Can hepatitis C virus infection be eradicated in people who inject drugs?

• The burden of hepatitis C virus infection is growing among people who inject drugs (PWID).
• HCV eradication is feasible, given therapy is effective in PWID.
• Harm reduction and HCV treatment as prevention provide a basis for eradication.
• HCV eradication requires broad expansion of effective, tolerable HCV therapy.
• Although eradication should be strived for, elimination is more feasible.

People who inject drugs (PWID) represent the core of the hepatitis C virus (HCV) epidemic in many countries and HCV-related disease burden continues to rise. There are compelling data demonstrating that with the appropriate programs, treatment for HCV infection among PWID is successful, with responses to therapy similar those observed in large randomized controlled trials in non-PWID. However, assessment and treatment for HCV infection lags far behind the numbers who could benefit from therapy, related to systems-, provider- and patient-related barriers to care. The approaching era of interferon-free directly acting antiviral therapy has the potential to provide one of the great advances in clinical medicine. Simple, tolerable and highly effective therapy will likely address many of these barriers, thereby enhancing the numbers of PWID cured of HCV infection. This commentary will consider why we should strive for the eradication of HCV infection among PWID, whether eradication of HCV infection among PWID is feasible, components that would be needed to achieve eradication of HCV infection in PWID, potential settings and strategies required to establish programs targeted towards eradicating HCV infection among PWID and the feasibility of eradication versus elimination of HCV infection among PWID. This article forms part of a symposium in Antiviral Research on “Hepatitis C: next steps toward global eradication.”