Changes in Alcohol Consumption following Direct-Acting Antiviral Treatment for Hepatitis C in VA Patients with Comorbid Alcohol Use Disorder and PTSD

Abstract

Objective

To investigate whether direct-acting antivirals (DAA) for hepatitis C viral infection (HCV): glecaprevir/pibrentasvir (GLE/PIB), ledipasvir/sofosbuvir (LDV/SOF), and sofosbuvir/velpatasvir (SOF/VEL) are associated with reduced alcohol consumption among veterans with alcohol use disorder (AUD) and co-occurring post-traumatic stress disorder (PTSD).

Methods

We measured change in Alcohol Use Disorder Identification Test-Consumption Module (AUDIT-C) scores in a retrospective cohort of veterans with PTSD and AUD receiving DAAs for HCV.

Results

One thousand two hundred and eleven patients were included (GLE/PIB n = 174, LDV/SOF n = 808, SOF/VEL n = 229). Adjusted frequencies of clinically meaningful improvement were 30.5% for GLE/PIB, 45.5% for LDV/SOF, and 40.5% for SOF/VEL. The frequency was lower for GLE/PIB than for LDV/SOF (OR = 0.59; 95% CI [0.40, 0.87]) or SOF/VEL (OR = 0.66; 95% CI [0.42, 1.04]).

Conclusions

DAA treatment for HCV was associated with a substantial reduction in alcohol use in patients with AUD and co-occurring PTSD. Further exploration of the role of DAAs in AUD treatment is warranted.

Keywords:

• Hepatitis C
• alcohol use disorder
• post-traumatic stress disorder
• direct-acting antiviral

Disclosure statement

The VA Technology Transfer Program filed a provisional patent covering the use of glecaprevir, pibrentasvir, and velpatasvir for PTSD and other psychiatric indications in December 2021 (63/285,841). The provisional patent application names Drs. Shiner and Gradus as co-inventors. Dr. Shiner claims inventorship in his role as a US Government employee and Dr. Gradus claims inventorship in her role as a Boston University employee. Drs. Shiner and Gradus registered the provisional patent application with iEdison as part of annual reporting to NIH in February 2022 (0894901-21-0005).

From March 2021 through August 2021, Dr. Shiner was the Principal Investigator on a Cooperative Research and Development Agreement between the Veterans Educational and Research Association of Northern New England, Inc., the United States Department of Veterans Affairs, and Otsuka Pharmaceutical Development and Commercialization, Inc.

Additional information

Funding

This work was supported by the National Institute of Mental Health (Grant No. R01MH121397 [to JLG and BS]). The cohort used for this study was developed through support from the Department of Defense (Grant No. PR160206 [to BS]). The sponsors had no role in the study design, methods, analysis, and interpretation of results or in the preparation of the manuscript and the decision to submit it for publication.