ADVANCED chronic liver disease declined among people who inject drugs in Australia between 2018 and 2025.

Researchers associated this reduction with unrestricted access to hepatitis C virus (HCV) treatment and increased treatment uptake, while highlighting the need for continued monitoring of liver health.

Liver Disease Declined Across Three Recruitment Waves

The observational cohort study assessed liver disease among people who inject drugs recruited through drug treatment clinics and needle and syringe programmes across Australia. Participants were enrolled during three waves: 2018–2019, 2019–2021, and 2023–2022025.

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. The proportion declined from 12.0% in the first recruitment wave to 7.9% in the second and 6.4% in the third.

Hepatitis C Infection and Liver Health

Current HCV infection declined from 24% in the first recruitment wave to 10% in the third. Among participants eligible for HCV treatment, reported treatment coverage increased from 64% in 2018–2019 to 87% in 2023–2025.

Longitudinal analysis also examined participants with liver stiffness measurements across multiple waves. Among 44 participants who had current HCV infection at their first visit but not their second, advanced chronic liver disease decreased from 19% to 5%.

Conversely, among 20 participants with current HCV infection at both visits, advanced chronic liver disease remained at 5%. Researchers also identified age and HCV status as factors associated with advanced chronic liver disease.

Continued Monitoring Remains Important

The findings suggest that unrestricted access to direct-acting antiviral therapies and declining HCV prevalence have contributed to reductions in advanced chronic liver disease among people who inject drugs.

Researchers concluded that continued monitoring, alongside improved access to HCV prevention, testing and treatment, is important to address ongoing liver disease burden in this population.

Reference:

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.