{
  "abstract": "Background and aims\n\nLiver disease is a significant risk for people who inject drugs due to the high burden of hepatitis C virus (HCV). There is limited data on the impact of the direct-acting antiviral (DAA) therapy era on liver disease among people who inject drugs. This study evaluated baseline and longitudinal liver disease in a national cohort of people who inject drugs recruited over three Waves: 2018-2019, 2019-2021, and 2023-2025.Methods\n\nThe ETHOS Engage Study is an observational cohort of people who inject drugs attending drug treatment clinics and needle and syringe programs in Australia. Participants completed a questionnaire and underwent point-of-care HCV RNA testing (Xpert HCV Viral Load Fingerstick) and liver stiffness measurement (LSM) by vibration-controlled transient hepatic elastography (FibroScan). Advanced chronic liver disease was defined by LSM of 10 kPa or above.Results\n\nAmong all enrolments with a valid LSM (n = 3126, 79% recruited at drug treatment clinics), 11% had advanced chronic liver disease, decreasing from 12.0% (154/1287) in 2018-2019 to 7.9% (66/839) in 2019-2021, and 6.4% (62/967) in 2023-2025. In adjusted analyses, participants recruited between 2019-2021 and 2023-2025 were less likely to have advanced chronic liver disease (vs. 2018-2019; aOR 0.66, 95% CI: 0.48-0.90 and aOR 0.56, 95% CI: 0.40-0.77, respectively). Current HCV infection declined from 24% in 2018-2019 to 10% in 2023-2025. Among participants with LSM in more than one wave and current HCV infection at first visit and no current HCV infection at second visit (n = 44), advanced chronic liver disease declined from 19% to 5%.Conclusions\n\nUnrestricted access to DAA therapies in Australia has been associated with reduced liver disease burden among people who inject drugs. Monitoring of liver health in this population is important, given potential ageing and non-HCV liver disease impacts.",
  "abstract_shown": true,
  "affiliations": [
    "The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.",
    "Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia.",
    "Centre for Epidemiology and Evidence, NSW Health, Sydney, New South Wales, Australia.",
    "Department of Health Systems and Populations, Macquarie University, Sydney, New South Wales, Australia.",
    "Epidemiology and Systems Branch, NSW Health, Sydney, New South Wales, Australia.",
    "Kirketon Road Centre, Sydney, New South Wales, Australia.",
    "National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia.",
    "Population Health Strategy & Performance, NSW Health, Sydney, New South Wales, Australia.",
    "Alcohol and Drug Service, Metro North Mental Health, Metro North Hospital and Health Service, Brisbane, Queensland, Australia.",
    "Next Step Community Alcohol and Drug Service, Perth, Western Australia, Australia.",
    "National Drug Research Institute, Curtin University, Perth, Western Australia, Australia.",
    "Drug and Alcohol Services South Australia, Adelaide, South Australia, Australia.",
    "Australian Injecting and Illicit Drug Users League (AIVL), Canberra, Australia."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 20,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Anna Conway",
      "orcid": "0000-0002-9082-9714"
    },
    {
      "affs": [
        0
      ],
      "name": "Heather Valerio",
      "orcid": "0000-0002-8608-2558"
    },
    {
      "affs": [
        0
      ],
      "name": "Jessie Payne",
      "orcid": "0000-0003-3543-9518"
    },
    {
      "affs": [
        0
      ],
      "name": "David Silk"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Alison D Marshall",
      "orcid": "0000-0001-7476-7894"
    },
    {
      "affs": [
        0
      ],
      "name": "Marianne Martinello",
      "orcid": "0000-0001-9444-0186"
    },
    {
      "affs": [
        0
      ],
      "name": "Shane Tillakeratne",
      "orcid": "0000-0002-5988-3579"
    },
    {
      "affs": [
        0
      ],
      "name": "Putu Novi Arfirsta Dharmayani",
      "orcid": "0000-0001-8227-1127"
    },
    {
      "affs": [
        2
      ],
      "name": "Andrew Milat"
    },
    {
      "affs": [
        3,
        4
      ],
      "name": "Janaki Amin"
    },
    {
      "affs": [
        0,
        5
      ],
      "name": "Phillip Read",
      "orcid": "0000-0001-5422-3777"
    },
    {
      "affs": [
        6
      ],
      "name": "Louisa Degenhardt",
      "orcid": "0000-0002-8513-2218"
    },
    {
      "affs": [
        7
      ],
      "name": "Annabelle Stevens",
      "orcid": "0000-0003-0524-7064"
    },
    {
      "affs": [
        8
      ],
      "name": "Jeremy Hayllar",
      "orcid": "0000-0003-3065-7591"
    },
    {
      "affs": [
        9,
        10
      ],
      "name": "Michael Christmass",
      "orcid": "0000-0001-9782-1849"
    },
    {
      "affs": [
        11
      ],
      "name": "Victoria Cock",
      "orcid": "0000-0002-2014-5077"
    },
    {
      "affs": [
        12
      ],
      "name": "Jessica Doumany"
    },
    {
      "affs": [
        0
      ],
      "name": "Jason Grebely",
      "orcid": "0000-0002-1833-2017"
    },
    {
      "affs": [
        0
      ],
      "name": "Gregory J Dore",
      "orcid": "0000-0002-4741-2622"
    },
    {
      "name": "ETHOS Engage Study Group"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/9gvtys0k7sab3.bib",
  "cited_by": 0,
  "doi": "10.1111/liv.70940",
  "fulltext_url": "https://europepmc.org/articles/PMC13720508",
  "id": "9gvtys0k7sab3",
  "issns": [
    "1478-3223",
    "1478-3231"
  ],
  "landing_url": "https://europepmc.org/article/MED/42958891",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Article"
    ],
    [
      "openalex",
      "2721|Hepatitis C virus research"
    ]
  ],
  "openalex": "W7224862197",
  "pdf_url": "https://europepmc.org/articles/PMC13720508?pdf=render",
  "pmcid": "PMC13720508",
  "pmid": "42958891",
  "published": "2026-10-30",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/9gvtys0k7sab3.ris",
  "sources": [
    {
      "first_seen": "2026-11-01T00:20:36Z",
      "native_id": "MED:42958891",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42958891"
    },
    {
      "first_seen": "2026-11-03T12:21:22Z",
      "native_id": "PMC13720508",
      "source": "pmc",
      "url": "https://doi.org/10.1111/liv.70940"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2721|Hepatitis C virus research",
      "subfield": "general"
    }
  ],
  "title": "Reductions in Advanced Chronic Liver Disease Among People Who Inject Drugs: The ETHOS Engage Study.",
  "title_text": "Reductions in Advanced Chronic Liver Disease Among People Who Inject Drugs: The ETHOS Engage Study.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-03T12:21:22Z",
  "url": "https://research.draconitic.com/paper/9gvtys0k7sab3",
  "venue": "Liver international : official journal of the International Association for the Study of the Liver",
  "versions": []
}