Skip to main content

Advertisement

SpringerLink
Log in

Reduced Alcohol Use Is Sustained in Patients Provided Alcohol-Related Counseling During Direct-Acting Antiviral Therapy for Hepatitis C

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Patients with chronic hepatitis C and risky/harmful alcohol use experience poor outcomes. Granular data evaluating whether alcohol counseling during hepatitis C treatment impacts longitudinal alcohol consumption are lacking.

Aims

To evaluate whether provider-delivered counseling in the context of direct-acting antiviral hepatitis C treatment associates with decreased longitudinal alcohol consumption.

Methods

We performed secondary data analysis from the Hep ART study including adults with hepatitis C who underwent provider-delivered counseling during direct-acting antiviral treatment between October 2014 and September 2017. Demographics and disease characteristics were summarized. Alcohol consumption, abstinence, and heavy drinking were evaluated in periods before, during, and after direct-acting antiviral treatment. Multivariate regression analyses were performed to evaluate the association of alcohol consumption with each 12-week time period for all patients and a subsample with cirrhosis.

Results

One hundred twenty-three patients were included; 41 had cirrhosis. Most patients were male (74.0%) and Black (58.5%). Alcohol consumption improved during direct-acting antiviral treatment and was notably sustained (< 12 weeks before treatment 32.5 g/day; during treatment 20.0 g/day; and 12–24 weeks after treatment 23.7 g/day). Multivariable analyses showed significantly improved alcohol consumption metrics during and after antiviral treatment compared to < 12 weeks before treatment (during treatment 13.04 g/day less, p = 0.0001; > 24 weeks after treatment 15.29 g/day less, p = 0.0001). The subsample with cirrhosis showed similar results (during treatment 13.21 g/day less, p = 0.0001; > 24 weeks after treatment 7.69 g/day less, p = 0.0001).

Conclusions

Patients with chronic HCV and risky/harmful alcohol use given provider-delivered alcohol-related counseling during HCV treatment sustain decreased alcohol consumption patterns during and after treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Yang JD, Larson JJ, Watt KD, Allen AM, Wiesner RH, Gores GJ et al. Hepatocellular carcinoma is the most common indication for liver transplantation and placement on the waitlist in the United States. Clin Gastroenterol Hepatol. 2017;15:767–775.e3. https://doi.org/10.1016/j.cgh.2016.11.034.

    Article  PubMed  Google Scholar 

  2. Younossi ZM, Zheng L, Stepanova M, Venkatesan C, Mir HM. Moderate, excessive or heavy alcohol consumption: each is significantly associated with increased mortality in patients with chronic hepatitis C. Aliment Pharmacol Ther. 2013;37:703–709. https://doi.org/10.1111/apt.12265.

    Article  CAS  PubMed  Google Scholar 

  3. EASL Recommendations on Treatment of Hepatitis C 2018. J Hepatol. 2018;69:461–511. https://doi.org/10.1016/j.jhep.2018.03.026.

  4. American Association for the Study of Liver Diseases. Recommendations for testing, managing, and treating hepatitis C [available at HCVguidelines.org]. 2019.

  5. Taylor AL, Denniston MM, Klevens RM, McKnight-Eily LR, Jiles RB. Association of hepatitis C virus with alcohol use among US adults: NHANES 2003–2010. Am J Prevent Med. 2016;51:206–215. https://doi.org/10.1016/j.amepre.2016.02.033.

  6. Burke BL, Arkowitz H, Menchola M. The efficacy of motivational interviewing: a meta-analysis of controlled clinical trials. J Consult Clin Psychol. 2003;71:843–861. https://doi.org/10.1037/0022-006x.71.5.843.

    Article  PubMed  Google Scholar 

  7. Beich A, Thorsen T, Rollnick S. Screening in brief intervention trials targeting excessive drinkers in general practice: systematic review and meta-analysis. BMJ (Clin Res Ed). 2003;327:536–542. https://doi.org/10.1136/bmj.327.7414.536.

    Article  Google Scholar 

  8. Bien TH, Miller WR, Tonigan JS. Brief interventions for alcohol problems: a review. Addiction (Abingdon). 1993;88:315–335. https://doi.org/10.1111/j.1360-0443.1993.tb00820.x.

    Article  CAS  Google Scholar 

  9. Bernstein E, Topp D, Shaw E, Girard C, Pressman K, Woolcock E et al. A preliminary report of knowledge translation: lessons from taking screening and brief intervention techniques from the research setting into regional systems of care. Acad Emerg Med. 2009;16:1225–1233. https://doi.org/10.1111/j.1553-2712.2009.00516.x.

    Article  PubMed  Google Scholar 

  10. Owens MD, Ioannou GN, Tsui JL, Edelman EJ, Greene PA, Williams EC. Receipt of alcohol-related care among patients with HCV and unhealthy alcohol use. Drug Alcohol Depend. 2018;188:79–85. https://doi.org/10.1016/j.drugalcdep.2018.03.047.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Proeschold-Bell RJ, Evon DM, Yao J, Niedzwiecki D, Makarushka C, Keefe KA et al. A randomized controlled trial of an integrated alcohol reduction intervention in patients with hepatitis C infection. Hepatology (Baltimore) 2019. https://doi.org/10.1002/hep.31058.

  12. Proeschold-Bell RJ, Patkar AA, Naggie S, Coward L, Mannelli P, Yao J et al. An integrated alcohol abuse and medical treatment model for patients with hepatitis C. Dig Dis Sci. 2012;57:1083–1091. https://doi.org/10.1007/s10620-011-1976-4.

    Article  PubMed  Google Scholar 

  13. Bertholet N, Daeppen JB, Wietlisbach V, Fleming M, Burnand B. Reduction of alcohol consumption by brief alcohol intervention in primary care: systematic review and meta-analysis. Arch Intern Med. 2005;165:986–995. https://doi.org/10.1001/archinte.165.9.986.

    Article  PubMed  Google Scholar 

  14. Sobell LC SM. Timeline follow-back: a technique for assessing self-reported alcohol consumption. In: Litten RZ AJ, editor. Measuring alcohol consumption. The Humana Press; 1992. p. 41–72.

  15. Zeger SL, Liang KY, Albert PS. Models for longitudinal data: a generalized estimating equation approach. Biometrics. 1988;44:1049–1060.

    Article  CAS  Google Scholar 

  16. Zou G. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol 2004;159:702–706. https://doi.org/10.1093/aje/kwh090.

    Article  PubMed  Google Scholar 

  17. Armstrong GL, Wasley A, Simard EP, McQuillan GM, Kuhnert WL, Alter MJ. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med 2006;144:705–714. https://doi.org/10.7326/0003-4819-144-10-200605160-00004.

    Article  PubMed  Google Scholar 

  18. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: recommendation statement. Ann Intern Med. 2004;140:554–546. https://doi.org/10.7326/0003-4819-140-7-200404060-00016.

  19. Babor TF, Steinberg K, Anton R, Del Boca F. Talk is cheap: measuring drinking outcomes in clinical trials. J Stud Alcohol. 2000;61:55–63. https://doi.org/10.15288/jsa.2000.61.55.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We are thankful to the study’s site PIs, Michael Fried and Susanna Naggie. We are also grateful to our study manager, Christina Makarushka, and interviewers, including Kelly Keefe, Becca Heine, Carla Mena, Courtenay Pierce, and Lavanya Vasudevan; our data managers including Ceci Chamorro and Donna Safley; our data entry team including Michael West, Blen Biru, Andy Elkins, Lauren Hunt, Caesar Lubangakene, and Nneka Molokwu; and Cathryn Mainville and Hayden Dawes who served as our Hep ART alcohol therapists.

Funding

This work was funded by the National Institutes of Health (Grant No. R01AA021133-01A1) and supported by the Duke University Center for AIDS Research (CFAR), an NIH-funded program (SP30 AI064518).

Author information

Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC, USA

    Yuval A. Patel, Elizabeth Goacher & Andrew J. Muir

  2. Duke Center for Health Policy and Inequalities Research, Duke University, Durham, NC, USA

    Jia Yao & Rae Jean Proeschold-Bell

  3. Duke Global Health Institute, Duke University, Durham, NC, USA

    Rae Jean Proeschold-Bell

  4. Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA

    Donna Niedzwiecki

  5. Duke Clinical Research Institute, Duke University, Durham, NC, USA

    Andrew J. Muir

Authors
  1. Yuval A. Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jia Yao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rae Jean Proeschold-Bell
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Donna Niedzwiecki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Elizabeth Goacher
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Andrew J. Muir
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Yuval A. Patel or Elizabeth Goacher.

Ethics declarations

Conflicts of interest

Yuval A. Patel serves as a consultant for Intercept. Jia Yao has no conflicts of interest to report. Rae Jean Proeschold-Bell has no conflicts of interest to report. Donna Niedzwiecki has no conflicts of interest to report. Elizabeth Goacher has served as a speaker, a consultant, and an advisory board member for Gilead, AbbVie, Intercept, and Dova. Andrew J. Muir serves on advisory boards for AbbVie and Gilead.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file 1 (DOCX 13 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Patel, Y.A., Yao, J., Proeschold-Bell, R.J. et al. Reduced Alcohol Use Is Sustained in Patients Provided Alcohol-Related Counseling During Direct-Acting Antiviral Therapy for Hepatitis C. Dig Dis Sci 66, 2956–2963 (2021). https://doi.org/10.1007/s10620-020-06616-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-020-06616-5

Keywords

Search

Navigation