Department of Gastroenterology, Alcohol and Drug Assessment Unit, Princess Alexandra and Mater Hospitals, Brisbane, Australia.
Faculty of Medicine, The University of Queensland, Brisbane, Australia.
Drug Alcohol Rev. 2024 Sep;43(6):1559-1572. doi: 10.1111/dar.13914. Epub 2024 Aug 2.
Alcohol use is common in patients with chronic hepatitis C virus (HCV) infection. We examined the impact of alcohol use on direct-acting antiviral (DAA) therapy outcome and the clinical course of liver disease and 2-year survival for patients receiving HCV DAA therapy.
Adults (n = 2624) recruited from 26 Australian hospital liver clinics during 2016-2021 were followed up for 2 years. Risky alcohol use was defined by a combination of self-report (≥40 g/day of ethanol), physician-reported history of problematic alcohol use, and anti-craving medication prescription via population-based database linkage. We examined factors associated with advanced liver fibrosis and survival using multivariable logistic and Cox regression.
Among 1634 patients (62.3%) with risky alcohol use, 24.6% reported consuming ≥40 g/day of alcohol, 98.3% physician-reported problematic alcohol use; only 4.1% were dispensed naltrexone/acamprosate. One hundred and forty-three patients with cirrhosis reported ≥40 g/day of alcohol, 6 (4.3%) were prescribed naltrexone/acamprosate. Risky alcohol use was associated with advanced fibrosis (adjusted-odds ratio 1.69, 95% confidence interval 1.32-2.17) and patients were over-represented for cirrhosis (45.1% vs. 25.6% in no-risky alcohol use [p < 0.001]) and hepatocellular carcinoma (5.7% vs. 2.5% [p < 0.001]). Sustained viral response (p = 0.319) and 2-year survival (adjusted-hazard ratio 1.98, 95% confidence interval 0.84-4.63) after DAA therapy were not associated with risky alcohol use.
Risky alcohol use in HCV patients was prevalent, but did not reduce HCV cure. Treatment for alcohol dependence was low. Risky alcohol use may be under-recognised in liver clinics. Better integration of addiction medicine into liver services and increased resourcing and addiction medicine training opportunities for hepatologists may help address this.
慢性丙型肝炎病毒（HCV）感染患者常饮酒。我们研究了饮酒对直接作用抗病毒（DAA）治疗结果以及接受 HCV DAA 治疗患者的肝病临床病程和 2 年生存率的影响。
2016 年至 2021 年间，我们从澳大利亚 26 家医院的肝脏诊所招募了 2624 名成年人进行随访 2 年。通过人群数据库链接，结合自我报告（乙醇≥40g/天）、医生报告的酒精使用问题史和抗渴求药物处方，定义了风险饮酒。我们使用多变量逻辑和 Cox 回归检查了与晚期纤维化和生存相关的因素。
在 1634 名（62.3%）有风险饮酒的患者中，24.6%报告饮酒≥40g/天，98.3%的医生报告有酒精使用问题；仅 4.1%的患者开出了纳曲酮/阿坎酸。143 名患有肝硬化的患者报告饮酒≥40g/天，6 名（4.3%）开出了纳曲酮/阿坎酸。风险饮酒与晚期纤维化相关（调整后的优势比 1.69，95%置信区间 1.32-2.17），且患者肝硬化（45.1%比无风险饮酒的 25.6%[p<0.001]）和肝细胞癌（5.7%比 2.5%[p<0.001]）的占比更高。DAA 治疗后的持续病毒应答（p=0.319）和 2 年生存率（调整后的危险比 1.98，95%置信区间 0.84-4.63）与风险饮酒无关。
HCV 患者的风险饮酒较为普遍，但并未降低 HCV 的治愈率。酒精依赖治疗的比例较低。肝脏诊所可能对风险饮酒认识不足。将成瘾医学更好地融入肝脏服务，为肝病学家提供更多的资源和成瘾医学培训机会，可能有助于解决这一问题。
