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Review: Lancet Infect Dis 2002; 2: 303-09
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Date Posted: Wed, May 22 2002, 5:10:45 PDT
In reply to:
Arch Intern Med 2002
's message, "Smoking and alcohol consumption are independently associated with disease progression" on Wed, April 17 2002, 7:52:29 PDT
Patients With Hepatitis C Must Be Discouraged From Drinking Alcohol
Lancet Infectious Diseases
05/06/2002
By Harvey McConnell
Doctors must persuade patients infected with hepatitis C to abstain from alcohol in order to reduce the risk of developing cirrhosis and hepatocellular carcinoma.
Hepatitis C virus (HCV) infection has been portrayed as a "silent killer" and there are now a plethora of reports and conferences devoted to subject, declares Drs Sandro Vento and Francesca Cainelli, Section of Infectious Diseases, Department of Pathology, University of Verona, Verona, Italy. Yet, numerous studies show that chronic HCV infection is highly prevalent in elderly people who, in most instances, do not develop end-stage liver disease.
Since 1989, a huge number of observations and publications have linked the virus with chronic hepatitis and cirrhosis. Research in Europe and Japan indicate an association between HCV and hepatocellular carcinoma, the clinicians say in their wide ranging review of clinical trials.
"An unprecedented number of patient organizations and advocates of treatment with interferon (now in combination with ribavirin) exist in western countries, and doctors in the industrialized world are under increasing pressure to treat as many patients as possible with the drug to avoid progression to end-stage liver disease and hepatocellular carcinoma," the clinicians said.
Alcohol consumption is thought by many to be a marginal cofactor in hepatitis C, and there are only a small number of publications on alcohol-related liver disease compared with the numbers devoted to hepatology.
"In our opinion, hepatitis C alone cannot be defined as a deadly disease" the clinicians assert. "However, when coupled with alcohol consumption, what we believe to be a fairly benign, although chronic, infection can become a serious and potentially life-threatening liver disease."
Several studies indicate alcohol affects progression of chronic hepatitis C toward development of cirrhosis and hepatocellular carcinoma.
The clinicians said that based on published evidence they firmly believe "that alcohol consumption must be thoroughly investigated and patients strongly and repeatedly encouraged to abstain from alcohol before beginning the administration of expensive treatments with considerable side-effects, difficult compliance, and often disappointing effectiveness, especially when assessed in "real-life settings" rather than in clinical trials."
Publicity about hepatitis C infection has caused many patients to assume the worst. Patients need a balanced perspective, which includes probabilities of no progression to cirrhosis, long-term survival, and even spontaneous clearance of HCV.
The Italian team conclude that doctors should treat appropriately "only those who really need targeted therapy. In our opinion, the most important factor in affecting outcome has, however, emerged already: alcohol." Clinical trials need to be redirected and doctors must be made aware of the importance of the part that alcohol plays in progression to liver cirrhosis (virus or non-virus-associated).
Lancet Infect Dis 2002; 2: 303-09
(HCOP note: Routine testing and early detection are critical to the prevention of liver disease in those with Hepatitis C seropositivity. Obviously, the earlier in the disease this counsel can be given, the better the outcome can be expected to be. th)
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