More than 2 million people in the US, predominantly people who inject drugs, are living with hepatitis C virus (HCV) infection. Despite the availability of direct-acting antiviral (DAA) therapy, the US Centers for Disease Control and Prevention recently estimated that only one-third of those who received a diagnosis of HCV infection had been cured, with lower estimates among younger people and those without health insurance. To combat the rising burden of infection, the White House has proposed a US National HCV Elimination Plan in the 2023 to 2024 budget, aiming to increase diagnosis and treatment for those most vulnerable.
In this context, it is timely that Litwin and colleagues1 have evaluated HCV reinfection incidence following DAA treatment among people who inject drugs in a preplanned secondary analysis of the Hepatitis C Real Options (HERO) study, a pragmatic randomized clinical trial. Participants were enrolled through opioid treatment programs and community health centers in 8 US cities. All reported injecting drug use within 90 days of enrollment, with most injecting within 4 weeks. The study population was considerably less stable than those traditionally included in HCV treatment trials with high under-employment or unemployment, housing instability, and limited education. HCV reinfection incidence following treatment was 11.4 per 100 person-years—a rate higher than that reported in many other studies, including those focused on people who inject drugs. In HERO, reinfection risk was higher among younger people, those who reported ongoing injecting drug use, and those who used methamphetamine. Reinfection risk was also higher in the first 6 months following treatment, decreasing over time.1
