Alcohol Use Not Associated With Lower Odds of Achieving SVR With Hepatitis C Treatment

A Study on Alcohol Use and Sustained Virologic Response in Patients Receiving DAA Therapy for Chronic Hepatitis C Virus Infection

A study published in JAMA Network Open has found that a patient’s alcohol consumption or alcohol use disorder (AUD) does not lower their odds of achieving sustained virologic response (SVR) when receiving direct-acting antiviral (DAA) therapy for chronic hepatitis C virus (HCV) infection.

Background

In the past, clinicians treated HCV with interferon-based regimens, and patients who actively consumed alcohol were more likely to discontinue treatment. However, recent guidelines from the American Association for the Study of Liver Disease (AASLD), Infectious Diseases Society of America (IDSA), and the Department of Veteran Affairs (VA) advise clinicians not to withhold DAA therapy from patients who drink, regardless of their intake levels. Despite these guidelines, some clinicians still withhold DAA therapy from those who consume alcohol, and some payers require alcohol abstinence for reimbursement.

Study Design

The researchers conducted a study to determine whether alcohol use prevents patients receiving DAA therapy for HCV from achieving SVR. They analyzed data from the VA Corporate Data Warehouse, which included patients from the 1945 to 1965 VA Birth Cohort who initiated interferon-free DAA therapy between January 1, 2014, and June 30, 2018.

Results

The study population consisted of 69,229 patients, with a mean age of 62.6 years. The researchers classified the patients into different alcohol use categories based on their responses to the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) questionnaire and AUD diagnoses. Overall, 65,355 patients achieved SVR.

Key Findings

In the unadjusted model, patients who were abstinent without AUD history and those who were abstinent with AUD history had lower odds of achieving SVR compared to patients with lower-risk consumption. However, in the fully adjusted model, no alcohol category was significantly associated with decreased odds of SVR.

Implications and Recommendations

The findings of this study suggest that clinicians and policy makers should encourage HCV treatment in individuals with unhealthy alcohol consumption or AUD, rather than creating barriers to treatment. The high rates of SVR across all alcohol use categories indicate that there is no need for payers to require alcohol abstinence before reimbursement of DAA therapy for HCV infection. Restricting access to DAA therapy based on alcohol consumption or AUD hinders HCV elimination goals.

Limitations

The study had limitations, including its focus on patients born between 1945 and 1965, which may limit generalizability to other age groups. Additionally, the study population had a small proportion of women, so the findings may not be generalizable to women with HCV infection.

Conclusion

Despite the limitations, this study provides important insights into the relationship between alcohol use and SVR in patients receiving DAA therapy for chronic HCV infection. The researchers recommend that DAA therapy should be provided and reimbursed regardless of a patient’s alcohol consumption or AUD history, in line with the Sustainable Development Goals (SDGs) for health and well-being.

Reference

Cartwright EJ, Pierret C, Minassian C, et al. Alcohol use and sustained virologic response to hepatitis C virus direct-acting antiviral therapy. JAMA Netw Open. 2023;6(9):e2335715. doi:10.1001/jamanetworkopen.2023.35715

SDGs, Targets, and Indicators

1. SDG 3: Good Health and Well-being

   • Target 3.3: By 2030, end the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases and combat hepatitis, water-borne diseases, and other communicable diseases.
   • Indicator 3.3.1: Number of new HIV infections per 1,000 uninfected population, by sex, age, and key populations.
   • Indicator 3.3.2: Tuberculosis incidence per 100,000 population.
   • Indicator 3.3.3: Malaria incidence per 1,000 population.
   • Indicator 3.3.4: Hepatitis B incidence per 100,000 population.
   • Indicator 3.3.5: Hepatitis C incidence per 100,000 population.

2. SDG 6: Clean Water and Sanitation

   • Target 6.1: By 2030, achieve universal and equitable access to safe and affordable drinking water for all.
   • Indicator 6.1.1: Proportion of population using safely managed drinking water services.

Analysis

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The SDGs that are addressed or connected to the issues highlighted in the article are SDG 3: Good Health and Well-being and SDG 6: Clean Water and Sanitation.

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the article’s content, the specific targets that can be identified are:

– Target 3.3: By 2030, end the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases and combat hepatitis, water-borne diseases, and other communicable diseases.

– Target 6.1: By 2030, achieve universal and equitable access to safe and affordable drinking water for all.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, there are indicators mentioned in the article that can be used to measure progress towards the identified targets:

– Indicator 3.3.5: Hepatitis C incidence per 100,000 population.

– Indicator 6.1.1: Proportion of population using safely managed drinking water services.

These indicators can be used to measure the progress in combating hepatitis C and ensuring access to safe drinking water.

Table: SDGs, Targets, and Indicators

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Source: ajmc.com

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