Reductions in Advanced Chronic Liver Disease Among People Who Inject Drugs: The ETHOS Engage Study.
13 affiliations
- 1The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
- 2Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia.
- 3Centre for Epidemiology and Evidence, NSW Health, Sydney, New South Wales, Australia.
- 4Department of Health Systems and Populations, Macquarie University, Sydney, New South Wales, Australia.
- 5Epidemiology and Systems Branch, NSW Health, Sydney, New South Wales, Australia.
- 6Kirketon Road Centre, Sydney, New South Wales, Australia.
- 7National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia.
- 8Population Health Strategy & Performance, NSW Health, Sydney, New South Wales, Australia.
- 9Alcohol and Drug Service, Metro North Mental Health, Metro North Hospital and Health Service, Brisbane, Queensland, Australia.
- 10Next Step Community Alcohol and Drug Service, Perth, Western Australia, Australia.
- 11National Drug Research Institute, Curtin University, Perth, Western Australia, Australia.
- 12Drug and Alcohol Services South Australia, Adelaide, South Australia, Australia.
- 13Australian Injecting and Illicit Drug Users League (AIVL), Canberra, Australia.
Abstract
Background and aims
Liver 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
The 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
Among 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
Unrestricted 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.
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BibTeX
@article{conway2026reductions,
title = {{Reductions in Advanced Chronic Liver Disease Among People Who Inject Drugs: The ETHOS Engage Study.}},
author = {Anna Conway and Heather Valerio and Jessie Payne and David Silk and Alison D Marshall and Marianne Martinello and Shane Tillakeratne and Putu Novi Arfirsta Dharmayani and Andrew Milat and Janaki Amin and Phillip Read and Louisa Degenhardt and Annabelle Stevens and Jeremy Hayllar and Michael Christmass and Victoria Cock and Jessica Doumany and Jason Grebely and Gregory J Dore and ETHOS Engage Study Group},
journal = {Liver international : official journal of the International Association for the Study of the Liver},
year = {2026},
month = oct,
doi = {10.1111/liv.70940},
url = {https://europepmc.org/article/MED/42958891},
note = {CC BY},
}
RIS
TY - JOUR
TI - Reductions in Advanced Chronic Liver Disease Among People Who Inject Drugs: The ETHOS Engage Study.
AU - Anna Conway
AU - Heather Valerio
AU - Jessie Payne
AU - David Silk
AU - Alison D Marshall
AU - Marianne Martinello
AU - Shane Tillakeratne
AU - Putu Novi Arfirsta Dharmayani
AU - Andrew Milat
AU - Janaki Amin
AU - Phillip Read
AU - Louisa Degenhardt
AU - Annabelle Stevens
AU - Jeremy Hayllar
AU - Michael Christmass
AU - Victoria Cock
AU - Jessica Doumany
AU - Jason Grebely
AU - Gregory J Dore
AU - ETHOS Engage Study Group
PY - 2026
DA - 2026/10/30
JO - Liver international : official journal of the International Association for the Study of the Liver
DO - 10.1111/liv.70940
UR - https://europepmc.org/article/MED/42958891
AB - Background and aims Liver 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 The 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 Among 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 Unrestricted 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.
SN - 1478-3223
SN - 1478-3231
ER -