Heavy alcohol consumption is not associated with reduced hepatitis C DAA response

Alcohol use and alcohol use disorder (AUD) are not associated with lower odds of sustained virologic response to direct-acting antiviral (DAA) treatment for chronic hepatitis C virus (HCV) infection, according to a retrospective cohort study of veterans.

Christopher T. Rentsch, MD, of the London School of Hygiene & Tropical Medicine, and colleagues reported that among more than 69,000 patients starting DAA therapy, there was no evidence that any category of alcohol consumption was significantly associated with a reduced odds of sustained virologic response:

• Withdrawal without history of AUD: OR 1.09, 95% CI 0.99-1.20
• Abstinence from alcohol with history of AUD: OR 0.92, 95% CI 0.82-1.04
• Moderate risk consumption: OR 0.96, 95% CI 0.80-1.15
• High-risk spending or Australian dollars: OR 0.95, 95% CI 0.85-1.07

There was also no evidence of an interaction between liver fibrosis stage as measured by the Fibrosis 4 score (ask=0.30), they are JAMA Network Open.

“Our findings suggest that DAA therapy should be offered and reimbursed despite alcohol consumption or a history of AUD,” Rentsch and team concluded. “Restricting access to DAA therapy based on alcohol consumption or AUD poses a risk to patients’ access to DAA therapy. creates unnecessary barriers and challenges HCV elimination goals.”

The authors noted that historically, clinicians have been reluctant to treat HCV patients who actively drink alcohol because patients are more likely to discontinue previously used interferon-based treatments. “However, for patients who successfully completed interferon therapy, comparable rates of sustained virological response were achieved regardless of reported alcohol consumption.”

Although current American Association for the Study of Liver Diseases/Infectious Diseases Society of America HCV treatment guidelines recommend that patients avoid excessive alcohol consumption, they do not recommend limiting DAA treatment based on alcohol intake, regardless of the amount consumed, Rentsch and colleagues said.

“Despite these recommendations, some clinicians still delay or discontinue hepatitis C treatment in patients who drink alcohol,” they added. “In addition, some payers include abstinence from alcohol as a requirement for HCV DAA treatment reimbursement.”

For the study, the authors used electronic health record data from 69,229 patients at the Department of Veterans Affairs, which does not restrict access to DAA HCV treatment based on a patient’s drinking status. Participants were born between 1945 and 1965 and received DAA treatment between January 2014 and June 2018.

Among these patients, 84.5% had HCV genotype 1. The average age was 62.6 years, 97% were male, 50.1% were white, and 40.6% were black.

Using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) Questionnaire and International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision Diagnosis of AUD:

• Abstinence without AUD (AUDIT-C score 0 and no AUD diagnosis): 46.6% of patients
• Abstinence from AUD (AUDIT-C score 0 and AUD diagnosis): 13.3% of patients
• Low-risk consumption (AUDIT-C score 1-3 and no AUD diagnosis): 19.4% of patients
• Moderate risk consumption (AUDIT-C score 4-7 and no AUD diagnosis): 4.5% of patients
• High-risk consumption or AUD (AUDIT-C score of 8 or AUD diagnosis and non-zero AUDIT-C score): 16.2% of patients

Sustained virologic response was defined as undetectable HCV RNA for 12 weeks or more after completion of DAA therapy. Overall, 94.4% of patients achieved sustained virologic response.

Rentsch and team noted that due to the observational nature of their study, “a degree of uncertainty remains due to potential residual confounding factors.”