HCV medications decreased liver disease among those using injection drugs

A Baltimore-based study found that half of participants with chronic hepatitis C virus (HCV) and a history of injection drug use at baseline were free of the virus by 2019, with associated reductions in their risk of cirrhosis and mortality.

The availability of oral medications for hepatitis C virus (HCV) significantly reduced liver disease and mortality among people with a history of injection drug use, a recent study found.

The longitudinal cohort study included 1,323 participants enrolled in the ALIVE (AIDS Linked to the IntraVenous Experience) study from 2006 to 2019. At baseline, all had long-term HCV infection. Median age was 49 years, and most were Black (82%), male (71%), and HIV negative (66%). Study outcomes included liver stiffness measures by transient elastography, HCV RNA, and mortality from the National Death Index. Results were published by Annals of Internal Medicine on July 12.

By 2019, the proportion of study participants with detectable HCV RNA had decreased to 48% (from 100% in 2006). Cirrhosis was detected in 15% in 2006, 19% in 2015, and 8% in 2019. Undetectable HCV RNA was significantly associated with reduced odds of cirrhosis (adjusted odds ratio, 0.28; 95% CI, 0.17 to 0.45) and reduced all-cause mortality risk (adjusted hazard ratio, 0.54; 95% CI, 0.38 to 0.77).

The study's results both show that oral treatment for HCV “has bent the rising arc of HCV-related liver disease” and, given that almost half of participants were still infected, “the imperative to overcome these residual barriers to eliminate HCV infection in the United States,” said the authors. “With continued testing, treatment, and interventions to strengthen linkage to care and prevent HCV transmission, elimination of HCV infection could be achieved within the next decade,” they concluded.