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Coffee is associated with virologic response in chronic Hepatitis C: Findings from the Hepatitis C Long - Term Treatment against Cirrhosis Trial (HALT - C) .
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Reported by Jules Levin
AASLD Nov 2 2010 Boston
N.D.Freedman1; T.M.Curto2; K.Lindsay3; E.C.Wright4; R.Sinha1; J.E.Everhart5
1. Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, MD; 2. New England Research Institutes, Watertown, MA; 3. Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA; 4. Office of the Director, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services, Bethesda, MD; 5. Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
Introduction: Higher coffee consumption has been associated with slower progression of pre-existing liver disease and lower risk of hepatocellular carcinoma. The relationship between coffee consumption and response to anti-viral treatment in CHC has not been evaluated.
Methods: Eight hundred eighty five patients with CHC, Ishak stage 3-6, and failure to respond to previous standard interferon therapy completed a food frequency questionnaire assessing typical coffee intake prior to retreatment with peginterferon alfa-2a (180 ug/wk) and ribavirin (1000-1200 mg/day) in the lead-in phase of HALT-C. Outcomes included a two log10 drop in HCV RNA level at week 12 of treatment (early virologic response, EVR, n=466), undetectable HCV RNA at week 20 of treatment (W20VR, n=320), and sustained virologic response (SVR, n=157) at week 72 (24 weeks after treatment completion).
Results: At baseline, coffee intake over the previous year was coded as none (n=133), < 1 cup (n=253), 1 to <3 cups (n=367), or 3 cups per day (N=132). Among non-coffee drinkers, the median log10 drop from baseline to week 12 was 1.7 (interquartile range (IQR): 0.7-3.6), whereas among those who drank >/= 3 cups per day, the median log10 drop was 3.7 (1.8-4.2) (p for trend across categories <0.0001). Highly statistically significant trends for the percent of patients with EVR, W20VR, and SVR were seen with increasing coffee consumption (Table) with an effect that was strongest for >/= 3 cups per day. Coffee intake at baseline was associated with Caucasian race, current alcohol drinking, rs12979860 (IL28B) genotype, tolerating the maximum dose of peginterferon alfa-2a during treatment, higher baseline log10 HCV RNA, hemoglobin, platelet, and neutrophil count, lower AST/ALT ratio, and less cirrhosis at biopsy (p<0.05 for all). In multivariate analysis which included these covariates, the association of coffee with outcomes was attenuated but remained for EVR (p=0.005), W20VR (p=0.006), and SVR (p=0.039).
Conclusion: Pre-treatment coffee intake was independently associated with improved virologic response during peginterferon alfa-2a and ribavirin in the HALT-C trial.
daily coffee consumption of 3 or more cups was associated with 25.8% SVR vs 20.7% for 1-<3 cups and 12.7% for <1 cup and these are all statistically significant. Coffee increased EVR & week20 responses too.
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