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HEAVY ALCOHOL CONSUMPTION AND SPONTANEOUS CLEARANCE OF HEPATITIS C VIRUS INFECTION
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This study presented at the AASLD liver conference in Nov 2002 finds that heavy alcohol use may reduce the ability to spontaneously clear HCV. Other studies have suggested that HIV, in the HIV/HCV coinfected person, may reduce the ability to clear HCV. The authors suggest that alcohol may impair an immune response. As well, perhaps HIV impairs an imune response. Here is link to report at AASLD liver conference examining the immune response of alcoholics and coinfected individuals:
http://www.natap.org/2002/AASLD/day22.htm
Purpose: During primary hepatitis C virus (HCV) infection, spontaneous viral clearance occurs in 15-45% of individuals. The hostŐs cellular immune response plays an important role in viral clearance and factors that impair it may promote HCV persistence. Given the high prevalence of HCV infection among alcoholics and the potential immunomodulatory effects of alcohol, we hypothesized that heavy alcohol ingestion contributes to HCV persistence. The aim of this study is to investigate the prevalence of chronic alcoholism in HCV seropositive individuals with and without HCV viremia recruited from the Philadelphia VA Medical Center (PVAMC).
Methods: This is a retrospective case control study. Cases and controls were identified from 2253 HCV antibody (Ab) positive individuals tested for HCV RNA (Roche Cobas Amplicor v2.0 and/or Amplicor Monitor v2.0) at the PVAMC between January 2000 and October 2001. Exclusion criteria included prior interferon therapy and autoimmune diseases that may influence HCV Ab and RNA results. The case group consisted of 103 HCV Ab positive but nonviremic (HCV RNA negative) veterans with presumed spontaneous recovery from HCV infection. Importantly, false positive HCV Ab tests are very unlikely in this group due to the high prevalence of HCV infection among patients at the PVAMC (>15%) and the high positive predictive value of the HCV Ab assay (>95%) in this population (Hepatology 2001;34:1200). The control group consisted of 99 veterans with chronic HCV infection (HCV Ab and RNA positive). Alcohol use was ascertained through careful chart review. Heavy alcohol use was defined by explicit chart documentation of alcohol dependence and/or use of alcohol dependence support services at any time.
Results: A documented history of heavy alcohol consumption was found in 54% of case subjects (HCV Ab+/RNA-) and in 70% of control subjects (HCV Ab+/RNA+). In a univariate analysis heavy alcohol consumption was strongly inversely associated with spontaneous clearance (odds ratio (OR), 0.50; 95% CI, 0.28-0.90; p=.019). In contrast, neither race nor age were associated with spontaneous clearance in univariate analyses (black race OR, 0.80; 95% CI, 0.43-1.48; p=.469) (age OR, 1.05; 95% CI, 0.71-1.54; p=.818). There was no evidence of confounding of the association between alcohol consumption and spontaneous clearance after adjusting for age or race.
Conclusions: Our results suggest that alcohol negatively influences a personŐs ability to naturally clear HCV viremia after exposure to the virus. Veterans with a history of heavy alcohol consumption were only half as likely to clear HCV spontaneously compared to veterans without a history of heavy alcohol consumption. We speculate that this may explain in part why HCV is so prevalent among alcoholics and why interferon therapy is less effective in alcoholic individuals. Further studies examining the impact of alcohol on host-virus dynamics are needed.
Barbara Piasecki et al, Philadelphia VA Medical Center, Philadelphia, PA. Abstract 887. AASLD. November 1-5, 2002. Boston, MA.
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