treatment is available and enable progress towards global HCV elimination, but additional comparative studies are required.

Keywords: hepatitis C; incidence; key populations; reinfection; testing interval.

Publication types

  • Meta-Analysis
  • Systematic Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antiviral Agents / therapeutic use
  • HIV Infections* / drug therapy
  • Hepacivirus
  • Hepatitis C* / diagnosis
  • Hepatitis C* / drug therapy
  • Hepatitis C* / epidemiology
  • Hepatitis C, Chronic* / drug therapy
  • Homosexuality, Male
  • Humans
  • Incidence
  • Male
  • Recurrence
  • Reinfection / drug therapy
  • Sexual and Gender Minorities*
  • Substance Abuse, Intravenous* / epidemiology


  • Antiviral Agents