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the treatment responses were excellent regardless of cirrhosis status and baseline drug screening results (Figure 3).[23] Glecaprevir-Pibrentasvir : In a pooled analysis of 7 phase 3 studies that involved HCV treatment with 8 or 12 weeks of glecaprevir-pibrentasvir, investigators compared SVR12 rates among persons with recent drug use (use in the past 12 months), former drug use (use more than 12 months ago), and no drug use.[28] The SVR12 rates were high among all groups: 93% in persons with recent drug use, 97% in those with former drug use, and greater than 99% in persons who did not use drugs.[28] A similar pooled analysis of 8 phase 2 and 3 trials of glecaprevir-pibrentasvir evaluated treatment outcomes among persons receiving opioid substitution therapy.[29] In the intention-to-treat analysis, SVR12 rates were 96% among persons receiving opioid substitution therapy and 98% in those not receiving opioid substitution therapy.[29] In an analysis of 2 prospective cohort studies in Spain, in the intention-to-treat analysis, the SVR12 rates were 97% among persons who never used drugs, 96% among persons with past drug use, and 85% among persons with recent or active drug use.[30] This slightly lower SVR12 rate among persons with recent or active drug use was felt to be secondary to voluntary discontinuation, as no difference in SVR12 rates was seen when comparing persons who never used drugs (99%), persons with past drug use (100%), and persons with recent or active drug use (100%) in the per-protocol analysis.[30] Ledipasvir-Sofosbuvir (ION Trials) : In the ION trials, participants with chronic HCV genotype 1 infection received 8, 12, or 24 weeks of ledipasvir-sofosbuvir.[31] Investigators performed a pooled data analysis to compare HCV treatment response in participants receiving opioid substitution therapy during treatment (n = 70) with participants not receiving opioid substitution therapy (n = 1882).[31] The two groups had similar treatment completion, adherence, and SVR12 rates (Figure 4).[31] Among those receiving opioid substitution therapy, 94% (66 of 71) achieved an SVR12.[31] In addition, a pilot trial of ledipasvir-sofosbuvir among 31 persons with active injection drug use randomized participants 1:1 to modified directly-observed treatment (mDOT) or unobserved dosing
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