NEW data from the U.S.-based HERO Study shed light on an important question for hepatitis C virus (HCV) management: How effective is retreatment among people who inject drugs (PWID)? In a population that remains central to the nation’s HCV burden, the findings point to a strikingly high success rate—even after initial treatment failure or reinfection.
The analysis followed participants enrolled in the HERO Study, a multi-site randomized trial conducted across eight U.S. states. All participants were DAA treatment–naïve PWID receiving care through opioid treatment programs or community clinics. After initial treatment with sofosbuvir/velpatasvir (SOF/VEL), 104 individuals either failed to achieve sustained virologic response (SVR) or were later reinfected.
Among this group, less than half—43 individuals—initiated retreatment. Despite this limited uptake, retreatment outcomes were overwhelmingly positive: of the 25 participants with SVR results available after retreatment, 24 were cured, resulting in a 96% SVR rate.
Interestingly, the data revealed a behavioral distinction between those who failed treatment versus those reinfected. Participants who did not achieve SVR initially tended to re-engage in care sooner, with an average of 471 days to retreatment initiation, compared with 784 days among those reinfected (P < .001). These findings highlight two important realities: first, that PWID who re-enter treatment after an unsuccessful or interrupted course can still achieve virologic success at high rates; and second, that delays in accessing retreatment—especially after reinfection—may hinder public health goals for HCV elimination. Given the robust response to retreatment, researchers emphasized the need for structured systems to rapidly reconnect PWID with care following treatment failure or reinfection. Without improved linkage to retreatment, the broader strategy to eliminate HCV in high-risk populations may fall short. The HERO Study results offer clear evidence that retreatment is not only feasible but highly effective—and underscore the public health imperative to support rapid re-engagement with antiviral therapy among PWID. Reference: Thomas AM et al. Retreatment of Hepatitis C Virus Among People Who Inject Drugs. Clin Infect Dis. 2025:ciaf082. doi: 10.1093/cid/ciaf082. [Epub ahead of print].
