Large Study Underscores Detrimental Effect of Alcohol on HCV

Doctors have confirmed that consuming alcohol can have a detrimental impact on the course of hepatitis C.1

The researchers, from Glasgow, Scotland and the University of Cambridge, performed an analysis of nearly two dozen previous studies involving more than 15,000 people with hepatitis C (HCV) to determine how much faster the viral infection can spread in those who drink alcohol.

Questions Remain
Several previous studies have reported a higher risk of further HCV progression in those who consume alcoholic drinks, wrote Dr. Sharon Hutchinson of Health Protection Scotland, part of the UK's National Health Service, and her colleagues. However, other research has failed to link heavy alcohol consumption with severe HCV infection, which can lead to liver cirrhosis. This study, therefore, was an attempt to clarify the possible association, and to find out how advanced HCV can become after consuming alcoholic beverages.

Determining which factors speed up the course of HCV is essential "to counsel those affected and help make decisions regarding antiviral therapy," Hutchinson and her team wrote.

Pooled Analysis Performed
For this analysis, the researchers pulled information on 20 previous studies, which had taken place in several countries.

Of all the patients who had taken part in these studies, 18 percent, collectively, progressed to advanced liver disease—cirrhosis, advanced fibrosis or liver cancer—after consuming alcohol. About one-fifth of these patients were defined as heavy alcohol users, consuming between 210 grams to 560 grams (about 7.4 ounces to about 19.8 ounces) per week.

In half the studies analyzed, the risk of contracting advanced hepatitis C infection from heavy alcohol use ranged from one-and-a-half times higher to nearly 12 times more, compared to those who drank little or no alcohol. In the other studies, a significant association between heavy alcohol consumption and the development of severe HCV infection could not be found.

However, after combining the results from all of these studies, even taking the lack of a risk found in some of them into account, Hutchinson and her associates concluded that the risk of developing aggressive HCV infection after heavy alcohol use is more than twice as high as for those who consume little or no alcohol.

Higher Risk for Men
In their meta-analysis (analysis of many studies), the researchers also found that men had a slightly higher risk of developing advanced liver disease from heavy alcoholic consumption compared to women.

"Excess alcohol consumption is likely to result in more severe [liver] injury, promoting pathologic progression to cirrhosis among patients with chronic HCV," the study team wrote after reviewing their findings.

Study Limits
There were some drawbacks to this study, Hutchinson and her colleagues acknowledged. For instance, information on alcohol consumption was collected from the patients themselves, and they may not have recalled exactly how much they had consumed in the past. In addition, the definition of "heavy" alcohol use widely varied in the previous studies analyzed (210 grams to 560 grams per week), "and so the true threshold above which alcohol accelerates HCV disease progression remains uncertain," the researchers wrote.

As a result of these limitations," the role of alcohol in HCV-related cirrhosis might be underestimated," Hutchinson's group wrote. "Nevertheless, the evidence overwhelmingly shows a worsened outcome for those with chronic HCV and concurrent alcohol use."

The investigators added that the amount of alcohol that is safe to consume for those with hepatitis C infection "is unclear" and thus, "alcohol consumption should be minimized as much as possible in those who have chronic HCV until a safe threshold is more definitively determined."

1. Hutchinson SJ, Bird, SM, Goldberg DJ. Influence of alcohol on the progression of hepatitis C virus infection: a meta-analysis. Clin Gastroenterol Hepatol 2005 Nov;3(11):1150-9.

Hepatitis Neighborhood ~ 11-15-05 ~ by John C. Martin