P734 a Systematic Review of Interventions to Reduce Alcohol Consumption Among Individuals With Chronic HCV Infection

Doyle, Joseph S; Hunt, David William; Aspinall, Esther; Hutchinson, Sharon J.; Goldberg, D.; Nguyen, Thao T. P.; Falck-Ytter, Y.; Morgan, Roy; Smith, Bryan; Stoove, MA; Lutchers, S.; Wiktor, Stefan Z.; Hellard, Margaret

doi:10.1016/s0168-8278(14)60895-3

Cited by 5 publications

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“…The impact of ameliorating HRBs in the CHC‐infected population could therefore be considerable, and so it is striking that the evidence base on this topic is so thin. In a recent systematic review, Doyle et al could identify only two randomized, controlled trials (RCTs) for an alcohol reduction intervention in patients with HCV . In the same vein, we were unable to identify a single RCT evaluating a smoking cessation intervention for patients with HCV in our own brief literature search (see http://onlinelibrary.wiley.com/doi/10.1002/hep.29419/suppinfo).…”

Section: Discussionmentioning

confidence: 92%

The contribution of health risk behaviors to excess mortality in American adults with chronic hepatitis C: A population cohort‐study

et al. 2017

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In resource-rich countries, chronic hepatitis C (CHC) infection is associated with a sizeable excess mortality risk. The extent to which this is due to (1) the biological sequelae of CHC infection versus (2) a high concomitant burden of health risk behaviors (HRBs) is unclear. We used data from the 1999-2010 U.S. National Health and Nutritional Examination Surveys (NHANES), which include detailed information on HRBs and CHC infection status. We calculated the prevalence of the five major HRBs-alcohol use; cigarette smoking, physical inactivity, unhealthy diet, and illicit drug useaccording to CHC after adjusting for sociodemographic differences. Mortality status after survey interview was ascertained by linkage to the U.S. National Death Index. To assess the contribution of HRBs to the excess mortality risk, we determined the all-cause mortality rate ratio (MRR) for individuals with CHC relative to individuals without, and then calculated the attenuation in this MRR following adjustment for HRBs. This analysis included 27,468 adult participants of NHANES of which 363 tested positive for CHC. All HRBs were markedly more prevalent among individuals with CHC versus individuals without. CHC was associated with a 2.4-fold higher mortality rate after adjustment for sociodemographic factors (MRR, 2.36; 95% CI, 1.60-3.49). Subsequent adjustment for all five HRBs attenuated this ratio by 50.7% to MRR 1.67 (95% CI, 1.14-2.44). Higher levels of attenuation (69.1%) were observed among individuals aged 45-70 years, who form the target demographic for U.S. birth cohort screening. Conclusion: At least half the excess mortality risk for individuals with CHC in the United States may be attributed to HRBs rather than CHC. The remedial response to hepatitis C must not neglect action on HRBs if it is to fully resolve the high mortality problem in this population. (HEPA-TOLOGY 2018;67:97-107).

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Section: Discussionmentioning

confidence: 92%

The contribution of health risk behaviors to excess mortality in American adults with chronic hepatitis C: A population cohort‐study

et al. 2017

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“…Few integrated HCV‐alcohol treatment models have been tested in patients with liver disease . A systematic literature review found only five behavioral studies targeting alcohol reduction among patients with HCV . Published HCV‐alcohol integrated treatments have mainly focused on people who inject drugs recruited from needle exchange settings or on patients with severe alcohol use disorders .…”

Section: Discussionmentioning

confidence: 99%

A Randomized Controlled Trial of an Integrated Alcohol Reduction Intervention in Patients With Hepatitis C Infection

et al. 2020

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BaCKgRoUND aND aIMS:Hepatitis C virus (HCV) and alcohol use are patient risk factors for accelerated fibrosis progression, yet few randomized controlled trials have tested clinic-based alcohol interventions. appRoaCH aND ReSUltS: A total of 181 patients with HCV and qualifying alcohol screener scores at three liver center settings were randomly assigned to the following: (1) medical provider-delivered Screening, Brief Intervention, and Referral to Treatment (SBIRT), including motivational interviewing counseling and referral out for alcohol treatment (SBIRT-only), or (2) SBIRT plus 6 months of integrated colocated alcohol therapy (SBIRT + Alcohol Treatment). The timeline followback method was used to assess alcohol use at baseline and 3, 6, and 12 months. Coprimary outcomes were alcohol abstinence at 6 months and heavy drinking days between 6 and 12 months. Secondary outcomes included grams of alcohol consumed per week at 6 months. Mean therapy hours across 6 months were 8.8 for SBIRT-only and 10.1 for SBIRT + Alcohol Treatment participants. The proportion of participants exhibiting full alcohol abstinence increased from baseline to 3, 6, and 12 months in both treatment arms, but no significant differences were found between arms (baseline to 6 months, 7.1% to 20.5% for SBIRT-only; 4.2% to 23.3% for SBIRT + Alcohol Treatment; P = 0.70). Proportions of participants with any heavy drinking days decreased in both groups at 6 months but did not significantly differ between the SBIRT-only (87.5% to 26.7%) and SBIRT + Alcohol Treatment (85.7% to 42.1%) arms (P = 0.30). Although both arms reduced average grams of alcohol consumed per week from baseline to 6 and 12 months, between-treatment effects were not significant. CoNClUSIoNS:Patients with current or prior HCV infection will engage in alcohol treatment when encouraged by liver medical providers. Liver clinics should consider implementing provider-delivered SBIRT and tailored alcohol treatment referrals as part of the standard of care. (Hepatology A ffecting an estimated 71 million people worldwide, (1) chronic hepatitis C virus (HCV) infection can lead to fibrosis, cirrhosis, and life-shortening complications of portal hypertension and hepatocellular carcinoma. (2) Alcohol use in the setting of HCV infection is associated with increased rates of fibrosis progression, liver-related mortality, and overall mortality. (3) Compared with people without HCV, people with HCV infection living in the United States are estimated to be excessive drinkers 1.3 times more often. (4) Consequently, guidelines recommend abstinence from alcohol and clinical interventions to facilitate alcohol cessation in patients with active infection. (5,6) Even after HCV cure with therapy, patients with cirrhosis remain at higher risk for fibrosis progression and hepatocellular carcinoma; these patients are particularly cautioned against excessive alcohol use. (5,6) Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based alcohol reduction practice. This 5-to 10-minute...

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“…First, alcohol reduction interventions may help decrease the level of consumption in HCV-infected individuals with moderate-to-high alcohol consumption. 46 Second, brief motivational interventions can help reduce the frequency of injection-related blood-borne virus risk behaviors, as shown in hazardous drinkers in one needle exchange program. 47 However, a systematic review 45 did not find sufficient evidence supporting the effectiveness of brief interventions in reducing alcohol use in people with concurrent illicit drug use and AUD.…”

Section: Efficacy Of Interventions To Manage Aud In People At Risk Of Hcvmentioning

confidence: 99%

Alcohol Use Disorder and Hepatitis C Prevention and Care in People Who Inject Drugs: The State of Play

et al. 2020

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Safe and effective treatment with direct-acting antivirals (DAAs) has ushered in an era in which hepatitis C virus (HCV) elimination, as set out by the World Health Organization, is possible. However, alcohol use disorder (AUD) has the potential to reduce the benefits of prevention interventions and reduce access to and continuity of HCV care in at-risk populations, such as people who inject drugs (PWID). We review the literature on the consequences of AUD on the effectiveness of HCV prevention and the cascade of care in PWID and provide recommendations for future research in the field of alcohol use and HCV.

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P734 a Systematic Review of Interventions to Reduce Alcohol Consumption Among Individuals With Chronic HCV Infection

Cited by 5 publications

References 0 publications

The contribution of health risk behaviors to excess mortality in American adults with chronic hepatitis C: A population cohort‐study

The contribution of health risk behaviors to excess mortality in American adults with chronic hepatitis C: A population cohort‐study

A Randomized Controlled Trial of an Integrated Alcohol Reduction Intervention in Patients With Hepatitis C Infection

Alcohol Use Disorder and Hepatitis C Prevention and Care in People Who Inject Drugs: The State of Play

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