After beating hepatitis C with direct-acting antivirals (DAAs), many people think they’re done. But HCV reinfection is real-and it’s happening more often than you might expect. If you’re someone who injects drugs, uses methamphetamine, or has ongoing exposure to the virus, getting cured doesn’t mean you’re safe forever. The good news? You can be treated again. And again. And again. There’s no limit. No stigma. No waiting. Just science-backed care that works.
What HCV Reinfection Actually Means
Hepatitis C reinfection happens when someone who was successfully cured of HCV gets infected again. This isn’t the virus coming back from hiding-it’s a brand-new infection. It’s like catching the flu after you’ve recovered from last year’s strain. The immune system doesn’t build lasting protection against HCV, so being cured doesn’t make you immune. Reinfection rates are highest in the first six months after cure, especially among people who inject drugs. Studies show that if you’re under 30 and still injecting, your risk is more than three times higher than older users. Methamphetamine use also doubles the risk. These aren’t abstract numbers-they’re lived realities. In cities like Boston, San Francisco, and Glasgow, we’re seeing clusters of reinfection in communities where access to clean needles or opioid treatment is limited.How Effective Is Retreatment?
The biggest myth about HCV reinfection is that retreatment doesn’t work. It does. Just as well as the first time. The standard retreatment for reinfection is 8 weeks of glecaprevir/pibrentasvir (Mavyret). This combo cures over 95% of cases-even in people who’ve been treated before. If you relapsed after an earlier course (meaning the virus came back after treatment ended), doctors may use sofosbuvir/velpatasvir/voxilaprevir (Vosevi) for 12 weeks, sometimes with ribavirin. But for most people who get reinfected, the same 8-week pill pack they got the first time works perfectly. A 2024 study in JAMA Network Open looked at over 1,200 people who were cured and later reinfected. Every single one was successfully retreated. No drop in effectiveness. No resistance issues. No exceptions. The study concluded: “DAA retreatment for reinfection is as effective as treatment for primary infection.”The New 4-Week Option for Early Infection
If you catch HCV right after exposure-within the first 24 weeks-there’s now a faster option. The PURGE-C trial tested a 4-week course of glecaprevir/pibrentasvir in people with acute HCV. It cured 84% of participants. That’s not 95%, but it’s still high. And for someone who can’t come back for follow-up visits, or who’s worried about stigma, it’s a game-changer. The FDA approved Mavyret for acute HCV in June 2025. It’s the first and only DAA therapy with that specific label. This isn’t experimental anymore. It’s standard care for people who test positive soon after exposure. And it’s not just about speed. Shorter courses mean fewer pills, less cost, and fewer chances for someone to drop out of care. In places like Portland and Toronto, clinics are now offering 4-week treatment on the same day someone tests positive-no waiting, no referrals, no judgment.
Harm Reduction Isn’t Optional-It’s Essential
You can’t cure your way out of HCV without fixing the systems that spread it. Treatment alone won’t stop reinfection. You need clean needles, opioid treatment, and support. Needle and syringe programs (NSPs) that give out at least 200 needles per person per year cut HCV transmission by 54%. Methadone or buprenorphine programs reduce new infections by half. These aren’t just “nice to have.” They’re proven, life-saving tools. But here’s the problem: only 38% of countries provide these services at the level science says is needed. In the U.S., 68% of people who inject drugs report being denied HCV treatment because they’re still using drugs. That’s not medical logic-it’s discrimination. The CDC’s 2024 guidelines say clearly: “Treatment should be offered to everyone with HCV, regardless of ongoing drug use.” And yet, clinics still turn people away. In Boston, a clinic that co-located HCV care with opioid treatment saw 82% of patients stick with their treatment plan. In San Francisco, where care was split between addiction clinics and liver specialists, 74% of patients got lost in the system.What Happens After You’re Cured?
Getting cured doesn’t mean you can stop caring. You still need to protect yourself. For the first six months after treatment, get tested for HCV RNA every three months. That’s when reinfection is most likely. After that, annual testing is enough unless you’re still at risk. Also, get tested for hepatitis B before starting any DAA treatment. HCV treatment can wake up a dormant HBV infection. Between 2019 and 2024, 12 cases of HBV reactivation were reported to the FDA in people who got HCV treatment without being screened first. It’s preventable.What About Immune Recovery?
Even after the virus is gone, your body doesn’t bounce back right away. Research in Frontiers in Immunology found that T cells-your body’s virus fighters-stay exhausted after cure, especially if you had liver scarring from long-term infection. That’s why reinfection is possible. Your immune system hasn’t fully healed. This isn’t a reason to give up. It’s a reason to be smarter. The goal isn’t just to cure HCV once. It’s to keep you healthy for life. That means ongoing support, regular testing, and access to harm reduction tools.
The Big Picture: Can We Really Eliminate HCV?
The World Health Organization wants to eliminate HCV by 2030. That means cutting new infections by 90% and treating 80% of people living with it. Right now, we have the tools. We have the drugs. We have the science. What we’re missing is political will, funding, and the end of stigma. In 2023, over 20 million people had been cured globally. That’s progress. But 1.5 million new infections still happen every year. Most of them are in people who inject drugs. And most of those people can’t get clean needles or opioid treatment. The U.S. is moving faster than most. As of August 2025, 32 states allow same-day HCV treatment for people who use drugs. That’s huge. But it’s not enough. We need every state to do it. We need every clinic to follow CDC guidelines. We need every nurse, doctor, and pharmacist to know: treating HCV again is not a failure. It’s the point.What You Can Do
If you’ve been cured of HCV:- Get tested every 3 months for the first 6 months after cure.
- Use clean needles every time. If you can’t, use bleach to rinse syringes (it’s not perfect, but it helps).
- Ask for opioid agonist therapy if you use opioids. It cuts your HCV risk in half.
- Don’t let anyone tell you you’re not eligible for treatment because you’re still using drugs. That’s not true.
- If you’re a clinician: Offer treatment the same day you diagnose HCV. No waiting. No conditions.
