Opioid use disorder and HCV (hepatitis C virus)

The opioid use disorder (OUD) epidemic has caused a staggering public health toll in the United States. One major consequence of the OUD epidemic is the spread of infectious diseases, including hepatitis C virus (HCV) infection. An estimated 10 million people who inject drugs (PWID) have been infected with HCV. Opioid-related HCV infection and its consequences disproportionally affect people who inject drugs (PWID). The availability of direct-acting antivirals (DAAs), which offer higher cure rates ≥95%, have a shorter duration, and produce fewer side effects compared to traditional interferon-based regimens, has revolutionized the HCV treatment landscape. DAAs also provide the possibility of eliminating HCV as a public health threat in the US and worldwide. However, providing HCV care to the PWID population is a critical component in preventing HCV transmission. High rates rates of sustained virologic response (SVR) are possible among PWID, including those on medications for opioid use disorder (MOUD) or with ongoing drug use. Unfortunately, most PWID have never been offered treatment and many PWID are denied HCV treatment due to concerns related to drug use or suboptimal adherence to DAAs. In addition, PWID face many patient-level, provider-level, and system-level barriers to HCV care. Co-located care models in which HCV care is provided at the same setting as other services is an effective strategy to mitigate these challenges and deliver HCV care among PWID. Overall, HCV reinfection rates among PWID are low, and there is emerging evidence to support treatment as prevention paradigm.