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To the Editor: Dr Thomas and colleagues¹ present the results of 9 years of follow-up in a cohort of injection-drug users with hepatitis C virus (HCV) infection. The primary outcome measures were viral clearance and end-stage liver disease (ESLD). Since injection drug use now accounts for 60% of cases of new HCV infections in the United States,² this work is a valuable prospective study of a high-risk population in which the natural history of infection has great public health consequences. The design avoids the referral bias that limits the validity of retrospective studies, and the study population is demographically distinct from previous study cohorts, which have tended to be older and sicker (such as transfusion-infected persons³) or younger and healthier (such as immune globulin recipients⁴). Nonetheless, these data do not answer several important questions.

First, it is not clear that the follow-up periods are sufficiently long to identify . . . [Full Text of this Article]

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