Moderate alcohol consumption - as little as one or two drinks per day - is associated
with an increased risk of mortality for people with chronic hepatitis C virus
(HCV) infection, according to research conducted in the United States and
published in Alimentary Pharmacology and
HCV-infected patients consuming between 1 and 19g of alcohol
daily (one to two glasses of wine) doubled their mortality risk compared to
HCV-uninfected controls. Moderate alcohol consumption added to the already
elevated mortality risk associated with HCV infection.
Chronic HCV infection is an increasingly
important cause of serious illness and death in the United States. A number of
factors are associated with disease progression, including excessive alcohol
consumption. The impact of moderate drinking on outcomes among patients with
chronic HCV is controversial.
A team of investigators therefore designed
a study based on results obtained from a national health survey conducted
between 1988 and 1994. Their aims were to determine the impact of moderate,
excess and heavy alcohol consumption on the risk of overall, liver-related and
cardiovascular-related mortality in people with chronic HCV. Moderate
consumption was considered to be between 1 and 19g of alcohol per day. Excess
consumption was above 20g per day and heavy consumption was drinking over 30g
of alcohol per day.
The study population comprised 8985
individuals, 218 of whom had chronic HCV.
There were significant baseline differences
between the HCV-infected patients and the controls. Individuals with chronic
HCV were significantly more likely to report excess alcohol consumption (28
vs 7%, p = 0.0075), and had higher rates of smoking (p = 0.0007) and a higher
prevalence of insulin resistance or diabetes (36 vs 16%, p = 0.0013) than the
The average duration of follow-up was
between 13 and 14 years.
Overall, 1320 (11%) of participants died. A
total of 415 (3%) of deaths were attributed to cardiovascular disease and 32
deaths (0.27%) were due to liver disease.
Compared to the controls, participants with
chronic HCV had a significantly higher risk death due to any cause (HR = 1.91;
95% CI, 1.16-3.15; p = 0.01) and liver-related death (HR = 49.52; 95% CI,
12.37-198.26; p < 0.001), but not death due to cardiovascular disease (HR =
0.053; 95% CI, 0.17-1.67; p = 0.28).
The investigators then evaluated the
combined effects of chronic HCV infection and alcohol consumption on mortality
For participants without excessive alcohol
consumption, chronic HCV increased the risk of all-cause mortality (HR = 2.44;
95% CI, 1.59-3.75; p < 0.01) and liver-related death (HR = 74.25; 95% CI,
19.62-280-92; p < 0.001).
Excess alcohol consumption had an even more
marked impact on the risk of all-cause mortality (HR = 5.12; 95% CI,
1.97-13.28; p < 0.001) and liver-related death (HR = 183.74; 95% CI,
15.98-infinity; p < 0.01). There was also a trend for associating excess
drinking with an increased risk of death due to cardiovascular disease (HR =
3.34; 95% CI, 0.55-20.50; p = 0.19).
The impact of chronic HCV on mortality
outcomes was then stratified according to levels of alcohol consumption.
For individuals with a history of drinking
(twelve or more drinks in a lifetime), chronic HCV doubled the overall
mortality risk (p = 0.01). Moderate alcohol consumption was also associated
with a two-fold increase in overall mortality risk for HCV-infected participants
(HR = 2.29; 95% CI, 1.36-3.88; p =0.01). Heavy consumption increased the
mortality risk by a factor of seven for those with HCV (p = 0.02). The
investigators also confirmed an association between heavy drinking and an
increased risk of death (p = 0.02) for individuals with HCV.
“This is the first study documenting the
combined effects of alcohol consumption and chronic HCV on both overall
mortality and liver related mortality,” comment the authors.
“Patients with chronic HCV are at increased
risk for both liver-related mortality and overall mortality. This risk
increases in chronic HCV patients who consume alcohol excessively and
The authors believe their findings have
implications for patient care, and that doctors should advise people with
chronic HCV infection to completely abstain from drinking alcohol.