Hepatitis C Treatment Reduces Cirrhosis and Mortality in People Who Inject Drugs

The World Health Organization and the US Department of Health & Human Services have made a goal of eliminating Hepatitis C virus (HCV) by 2030. In order to achieve this, it is estimated that we need to identify 90% of people infected with HCV and treat at least 80%. In the US, over 90% of those with HCV are people with a history of injection drug use (PWID). The purpose of this study was to determine whether PWID are approaching treatment targets, and assess the impact of treatment uptake on liver disease and mortality. Researchers used 2006-2019 data from the AIDS Linked to the Intravenous Experience (ALIVE) study in Baltimore, Maryland and included patients with a positive HCV RNA and liver stiffness measurement (LSM). The main outcomes were cirrhosis on LSM and mortality, adjusting for other factors including age, gender, race, alcohol use, injection drug use in the last 6 months, body mass index, and comorbidities (including HIV, renal disease, and diabetes).

• Among the 1323 patients, HCV treatment increased from 3% in 2006 to 39% in 2019.
• HCV cure/clearance was associated with reduced liver disease burden, with a 72% reduction in odds of cirrhosis (adjusted odds ratio, 0.28).
• HCV cure/clearance was associated with reduced overall mortality (54 versus 9 deaths per 1000 person years for untreated and treated, respectively; adjusted hazard ratio, 0.42).

Comments: This study is one of the first to show HCV treatment reducing morbidity and mortality on a population level. While treatment rates are increasing, we are far from meeting the goals needed to eliminate this infection. This reinforces the importance of screening PWID for HCV and offering low-barrier treatment.

Corey McBrayer, DO, MPH* & Darius A. Rastegar, MD

* Rich Saitz Editorial Intern & Grant Medical Center Addiction Medicine Fellow, OhioHealth.

Reference: Cepeda JA, Thomas DL, Astemborski J, et al. Impact of hepatitis C treatment uptake on cirrhosis and mortality in persons who inject drugs: a longitudinal, community-based cohort study. Ann Intern Med. 2022;175(8):1083–1091.