Liver Disease Declines Among Drug Injectors
Advanced chronic liver disease declined among people who inject drugs in Australia between 2018 and 2025, according to an observational cohort study published in Liver International.
Researchers associated this reduction with unrestricted access to hepatitis C virus treatment and increased treatment uptake. The study assessed liver health across drug treatment clinics and needle and syringe programmes across Australia in three distinct recruitment waves.
Participants were enrolled during 2018–2019, 2019–2021, and 2023–2025. Researchers measured liver stiffness using vibration-controlled transient elastography alongside point-of-care HCV RNA testing.
Decline Across Three Recruitment Waves
Among 3,093 participants with liver stiffness measurements, 9.1% had advanced chronic liver disease overall. That proportion dropped from 12.0% in the first recruitment wave to 7.9% in the second wave. By the third wave, the figure fell to 6.4%.
Current HCV infection rates dropped from 24% in the first recruitment wave down to 10% in the third wave. Treatment coverage among eligible participants increased from 64% in 2018–2019 to 87% in 2023–2025, as reported in the ETHOS Engage Study.
Longitudinal analysis tracked participants evaluated across multiple visits. Among 44 individuals carrying a current HCV infection at their first visit who cleared it by their second visit, advanced chronic liver disease dropped from 19% to 5%.
Conversely, among 20 participants who tested positive for current HCV infection at both visits, the prevalence of advanced chronic liver disease remained steady at 5%. Researchers identified age and HCV status as primary factors associated with advanced chronic liver disease.
Liver Health Monitoring Requirements
The findings indicate that unrestricted access to direct-acting antiviral therapies directly drives down advanced liver pathology in this demographic. Investigators emphasized that public health systems must maintain ongoing screening protocols alongside prevention measures.
Researchers concluded that continued monitoring, alongside improved access to HCV prevention, testing, and treatment, remains vital to address the ongoing liver disease burden in this population.
Common Questions About Liver Disease Trends
How was liver disease assessed in the study?
Researchers evaluated participants using vibration-controlled transient elastography to measure liver stiffness. Participants also completed questionnaires and underwent point-of-care HCV RNA testing.
What caused the reduction in advanced chronic liver disease?
Investigators associated the decrease with unrestricted access to hepatitis C virus direct-acting antiviral therapies and higher treatment uptake, which rose to 87% in the final recruitment wave.
Which groups face higher risks of liver disease?
The study identified age and ongoing hepatitis C virus status as the key factors associated with advanced chronic liver disease among people who inject drugs.
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