Background: The impact of alcohol use and HIV infection on receipt of direct-acting antiviral (DAA) therapy and subsequent cure of chronic hepatitis C virus (HCV) is unknown.
Methods: Using the Veterans Health Administration (VA) Birth Cohort (>4.5 million patients born 1945-1965), we performed a cohort study among HCV RNA+ patients with at least one outpatient visit between 1 January 2014 and 31 May 2017; laboratory values were assessed through 30 November 2017. Alcohol use (abstinent, lower risk drinking, hazardous/binge drinking, diagnosis of alcohol use disorder [AUD]) was assessed in the year prior to the initial outpatient visit based on Alcohol Use Disorders Identification Test-Consumption questionnaire scores and validated ICD AUD codes. We defined DAA receipt based on filled prescriptions and achievement of HCV cure as sustained virologic response ≥12 weeks after treatment (SVR12). We calculated frequency of DAA receipt and SVR12 by alcohol use category and HIV status. We estimated associations between alcohol use and SVR12 by HIV status using logistic regression.
Results: Among 134,491 HCV RNA+ patients with known alcohol use status, 3,670 (3%) were HIV+. More HIV+ patients were dispensed DAA therapy than uninfected persons (53.6% vs 49.5%; p<0.0001). Abstinent and lower risk drinkers were more likely to receive DAAs than hazardous/binge drinkers or those with an AUD (52.9%, 51.5%, 47.1%, 44.6%, respectively; p<0.0001, Figure 1). While high SVR12 rates were observed across all alcohol use categories (range, 88.8-92.4% HIV+; 90.1-93.2% uninfected), those with AUD experienced modestly lower rates of SVR12 compared with abstinent individuals (89.1% vs. 92.1% HIV+; 90.1% vs. 91.6% HIV-, Figure 2). After adjusting for age, FIB-4, BMI, and hepatic decompensation, HIV- patients with an AUD were significantly less likely to achieve SVR12 compared with abstinent patients (OR, 0.88; 95% CI 0.81-0.94, Figure 3).
Conclusion: HIV+ patients and abstinent or lower risk drinkers were more likely to receive DAAs compared to uninfected patients and hazardous/binge drinkers or those with an AUD. High SVR12 rates were observed across all alcohol categories. These findings indicate a potential role for alcohol interventions along with HCV care and treatment.
E. J. Cartwright,
D. A. Esserman, None
J. P. Tate, None
D. A. Fiellin, None
V. Lo Re III, None
A. C. Justice, None