‘No evidence’ linking alcohol use, decreased sustained virologic response in chronic HCV
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Key takeaways:
- Most patients who initiated direct-acting antivirals achieved sustained virologic response, regardless of alcohol use.
- Restricting access to DAA therapy based on alcohol use creates barriers to HCV elimination.
Alcohol use at initiation of direct-acting antiviral treatment was not associated with reduced odds for achieving sustained virologic response among veterans with chronic hepatitis C virus infection, according to data in JAMA Network Open.
“In the interferon era, patients with active alcohol use in the previous year were more likely to discontinue interferon-based HCV treatment; consequently, many clinicians were reluctant to treat those with recent alcohol use,” Emily J. Cartwright, MD, of the Atlanta Veterans Affairs Medical Center, and colleagues wrote. “However, for patients who successfully completed interferon-based therapy, comparable rates of sustained virologic response were achieved regardless of reported alcohol use.”
They continued: “With the advent of safe and highly effective direct-acting antiviral therapy for HCV, the impact of alcohol use on achieving SVR is less clear.”
In a retrospective study using national Veterans Affairs data from the 1945 to 1965 birth cohort, Cartwright and colleagues evaluated 69,229 individuals with chronic HCV infection (mean age, 62.6 years; 97% men; 84.5% HCV genotype 1) to investigate the association between alcohol use and SVR.
Researchers reported variation in alcohol use among the cohort, with 46.6% abstinent without alcohol-use disorder (AUD), 13.3% abstinent with AUD, 19.4% lower-risk consumption, 4.5% moderate-risk consumption and 16.2% high-risk consumption or AUD. Fibrosis-4 scores also varied: 50.6% of patients had scores between 1.45 and 3.25, 26.1% had scores greater than 3.25 and 23.3% had scores less than 1.45.
The primary outcome was SVR, defined as undetectable HCV RNA for at least 12 weeks following completion of DAA therapy.
Results showed 94.4% of all patients who initiated DAA therapy achieved SVR. Of those, 58,651 SVR outcomes were measured 12 weeks to 6 months after treatment completion and 6,704 outcomes were measured at 4 to 12 weeks.
An unadjusted analysis showed patients who were abstinent without history of AUD (OR = 0.89; 95% CI, 0.81-0.97) or with history of AUD (OR = 0.71; 95% CI, 0.64-0.8) had decreased odds of achieving SVR compared with patients who reported lower-risk consumption.
However, after fully adjusting for demographics, clinical characteristics and liver-related and treatment-related variables, researchers found “no evidence” that any alcohol category was significantly associated with decreased odds of SVR, including moderate-risk consumption (OR = 0.96; 95% CI, 0.8-1.15) and high-risk consumption (OR = 0.95; 95% CI, 0.85-1.07). Stage of hepatic fibrosis when starting DAA treatment did not affect the odds of SVR, researchers reported.
“Our findings suggest that DAA therapy should be provided and reimbursed despite alcohol consumption or history of AUD,” Cartwright and colleagues concluded. “Restricting access to DAA therapy according to alcohol consumption or AUD creates an unnecessary barrier to patients accessing DAA therapy and challenges HCV elimination goals.”
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