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We examined the impact of alcohol use on direct\u2010acting antiviral (DAA) therapy outcome and the clinical course of liver disease and 2\u2010year survival for patients receiving HCV DAA therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Adults (<jats:italic>n<\/jats:italic>\u2009=\u20092624) recruited from 26 Australian hospital liver clinics during 2016\u20132021 were followed up for 2\u2009years. Risky alcohol use was defined by a combination of self\u2010report (\u226540\u2009g\/day of ethanol), physician\u2010reported history of problematic alcohol use, and anti\u2010craving medication prescription via population\u2010based database linkage. We examined factors associated with advanced liver fibrosis and survival using multivariable logistic and Cox regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 1634 patients (62.3%) with risky alcohol use, 24.6% reported consuming \u226540\u2009g\/day of alcohol, 98.3% physician\u2010reported problematic alcohol use; only 4.1% were dispensed naltrexone\/acamprosate. One hundred and forty\u2010three patients with cirrhosis reported \u226540\u2009g\/day of alcohol, 6 (4.3%) were prescribed naltrexone\/acamprosate. Risky alcohol use was associated with advanced fibrosis (adjusted\u2010odds ratio 1.69, 95% confidence interval 1.32\u20132.17) and patients were over\u2010represented for cirrhosis (45.1% vs. 25.6% in no\u2010risky alcohol use [<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001]) and hepatocellular carcinoma (5.7% vs. 2.5% [<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001]). Sustained viral response (<jats:italic>p<\/jats:italic>\u2009=\u20090.319) and 2\u2010year survival (adjusted\u2010hazard ratio\u20091.98, 95% confidence interval 0.84\u20134.63) after DAA therapy were not associated with risky alcohol use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion and Conclusions<\/jats:title><jats:p>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\u2010recognised 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.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dar.13914","type":"journal-article","created":{"date-parts":[[2024,8,2]],"date-time":"2024-08-02T07:20:04Z","timestamp":1722583204000},"page":"1559-1572","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Alcohol does not impact chronic hepatitis <scp>C<\/scp> treatment outcomes but increases risk for progressive liver disease: <scp>Findings<\/scp> from a prospective multicentre <scp>Australian<\/scp> study (<scp>OPERA\u2010C<\/scp>)"],"prefix":"10.1111","volume":"43","author":[{"given":"Paul J.","family":"Clark","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Alcohol and Drug Assessment Unit Princess Alexandra and Mater Hospitals  Brisbane Australia"},{"name":"Faculty of Medicine The University of Queensland  Brisbane Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8823-3006","authenticated-orcid":false,"given":"Patricia C.","family":"Valery","sequence":"additional","affiliation":[{"name":"Faculty of Medicine The University of Queensland  Brisbane Australia"},{"name":"QIMR Berghofer Medical Research Institute  Brisbane Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simone I.","family":"Strasser","sequence":"additional","affiliation":[{"name":"AW Morrow Gastroenterology and Liver Centre Royal Prince Alfred Hospital  Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Weltman","sequence":"additional","affiliation":[{"name":"Hepatology Services Nepean Hospital  Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alex","family":"Thompson","sequence":"additional","affiliation":[{"name":"Department of 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