Study Finds Hepatitis C Treatment Gap for Those With Alcohol Use Disorder

Individuals with alcohol use disorder are less likely to receive antivirals for hepatitis C, despite current guidelines recommending antiviral treatment regardless of alcohol use, according to a new study supported by the National Institutes of Health.

Direct-acting antiviral treatment is highly effective at reducing serious illness and death among individuals with hepatitis C virus infection, a condition that commonly occurs among people with alcohol use disorder. 

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 hepatitis C virus and alcohol use disorder — and these gaps need to be addressed,” said corresponding author Dr. Lamia Y. Haque, 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 hepatitis C virus and alcohol use disorder, this refers to a gap not only in  alcohol use disorder treatment, but also in lifesaving hepatitis C virus treatment. Both are crucial for liver health,” she said.

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 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 hepatitis C than other age group.

From this sample, data from 133,753 individuals (97% male) were identified and analyzed based on their history of hepatitis C, documented Alcohol Use Disorder Identification Test-Consumption questionnaire responses, and having visited any VHA location from January 2014 through May 2017.

The authors point to several underlying causes that could be reflected in the hepatitis C-alcohol use disorder treatment gap, including stigma surrounding substance use, hesitancy to prescribe treatment based on concerns about adherence to treatment protocols, patients’ acceptance of hepatitis C treatment, and unintended delays if abstinence from alcohol is mandated for treatment access or patients are unable to establish care for alcohol use disorder.

Untreated hepatitis C 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 hepatitis C virus among individuals with alcohol use disorder, as outcomes can be more serious in this population.”

According to George F. Koob, Ph.D., director of the National Institute on Alcohol Abuse and Alcoholism, “This research exemplifies why efforts to reduce stigma around alcohol use disorder, and to integrate care for AUD and co-occurring conditions such as liver disease and HCV, are critically important in closing the treatment gap.

“Health care professionals play essential roles in identifying and addressing problematic alcohol consumption and co-occurring disorders, which can contribute to better health outcomes,” he said.