Alcohol abstinence not required for direct-acting antivirals to cure HCV, study finds

Patients need not abstain from alcohol to receive direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) infection, a study found.

Researchers performed a retrospective cohort study via Veterans Affairs electronic health records of 69,229 patients born from 1945 to 1965 who received DAA therapy for HCV from January 2014 through June 2018. The primary outcome was sustained viral response (SVR), defined as undetectable HCV RNA for 12 weeks or longer after finishing DAA therapy. Results were published Sept. 26 in JAMA Network Open.

Overall, 32,290 individuals (46.6%) were abstinent without alcohol use disorder (AUD), 9,192 (13.3%) were abstinent with AUD, 13,415 (19.4%) had lower-risk consumption, 3,117 (4.5%) had moderate-risk consumption, and 11,215 (16.2%) had high-risk consumption or AUD. Among all patients undergoing DAA therapy, 65,355 (94.4%) achieved SVR. After adjustment, there was no difference in SVR rates across alcohol use categories: Odds ratios were 1.09 (95% CI, 0.99 to 1.20) for abstinent without AUD history, 0.92 (95% CI, 0.82 to 1.04) for abstinent with AUD history, 0.96 (95% CI, 0.80 to 1.15) for moderate-risk consumption, and 0.95 (95% CI, 0.85-1.07) for high-risk consumption or AUD. The study also found no evidence of interaction by stage of hepatic fibrosis, as measured by fibrosis-4 score, with SVR (P =0.30 for the interaction).

“Our findings suggest that clinicians and policy makers should encourage HCV treatment in those with unhealthy alcohol consumption or AUD, rather than creating barriers to HCV treatment,” the authors wrote. “Given the high rates of SVR across all alcohol use categories, there is no indication for payers to require alcohol abstinence before reimbursement of DAA therapy for HCV infection.”