Alcohol use disorder among chronic hepatitis C patients: prevalence and treatment outcomes, CHeCS, 2006-2013

Background: Alcohol use in patients with chronic hepatitis C (CHC) results in progression of liver disease and represents a barrier to antiviral therapy. We sought to determine the prevalence of alcohol abuse and alcohol-related liver disease among CHC patients to assess their access to HCV treatment. Methods: We used CHeCS data collected from CHC patients seen in four large U.S. healthcare systems from 2006-2013. Among patients with documented ICD 9 codes indicative of any alcohol use disorder defined as alcohol abuse/dependence and alcohol-related liver disease, we determined the percentage of patients with any alcohol disorder, with alcohol abuse/dependence, and with alcohol-related liver disease who received HCV treatment. We used multivariable analysis to identify factors associated with HCV treatment by alcohol status. Results: Of the 11,636 CHC patients, 3,553 (30.5%) had at least one documented ICD-9 code indicative of any alcohol use disorder. Among those with any alcohol use disorder, 70.4% were male, 92.5% were aged \u3e44 years, 58.7% were white, and 19.9% had alcohol-related liver disease. Overall, 40.3% of CHC patients received HCV treatment. Only 30.4% of those with alcohol abuse and 50.4% of those with alcohol-related liver disease received treatment. Sustained virologic response rates were 41.6% overall, 44.7% for those with alcohol abuse, and 28.4% for those with alcohol-related liver disease. In univariate analysis HCV treatment was associated with age, race, household income, ever having biopsy and biopsy stage (