Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

HCV Treatment as Prevention in PWIDs

Lancet; 2018 Feb; Zelenev, Li, et al

In an extended network of people who inject drugs (PWID), successful hepatitis C virus (HCV) treatment as prevention should incorporate the baseline HCV prevalence and will achieve greatest benefit when coverage is expanded, a recent study found. 5 graph models were fit using 1,574 PWID in Hartford, CT. The effectiveness of 7 treatment-as-prevention strategies on reducing HCV prevalence over 10 years and 20 years was compared to no treatment. Researchers found:

  • At the highest baseline HCV prevalence in PWID (85%), expansion of treatment coverage does not substantially reduce HCV prevalence for any treatment-as-prevention strategy.
  • However, when baseline HCV prevalence is ≤60%, treating >120 individuals per 1,000 PWID per year would likely eliminate HCV within 10 years.
  • Assigning treatment randomly to PWID is better than targeting those with the most injection partners.


Zelenev A, Li J, Mazhnaya A, Basu S, Altice FL. Hepatitis C virus treatment as prevention in an extended network of people who inject drugs in the USA: A modelling study. Lancet. 2018;18(2):215-224. doi:10.1016/S1473-3099(17)30676-X.

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