{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T20:18:59Z","timestamp":1792441139935,"version":"4.5.0"},"reference-count":62,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Direct-acting antiviral (DAA) treatment for hepatitis C virus (HCV) infection is associated with lower mortality and is effective in individuals with alcohol use disorder (AUD). However, despite recommendations, patients with AUD may be less likely to receive DAAs.<\/jats:p><\/jats:sec>Objective<\/jats:title>To assess the association between alcohol use and receipt of DAA treatment among patients with HCV within the Veterans Health Administration (VHA).<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This cohort study included 133\u202f753 patients with HCV born from 1945 to 1965 who had completed the Alcohol Use Disorders Identification Test\u2013Consumption (AUDIT-C) questionnaire and had at least 1 outpatient visit in the VHA from January 1, 2014, through May 31, 2017, with maximal follow-up of 3 years until May 31, 2020; DAA receipt; or death, whichever occurred first.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Alcohol use categories generated using responses to the AUDIT-C questionnaire and International Classification of Diseases, Ninth Revision<\/jats:italic> and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision<\/jats:italic> diagnoses: current AUD, abstinent with AUD history, at-risk drinking, lower-risk drinking, and abstinent without AUD history. Demographic, other clinical, and pharmacy data were also collected.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Associations between alcohol use categories and DAA receipt within 1 and 3 years estimated using Cox proportional hazards regression stratified by calendar year.<\/jats:p><\/jats:sec>Results<\/jats:title>Of 133\u202f753 patients (130\u202f103 men [97%]; mean [SD] age, 60.6 [4.5] years; and 73\u202f493 White patients [55%]), 38% had current AUD, 12% were abstinent with a history of AUD, 6% reported at-risk drinking, 14% reported lower-risk drinking, and 30% were abstinent without a history of AUD. Receipt of DAA treatment within 1 year was 7%, 33%, 53%, and 56% for patients entering the cohort in 2014, 2015, 2016, and 2017, respectively. For patients entering in 2014, those with current AUD (hazard ratio [HR], 0.72 [95%, CI, 0.66-0.77]) or who were abstinent with an AUD history (HR, 0.91 [95% CI, 0.84-1.00]) were less likely to receive DAA treatment within 1 year compared with patients with lower-risk drinking. For those entering in 2015-2017, patients with current AUD (HR, 0.75 [95% CI, 0.70-0.81]) and those who were abstinent with an AUD history (HR, 0.76 [95% CI, 0.68-0.86]) were less likely to receive DAA treatment within 1 year compared with patients with lower-risk drinking.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This cohort study suggests that individuals with AUD, regardless of abstinence, were less likely to receive DAA treatment. Improved access to DAA treatment for persons with AUD is needed.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2022.46604","type":"journal-article","created":{"date-parts":[[2022,12,14]],"date-time":"2022-12-14T16:01:02Z","timestamp":1671033662000},"page":"e2246604","source":"Crossref","is-referenced-by-count":21,"title":["Association Between Alcohol Use Disorder and Receipt of Direct-Acting Antiviral Hepatitis C Virus Treatment"],"prefix":"10.1001","volume":"5","author":[{"given":"Lamia Y.","family":"Haque","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut"},{"name":"Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Fiellin","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut"},{"name":"Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut"},{"name":"Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet P.","family":"Tate","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut"},{"name":"Veterans Affairs Connecticut Health Care System, West Haven"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise","family":"Esserman","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debika","family":"Bhattacharya","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles"},{"name":"Veterans Affairs Greater Los Angeles Health Care System, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adeel A.","family":"Butt","sequence":"additional","affiliation":[{"name":"Department of Medicine, Weill Cornell Medicine, New York, New York"},{"name":"Department of Population Health Sciences, Weill Cornell Medicine, New York, New York"},{"name":"Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Crystal","sequence":"additional","affiliation":[{"name":"Center for Health Services Research, Rutgers University, New Brunswick, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. 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