HCV treatment with direct-acting antivirals linked to reduced alcohol use in people who inject drugs

BACKGROUND/AIMS: People who inject drugs (PWID) have high rates of HCV infection. Concurrent alcohol use is associated with higher rates of HCV and acceleration of HCV-related liver disease. This study analyzed alcohol use among PWID both during and after treatment of HCV with direct-acting antivirals. APPROACH/RESULTS: We conducted a secondary analysis of the HERO study, a multisite pragmatic randomized trial, in which PWID with active drug use (n = 755) were assigned to either patient navigation or modified directly observed therapy models of HCV care. Alcohol use was measured using the modified Addiction Severity Index (ASI) and the Alcohol Use Disorders Identification Test-Concise (AUDIT-C). Linear mixed-effects models were used to analyze changes in alcohol use between baseline, treatment (weeks 4, 8, and 12), and after-treatment follow-up visits (weeks 24, 72, 120, 168). Overall, there were no significant differences in ASI or AUDIT-C scores by sustained virological response (SVR) or treatment arm. Among patients who achieved SVR, there was a significant reduction in AUDIT-C scores at all follow-up visits compared to baseline (all, p < 0.05). Among those with high AUDIT-C score at baseline, there were significant reductions in drinking at all visits compared to baseline in both treatment arms (all, p ≤ 0.001). CONCLUSIONS: Among PWID who achieved SVR or with high AUDIT-C scores at baseline, there was a significant reduction in AUDIT-C scores at all visits after baseline. The treatment period for HCV may represent a unique opportunity to address dual causes of liver disease, especially for individuals with hazardous alcohol use.