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
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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