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酒精使用和对肝炎C病毒的持续病毒学反应直接作用抗病毒疗法

Emily J Cartwright^1,2, Chloe Pierret³, Caroline Minassian³

¹Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia.

JAMA network open

|September 26, 2023

概括

酒精使用和酒精使用障碍 (AUD) 不会影响慢性肝炎C病毒 (HCV) 患者的直接作用抗病毒疗法 (DAA) 持续病毒反应 (SVR) 率. 这些发现表明,要求禁欲制造了对治疗的不必要障碍,并阻碍了消除HCV的努力.

科学领域:

肝病学肝病学是一种肝病学.
传染性疾病传染性疾病
公共卫生公共卫生

背景情况:

一些医疗保健提供者和支付者要求在治疗慢性型肝炎病毒 (HCV) 感染的直接作用抗病毒疗法 (DAA) 的患者中戒酒.
这一政策可能会给那些有过酒精使用史或酒精使用障碍 (AUD) 的人造成治疗障碍.

研究的目的:

调查DAA治疗开始时的酒精使用与实现持续病毒学反应 (SVR) 的可能性之间的联系.
确定酒精消费模式是否会影响慢性HCV的治疗结果.

主要方法:

一项回顾性队列研究,利用美国退伍军人事务部 (VA) 医疗保健系统的电子健康记录.
包括1945-1965年间出生的患者,在2014-2018年间开始DAA治疗.
酒精使用被分类使用AUDIT-C分数和AUD诊断;SVR被定义为不可检测的HCVRNA治疗后≥12周. 多变量逻辑回归分析了酒精使用类别与SVR之间的关联.

主要成果:

在开始DAA治疗的69229名患者中,94.4%的患者实现了SVR.
不同的饮酒类别,包括高风险饮酒或AUD (OR,0.95;95%CI,0.85-1.07) 之间没有观察到SVR率的显著差异.
在SVR方面,没有发现酒精使用和肝纤维化阶段 (FIB-4分数) 之间的相互作用.

结论:

酒精使用和AUD与在接受DAA治疗HCV的患者中减少SVR率无关.
强制戒酒作为DAA治疗的先决条件是一个不必要的障碍,阻碍了HCV消除目标.
应审查临床指导方针和付款人政策,以确保公平获得有效的HCV治疗.

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