Advanced chronic liver disease declined among people who inject drugs in Australia between 2018 and 2025, driven by unrestricted access to direct-acting antiviral treatments for hepatitis C.
- Direct-acting antivirals: Highly effective prescription medications that cure most cases of hepatitis C by stopping the virus from multiplying.
- Transient elastography: A non-invasive ultrasound scan used to measure liver stiffness and detect scarring or advanced disease.
- HCV RNA testing: A blood test that detects active hepatitis C virus genetic material in the bloodstream to confirm a current infection.
Liver disease among individuals injecting drugs across Australia was evaluated through this observational cohort study, which gathered participants via needle and syringe programmes and drug treatment clinics. Participants were enrolled during three waves: 2018–2019, 2019–2021, and 2023–2025. Researchers assessed liver stiffness using vibration-controlled transient elastography.
Participants also completed questionnaires and underwent point-of-care HCV RNA testing. Among 3,093 participants with liver stiffness measurements, 9.1% had advanced chronic liver disease. Rates dropped across the enrollment periods, falling from 12.0% initially to 7.9% in wave two and reaching 6.4% in the third wave.
Current HCV infection declined from 24% in the first recruitment wave to 10% in the third. Documented treatment coverage among participants who qualified for HCV therapy rose to 87% in 2023–2025, up from 64% during 2018–2019.
Longitudinal analysis also examined participants with liver stiffness measurements across multiple waves. Advanced chronic liver disease dropped from 19% down to 5% among the 44 individuals who cleared a current HCV infection between their initial and subsequent visits.
On the other hand, the prevalence of advanced chronic liver disease stayed steady at 5% for the 20 participants who tested positive for a current HCV infection during both visits. Researchers also identified age and HCV status as factors associated with advanced chronic liver disease.
| Recruitment Wave | Participants Measured | Advanced Chronic Liver Disease (%) | Current HCV Infection (%) | Treatment Coverage (%) |
|---|---|---|---|---|
| 2018–2019 | — | 12.0% | 24% | 64% |
| 2019–2021 | — | 7.9% | — | — |
| 2023–2025 | 3,093 (Total) | 6.4% | 10% | 87% |
These outcomes indicate that falling hepatitis C rates, combined with open access to direct-acting antiviral medications, have helped lower advanced chronic liver disease levels within the drug-injecting community. The study’s authors determined that ongoing surveillance, paired with better availability of HCV prevention, diagnostic testing, and medical care, is vital for tackling the persistent challenges of liver disease within this group.
- Conway A et al. Reductions in Advanced Chronic Liver Disease Among People Who Inject Drugs: The ETHOS Engage Study. Liver International. 2026; DOI: 10.1111/liv.70940.
Disclaimer: This reporting is intended for informational and educational purposes based on peer-reviewed clinical research and does not constitute medical advice, diagnosis, or treatment.
