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Study Confirms Importance of Alcohol Abstention in Patients Infected with Hepatitis C Virus
Study authors estimate that heavy alcohol abuse increased the risk of developing cirrhosis from transfusion-associated HCV 31.1 times
By Brian Boyle, MD

Almost 4 million people in the United States have been infected with the hepatitis C virus (HCV). Estimates are that 70% of these infections are chronic and slowly progressive, and place the HCV-infected person at risk for progressive liver disease and cancer. Unfortunately, while new therapies being studied may significantly improve the tolerability and effectiveness of the treatments for HCV, HCV therapy still remains difficult to tolerate and of limited effectiveness for most patients. Since many patients are unable to tolerate HCV treatment or the treatment fails to eliminate or cure HCV infection, they remain at risk for progressive liver disease, which may take decades to develop. As a result, many researchers are examining alternative ways to slow the progressive liver disease caused by HCV, including lifestyle alterations that may decrease risk.

One potentially beneficial lifestyle change is forbearance from alcohol. Several studies have indicated that alcohol use may increase the risk of liver disease and cirrhosis in HCV-infected patients. Accordingly, for some time, physicians caring for patients infected with the hepatitis C virus (HCV) have advised those patients to abstain entirely from the use of alcohol.

A recent retrospective study from Harris and colleagues, published in the January 16, 2001 issue of the Annals of Internal Medicine, confirms the deleterious interaction of HCV and alcohol on the liver and places new emphasis on the advice that patients with HCV should abstain from alcohol use. The study examined the interaction of alcohol use and HCV in 836 patients enrolled in long-term follow-up studies for transfusion-associated HCV. They found that development of cirrhosis was unrelated to tattooing, ear piercing, occupational exposures, extended travel to areas in which hepatitis is endemic, and use of injection or other illegal drugs. They also found, however, that development of cirrhosis was associated with transfusion-associated hepatitis status, race/ethnicity, units of blood originally transfused, history of heavy alcohol abuse and vital status at follow-up.

Based upon a statistical analysis of this data, the authors estimate that heavy alcohol abuse increased the risk of developing cirrhosis from transfusion-associated HCV 31.1 times. The authors state "Although numerous reports have identified a strong role of alcohol in promoting progression of liver disease among persons with chronic HCV infection, our findings provide a quantitative measure to assess the strength of this association. These results stress the need to counsel patients with HCV about their drinking habits."

Given these results, and the results of prior studies, physicians should re-double their efforts to have HCV-infected patients abstain from alcohol, especially in those patients with a heavy use of alcohol.

Harris D and others. The Relationship of Acute Transfusion-Associated Hepatitis to the Development of Cirrhosis in the Presence of Alcohol Abuse. Annals of Internal Medicine. 2001, 134:120-124.

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