2 A multiple cohort model has been developed to predict the effect of chronic hepatitis C infection (HCV+) on public health.3 The model takes into consideration known differences in disease progression related to sex and age at infection. It predicts that 24.8% of the cohort infected between 1970 and 1990 will have cirrhosis by 2010, and 44.9% will progress to cirrhosis by 2030. Eleven percent of the cohort with cirrhosis currently

have hepatic decompensation, and this proportion will increase through 2030. The incidence of HCV-related hepatocellular carcinoma (HCC) is increasing and is forecast to peak in 2019.3 The effect of these projections is already becoming evident. HCV-related ambulatory care visits more than doubled between 1997-1999 and 2003-2005.4 Complications related Roxadustat in vivo to HCV are already the leading cause for liver transplants, BMS-907351 concentration and this

demand is expected to increase, exacerbating the current shortage of available organs.5 The incidence of HCC, much of which is caused by HCV, tripled between 1975 and 2005,6 and HCV-related mortality increased 123% between 1995 and 2004.7 Treatment has the potential to greatly reduce the public health effect of this epidemic. In 2010, it was estimated that based on current treatment practices (i.e., chronic hepatitis C infection [HCV+] was diagnosed in 30% of cases; 25% were treated and 40% responded to treatment), only 1% of cirrhosis cases would be prevented.3 Since then, more effective antiviral therapies have been approved, but more patients need to be diagnosed and treated to fully realize the potential of HCV treatment to reduce HCV-related disease.

In this article, we focus on barriers to treatment, specifically findings that patients with a history of alcohol abuse are less likely to be treated,8 and that patients who reported any drinking in the 12 months before treatment were less likely to respond to treatment.9 The issue of how to manage HCV in patients with a history of moderate to heavy drinking is a critical one because many patients with HCV have such a history. A national seroprevalence survey found that 48% of HCV+ participants had VAV2 had five or more drinks in a single day during the previous year, and 33% had done so on at least 50 days.1 This study extends previous research in three ways. One, it was conducted in a representative cohort of privately insured members of an integrated health care plan. HCV treatment outcomes have been understudied in insured patients, despite the fact that they represent a large portion of the infected population, and they are likely to have access to resources needed to obtain treatment. Two, it contributes to the limited information available on the relation of alcohol consumption to outcomes of treatment with pegylated interferon-alpha and ribavirin (P/R).