The contribution of alcohol use disorder to decompensated cirrhosis among people with hepatitis C: An international study

Alavi, Maryam; Janjua, Naveed Z.; Chong, Mei; Grebely, Jason; Aspinall, Esther; Innes, Hamish; Valerio, Heather; Hajarizadeh, Behzad; Hayes, Peter; Krajden, Mel; Amin, Janaki; Law, Matthew; George, Jacob; Goldberg, David J.; Hutchinson, Sharon J.; Dore, Gregory J.

doi:10.1016/j.jhep.2017.10.019

Cited by 67 publications

(63 citation statements)

References 30 publications

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“…In a recent multicenter study, among patients with HCV diagnosis, the incidence of decompensated cirrhosis was higher among patients with alcohol use disorder. (20) Two additional smaller studies also found that alcohol in the presence of HCV and HBV cirrhosis, respectively, increases the risk of HCC. (21,22) We therefore add to the growing international literature that alcohol use may have more severe effects in subgroups of patients, including those who do not respond to treatment or have more advanced liver disease prior to therapy.…”

Section: Discussionmentioning

confidence: 98%

Alcohol Use and Long‐Term Outcomes Among U.S. Veterans Who Received Direct‐Acting Antivirals for Hepatitis C Treatment

et al. 2020

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Outcomes related to alcohol use after hepatitis C virus (HCV) treatment are unknown in the direct-acting antiviral (DAA) era. We assessed levels of alcohol use before and after HCV treatment and their association with long-term outcomes in a cohort of U.S. veterans. In this retrospective cohort analysis, 29,037 patients who initiated DAA regimens between 2013 and 2015 were followed for a mean of 3.04 years. We categorized alcohol use into three categories (nondrinking, low-level drinking, and unhealthy drinking) using Alcohol Use Disorders Identification Test-Consumption questionnaires administered within 1 year before (baseline) and after treatment. Multivariable Cox proportional hazards regression was used to determine the associations between alcohol use and mortality or liver-related outcomes. Before DAA treatment, 68% of veterans reported nondrinking, 22.9% reported low-level drinking, and 9.1% reported unhealthy drinking. Compared to patients with baseline non-drinking, those with unhealthy drinking had a higher risk of mortality (adjusted hazard ratio [HR] 1.53, 95% confidence interval [CI]: 1.34-1.75) and decompensated cirrhosis (adjusted HR 1.30, 95% CI: 1.06-1.59) and lower likelihood of liver transplantation (adjusted HR 0.24, 95% CI: 0.06-0.92). These associations were greater in patients without sustained virologic response than in those with sustained virologic response. When alcohol use before and after treatment was modeled as a time-varying covariate, similar associations were observed. Survival analysis also found that unhealthy drinking was significantly associated with a lower probability of survival compared with nondrinking. Low-level alcohol use was not associated with increased risk of adverse outcomes. Conclusion: In this large cohort of U.S. veterans with HCV who received DAAs, unhealthy drinking was common and associated with a higher risk of posttreatment mortality. Interventions to achieve alcohol cessation before and during antiviral treatment should be encouraged. (Hepatology Communications 2020;4:314-324).

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Section: Discussionmentioning

confidence: 98%

Alcohol Use and Long‐Term Outcomes Among U.S. Veterans Who Received Direct‐Acting Antivirals for Hepatitis C Treatment

et al. 2020

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“…Accurate assessment of the full spectrum of ALD prevalence is challenging, particularly given the difficulty with identifying earlier, asymptomatic stages of ALD, such as ASH or moderate AH, challenges that may be overcome with broader use of noninvasive steatosis and fibrosis assessment tools and increased awareness for the need to diagnose early‐stage disease. Many studies underestimate the true prevalence and burden by counting as ALD only those patients without additional liver diseases such as HCV, in spite of the fact that concomitant ALD rates are as high as 61% in some patients with other liver diseases, in particular nonalcoholic steatohepatitis (NASH), HCV, and hemochromatosis . These factors may result in as much as a 2‐fold underestimate for ALD‐related mortality …”

Section: Prevalence and Burden Of Alcohol‐associated Liver Diseasementioning

confidence: 99%

“…Many studies underestimate the true prevalence and burden by counting as ALD only those patients without additional liver diseases such as HCV, in spite of the fact that concomitant ALD rates are as high as 61% in some patients with other liver diseases, in particular nonalcoholic steatohepatitis (NASH), HCV, and hemochromatosis. (14,19) These factors may result in as much as a 2-fold underestimate for ALD-related mortality. (11)…”

Section: Prevalence and Burden Of Alcohol-associated Liver Diseasementioning

confidence: 99%

Diagnosis and Treatment of Alcohol‐Associated Liver Diseases: 2019 Practice Guidance From the American Association for the Study of Liver Diseases

et al. 2020

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“…For opioid‐associated diagnosis codes, the corresponding figures were 42.9% and 12.7%. Thus, while DAAs may eliminate HCV infection, other risk factors, such as alcohol misuse and obesity, could continue to drive liver disease progression and offset the beneficial impact of DAAs on ESLD and HCC burden . A history of alcohol abuse is associated with a high incidence of ESLD, regardless of whether patients are chronically infected with HCV or have cleared their infection and nonalcoholic fatty liver disease prevalence is increasing globally .…”

Section: Discussionmentioning

confidence: 99%

Data linkage to monitor hepatitis C‐associated end‐stage liver disease and hepatocellular carcinoma inpatient stays in England

Ireland

Simmons

Hickman

et al. 2019

Journal of Viral Hepatitis

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Persons with chronic hepatitis C (HCV) infection are at increased risk of end‐stage liver disease (ESLD) and hepatocellular carcinoma (HCC). The impact of hepatitis treatment scale‐up and elimination strategies on ESLD and HCC incidence is a critical measure of progress towards WHO targets. Data from national laboratory surveillance of HCV diagnoses were linked to inpatient care records in Hospital Episode Statistics (HES). For persons first diagnosed with HCV between 1998 and 2016, we describe the characteristics of those with ESLD and HCC and estimate incidence. Of persons diagnosed with HCV between 1998 and 2016 (104 674), 9.1% (9525) had an admission for ESLD and 2.5% (2610) for HCC. The majority of persons with ESLD and HCC were male (70.7% and 82.7%) and of white ethnicity (89.9% and 82.7%). Crude incidence of ESLD and HCC admission was 10.4 and 3.2 per 1000 person‐years, respectively. When compared to 2011‐2013, incidence of ESLD and HCC admissions in 2014‐2017 were lower (ESLD incidence rate ratio [IRR]: 0.81; 95% Confidence interval [CI]: 0.76‐0.86; HCC IRR: 0.90; 95% CI: 0.82‐1.00, P = .045). Data linkage showed considerable underreporting of HCV in HES coding for ESLD and HCC (16.0% and 11.3%, respectively). In conclusion, we found a decline in incidence of ESLD and HCC‐related inpatient admissions since 2011‐2013. Linked analysis is required for the continued monitoring of ESLD and HCC inpatient incidence. However, HES data quality issues around completeness of identifiers contribute to uncertainty in linkage and may limit our ability to robustly monitor progress towards WHO elimination goals.

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The contribution of alcohol use disorder to decompensated cirrhosis among people with hepatitis C: An international study

Cited by 67 publications

References 30 publications

Alcohol Use and Long‐Term Outcomes Among U.S. Veterans Who Received Direct‐Acting Antivirals for Hepatitis C Treatment

Alcohol Use and Long‐Term Outcomes Among U.S. Veterans Who Received Direct‐Acting Antivirals for Hepatitis C Treatment

Diagnosis and Treatment of Alcohol‐Associated Liver Diseases: 2019 Practice Guidance From the American Association for the Study of Liver Diseases

Data linkage to monitor hepatitis C‐associated end‐stage liver disease and hepatocellular carcinoma inpatient stays in England

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