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Introduction: Alcohol use is common in patients with chronic hepatitis C virus (HCV) infection. We examined the impact of alcohol use on direct‐acting antiviral (DAA) therapy outcome and the clinical course of liver disease and 2‐year survival for patients receiving HCV DAA therapy. Methods: Adults (n = 2624) recruited from 26 Australian hospital liver clinics during 2016–2021 were followed up for 2 years. Risky alcohol use was defined by a combination of self‐report (≥40 g/day of ethanol), physician‐reported history of problematic alcohol use, and anti‐craving medication prescription via population‐based database linkage. We examined factors associated with advanced liver fibrosis and survival using multivariable logistic and Cox regression. Results: Among 1634 patients (62.3%) with risky alcohol use, 24.6% reported consuming ≥40 g/day of alcohol, 98.3% physician‐reported problematic alcohol use; only 4.1% were dispensed naltrexone/acamprosate. One hundred and forty‐three patients with cirrhosis reported ≥40 g/day of alcohol, 6 (4.3%) were prescribed naltrexone/acamprosate. Risky alcohol use was associated with advanced fibrosis (adjusted‐odds ratio 1.69, 95% confidence interval 1.32–2.17) and patients were over‐represented for cirrhosis (45.1% vs. 25.6% in no‐risky alcohol use [p < 0.001]) and hepatocellular carcinoma (5.7% vs. 2.5% [p < 0.001]). Sustained viral response (p = 0.319) and 2‐year survival (adjusted‐hazard ratio 1.98, 95% confidence interval 0.84–4.63) after DAA therapy were not associated with risky alcohol use. Discussion and Conclusions: 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‐recognised 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. [ABSTRACT FROM AUTHOR]

Background: Direct‐acting antiviral (DAA) therapies for hepatitis C virus infection (HCV) lead to excellent rates of sustained virological response (SVR). However, loss to follow‐up (LTFU) for SVR testing remains a challenge. We examine factors associated with LTFU in a real‐world setting. Methods: Adults who received DAA therapy for HCV in one of 26 centers across Australia during 2016–2021 were followed up for 2 years. Data sources included the patient medical records and the national Pharmaceutical and Medicare Benefits Schemes. Linkage to Medicare provided utilization data of other health‐care providers and re‐treatment with DAAs. LTFU was defined as no clinic attendance for SVR testing by at least 52 weeks after DAA treatment commencement. Multivariable logistic regression assessed factors associated with LTFU. Results: In 3619 patients included in the study (mean age 52.0 years; SD = 10.5), 33.6% had cirrhosis (69.4% Child–Pugh class B/C), and 19.3% had HCV treatment prior to the DAA era. Five hundred and fifteen patients (14.2%) were LTFU. HCV treatment initiation in 2017 or later (adj‐OR = 2.82, 95% confidence interval [CI] 2.25–3.54), younger age (adj‐OR = 2.63, 95% CI 1.80–3.84), Indigenous identification (adj‐OR = 1.99, 95% CI 1.23–3.21), current injection drug use or opioid replacement therapy (adj‐OR = 1.66, 95% CI 1.25–2.20), depression treatment (adj‐OR = 1.49, 95% CI 1.17–1.90), and male gender (adj‐OR = 1.31, 95% CI 1.04–1.66) were associated with LTFU. Conclusions: These findings stress the importance of strengthening the network of providers caring for patients with HCV. In particular, services targeting vulnerable groups of patients such as First Nations Peoples, youth health, and those with addiction and mental health disorders should be equipped to treat HCV. [ABSTRACT FROM AUTHOR]

Background and Aim: Hepatitis C virus (HCV) cure with direct‐acting antiviral (DAA) therapy improves survival in patients with HCV‐related hepatocellular carcinoma (HCC). We hypothesized that HCV‐HCC survival has increased in the DAA era, more than other aetiologies of HCC. We aimed to evaluate survival following HCC diagnosis in the pre‐DAA and DAA eras, across each aetiology of HCC. Methods: Patients with HCC at three tertiary referral hospitals were included retrospectively (January 2008 to December 2019). Patients were categorized as HCV‐HCC, hepatitis B virus (HBV)‐HCC, or non‐viral HCC. For each aetiology, the risk of death following incident HCC among patients diagnosed in the DAA era (2015–2019) was compared with patients diagnosed in the pre‐DAA era (2008–2014). Results: Among 1161 patients, there were 422 (36%) patients with HCV‐HCC, 227 (20%) with HBV‐HCC, and 512 (44%) with non‐viral HCC. In adjusted analysis, the risk of death was lower in patients with HCV‐HCC diagnosed in 2015–2019, compared with patients diagnosed in 2008–2014 (adjusted hazard ratio [aHR]: 0.68; 95% confidence interval [CI]: 0.52–0.89; P = 0.005). In contrast, there was no difference in the risk of death between time periods for patients with HBV‐HCC (HR: 0.91; 95% CI: 0.64–1.29; P = 0.602) or non‐viral HCC on adjusted analysis (aHR: 0.92; 95% CI: 0.74–1.15; P = 0.476). Although patients with HBV‐HCC had better survival compared with patients with HCV‐HCC in 2008–2014 (aHR: 0.74; 95% CI: 0.55–0.98; P = 0.037), this difference disappeared in 2015–2019 (aHR: 1.26; 95% CI: 0.90–1.77; P = 0.175). Conclusions: Hepatitis C virus‐related HCC survival has increased in the DAA era, whereas adjusted survival remained stable for HBV‐HCC and non‐viral HCC. [ABSTRACT FROM AUTHOR]

The impact of hepatitis C virus (HCV) cure on survival in patients with HCV‐related hepatocellular carcinoma (HCC) has been examined, although many studies have been subject to survivor treatment selection bias. We assessed the impact of HCV cure before HCC diagnosis on overall survival. Patients with HCV‐related HCC at three referral hospitals in Australia were included retrospectively (January 2008 to December 2019). The risk of death following HCC diagnosis among patients who achieved HCV cure before HCC diagnosis was compared to patients who were viraemic at diagnosis. Among 422 patients with HCV‐related HCC, 101 (24%) achieved HCV cure before HCC diagnosis, 37 with interferon (IFN) and 64 with direct‐acting antiviral (DAA) therapy. Patients with HCV cure were more likely to have no cirrhosis or Child‐Pugh A liver disease (83% vs. 66%, p =.002), surveillance detection (71% vs. 48%, p <.001), HCC stage O or A (64% vs. 45%, p <.001) and receive curative initial HCC management (51% vs. 28%, p <.001), compared with patients who were viraemic at diagnosis. The 5‐year overall survival was 51% in the HCV cure group and 22% in the viraemic group. In adjusted analysis, risk of death was lower in patients with HCV cure before HCC diagnosis compared with patients who were viraemic at diagnosis (adjusted hazard ratio: 0.63; 95% CI: 0.44–0.91; p =.013). Patients with HCV‐related HCC who have achieved HCV cure before HCC diagnosis have improved overall survival compared with patients who were viraemic at diagnosis. [ABSTRACT FROM AUTHOR]

Issue addressed: Increasing the uptake of hepatitis C treatment by injecting drug users (IDUs) is a key strategy in addressing the escalating disease burden of chronic hepatitis C virus (HCV) infection in Australia. Little is known about barriers to treatment uptake among culturally diverse groups of IDUs. Indo-Chinese IDUs represent a marginalised group with high rates of incident and prevalent HCV infection. Methods: An ethnographic study was conducted to explore barriers to HCV treatment uptake experienced by Indo-Chinese IDUs and inform the development of policies and practices that promote access to treatment. Following a baseline interview, participants (n=23) received a brief intervention about HCV treatment and an offer of facilitated referral to a tertiary liver clinic. Follow-up interviews were conducted three and six months post intervention, to explore decision-making about treatment-seeking and experiences accessing the clinic. Results: While 'getting rid of' HCV was regarded as highly desirable, only three participants were assessed for treatment. For most participants, seeking treatment was not seen as feasible given social and structural barriers related to their drug use, lack of resources and support. Institutional barriers included the clinic's administrative procedures, limited flexibility and apparent reluctance to consider current IDUs suitable candidates for treatment. Conclusions: Resources and support, flexible, low threshold approaches to assessment and a willingness to provide treatment to current IDUs, would promote equitable access to treatment among these groups. [ABSTRACT FROM AUTHOR]