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Objectives Real world data on glecaprevir/pibrentasvir (G/P) among active drug users are scarce. We evaluated the sustained virological response (SVR) rates of G/P among individuals with and without active drug use in routine clinical practice. Methods Two ongoing prospective multicenter cohorts of individuals starting G/P were analyzed. Overall SVR intention-to-treat (ITT), discontinuations due to adverse effects and dropouts were evaluated. Results in patients with active, past and without active drug use were compared. Results Overall, 644 individuals started G/P and have reached the date of SVR evaluation. Of them, 613 (95.2%) individuals achieved SVR. There were two (0.3%) relapses, one (0.2%) discontinuation due to side effects and 35 (5.4%) dropouts. SVR rates for patients with active drug use, past drug use and those who never used drugs were 85.4%(n/N = 70/82), 96.1%(n/N = 320/333) and 97.4%(n/N = 223/229) respectively (p < 0.001). After adjustment by sex, age, HCV genotype and opioid agonist therapy, active drug use was the only factor independently associated with SVR (ITT) [adjusted OR (95%confidence interval): 0.29(0.09–0.99),p = 0.048]. Conclusions Active drug use was independently associated with lower SVR rates to G/P, mainly due to voluntary dropout. G/P could be particularly beneficial in this scenario but specific strategies designed to increase the retention in care are needed.

People living with human immunodeficiency virus (PLWH) constitute a population among whom elimination of hepatitis C virus (HCV) is a priority [1]. In April 2015, Spaindwhich provides universal and free access to healthcaredelaborated on a recommendation for the prioritization of HCV treatment based mainly on the liver fibrosis stage. This recommendation was updated in September 2017, considering treatment uptake for every patient with a detectable HCV viral load. This change in statement facilitates micro-elimination in high-priority populations such as PLWH. Because of the high proportion of coinfected patients identified, the routinely programmed clinical visits, and the proactive screening strategies implemented in this setting, HCV elimination in this subgroup of patients is feasible.