HCV Reinfection and Cure: What You Need to Know About Retreatment and Harm Reduction

After beating hepatitis C with direct-acting antivirals (DAAs), many people think they’re done. But for those still exposed to the virus-especially people who inject drugs-HCV reinfection is real, and it’s happening more often than you’d expect. The good news? You can be cured again. And again. And again. There’s no limit. No stigma. No waiting. Just treatment, no questions asked.

How HCV Comes Back After Cure

Hepatitis C doesn’t stick around forever after treatment. More than 95% of people who finish an 8- to 12-week course of DAAs like glecaprevir/pibrentasvir (Mavyret) or sofosbuvir/velpatasvir (Epclusa) are cured. That’s called sustained virologic response at 12 weeks (SVR12). The virus is gone. Liver damage stops. Cancer risk drops.

But if you’re still injecting drugs, sharing needles, or having unprotected sex with someone who has HCV, you can catch it again. Reinfection isn’t rare. In some high-risk groups, up to 1 in 5 people get HCV a second time within two years. The first six months after cure are the riskiest. That’s when your body hasn’t built up any lasting immunity. You’re just as vulnerable as you were before.

Studies like the HERO trial show that younger people under 30, those still using methamphetamine, and people who inject drugs regularly are three times more likely to get reinfected. It’s not about willpower. It’s about exposure. And if you’re in a community where HCV is circulating, you’re at risk-even if you’ve been cured before.

Can You Be Cured Again? Yes. Easily.

Some clinics still refuse to treat people who’ve been cured before, saying, “You should’ve stayed clean.” That’s outdated. That’s harmful. And it’s not what the science says.

The CDC, WHO, and major liver societies all agree: treat HCV every time it shows up. No exceptions. No waiting. No judgment.

For reinfection, the standard is still 8 weeks of glecaprevir/pibrentasvir. Same as the first time. Cure rates stay above 95%. No extra drugs. No longer treatment. No resistance issues. It works just as well as the first cure.

If you relapsed after your first treatment-meaning the virus came back after you finished-you might need a different combo. That’s where sofosbuvir/velpatasvir/voxilaprevir (Vosevi) for 12 weeks comes in. It’s used when the virus didn’t fully clear the first time, not when you got it again from outside.

And here’s the kicker: even if you failed a 4-week treatment, you can still be cured with the full 8-week course. The PURGE-C trial proved it. People who didn’t clear the virus with a short course didn’t develop resistance. They just needed more time. That’s huge. It means we don’t have to give up on people who miss the mark the first time.

Why Shorter Treatments Are Changing the Game

For years, treatment meant 12 weeks of pills. Now, we’re seeing that 8 weeks works for most. And for people with early infection-someone who just got HCV in the last 6 months-8 weeks might be overkill.

The FDA just approved Mavyret for acute HCV in June 2025. That’s the first time any DAA has been officially labeled for early infection. In the PURGE-C trial, 84% of people with new HCV infections were cured with just 4 weeks of glecaprevir/pibrentasvir. That’s not 95%, but it’s close. And for someone who can’t come back for a 12-week refill, 4 weeks is life-changing.

The NIH is already testing 2-week courses in the PURGE-2 trial. If that works, we could be looking at a single weekend of pills for early HCV. Imagine that. Walk into a clinic on Monday, get tested, start treatment, and be done by Friday. No follow-up needed. No stigma. No barriers.

Harm Reduction Isn’t Optional-It’s Essential

You can’t cure your way out of HCV without fixing the systems that spread it.

Needle exchanges aren’t just “nice to have.” They’re the single most effective tool to stop transmission. Studies show that when programs give out 200 or more clean needles per person per year, HCV infections drop by 54%. That’s not a guess. That’s data.

Methadone and buprenorphine do the same thing. People on opioid agonist therapy cut their risk of catching HCV in half. That’s not because they stop using drugs. It’s because they stop sharing needles. They stop risking their liver for a fix.

And here’s the truth: most people who get reinfection aren’t being offered these services. A 2024 survey of 1,200 people who inject drugs across 15 U.S. cities found 68% were denied HCV treatment because they were still using drugs. That’s not just wrong. It’s deadly.

The best results come when HCV care is right next to addiction treatment. In Boston, clinics that co-locate hepatitis C treatment with methadone programs saw 82% of patients stick with their treatment. Why? Because they didn’t have to go to three different places. They didn’t have to face judgment twice. They got care where they already were.

What You Need to Do After Cure

If you’ve been cured, here’s what you need to do next:

• Get tested for HCV RNA every 3 months for the first 6 months. That’s when reinfection is most likely.
• Use clean needles every time. If you can’t, use bleach or a new syringe. Never reuse.
• Ask for opioid agonist therapy if you use opioids. It cuts your risk in half.
• Get vaccinated for hepatitis A and B. They don’t protect against HCV, but they protect your liver.
• Know your rights. You can be treated as many times as needed. No clinic can legally refuse you.

What’s Holding Us Back?

We have the tools. We have the drugs. We have the data.

But only 38% of countries offer needle exchanges at the level the WHO recommends. In the U.S., only 32 states allow same-day HCV treatment for people who inject drugs. The rest still make you prove you’re “ready.”

And the cost? It’s still a problem. In the U.S., a full course of treatment can cost up to $60,000. But Medicare and Medicaid are covering more of it now. Generic versions are coming. In places like Egypt and Pakistan, treatment costs less than $50. We can do better.

The real barrier isn’t medicine. It’s stigma. It’s bureaucracy. It’s the idea that people who use drugs don’t deserve to live.

What’s Next?

By 2030, the WHO wants to cut HCV infections by 90%. We can do it. But only if we treat people when they need it-not when we think they’re worthy of it.

We need clinics that offer treatment on the same day as testing. We need pharmacies that hand out pills without asking for proof of sobriety. We need police and social workers to refer people to care, not arrest them.

And we need to stop calling reinfection a failure. It’s not. It’s a signal. A signal that we haven’t done enough to protect people. The cure isn’t just in a pill. It’s in a clean needle. In a kind doctor. In a system that says, “We’re here for you, no matter what.”