Drinking alcohol or alcohol use disorder (AUD) does not reduce the effectiveness of patients receiving direct-acting antiviral (DAA) therapy for chronic hepatitis C virus (HCV) infection, according to a study published in the journal 2017 Probability of sustained virological response (SVR). JAMA Network Open.
Researchers explained that clinicians previously used interferon-based regimens to treat hepatitis C, and patients who actively drank alcohol in the previous year were more likely to discontinue treatment. Therefore, many clinicians are reluctant to treat patients who have recently consumed alcohol, even though these patients still achieve SVR.
Today, clinicians use DVV therapy to treat HCV. Current guidelines from the American Association for the Study of Liver Diseases (AASLD), the Infectious Diseases Society of America (IDSA), and the Department of Veterans Affairs (VA) do not recommend that clinicians discontinue DAA therapy in patients who drink alcohol, regardless of symptoms. their intake. However, some clinicians still refuse to treat drinkers with DAA, and some payers require abstinence from alcohol for reimbursement, the researchers explained. Therefore, they conducted a study to determine whether alcohol consumption would prevent patients receiving DAAs for HCV from achieving SVR.
The researchers created a study population based on data from the VA Corporate Data Warehouse, which was collected from more than 1,200 medical institutions. Their population consisted of patients from the 1945 to 1965 Veterans Administration birth cohort who initiated interferon-free DAA therapy between January 1, 2014, and June 30, 2018.
“This birth cohort was chosen because persons born between 1945 and 1965 are known to have HCV infection rates that are six times higher than those of all other age groups,” the authors wrote. “In addition, the CDC and U.S. Preventive Services The group recommends one-time HCV screening for these individuals during the study period.”
Hepatitis C virus
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The researchers included 69,229 patients in the primary analysis, with a mean (SD) age of 62.6 (4.5) years. The population included 67,150 (97.0%) men, 34,655 (50.1%) non-Hispanic white patients, and 28,094 (40.6%) non-Hispanic black patients.
They created drinking categories based on responses to the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire and AUD diagnoses defined in two documents. International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases, Tenth Revision.
Based on patients’ responses and diagnosis, the researchers classified them into one of the following categories: abstinent alcoholics with no history of AUD (AUDIT-C score of 0 and no AUD diagnosis), abstinent alcoholics with a history of AUD (AUDIT-C score of 0 and no AUD diagnosis), and abstinent alcoholics with a history of AUD 0 and no AUD diagnosis), low-risk consumption (AUDIT-C score of 1-3 and no AUD diagnosis), moderate-risk consumption (AUDIT-C score of 4-7 and no AUD diagnosis), or high-risk consumption Risky spending or AUD (AUDIT-C score >8 or AUD diagnosis present and AUDIT-C score non-zero).
The researchers found that 32,290 patients (46.6%) quit smoking without AUD, 13,415 patients (19.4%) had low-risk consumption, 11,215 patients (16.2%) had high-risk consumption or AUD, and 9192 (13.3%) had high-risk consumption or AUD. ) had AUD and 3117 (4.5%) had moderate risk consumption. Overall, 65,355 patients achieved SVR; the researchers noted that 58,651 did so within 12 weeks to 6 months after completion of DAA therapy, and 6704 did so between 4 and 12 weeks after completion.
In unadjusted models, the researchers explained that abstinent alcoholics without a history of AUD (odds ratio (OR), 0.89; 95% CI, 0.81-0.97) and abstinent alcoholics with a history of AUD (OR, 0.71; 95% CI, 0.64-0.80) had lower odds of achieving SVR compared with patients who reported low-risk consumption. On the other hand, in the fully adjusted model, no alcohol category was significantly associated with reduced odds of SVR (abstinent alcoholics without a history of AUD: OR, 1.09; 95% CI, 0.99-1.20; abstaining alcoholics with a history of AUD )
“Our findings suggest that clinicians and policymakers should encourage those with unhealthy drinking or AUD to receive hepatitis C treatment rather than erecting barriers to hepatitis C treatment,” the authors wrote. “Given the high SVR rates across all drinking categories , there is no indication that payers require alcohol abstinence before reimbursing DAA treatment for HCV infection.”
The researchers acknowledged various limitations to their study, one of which is that they used data from patients born between 1945 and 1965, meaning their findings may not be generalizable to patients born outside that time frame. patient. Additionally, these findings may not apply to women because they constituted only a small portion of the study population.
Despite these limitations, the researchers note that their study has a number of strengths, including access to detailed and diverse electronic health record data. Therefore, they are confident in their findings and note that DAA treatment should be offered and reimbursed regardless of a patient’s drinking status or history of AUD.
“Restricting access to DAA therapy based on alcohol consumption or AUD creates unnecessary barriers to patients receiving DAA therapy and challenges HCV elimination goals,” the authors concluded.
refer to
Cartwright EJ, Pierret C, Minassian C, et al. Alcohol consumption and sustained virologic response to direct-acting antiviral therapy for hepatitis C virus. JAMA Network Open. 2023;6(9):e2335715. doi:10.1001/jamanetworkopen.2023.35715