{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T16:35:18Z","timestamp":1787589318709,"version":"build-2736575974"},"reference-count":57,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Some payers and clinicians require alcohol abstinence to receive direct-acting antiviral (DAA) therapy for chronic hepatitis C virus (HCV) infection.<\/jats:p><\/jats:sec>Objective<\/jats:title>To evaluate whether alcohol use at DAA treatment initiation is associated with decreased likelihood of sustained virologic response (SVR).<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This retrospective cohort study used electronic health records from the US Department of Veterans Affairs (VA), the largest integrated national health care system that provides unrestricted access to HCV treatment. Participants included all patients born between 1945 and 1965 who were dispensed DAA therapy between January 1, 2014, and June 30, 2018. Data analysis was completed in November 2020 with updated sensitivity analyses performed in 2023.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Alcohol use categories were generated using responses to the Alcohol Use Disorders Identification Test\u2013Consumption (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 for alcohol use disorder (AUD): abstinent without history of AUD, abstinent with history of AUD, lower-risk consumption, moderate-risk consumption, and high-risk consumption or AUD.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome was SVR, which was defined as undetectable HCV RNA for 12 weeks or longer after completion of DAA therapy. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% CIs of SVR associated with alcohol category.<\/jats:p><\/jats:sec>Results<\/jats:title>Among 69\u202f229 patients who initiated DAA therapy (mean [SD] age, 62.6 [4.5] years; 67\u202f150 men [97.0%]; 34\u202f655 non-Hispanic White individuals [50.1%]; 28\u202f094 non-Hispanic Black individuals [40.6%]; 58\u202f477 individuals [84.5%] with HCV genotype 1), 65\u202f355 (94.4%) achieved SVR. A total of 32\u202f290 individuals (46.6%) were abstinent without AUD, 9192 (13.3%) were abstinent with AUD, 13\u202f415 (19.4%) had lower-risk consumption, 3117 (4.5%) had moderate-risk consumption, and 11\u202f215 (16.2%) had high-risk consumption or AUD. After adjustment for potential confounding variables, there was no difference in SVR across alcohol use categories, even for patients with high-risk consumption or AUD (OR, 0.95; 95% CI, 0.85-1.07). There was no evidence of interaction by stage of hepatic fibrosis measured by fibrosis-4 score (P<\/jats:italic> for interaction\u2009=\u2009.30).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cohort study, alcohol use and AUD were not associated with lower odds of SVR. Restricting access to DAA therapy according to alcohol use creates an unnecessary barrier to patients and challenges HCV elimination goals.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.35715","type":"journal-article","created":{"date-parts":[[2023,9,26]],"date-time":"2023-09-26T15:00:53Z","timestamp":1695740453000},"page":"e2335715","source":"Crossref","is-referenced-by-count":15,"title":["Alcohol Use and Sustained Virologic Response to Hepatitis C Virus Direct-Acting Antiviral Therapy"],"prefix":"10.1001","volume":"6","author":[{"given":"Emily J.","family":"Cartwright","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia"},{"name":"Atlanta Veterans Affairs Medical Center, Decatur, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chloe","family":"Pierret","sequence":"additional","affiliation":[{"name":"Faculty of Epidemiology and Population Health, London School of 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