Alcohol Use Has Little, If Any, Effect on Hepatitis C Treatment Response

Hepatitis C virus (HCV) is a major cause of liver disease and alcohol use contributes to adverse health outcomes. Recently developed direct-acting antiviral agents (DAAs) have been shown to be highly effective at eliminating HCV, but many studies exclude individuals with current or recent alcohol or other drug use. Researchers used data from the Veterans Affairs health care system to examine the association between DAA treatment outcomes (sustained virologic response [SVR]), and alcohol use, as assessed using the Alcohol Use Disorders Identification Test Consumption (AUDIT-C) questionnaire.*

• Among 17,847 patients who initiated DAAs, 87% completed AUDIT-C screening within one year prior to initiating treatment; of these, 69% were categorized as abstinent, 23% with “low-level” drinking, and 9% with “unhealthy” drinking.
• There was no difference in SVR between those who were abstinent (92%), had low-level drinking (93%), or unhealthy drinking (91%). If everyone with missing SVR data was considered a treatment failure, the SVR rate for those with unhealthy drinking (79%) was lower than for those who were abstinent (84%), or had low-level drinking (84%).
• On multivariable analysis, there was no difference in SVR between the 3 drinking categories. However, in a model with imputation of missing SVR data, when compared with those who were abstinent, those with unhealthy drinking were less likely to achieve SVR (adjusted odds ratio [aOR], 0.75), while those with low-level drinking were not (aOR, 1.03).

* AUDIT-C scores were categorized as: abstinence (0), low-level drinking (1-3 for men, 1-2 for women), and unhealthy drinking (4-12 in men, 3-12 in women).

Comments: This study adds to a growing body of evidence showing high success rates for treatment of HCV, regardless of alcohol or other drug use. Even if the success rates are somewhat lower among those with alcohol use disorder, this should not deter us from treating patients who need it. Unfortunately, some clinicians and insurers still consider alcohol or other drug use to be contraindication to treatment. Given the high risk of liver disease in this population and the effectiveness of treatment regardless of alcohol or other drug use, we should be targeting this population for treatment of HCV (and substance use disorder), rather than creating barriers.

Darius A. Rastegar, MD

Reference: Tsui JI, Williams EC, Green PK, et al. Alcohol use and hepatitis C virus treatment outcomes among patients receiving direct antiviral agents. Drug Alcohol Depend. 2016;169:101–109.