The likelihood of achieving sustained virological response (SVR) with direct-acting antivirals (DAAs) in patients with hepatitis C virus (HCV) infection is higher in patients who drink alcohol or have alcohol use disorder (AUD), according to study Doesn’t seem to reduce learning.
The odds of SVR were similar for the following drinking categories, using low-risk drinking (AUDIT-C* score 1-3 and no AUD diagnosis) as a reference: Abstainers with no history of AUD (odds ratio (OR), 1.09), 95% confidence OR , 0.96, 95% CI, 0.80–1.15), and high-risk consumption/AUD (OR, 0.95, 95% CI, 0.85–1.07). (JAMA Network Open
2023;6:e2335715)
There was no evidence that the effect of alcohol consumption on response to DAA therapy for HCV differed by stage of liver fibrosis as measured by the Fibrosis 4 score (p for interaction=0.30).
The analysis was based on data from 69,229 HCV patients (mean age 62.6 years, 97.0% male, 50.1% non-Hispanic white, 84.5% HCV genotype 1) who initiated DAA therapy. Among them, 32,290 people (46.6%) had no history of Australian dollar consumption, 9,192 people (13.3%) had a history of Australian dollar consumption, 13,415 people (19.4%) had low-risk consumption, 3,117 people (4.5%) had medium-risk consumption, and 11,215 people (11,215 Person) has a history of Australian dollar consumption. 16.2%) have high-risk consumption/AUD. A total of 65,355 patients (94.4%) achieved SVR.
The researchers say patients who achieve SVR are an older population with multiple comorbidities who are often underrepresented in clinical trials. In addition, some of these patients were treated with older DAA regimens such as sofosbuvir and ribavirin, which were less well tolerated and resulted in a lower proportion of patients achieving SVR.
Drinking alcohol is not a reason to refuse DAA treatment
“Our results support the current AASLD/IDSA** recommendation that current or previous alcohol consumption is not a contraindication to HCV DAA therapy,” the researchers said.
“Despite these recommendations, some clinicians still delay or discontinue HCV treatment in patients who drink alcohol. Additionally, some payers include abstinence from alcohol as a requirement for HCV DAA treatment reimbursement,” they added. (American Journal of Preventive Medicine 2021;61:716-723; JAMA Network Open 2022;5:e2246604;
public health representative 2023;138:467-474; https://stateofhepc.org/2023-national-snapshot-report/)
The researchers believe that limiting DAA treatment based on alcohol use or AUD is unnecessary and counterproductive, making it more difficult to achieve HCV elimination goals.
“(C) Clinicians and policymakers should encourage those with unhealthy drinking or AUD to receive hepatitis C treatment rather than erecting barriers to hepatitis C treatment. Given that SVR rates are high across all drinking categories… despite drinking or a history of AUD , but DAA treatment should still be provided and reimbursed,” they noted.
The study has some limitations, including the possibility of residual confounding due to the observational nature of the study, and the possibility that some high-risk drinking patients may have been misclassified at lower consumption levels because alcohol use measures may have been affected by both patients. – level and practitioner level factors.
*Alcohol Use Disorder Identification Test-Consumption Questionnaire
**American Association for the Study of Liver Diseases/Infectious Diseases Society of America