Improved health-related quality of life after hepatitis C viraemic clearance among people who inject drugs may not be durable

Scott A McDonald (Lead / Corresponding author), Gareth Myring, Norah E Palmateer, Andrew McAuley, Lewis Beer, John F Dillon, William Hollingworth, Rory Gunson, Matthew Hickman, Sharon J Hutchinson

Research output: Contribution to journalArticlepeer-review


Background and Aims: Chronic infection with the hepatitis C virus (HCV) has a detrimental impact on health-related quality of life (QoL). Scale-up of HCV direct-acting antiviral (DAA) therapy among people who inject drugs (PWID) is underway in several countries since the introduction of interferon-free regimens. This study aimed to assess the impact of DAA treatment success on QoL for PWID.

Design: Cross-sectional study using two rounds of the Needle Exchange Surveillance Initiative, a national anonymous bio-behavioural survey, and a longitudinal study involving PWID who underwent DAA therapy.

Setting: Cross-sectional study: Scotland (2017-18, 2019-20). Longitudinal study: Tayside region, Scotland (2019-2021).

Participants: Cross-sectional study: PWID recruited from services providing injecting equipment (n=4009). Longitudinal study: PWID on DAA therapy (n=83).

Measurements: Cross-sectional study: the association between QoL (measured using the EQ-5D-5L quality of life instrument) and HCV diagnosis and treatment was assessed using multilevel linear regression. Longitudinal study: QoL was compared at four timepoints using multilevel regression, from treatment commencement until 12 months following commencement.

Findings: Cross-sectional study: 41% (n=1618) were ever chronically HCV infected, of whom 78% (n=1262) were aware of their status, and of whom 64% (n=704) had undergone DAA therapy. There was no evidence for a marked QoL improvement associated with viral clearance among those treated for HCV (B=0.03, 95% confidence interval [CI]: -0.03 - 0.09). Longitudinal study: improved QoL was observed at the sustained virologic response test timepoint (B=0.18, 95%CI: 0.10-0.27), but this was not maintained at 12 months following start of treatment (B=0.02, 95%CI: -0.05-0.10).

Conclusions: Successful direct-acting antiviral therapy for hepatitis C infection may not lead to a durable improvement in quality of life among people who inject drugs, although there may be a transient improvement around the time of sustained virologic response. Economic models of the impact of scaling-up treatment may need to include more conservative quality of life benefits over and above reductions in mortality, disease progression, and transmission of infection.

Original languageEnglish
Early online date20 Feb 2023
Publication statusE-pub ahead of print - 20 Feb 2023


  • Hepatitis C virus
  • health-related quality of life
  • direct-acting antivirals
  • sustained virological response
  • PWID


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