Patients With AUD Less Likely to Receive Direct-Acting Antiviral HCV Treatment

Individuals with alcohol use disorder (AUD) were less likely to receive direct-acting antiviral (DAA) treatment for hepatitis C virus (HCV) than those without AUD. These findings were published in JAMA Network Open.

Investigators from Yale School of Medicine sourced data for this study from the Veterans Health Administration (VHA) Birth Cohort which comprised veterans who were born between 1945 and 1965 and visited a VHA center between 2000 and 2016. The subset of patients (N=133,753) with HCV who completed an Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire were evaluated for receipt of DAA through 2020 on the basis of AUD.

The patient population included individuals with a mean age of 60.6 (SD, 4.5) years, 97% were men, 55% were White, 67% had genotype 1 HCV, 47% had drug use disorder, 36% had severe mental illness, 34% had depression, 27% had diabetes, and 12% had cirrhosis.

According to AUDIC-C scores, 51,372 had current AUD, 40,537 were abstinent without a history of AUD, 18,230 were lower-risk drinkers, 16,063 were abstinent with a history of AUD, and 7551 were at-risk drinkers.

Compared with lower-risk drinkers, individuals with current AUD were less likely to receive DAA treatment within 1 year of diagnosis of HCV in 2014 (hazard ratio [HR], 0.72) or 2015-2017 (HR, 0.75) and within 3 years of diagnosis in 2014 (HR, 0.81) or 2015-2017 (HR, 0.80). Those who were abstinent but had a history of AUD were also less likely to receive treatment within 1 (HR, 0.76) or 3 (HR, 0.81) years if they had been diagnosed in 2015-2017. At-risk drinkers were less likely to receive treatment within 3 years of diagnosis in 2014 (HR, 0.93).

Other predictors associated with lower DAA treatment receipt included being underweight compared with normal weight (HR range, 0.46-0.80), Black ethnicity (HR range, 0.69-0.89) and other ethnicity (HR range, 0.84-0.90) compared with White ethnicity, drug use disorder (HR range, 0.71-0.81), Fibrosis-4 Index for Liver Fibrosis score of <1.45 compared with a score of 1.45-3.25 (HR range, 0.71-0.89), and severe mental illness (HR range, 0.87-0.94).

The results of this study may have been biased, as AUD was based on self-report and documented diagnoses.

Study authors concluded, “Given the higher risk of liver-related complications, DAA treatment should be prioritized for patients with HCV and unhealthy alcohol use. […] Providing alcohol treatment in liver clinics can decrease alcohol consumption among patients with HCV as well. Further research to determine barriers to and facilitators of DAA treatment for patients with HCV and AUD and to develop interventions to ensure access to DAAs are needed.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.