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THE IMPACT OF ALCOHOL AND INTERFERON TREATMENT ON THE CLINICAL OUTCOME OF
HEPATITIS C (HCV)-RELATED CIRRHOSIS
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M Mazen Jamal, Kenneth J. Vega, Ehab Rabaa, David E. Johnston, Long Beach,
CA; Jacksonville, FL; Rockville, MD; Everett, WA
This study discusses whether interferon can slow HCV disease progression with
or without a viral response. And the effects of continued alcohol use on
disease progression are discussed. Here is yet another study showing
interferon slows disease progression. Aside from its antiviral effect,
interferon is said slow disease progression. 226 patients with HCV cirrhosis
were looked at between June 1992 and June 2000. Patients with HIV were
excluded but HIV appears to accelerate HCV progression. Some patients
received HCV therapy & some did not. They found that 33% developed
decompensation (ascites, GI bleed, encepholopathy, jaundice). And 67%
remained compensated. 65% were men, 50% white. follow-up was 52 months. 102
patients received interferon and 124 did not. The treated patients had higher
platelet counts.
The study found that patients who received interferon therapy were 2.3 times
less likely to experience HCV disease progression to decompensation. Patients
that continued to drink alcohol heavily were 5.6 times more likely to develop
decompensation. Perhaps the most important point the author stressed was that
patients in the study experienced slowing of HCV disease progression whether
or not they were viral responders. Not receiving interferon therapy increased
risk for death by 3.8 times. So refusing to take interferon increased death
in this study. Continuing heavy alcohol use increased risk for death by 11
times.
After 72 months the probability for developing decompensated cirhosis was 50%
in the interferon untreated patients and 14% in the treated patients. After
72 months patients who were abstinent from alcohol had a 14% risk for
decompensated disease compared to 67% for those who continued heavy alcohol
use. After 72 months patients who received interferon had a 95% probaility of
survival vs 68% for patients who did not receive interferon. Heavy drinkers
also had decreased survival at 72 months (55%) vs those who were abstinent
(98%).
There are numerous studies showing interferon can slow disease progression.
But the study findings are not conclusive. The potential benefit to
maintenance therapy or interferon is controversial. The data indicates that
interferon slows disease progression. A large NIH study called HALT-C is
looking at this question but results will not be ready for several years. A
few investigators are trying to start a smalled study to get answers more
quickly.
abstract:
Background:The long-term prognosis of chronic liver disease secondary to
hepatitis C is not clearly defined. This study examines predictive factors of
decompensation and the effects of treatment and alcohol consumption on time
to decompensation and death in patients with hepatitis C-related compensated
cirrhosis.
Methods: A cohort of 226 patients with compensated cirrhosis was enrolled and
followed up for a mean period of 52.9 months. Inclusion criteria were biopsy
proven liver cirrhosis, positive hepatitis C RNA, absence of decompensation,
and no evidence of hepatitis B, HIV and metabolic, or autoimmune liver
diseases. Age, sex, ethnicity, age at infection, duration of infection,
alcohol consumption, continuing heavy alcohol consumption, LFT's, interferon
treatment, platelets, HCV RNA and genotype were evaluated as potential
predictive factors for time to decompensation and death.
Results: One hundred and two patients were treated with interferon or
rebetron for a mean duration of 10.2 months. During follow-up, 35 patients
(15.5%) died and decompensation occurred in 74 patients (32.7%). In
multivariate analysis lack of treatment and continuing heavy alcohol
consumption were predictive factors of decompensation. Predictors of survival
included interferon treatment and no history of heavy alcohol consumption
(Table). The probability of decompensation was 0% at 2 years, 6.8% at 4 years
and 14% at 6 years for treated patients and 9.2%, 18% and 50.2% for untreated
patients.The probability of decompensation for patients with no heavy alcohol
consumption was 0%, 4.6% and 13.8% at 2, 4 and 6 years and 15.4%, 29.8% and
67% for continuing heavy alcohol consumption patients. Death was highest
among non-treated patients and patients with continuing heavy alcohol
consumption.
Conclusions: 1- Continuing heavy alcohol consumption and lack of interferon
therapy are independent predictors of poor outcome. 2- Survival probability
is better in interferon treated patients and in patients with no heavy
alcohol consumption. 3- Interferon therapy and abstinence increase the time
to decompensation and death.
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