Hepatitis C Management in Special Populations

  • Author: Mark S. Sulkowski, MD (More Info)
  • Editor In Chief: Stefan Zeuzem, MD
  • Last Reviewed: 8/17/18 (What's New)

Supporting Assets

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Table 1. Summary of Guidance Committee Recommendations on Managing HCV Infection in PWID[AASLD-IDSA HCV; EASL HCV]

Care Component




  • Screen for HCV at least  annually in PWID with no previous testing and in PWID following negative test
  • Consider increasing HCV screening frequency according to level of risk
  • Needle exchange programs and substance use disorder treatment programs: Offer routine, opt-out HCV antibody testing with reflexive/immediate confirmatory HCV RNA testing and linkage to care
  • Provide voluntary, routine testing for anti-HCV antibodies and HCV RNA in PWID
  • Test HCV RNA annually and after any high-risk injecting episode in HCV RNA–negative PWID


  • Counsel on strategies to reduce risk of transmitting HCV
  • Address HCV transmission, risk factors for fibrosis progression, treatment, risk for reinfection, and strategies for harm reduction during pretherapeutic education

Harm reduction

  • Offer linkage to available harm-reduction services (ie, needle exchange programs, substance use disorder treatment programs)
  • Prescribe naloxone to all PWID who use opioids
  • Provide appropriate access to medication treatment for opioid use disorder plus clean drug injecting equipment as part of harm-reduction programs (including in prisons)

HCV treatment

  • Active/recent drug use or concerns about reinfection are not contraindications to HCV treatment
  • All PWIDs with HCV infection have indication for antiviral treatment
  • For patients receiving medication treatment for opioid use disorder, DAA therapies do not require methadone or buprenorphine dose adjustment
  • Offer HCV treatment to all incarcerated patients with HCV infection
  • HCV treatment should be scaled- up in PWIDs to increase likelihood of achieving HCV elimination goals, including treatment as prevention

Follow-up After SVR

  • Test HCV RNA at least annually in PWID with recent IDU who have been successfully treated or spontaneously cleared HCV infection
  • Reduce risk of HCV reinfection by providing harm reduction, education, and counseling in setting of HCV treatment
  • Test HCV RNA at least annually (preferably biannually) in PWID with ongoing risk behavior
  • Provide retreatment if reinfection identified


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