Globally, 12 million people are estimated to have injected drugs in the past year, 50% of whom have chronic HCV infection, with people who have previously injected drugs presenting an additional large reservoir of infection. The availability of simple and tolerable interferon-free direct-acting antiviral agents (DAAs) for HCV infection, which have a cure rate of >95% represents one of the most exciting advances in clinical medicine in the past few decades. Adherence and response to DAA therapy among people who inject drugs (PWID) receiving opioid substitution therapy (OST) in clinical trials are comparable to populations without a history of injecting drugs. Further data are required among current PWID not receiving OST. Given the potential prevention benefits of treatment, DAAs have enhanced cost-effectiveness among PWID. As HCV therapy is expanded to populations of PWID with high-risk behaviours for re-exposure, acknowledgement that HCV reinfection will occur is crucial, and appropriate strategies must be in place to maximize prevention of reinfection and offer retreatment for reinfection. This Review will also discuss essential components for broadening access to HCV care for PWID as we strive for the global elimination of HCV infection.

在过去的一年中，全球估计有1200万人注射了药物，其中50％患有慢性HCV感染，而以前注射过药物的人又增加了一大批感染源。用于HCV感染的简单且可耐受的无干扰素直接作用抗病毒药物（DAA）的治愈率> 95％，是过去几十年来临床医学中最令人兴奋的进展之一。在临床试验中，接受阿片类药物替代疗法（OST）的注射药物（PWID）人群中对DAA疗法的依从性和反应与没有注射药物史的人群相当。当前未接收OST的PWID中需要其他数据。考虑到治疗的潜在预防益处，DAA在PWID中提高了成本效益。随着HCV治疗扩展到具有高风险行为的PWID人群进行再次暴露，认识到HCV再感染将发生是至关重要的，必须采取适当的策略以最大程度地防止再感染并为再感染提供再治疗。本综述还将讨论在我们努力在全球范围内消除HCV感染的过程中，扩大为PWID提供HCV护理的必要组成部分。