HCV treatment helps prevent cirrhosis, death in persons who inject drugs

People who inject drugs (PWID) and are receiving treatment for hepatitis C virus (HCV) show a substantial decline in liver disease and mortality, according to a study.

“Additional efforts will be needed to reduce residual barriers to treatment and to eliminate HCV as a public health threat for PWID,” the investigators said.

This community-based, longitudinal cohort study of PWID was conducted in Baltimore, Maryland, in the US and included 1,323 participants enrolled in the ALIVE (AIDS Linked to the IntraVenous Experience) study from 2006 to 2019 and chronically infected with HCV.

The investigators measured liver stiffness (LSM) by transient elastography, HCV RNA, and mortality from the National Death Index.

Of the participants with chronic HCV at baseline (median age 49 years), 71 percent were male, 82 percent were Black, and 66 percent were HIV-negative.

The proportion of patients in whom HCV RNA was detected dropped from 100 percent in 2006 to 48 percent in 2019. From a total of 10,350 valid LSMs, cirrhosis was found in 15 percent of participants in 2006, 19 percent in 2015, and 8 percent in 2019.

Undetectable HCV RNA significantly correlated with a lower likelihood of cirrhosis (adjusted odds ratio, 0.28, 95 percent confidence interval [CI], 0.17‒0.45) and lower all-cause mortality risk (adjusted hazard ratio, 0.54, 95 percent CI, 0.38‒0.77).

Of note, the study was limited by the nonvalidation of noninvasive markers of liver fibrosis in persons with sustained virologic response.

“HCV infection can be cured, and the United States has joined the World Health Organization in calling for HCV elimination by 2030,” the investigators said. “However, historically low uptake of HCV treatment among PWID threatens HCV elimination and exacerbates social and racial health disparities.”