A new study supported by the National Institutes of Health shows that individuals with alcohol use disorder (AUD) are less likely to receive antivirals for hepatitis C, despite current guidelines recommending antiviral treatment regardless of alcohol use. Direct-acting antiviral treatment is highly effective at reducing serious illness and death among individuals with hepatitis C virus (HCV) infection, a condition that commonly occurs among people with AUD. Led by scientists at Yale University, New Haven, Connecticut, the research was conducted by a team of international scientists and published in JAMA Network Open.
“There are treatment gaps for individuals with co-occurring HCV and AUD—and these gaps need to be addressed,” said corresponding author Lamia Y. Haque, M.D., M.P.H., assistant professor and director of the Yale Clinic for Alcohol and Addiction Treatment in Hepatology, Digestive Diseases at the Yale School of Medicine. “For patients with HCV and AUD, this refers to a gap not only in AUD treatment, but also in lifesaving HCV treatment. Both are crucial for liver health.”
Dr. Haque and her colleagues used data from the Veterans Birth Cohort, an observational study containing electronic health records of all patients receiving care through the Veterans Health Administration (VHA) born between 1945 and 1965. This cohort was chosen for the study since people in this age range are more likely to have been diagnosed with HCV than other age groups. From this sample, data from 133,753 individuals (97% male) were identified and analyzed based on their history of HCV, documented Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) questionnaire responses, and having visited any VHA location from January 2014 through May 2017.
Study participants were divided into three categories: current AUD, at-risk or lower-risk drinking, and abstinence with or without a history of AUD. The researchers found that in all years tested, individuals who met criteria for AUD—regardless of whether they were currently abstinent from alcohol use—were less likely to receive direct-acting antiviral treatment for HCV within either one or three years of HCV diagnosis, compared with individuals without AUD.
The authors point to several underlying causes that could be reflected in the HCV-AUD treatment gap, including stigma surrounding substance use, hesitancy to prescribe treatment based on concerns about adherence to treatment protocols, patients’ acceptance of HCV treatment, and unintended delays if abstinence from alcohol is mandated for treatment access or patients are unable to establish care for AUD.
Untreated HCV is a serious medical concern, leading to severe illness and even death due to complications such as cirrhosis and liver cancer. Cirrhosis and other forms of liver disease are also major concerns among individuals who misuse alcohol. Haque adds that, because of this, “it is logical to prioritize treatment of HCV among individuals with AUD, as outcomes can be more serious in this population.”
“This research exemplifies why efforts to reduce stigma around AUD, and to integrate care for AUD and co-occurring conditions such as liver disease and HCV, are critically important in closing the treatment gap. Healthcare professionals play essential roles in identifying and addressing problematic alcohol consumption and co-occurring disorders, which can contribute to better health outcomes,” said NIAAA Director George F. Koob, Ph.D.
Reference: Haque, L.Y.; Fiellin, D.A.; Tate, J.P. et al. Association between alcohol use disorder and receipt of direct-acting antiviral hepatitis C treatment. JAMA Network Open. 2022. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2799555
About the National Institute on Alcohol Abuse and Alcoholism (NIAAA):
The National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health, is the primary U.S. agency for conducting and supporting research on the causes, consequences, diagnosis, prevention, and treatment of alcohol use disorder. NIAAA also disseminates research findings to general, professional, and academic audiences. Additional alcohol research information and publications are available at www.niaaa.nih.gov.
About the National Institutes of Health (NIH):
NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
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JAMA Network Open
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Association Between Alcohol Use Disorder and Receipt of Direct-Acting Antiviral Hepatitis C Virus Treatment
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Dr. Haque reported receiving grant support from the National Institutes of Health (NIH). Dr Fiellin reported that his wife is owner of Playbl, which distributes serious video games for risk prevention, including substance use, in youth. Dr Tate reported receiving grants from the NIH during the conduct of the study. Dr Esserman reported receiving grants from the NIH during the conduct of the study. Dr Bhattacharya reported receiving grants from Gilead Sciences outside the submitted work. Dr Gordon reported receiving grants from the US Department of Veterans Affairs to his institution, the NIH to his institution, and the US Department of Health and Human Services to his institution during the conduct of the study; receiving personal fees and honoraria from UpToDate; serving on the board of directors for the American Society of Addiction Medicine, the Association for Multidisciplinary Education and Research in Substance Use and Addiction, and the International Society of Addiction Journal Editors outside the submitted work. Dr Bryant reported receiving funding from the NIH during the conduct of the study and was assigned as the Scientific Collaborator under the cooperative agreement that generated these data and conceptualized this research in a broad program focused on the impact of alcohol on HIV prevention and treatment and other comorbidities, coinfections (including hepatitis), and complications. Dr Lo Re reported receiving personal fees from Takeda Consulting outside the submitted work. No other disclosures were reported.