The Impact of Direct-acting Antiviral Therapy on End Stage Liver Disease Among Individuals with Chronic Hepatitis C and Substance Use Disorders.

To evaluate the impact of direct-acting antivirals (DAAs) on decompensated cirrhosis (DCC) and hepatocellular carcinoma (HCC) in patients with chronic hepatitis C virus (HCV) and substance use disorder (SUD) compared to those without an SUD. This retrospective cohort study used the MarketScan database (2013-2018) to identify 29 228 patients with chronic HCV, where 22% (n=6385) had ≥1 SUD diagnosis. The inverse probability of treatment weighted (IPTW) multivariable Cox proportional hazard models were used to compare the risk of developing DCC and HCC. Among the non-cirrhotics, treatment reduced the DCC risk among SUD (aHR 0.13; 95% CI, 0.06-0.30) and non-SUD (aHR 0.11; 95% CI, 0.07-0.18) while 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 to untreated patients, 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) while the risk for DCC was not reduced for the SUD group (aHR, 0.64; 95% CI, 0.37-1.13). Among untreated patients with cirrhosis, 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 to non-SUD group. Conclusions: Among the HCV SUD group, DAA treatment reduced the risk of DCC but not HCC for the non-cirrhotics while DAA treatment reduced the risk of HCC but not DCC for those with cirrhosis. Among the non-treated, patients with an SUD had a significantly higher risk of DCC and HCC compared to those without an SUD. Thus, DAA treatment should be considered for all HCV patients with an SUD while also addressing the SUD.