HCV: alcohol is a major contributor to liver disease burden

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  • Alcohol-use disorder (AUD) is a major contributing factor for decompensated cirrhosis (DC) in HCV.
  • Magnitude of effect varies by geographic location.

Why this matters

  • Although direct-acting antivirals (DAAs) effectively "cure" HCV, alcohol use can compromise benefit and survival.

Study design

  • International study of patients with HCV notifications in British Columbia, Canada (BC; n=58,487), New South Wales, Australia (NSW; n=84,529), and Scotland (n=31,924), cross-referenced with hospital admissions.
  • Funding: British Columbia Center for Disease Control, Canadian Institutes of Health Research, Kirby Institute, NSW Ministry of Health, Sydney West Translational Cancer Research Center, Scottish government.

Key results

  • Prevalence of DC in BC, NSW, and Scotland was 4.6%, 3.7%, and 4.3%, respectively; corresponding proportion of AUD in DC was 28%, 32%, and 50%.
  • Age-standardized DC rates were significantly higher among patients with AUD in NSW and Scotland vs BC.
  • In multivariate analysis, AUD predicted DC among patients with HCV in BC (aHR, 1.92), NSW (aHR, 3.68), and Scotland (aHR, 3.88; P<.001 for all).
  • AUD contribution to DC was higher in Scotland vs BC and NSW (population-attributable fraction [PAF], 40% vs 13% and 25%), particularly for patients born in 1965 or later (PAF, 48% vs 21% and 36%).


  • Reliance on administrative data.
  • Conducted prior to DAA era.