Most people on opiate substitution therapy were successfully treated for hepatitis C with an interferon-free regimen of grazoprevir/elbasvir (Zepatier), and only a small number became reinfected during three years of follow-up, researchers reported yesterday at the 25th International Harm Reduction Conference (HR17) in Montréal.

Hepatitis C virus (HCV) is easily transmitted through shared drug injection equipment. The advent of new direct-acting antivirals (DAAs) used in interferon-free regimens has transformed hepatitis C treatment. But due to their high cost, many providers, insurers and government payers have made people who inject drugs ineligible for therapy, even though they make up a large proportion of the population living with HCV.

“In many countries there are still restrictions based on drug and alcohol use criteria, which is a human rights violation,” said Jason Grebely of the Kirby Institute at the University of New South Wales. “We really need to be working to build the evidence base around how people can be successfully treated with these new DAAs.”

The fact that some people get reinfected reflects a lack of adequate harm reduction services and ready access to clean injection supplies, they argued. Getting more people treated and cured would also reduce the risk of reinfection.

“Reinfection is not about being careless, it’s about education and the availability of appropriate health care,” said Mary Ellen Harrod of the New South Wales Users and AIDS Association.

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