Breaking Barriers: Hepatitis C Treatment safe and may be continued in alcohol use disorder

In a groundbreaking study, researchers have found that alcohol use and alcohol use disorder (AUD) should not be used as criteria for determining eligibility for hepatitis C treatment. The study, conducted within the US Department of Veterans Affairs healthcare system, challenges the common practice of requiring patients to abstain from alcohol before receiving direct-acting antiviral (DAA) therapy for chronic hepatitis C virus (HCV) infection. 

The study results were published in the journal JAMA Network Open: Gastroenterology and Hepatology. 

HCV is a serious viral infection that affects millions of people worldwide and can lead to severe liver damage if left untreated. Achieving sustained virologic response (SVR), which means the virus is undetectable for 12 weeks or more after treatment, is a crucial goal in HCV treatment. American Association for the Study of Liver Diseases (AASLD) treatment guidelines state that candidates for HCV treatment should be abstinent from alcohol for a minimum of 6 months before initiating treatment. However, there is uncertainty on how alcohol usage affects reaching SVR. Hence researchers from the U.S.A. conducted a retrospective cohort study to evaluate whether alcohol use at DAA treatment initiation is associated with decreased likelihood of sustained virologic response (SVR). 

The study included data of the patients, retrieved from the electronic health records of the US Department of Veterans Affairs (VA), born between 1945 and 1965 and who were dispensed DAA therapy between January 1, 2014, and June 30, 2018. Patients were categorized into groups, including those who were abstinent without a history of AUD, those who were abstinent with a history of AUD, and those with lower-risk alcohol consumption, moderate-risk consumption, and high-risk consumption or AUD. The primary outcome of the study was SVR, defined as undetectable HCV RNA for 12 weeks or longer after completing DAA therapy. Achieving SVR is a crucial goal in HCV treatment, as it indicates that the infection has been effectively cleared. 

Findings: 

• Among 69 229 patients who initiated DAA therapy, 65 355 (94.4%) achieved SVR.
• The patients with high-risk alcohol consumption or AUD did not show lower odds of achieving SVR compared to those who were completely abstinent from alcohol. 

Thus, this study's results challenge these outdated practices and have the potential to influence clinical guidelines and policies related to HCV treatment. It paves the way for more inclusive access to DAA therapy, offering hope to a broader range of patients who urgently need treatment to combat this life-threatening infection.

Further reading: 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