Alcohol Use and Long‐Term Outcomes Among U.S. Veterans Who Received Direct‐Acting Antivirals for Hepatitis C Treatment
Outcomes related to alcohol use after hepatitis C virus (HCV) treatment are unknown in the direct‐acting antiviral (DAA) era. We assessed levels of alcohol use before and after HCV treatment and their association with long‐term outcomes in a cohort of U.S. veterans. In this retrospective cohort anal...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Health/LWW
2020-02-01
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| Series: | Hepatology Communications |
| Online Access: | https://doi.org/10.1002/hep4.1464 |
| _version_ | 1797934977700069376 |
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| author | Nicole J. Kim Meredith Pearson Philip Vutien Feng Su Andrew M. Moon Kristin Berry Pamela K. Green Emily C. Williams George N. Ioannou |
| author_facet | Nicole J. Kim Meredith Pearson Philip Vutien Feng Su Andrew M. Moon Kristin Berry Pamela K. Green Emily C. Williams George N. Ioannou |
| author_sort | Nicole J. Kim |
| collection | DOAJ |
| description | Outcomes related to alcohol use after hepatitis C virus (HCV) treatment are unknown in the direct‐acting antiviral (DAA) era. We assessed levels of alcohol use before and after HCV treatment and their association with long‐term outcomes in a cohort of U.S. veterans. In this retrospective cohort analysis, 29,037 patients who initiated DAA regimens between 2013 and 2015 were followed for a mean of 3.04 years. We categorized alcohol use into three categories (nondrinking, low‐level drinking, and unhealthy drinking) using Alcohol Use Disorders Identification Test‐Consumption questionnaires administered within 1 year before (baseline) and after treatment. Multivariable Cox proportional hazards regression was used to determine the associations between alcohol use and mortality or liver‐related outcomes. Before DAA treatment, 68% of veterans reported nondrinking, 22.9% reported low‐level drinking, and 9.1% reported unhealthy drinking. Compared to patients with baseline non‐drinking, those with unhealthy drinking had a higher risk of mortality (adjusted hazard ratio [HR] 1.53, 95% confidence interval [CI]: 1.34‐1.75) and decompensated cirrhosis (adjusted HR 1.30, 95% CI: 1.06‐1.59) and lower likelihood of liver transplantation (adjusted HR 0.24, 95% CI: 0.06‐0.92). These associations were greater in patients without sustained virologic response than in those with sustained virologic response. When alcohol use before and after treatment was modeled as a time‐varying covariate, similar associations were observed. Survival analysis also found that unhealthy drinking was significantly associated with a lower probability of survival compared with nondrinking. Low‐level alcohol use was not associated with increased risk of adverse outcomes. Conclusion: In this large cohort of U.S. veterans with HCV who received DAAs, unhealthy drinking was common and associated with a higher risk of posttreatment mortality. Interventions to achieve alcohol cessation before and during antiviral treatment should be encouraged. |
| first_indexed | 2024-04-10T18:07:21Z |
| format | Article |
| id | doaj.art-97e7390ed0784ba58d755b1dc5cc5852 |
| institution | Directory Open Access Journal |
| issn | 2471-254X |
| language | English |
| last_indexed | 2024-04-10T18:07:21Z |
| publishDate | 2020-02-01 |
| publisher | Wolters Kluwer Health/LWW |
| record_format | Article |
| series | Hepatology Communications |
| spelling | doaj.art-97e7390ed0784ba58d755b1dc5cc58522023-02-02T12:36:12ZengWolters Kluwer Health/LWWHepatology Communications2471-254X2020-02-014231432410.1002/hep4.1464Alcohol Use and Long‐Term Outcomes Among U.S. Veterans Who Received Direct‐Acting Antivirals for Hepatitis C TreatmentNicole J. Kim0Meredith Pearson1Philip Vutien2Feng Su3Andrew M. Moon4Kristin Berry5Pamela K. Green6Emily C. Williams7George N. Ioannou8Division of Gastroenterology University of Washington Seattle WADivision of Gastroenterology University of Washington Seattle WADivision of Gastroenterology University of Washington Seattle WADivision of Gastroenterology University of Washington Seattle WADivision of Gastroenterology University of North Carolina Chapel Hill NCHealth Service Research and Development Veterans Affairs Puget Sound Health Care System Seattle WAHealth Service Research and Development Veterans Affairs Puget Sound Health Care System Seattle WAHealth Service Research and Development Veterans Affairs Puget Sound Health Care System Seattle WADivision of Gastroenterology University of Washington Seattle WAOutcomes related to alcohol use after hepatitis C virus (HCV) treatment are unknown in the direct‐acting antiviral (DAA) era. We assessed levels of alcohol use before and after HCV treatment and their association with long‐term outcomes in a cohort of U.S. veterans. In this retrospective cohort analysis, 29,037 patients who initiated DAA regimens between 2013 and 2015 were followed for a mean of 3.04 years. We categorized alcohol use into three categories (nondrinking, low‐level drinking, and unhealthy drinking) using Alcohol Use Disorders Identification Test‐Consumption questionnaires administered within 1 year before (baseline) and after treatment. Multivariable Cox proportional hazards regression was used to determine the associations between alcohol use and mortality or liver‐related outcomes. Before DAA treatment, 68% of veterans reported nondrinking, 22.9% reported low‐level drinking, and 9.1% reported unhealthy drinking. Compared to patients with baseline non‐drinking, those with unhealthy drinking had a higher risk of mortality (adjusted hazard ratio [HR] 1.53, 95% confidence interval [CI]: 1.34‐1.75) and decompensated cirrhosis (adjusted HR 1.30, 95% CI: 1.06‐1.59) and lower likelihood of liver transplantation (adjusted HR 0.24, 95% CI: 0.06‐0.92). These associations were greater in patients without sustained virologic response than in those with sustained virologic response. When alcohol use before and after treatment was modeled as a time‐varying covariate, similar associations were observed. Survival analysis also found that unhealthy drinking was significantly associated with a lower probability of survival compared with nondrinking. Low‐level alcohol use was not associated with increased risk of adverse outcomes. Conclusion: In this large cohort of U.S. veterans with HCV who received DAAs, unhealthy drinking was common and associated with a higher risk of posttreatment mortality. Interventions to achieve alcohol cessation before and during antiviral treatment should be encouraged.https://doi.org/10.1002/hep4.1464 |
| spellingShingle | Nicole J. Kim Meredith Pearson Philip Vutien Feng Su Andrew M. Moon Kristin Berry Pamela K. Green Emily C. Williams George N. Ioannou Alcohol Use and Long‐Term Outcomes Among U.S. Veterans Who Received Direct‐Acting Antivirals for Hepatitis C Treatment Hepatology Communications |
| title | Alcohol Use and Long‐Term Outcomes Among U.S. Veterans Who Received Direct‐Acting Antivirals for Hepatitis C Treatment |
| title_full | Alcohol Use and Long‐Term Outcomes Among U.S. Veterans Who Received Direct‐Acting Antivirals for Hepatitis C Treatment |
| title_fullStr | Alcohol Use and Long‐Term Outcomes Among U.S. Veterans Who Received Direct‐Acting Antivirals for Hepatitis C Treatment |
| title_full_unstemmed | Alcohol Use and Long‐Term Outcomes Among U.S. Veterans Who Received Direct‐Acting Antivirals for Hepatitis C Treatment |
| title_short | Alcohol Use and Long‐Term Outcomes Among U.S. Veterans Who Received Direct‐Acting Antivirals for Hepatitis C Treatment |
| title_sort | alcohol use and long term outcomes among u s veterans who received direct acting antivirals for hepatitis c treatment |
| url | https://doi.org/10.1002/hep4.1464 |
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