Epidemiology

Hepatitis C-related fibrosis occurs with low alcohol intake

Last Updated: 2004-04-14 12:55:18 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Hepatitis C-related fibrosis occurs at all levels of alcohol intake, though variables other than alcohol intake predominate in producing hepatic fibrosis, according to a report in the March issue of Hepatology.

Heavy alcohol consumption may contribute to the progression of hepatitis C virus (HCV)-related liver disease, the authors explain, but light alcohol intake has not been shown to increase liver disease progression and may, in fact, bestow other health benefits.

To further investigate, Dr. Alexander Monto and colleagues from University of California at San Francisco compared liver biopsies and detailed records of daily alcohol intake from 800 patients with chronic HCV infection.

Alcohol intake correlated with patient age at biopsy, the authors report, but not with ALT value or inflammation score on liver biopsy.

Increased fibrosis was associated with significant alcohol use, as measured by a self-reported alcohol problem, a positive CAGE screen--the most commonly used alcohol abuse screening questions, or alcohol use in the top quartile of patients, the report indicates. There was, however, no association between alcohol and mean fibrosis or mean fibrosis progression overall.

The researchers emphasize that there was a range of hepatic fibrosis in each category of alcohol intake, though overall fibrosis was greater in patients who drank heavily than in those who did not.

The findings were somewhat different in women, the investigators report. Their fibrosis scores were lower, and the association between alcohol intake and fibrosis was less clear.

In a multivariate model of fibrosis, only histological inflammation, serum ALT and patient age were independent predictors of fibrosis. Alcohol intake was not independently associated with fibrosis.

"One important question has been: is there a 'safe' level of alcohol intake in patients with chronic HCV infection?" the authors note. "This study does not find this to be the case."

"Light and moderate intake exert less of an effect on fibrosis than heavy intake, however, and may indeed have minimal or no effect," the authors conclude. "Balancing this small risk of liver disease progression against potential cardiovascular benefit may be particularly pertinent to middle-aged men, who worldwide constitute the majority of patients with HCV, and who are also at high risk for cardiovascular disease. Risk-benefit assessment should be individualized for each patient."

"The variability in natural history for a given level of alcohol intake points to a central role for immunological and/or genetic variables in HCV disease progression," the investigators add.

Hepatology 2004;39:826-834.