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.
1/24/01
Reference
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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