- Some mistakenly believe a person who uses alcohol cannot be offered hepatitis C treatment
- A U.S. study assessed over 69,000 people who took hepatitis C treatment and their alcohol use
- Researchers found that alcohol use did not impact rates of being cured of this virus
Before 2014, treatment of chronic hepatitis C virus (HCV) generally consisted of regular injections of interferon-alpha. This treatment was not highly effective and had a range of side effects, some of which could be very unpleasant.
A new class of HCV treatment called direct acting antiviral (DAA) therapy became available in 2014. DAAs are taken in combination and are available in pill formulation. DAAs today are highly effective, resulting in more than 95% of people being cured of HCV. The drugs are generally well tolerated and need to be taken for between eight and 12 weeks.
Studies have found that some clinics in the U.S. have delayed or withheld treatment from some people with HCV who have alcohol use disorder. A team of researchers across the U.S. analysed health-related information from more than 69,000 people with chronic HCV who were prescribed DAA therapy between 2014 and 2018. According to the researchers in that study, 47% of people did not drink alcohol during DAA treatment, while the remaining participants did drink alcohol and were categorized by researchers as follows:
- 19.4% had “lower risk consumption” of alcohol
- 4.5% had “moderate risk consumption” of alcohol
- 16.2% had “high risk consumption or alcohol use disorder”
Taking many factors into consideration (including the degree of liver injury), researchers found that there were no differences in rates of HCV cure across different categories of alcohol consumption. As a result, the researchers stated that “restricting access to DAA therapy according to alcohol use creates an unnecessary barrier to patients and challenges HCV elimination goals.”
Study details
The databases maintained by the U.S. Department of Veterans Affairs (VA) collect detailed health-related information that can be analysed to produce reports. Scientists at the VA have previously used such databases to compile useful analyses on different health-related issues for people with viral infections such as HCV and HIV. Such analyses have been used to inform clinical care.
A brief average profile of participants when they entered the study is as follows:
- age – 63 years
- 97% male, 3% female
- main ethno-cultural groups: White – 50%; Black – 41%
- most common type of HCV – genotype 1
- 15% had previously been treated with interferon but this treatment failed
- 3.2% were co-infected with HIV
- 2% were co-infected with hepatitis B virus
Most participants (nearly 60%) used the fixed-dose combination pill Harvoni, which contains two DAAs—sofosbuvir + ledipasvir.
Alcohol consumption was assessed via a simple and well-validated questionnaire called AUDIT-C. It is possible that some people may have understated their alcohol consumption.
Bear in mind
The present study was not a randomized, controlled clinical trial but an observational study. Such studies can sometimes inadvertently lead scientists to draw biased conclusions. However, the VA scientists took steps to minimize this and conducted sensitivity analyses to confirm their findings. The study had many strengths, including monitoring people for several years and using detailed biomedical information collected from a diverse population across the U.S.
The researchers stated that their findings “suggest that clinicians and policy makers should encourage HCV treatment in those with unhealthy alcohol consumption or alcohol use disorder, rather than creating barriers to HCV treatment.” The VA researchers also reminded clinicians about the option of referring patients for treatment of substance use disorder when needed.
—Sean R. Hosein
RESOURCES:
Hepatitis C Guidance 2023 Update: American Association for the study of Liver Diseases and Infectious Diseases Society of America Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection — Clinical Infectious Diseases
Hepatitis C basics – CATIE
Hepatitis C testing and diagnosis – CATIE
Hepatitis C medications – CATIE
Canadian study finds hepatitis C cure leads to gradual improvement in symptoms of depression in people with HIV – CATIE News
U.S. study finds less access to important surgeries in people with HIV or hepatitis C virus and in racialized groups – CATIE News
Alberta researchers find high rates of hepatitis C virus and syphilis co-infection during pregnancy – CATIE News
Researchers underscore the need for high-tech tests to uncover acute hepatitis C virus infection – CATIE News
REFERENCE:
Cartwright EJ, Pierret C, Minassian C, et al. Alcohol use and sustained virologic response to hepatitis C virus direct-acting antiviral therapy. JAMA Network Open. 2023 Sep 5;6(9):e2335715.