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. 2025 Apr 15:ciaf082.
doi: 10.1093/cid/ciaf082. Online ahead of print.

Retreatment of Hepatitis C Virus Among People Who Inject Drugs

Aurielle M Thomas  1   2 , Alain H Litwin  3   4   5 , Judith I Tsui  6 , Sophie Sprecht-Walsh  7 , Kendra L Blalock  8 , Karen T Tashima  9 , Paula J Lum  10 , Judith Feinberg  11 , Kimberly Page  12 , Shruti H Mehta  13 , Arthur Y Kim  14 , Brianna L Norton  15 , Moonseong Heo  16 , Ellen S Stein  10 , Cristina Murray-Krezan  17 , Julia Arnsten  15 , Megan Groome  5 , Emily Waters  4 , Lynn E Taylor  1   18
Affiliations

Retreatment of Hepatitis C Virus Among People Who Inject Drugs

Aurielle M Thomas et al. Clin Infect Dis. .

Abstract

Background: Hepatitis C virus (HCV) is a leading cause of infectious disease death in the United States. Although highly effective direct-acting antiviral (DAA) regimens are well established, retreatment among people who inject drugs (PWID) has not been sufficiently studied. This study assessed DAA retreatment outcomes and associated factors.

Methods: We performed analyses of longitudinal data from the HERO Study, a US-based multi-site pragmatic randomized trial conducted in 8 states to evaluate effectiveness of 2 HCV care models among DAA treatment-naïve PWID in opioid treatment programs and community clinics. After initial HERO Study sofosbuvir/velpatasvir (SOF/VEL) treatment, participants eligible for retreatment were identified, from 15 September 2016 to 13 September 2021. This analysis characterizes participants who either did not achieve sustained virologic response (SVR) or were reinfected with HCV post-SVR. We compared categorical variables using Fisher exact test and continuous variables using the Welch 2 sample t test for means and an asymptotic 2-sample Mood median test.

Results: One hundred four participants were identified as eligible for retreatment. Less than half, 43 (41.3%), initiated retreatment. Among the 25 who initiated retreatment and for whom SVR results were available, 24 achieved SVR (96%). Participants who did not achieve SVR initiated retreatment more promptly than participants reinfected post-SVR (respectively, 471 vs 784 days on average, P < .001).

Conclusions: After reinfection or not achieving SVR with the first DAA regimen, retreated PWID achieved higher SVR rates than with initial DAA treatment. To attain HCV elimination and benefit individual and public health, assisting PWID with accessing prompt retreatment is crucial.

Keywords: direct-acting antivirals (DAAs); hepatitis C virus infection (HCV); people who inject drugs (PWID); reinfection; retreatment.

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Conflict of interest statement

Potential conflicts of interest. A, H. L. has served on advisory boards for Gilead Sciences and AbbVie Inc. and has received research funding from Gilead Sciences. S. H. M. has received equipment, materials, drugs, medical writing, gifts, or other services from Abbott Laboratories. P. J. L. served in a leadership or fiduciary role for the Association for Multidisciplinary Education and Research on Substance use and Addiction (AMERSA) Board of Directors (president 2019–2022), and on the American College of Academic Addiction Medicine (ACAAM) Board of Directors (2019–present). Dr Feinberg has received research grants from Gilead Sciences. Dr Kim has received royalties or licenses and has participated on data safety monitoring boards or advisory boards for Kintor Pharmaceuticals. Dr Norton has received grants from the National Institutes of Health (NIH), received payment or honoraria for lecturing, and has participated on a data safety monitoring board or advisory board for an NIH-funded study. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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