Response to HCV Treatment Among People with Heavy Alcohol Use is Similar to Those Who Abstain
Management of hepatitis C virus (HCV) infection among people with heavy alcohol use is often challenging. In a sample of patients with chronic HCV infection (defined by detectable HCV RNA for at least 6 months), French researchers conducted a retrospective case-control study* to compare access to antiviral therapy and response to treatment between patients with and without heavy alcohol use (≥60 g, or ≥4–5 U.S. standard drinks, per day for at least 1 year at the time of referral versus below 40 g per day without previous periods of heavy use). Sixty-nine participants with heavy alcohol use were included and matched to controls. Of those, 31 received treatment.
- The percentage of patients with a recommendation for treatment according to French guidelines was similar in cases and controls (75%).**
- The proportion of patients accessing treatment was lower among those with heavy alcohol use than those without (45% versus 71%).
- Among people with heavy alcohol use, the main reason not to treat despite indication was the absence of abstinence. Factors associated with treatment access were fibrosis stage, employment, and alcohol consumption of ≤170 g per day.
- Of those who received antiviral therapy, a sustained virological response was obtained in 32% of people with heavy alcohol use versus 26% of controls.
- Among patients with heavy alcohol use, response to treatment was similar whether or not patients were abstinent for 6 months before treatment initiation.
* To compare access to treatment, participants were matched according to stage of fibrosis, genotype, and, when possible, gender and age. To compare response to treatment, participants were matched to type of antiviral therapy, genotype, and, when possible, stage of fibrosis, gender, and age.
** HCV genotype 2 or 3 or bridging fibrosis.
Comments:This case-control study suggests that, when delivered by a multidisciplinary team (including an addiction specialist), HCV treatment among people with heavy alcohol use is feasible and allows for satisfactory response to treatment. These data call for efficacy trials of integrated care among patients with HCV and recent heavy drinking. Nicolas Bertholet, MD, MSc
Costentin CE, Trabut JB, Mallet V, et al. Management of hepatitis C infection in heavy drinkers. Alcohol Alcohol. 2013;48(3):337–342.