BACKGROUND & AIMS Hepatitis C virus (HCV) infection is a prevalent disease at drug treatment centers (DTC). Alcohol abuse may also contribute to liver fibrosis at DTC, which may affect the prescription of HCV therapy. This study evaluated the risk of alcohol intake and other predictive factors for fibrosis progression.

METHODS An on-site dried-blood-spot (DBS) testing program for hepatitis C care at DTC from 2017 to 2019 was used to identify patients with previous HCV-antibody testing and fibrosis score data. Patients were grouped based on RNA status, alcohol intake and advanced liver disease (ALD ⩾ F3). Fibrosis progression was assessed using APRI and FIB-4. Kaplan-Meier and Cox-regression analyses were performed.

RESULTS Positive HCV RNA patients (n = 138) exhibited a higher rate of ALD (11% vs 2.2%,  < .001) and a higher risk of fibrosis progression during follow-up (HR = 3.14, 95% CI: 1.2-8.2) than patients who did not have an infection (n = 230). Overall, 25% (n = 84) reported high-risk alcohol consumption, which was associated with an increased risk of ALD in patients with RNA positivity (HR = 3.2; 95% CI: 1.1-9.1). Alcohol consumption at any dose regardless of HCV infection status was not associated with ALD. Age, high-risk alcohol consumption, and RNA positivity were independent factors for progression to ALD.

CONCLUSIONS Patients with active HCV infections at DTC have an increased risk for ALD compared to patients without HCV. High-risk alcohol consumption is present in a minority of patients aggravating fibrosis. These results suggest that HCV treatment should not be delayed at DTC regardless of alcohol consumption.