Injection drug use (IDU) is the primary driver of hepatitis C virus (HCV) infection in North America and Europe, with seroprevalence among people who inject drugs (PWID) ranging from 18% to 88%. Most new HCV infections in the United States are linked to IDU, especially in the early years of injection. Despite the absence of a vaccine, expanded testing, linkage to care, and direct-acting antiviral (DAA) treatment can significantly reduce HCV incidence. Annual testing is recommended for PWID, with integration into harm reduction and substance use programs. Ongoing drug use is not a barrier to treatment, and expanding access to care for PWID is a critical public health strategy.

PWID can achieve high cure rates (SVR ≥95%) with DAAs, even with ongoing drug use or while receiving medications for opioid use disorder (MOUDs). Integrated care and patient navigation improve adherence and treatment outcomes. Though reinfection is possible, it’s less common than primary infection and can be reduced through harm-reduction services like MOUDs, syringe service programs, and naloxone distribution. HCV treatment not only cures individuals but also helps prevent transmission, reinforcing the need to scale up care and reduce barriers for this high-risk population.

Reference: American Association for the Study of Liver Diseases (AASLD), Infectious Diseases Society of America (IDSA). Key Populations: Identification and Management of HCV in People Who Inject Drugs. HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C. Published December 19, 2023. Accessed April 7, 2025. https://www.hcvguidelines.org/unique-populations/pwid