Association Between Alcohol Use Disorder and Receipt of Direct-Acting Antiviral Hepatitis C Virus Treatment

Abstract

ImportanceDirect-acting antiviral (DAA) treatment for hepatitis C virus (HCV) infection is associated with lower mortality and is effective in individuals with alcohol use disorder (AUD). However, despite recommendations, patients with AUD may be less likely to receive DAAs.ObjectiveTo assess the association between alcohol use and receipt of DAA treatment among patients with HCV within the Veterans Health Administration (VHA).Design, Setting, and ParticipantsThis cohort study included 133 753 patients with HCV born from 1945 to 1965 who had completed the Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) questionnaire and had at least 1 outpatient visit in the VHA from January 1, 2014, through May 31, 2017, with maximal follow-up of 3 years until May 31, 2020; DAA receipt; or death, whichever occurred first.ExposuresAlcohol use categories generated using responses to the AUDIT-C questionnaire and International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnoses: current AUD, abstinent with AUD history, at-risk drinking, lower-risk drinking, and abstinent without AUD history. Demographic, other clinical, and pharmacy data were also collected.Main Outcomes and MeasuresAssociations between alcohol use categories and DAA receipt within 1 and 3 years estimated using Cox proportional hazards regression stratified by calendar year.ResultsOf 133 753 patients (130 103 men [97%]; mean [SD] age, 60.6 [4.5] years; and 73 493 White patients [55%]), 38% had current AUD, 12% were abstinent with a history of AUD, 6% reported at-risk drinking, 14% reported lower-risk drinking, and 30% were abstinent without a history of AUD. Receipt of DAA treatment within 1 year was 7%, 33%, 53%, and 56% for patients entering the cohort in 2014, 2015, 2016, and 2017, respectively. For patients entering in 2014, those with current AUD (hazard ratio [HR], 0.72 [95%, CI, 0.66-0.77]) or who were abstinent with an AUD history (HR, 0.91 [95% CI, 0.84-1.00]) were less likely to receive DAA treatment within 1 year compared with patients with lower-risk drinking. For those entering in 2015-2017, patients with current AUD (HR, 0.75 [95% CI, 0.70-0.81]) and those who were abstinent with an AUD history (HR, 0.76 [95% CI, 0.68-0.86]) were less likely to receive DAA treatment within 1 year compared with patients with lower-risk drinking.Conclusions and RelevanceThis cohort study suggests that individuals with AUD, regardless of abstinence, were less likely to receive DAA treatment. Improved access to DAA treatment for persons with AUD is needed.

Alcohol Use and Sustained Virologic Response to Hepatitis C Virus Direct-Acting Antiviral Therapy

“…Consistent with a recent study on DAA initiation in the VA, we classified patients into 5 mutually exclusive groups on the basis of AUDIT-C score and AUD diagnoses: (1) abstinent without AUD (AUDIT-C score of 0 and absence of AUD diagnosis); (2) abstinent with AUD (AUDIT-C score of 0 and presence of AUD diagnosis); (3) lower-risk consumption (AUDIT-C score of 1-3 and absence of AUD diagnosis); (4) moderate-risk consumption (AUDIT-C score of 4-7 and absence of AUD diagnosis); and (5) high-risk consumption or AUD (AUDIT-C score of ≥8 or presence of AUD diagnosis with nonzero AUDIT-C score). Similar to Haque et al, we used lower-risk consumption as the referent group in all analyses.…”

“…The AUDIT-C is an externally validated 3-item questionnaire that assesses alcohol consumption and has been required annually in the VA since 2007. [27][28][29][30] We classified patients as having AUD by the Consistent with a recent study on DAA initiation in the VA, 20…”

“…DAA therapy is available to patients with HCV infection at no or substantially reduced cost to the individual in the VA system . Despite these recommendations, some clinicians continue to delay or withhold HCV therapy from patients who consume alcohol . Furthermore, some payers include alcohol abstinence as a requirement for reimbursement of DAA therapy for HCV .…”

Leveraging opportunities for treatment/user simplicity (LOTUS): Navigating the current treatment landscape for achieving hepatitis C virus elimination among persons who inject drugs

“…Alcohol use disorder and HCV infection are common comorbidities (16% to >40% of patients) 52,60 . Sobriety requirements deny treatment to individuals with concurrent alcohol use disorder in many jurisdictions 61,62 . However, alcohol use does not reduce the effectiveness of HCV treatment and was not an exclusion criterion in the most comprehensive real‐world trials conducted to date (e.g.…”

Error in Byline

“…In the Original Investigation titled “Association Between Alcohol Use Disorder and Receipt of Direct-Acting Antiviral Hepatitis C Virus Treatment,” published December 14, 2022, the academic degree shown in the byline for Dr Tate should have been MPH, ScD rather than PhD. This article has been corrected …”