The Impact of Direct‐Acting Antiviral Therapy on End‐Stage Liver Disease Among Individuals with Chronic Hepatitis C and Substance Use Disorders
Autor: | David R. Nelson, Wei-Hsuan Lo-Ciganic, Robert L. Cook, Xinyi Jiang, Vincent Lo Re, Lindsey M. Childs-Kean, Hyun Jin Song, Haesuk Park |
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Rok vydání: | 2021 |
Předmět: |
Adult
Liver Cirrhosis Male 0301 basic medicine medicine.medical_specialty Carcinoma Hepatocellular Cirrhosis Adolescent Databases Factual Substance-Related Disorders Antiviral Agents Risk Assessment Severity of Illness Index behavioral disciplines and activities Gastroenterology End Stage Liver Disease Young Adult 03 medical and health sciences 0302 clinical medicine Chronic hepatitis Risk Factors Internal medicine mental disorders medicine Humans Aged Retrospective Studies Hepatology business.industry Incidence Liver Neoplasms Hazard ratio Retrospective cohort study End stage liver disease Hepatitis C Chronic Middle Aged medicine.disease humanities Substance abuse Editorial 030104 developmental biology Hepatocellular carcinoma Female 030211 gastroenterology & hepatology Substance use business Administrative Claims Healthcare |
Zdroj: | Hepatobiliary Surg Nutr |
ISSN: | 1527-3350 0270-9139 2013-2018 |
Popis: | BACKGROUND AND AIMS Our aim was to evaluate the impact of direct-acting antivirals (DAAs) on decompensated cirrhosis (DCC) and HCC in patients with chronic HCV and substance use disorder (SUD) compared with those without an SUD. APPROACH AND RESULTS This retrospective cohort study used the MarketScan database (2013-2018) to identify 29,228 patients with chronic HCV, where 22% (n = 6,385) had ≥1 SUD diagnosis. The inverse probability of treatment weighted multivariable Cox proportional hazard models were used to compare the risk of developing DCC and HCC. Among the those who were noncirrhotic, treatment reduced the DCC risk among SUD (adjusted hazard ratio [aHR] 0.13; 95% CI, 0.06-0.30) and non-SUD (aHR 0.11; 95% CI, 0.07-0.18), whereas the risk for HCC was not reduced for the SUD group (aHR 0.91; 95% CI, 0.33-2.48). For those with cirrhosis, compared with patients who were untreated, treatment reduced the HCC risk among SUD (aHR, 0.33; 95% CI, 0.13-0.88) and non-SUD (aHR, 0.40; 95% CI, 0.25-0.65), whereas the risk for DCC was not reduced for the SUD group (aHR, 0.64; 95% CI, 0.37-1.13). Among patients with cirrhosis who were untreated, the SUD group had a higher risk of DCC (aHR, 1.52; 95% CI, 1.03-2.24) and HCC (aHR, 1.69; 95% CI, 1.05-2.72) compared with non-SUD group. CONCLUSIONS Among the HCV SUD group, DAA treatment reduced the risk of DCC but not HCC for those who were noncirrhotic, whereas DAA treatment reduced the risk of HCC but not DCC for those with cirrhosis. Among the nontreated, patients with an SUD had a significantly higher risk of DCC and HCC compared with those without an SUD. Thus, DAA treatment should be considered for all patients with HCV and an SUD while also addressing the SUD. |
Databáze: | OpenAIRE |
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