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Alcohol use disorder compromises benefits of DAA therapy for HCV

An international study showed that alcohol use disorder contributed significantly to liver disease burden in patients with hepatitis C. Researchers suggest that, where appropriate, countries develop strategies that combine direct-acting antiviral therapy with management of alcohol use disorders.

“Elimination of HCV infection as a public health threat by 2030 is defined by a 65% reduction in liver-related mortality and an 80% reduction in incidence compared with the 2015 baseline,” Maryam Alavi, PhD, from the Kirby Institute, New South Wales, Australia, and colleagues wrote. “To reach the 65% mortality reduction component of the elimination target, concentrated policy action is required to enhance HCV treatment uptake, and where needed, improve alcohol use disorder management at the national level.”

Alavi and colleagues selected British Columbia, Canada; New South Wales, Australia; and Scotland for the study, as each has established surveillance systems for monitoring patients with HCV. The study comprised 58,487 people with an HCV notification from British Columbia, 84,529 from New South Wales, and 31,924 from Scotland.

British Columbia had more patients born before 1965 (70%) compared with New South Wales (47%) and Scotland (28%). Scotland had a higher proportion of patients with alcohol use disorder (27%) compared with British Columbia (19%) and New South Wales (18%).

While British Columbia had the highest proportion of patients with decompensated cirrhosis (4.6%) compared with Scotland (4.3%) and New South Wales (3.7%), Scotland had the highest proportion of patients with decompensated cirrhosis and alcohol use disorder (50%) compared with New South Wales (32%) and British Columbia (28%).

Patients with alcohol use disorder, compared with those without the disorder, were younger at decompensated cirrhosis diagnosis in British Columbia (52 vs. 56 years; P < .001), New South Wales (48 vs. 52 years; P < .001) and Scotland (43 vs. 49 years; P < .001).

Multivariate analysis showed that alcohol use disorder independently predicted decompensated cirrhosis in British Columbia (HR = 1.92; 95% CI, 1.76-2.1), New South Wales (HR = 3.68; 95% CI, 3.38-4) and Scotland (HR = 3.88; 95% CI, 3.42-4.4).

For decompensated cirrhosis diagnoses, alcohol use disorder correlated with a population attributable fraction of 13% in British Columbia (95% CI, 11-15), 25% in New South Wales (95% CI, 23-27) and 40% in Scotland (95% CI, 36-44). Specifically, among people born in or after 1965, alcohol use disorder correlated with a population attributable fraction of 21% in British Columbia (95% CI, 16-25), 36% in New South Wales (95% CI, 32-40) and 48% in Scotland (95% CI, 43-53) for decompensated cirrhosis.

“Continued heavy alcohol intake is likely to impact potential benefits of DAA-based cure on individual-level liver disease progression and population-level liver disease burden,” the researchers wrote. “Use of administrative databases for surveillance, particularly with the addition of individual-level antiviral treatment data will be a valuable tool for ongoing evaluation and comparison of the impact of DAA-based therapies on the individual-level liver disease progression and population-level burden of HCV, given differences in the epidemiology of HCV and HCV public health strategies across the three settings.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.