Assessing Prevalence of Alcohol Use and Association with Receipt of Direct-acting Antiviral Treatment and Sustained Virologic Response among Veterans with Chronic Hepatitis C at the Atlanta VA Medical Center Open Access

Abstract

Aims

To describe the prevalence of alcohol use in veterans with chronic Hepatitis C Virus (HCV) infection presenting for care at the Atlanta VA medical center (AVAMC) between 1/1/2015 – 11/29/2017 using alcohol biomarkers, ethyl glucuronide (EtG) and ethyl sulfate (EtS), and evaluate the association between alcohol use and receipt of direct-acting antiviral (DAA) therapy and achievement of sustained virologic response (SVR).           

Short Summary

Many veterans were ineligible for interferon-based therapy because of alcohol use. DAAs are safer and more effective, lifting historical alcohol abstinence requirements from national HCV treatment guidelines. Data are still limited regarding the impact of alcohol use on virologic outcomes in the DAA era.

Methods

Prevalence of alcohol use was determined using detectable values of EtG and EtS between 1/1/2015 to 11/29/2017. To determine association between alcohol use and receipt of HCV antiviral therapy and SVR, multivariable logistic regression analysis was conducted.  

Results

Of the 1764 patients tested, 34% had detectable values of EtG and EtS. For those who used alcohol during study period, the odds of receiving DAA was 0.708 (95% CI: 0.574, 0.873; p=0.0013); the odds of achieving SVR was 0.719 (95% CI: 0.515, 1.004; p=0.0525).

Conclusions

Alcohol use during the study period decreased the odds of receiving DAA but had no statistical significance on odds of achieving SVR. Overall, 85.8% of patients who received DAA therapy achieved SVR. Patients with a history of substance or alcohol use disorders should be considered for HCV antiviral therapy DAA on a case-by-case basis. 

Table of Contents

Chapter 1: Literature Review

Chapter 2: Journal Article

Chapter 3: Conclusions

References

Tables and Figures

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Executive Masters of Public Health - MPH
Subfield / Discipline	Applied Epidemiology
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	Alcohol Use Veterans Chronic Hepatitis C Direct Acting Antivirals Sustained Virologic Response
Committee Chair / Thesis Advisor	Emily Cartwright, Atlanta Veterans Affairs Medical Center Jodie Guest, Emory University

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