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Nina Kim, MD, MSc Associate Editor Professor of Medicine Division of Allergy & Infectious Diseases University of Washington Disclosures : None Learning Objective Performance Indicators Discuss the prevalence of substance use among persons in the United States Describe HCV treatment responses in persons with substance use disorders compared with those who do not have substance use disorders Summarize HCV treatment eligibility in persons who have a past or current substance use disorder List support services and management strategies for persons with substance use disorders who have chronic HCV infection Explain the concept of HCV reinfection in persons who inject drugs Background Substance use disorders are common in the United States, with 2022 data indicating that nearly 1 in 4 (24.9%) of persons 12 years of age or older used an illicit drug in the past year (Figure 1).[1] The availability of highly effective direct-acting antiviral (DAA) medications has radically changed the assessment and consideration of substance use in hepatitis C virus (HCV) treatment decisions