Patients with HCV responsive to alcohol intervention

Patients with current or prior hepatitis C infection were willing to engage in alcohol intervention including counseling and referral to treatment when encouraged by liver medical providers, according to data published in Hepatology.

“Alcohol use in the setting of HCV infection is associated with increased rates of fibrosis progression, liver-related mortality, and overall mortality,” Rae Jean Proeschold-Bell, PhD, from the Duke Global Health Institute in North Carolina, and colleagues wrote, citing that patients with HCV were 1.3 times more likely to be excessive drinkers compared with the general population.

“Consequently, guidelines recommend abstinence from alcohol and clinical interventions to facilitate alcohol cessation in patients with active infection,” they wrote. “Even after HCV cure with therapy, patients with cirrhosis remain at higher risk for fibrosis progression and hepatocellular carcinoma; these patients are particularly cautioned against excessive alcohol use.”

Between October 2014 and September 2017, the researchers randomly assigned 181 patients to receive Screening, Brief Intervention, and Referral to Treatment (SBIRT) with alcohol treatment (n = 95) or SBIRT only (n = 86).

The proportion of patients who exhibited full alcohol abstinence increased from baseline at 3 months, 6 months and 12 months with no significant difference between the groups.

Similarly, the proportion of patients with any heavy drinking days decreased from 85.7% over 3 months prior to baseline to 42.1% between 7 months and 12 months among the SBIRT with alcohol treatment group, and from 87.5% to 26.7% in the SBIRT only group with no significant difference between the two.

Among participants with heavy alcohol use at baseline, referred to as binge drinking for 5 days or more during the prior 3 months to enrollment, patients in the SBIRT only group improved more than the SBIRT with alcohol treatment group, though this did not meet significance.

Proeschold-Bell and colleagues noted that while alcohol reduction with a goal of abstinence is the recommended course for patients with HCV, alcohol use is not considered a contraindication for antiviral therapy and patients in recent years may be less motivated to decrease their alcohol use as a result.

“The current study is important in that it shows that patients with current or prior HCV-infection will engage in alcohol treatment when encouraged by liver medical providers, even in the DAA era,” they concluded. “Our trial demonstrates the value of integrating alcohol use disorder interventions into hepatitis care and could serve as a model for incorporating other alcohol treatments, including psychosocial, behavioral, and pharmacological treatments, to provide patient-centered holistic approaches to these comorbid diseases.” – by Talitha Bennett

Disclosures: Proeschold-Bell reports that the study was funded by the National Institutes of Health and supported by the Duke University Center for AIDS Research (CFAR), an NIH-funded program.