Direct-acting antivirals (DAAs) hold considerable promise for eliminating the global burden of hepatitis C (HCV) infection and chronic liver disease. The relative contribution of alcohol use to HCV-related decompensated cirrhosis is unclear, and restriction of DAA access on the basis of ongoing alcohol use persists in many settings. Researchers evaluated the contribution of alcohol-related diagnoses—defined as non-liver-related hospitalization due to alcohol use and labeled alcohol use disorder (AUD)—to population-level diagnosis of decompensated cirrhosis among people with HCV (defined by presence of antibody). HCV diagnosis notifications from British Columbia (BC), Canada; New South Wales (NSW), Australia; and Scotland from 1995 through 2011, 2012, and 2013, respectively, were linked to hospital admission data between 2001 and 2012, 2013, and 2014, respectively. Age-standardized decompensated cirrhosis incidence was determined and associated factors, including AUD-associated population attributable fractions (PAF), were computed.
- 6%, 3.7%, and 4.3% of people with HCV in BC, NSW, and Scotland, respectively, had decompensated cirrhosis diagnosis and 28%, 32%, and 50% of those with decompensated cirrhosis had AUD based on the authors’ definition.
- Age-standardized decompensated cirrhosis rates were higher in people with AUD in NSW and Scotland.
- The PAFs of decompensated cirrhosis related to AUD were 13%, 25%, and 40%, respectively.
Comments: Although the definitions for HCV infection, AUD, and decompensated cirrhosis diagnoses were not standardized and perhaps lack clinical correlation, these data suggest a strong contribution of AUD to decompensated cirrhosis among patients with HCV. The results suggest the need for tailored interventions to include DAA access for all patients with HCV linked to specialized treatment for those with alcohol-related diagnoses.
Jeanette M. Tetrault, MD
Reference: Alavi M, Janjua NZ, Chong M, et al. The contribution of alcohol use disorder to decompensated cirrhosis among people with hepatitis C: An international study. Journal of Hepatology. 2018;68(3):393–401.