Smoking may undermine gains made through DAA treatment, experts warn

Hepatology

By Tessa Hoffman

9 Nov 2017

The alarmingly high smoking rate in people living with hepatitis C is likely to be offsetting any gains made through treatment with direct-acting antivirals, public health experts warn.

Writing in the Lancet, the Australian researchers say early research findings suggest that hepatitis C (HCV), like HIV, increases susceptibility to tobacco-related diseases.

And it is estimated that up to 67% of people living with the hepatitis C virus are smokers.

“This high prevalence of smoking could mean that any reductions in HCV-related morbidity and mortality produced by direct-acting antivirals (DAAs) are partially offset by tobacco-related morbidity and mortality,” wrote Coral Gartner from the University of Queensland’s School of Public Health and her co-authors.

“For example, smoking is strongly associated with increased liver fibrosis in people with HCV, and might affect development of cirrhosis.

“Smoking and HCV are independent predictors of cardiovascular disease and hepatocellular carcinoma, and a meta-analysis of six studies showed a multiplicative interaction index score of 1·60 (95% CI 1·16–2·20) between tobacco smoking and chronic HCV and risk of hepatocellular carcinoma.”

With this in mind, it makes sense to piggy back smoking cessation treatment off DAA treatment programs, they argue.

“These treatments need to target the high smoking prevalence in people living with HCV to avoid reducing the potential improvements in health and longevity that are made possible by advances in DAA treatment.”

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