Volume 192 - Issue 4
The role of general practitioners in managing and treating hepatitis C
Authors: Margaret E Hellard, Yung-Hsuan J Wang and Rachel Sacks-Davis
Med J Aust 2010; 192 (4): 239. || doi: 10.5694/j.1326-5377.2010.tb03494.x
Published online: 15 February 2010
Published online: 15 February 2010
In reply: Duggan and Duggan are correct to highlight the well recognised role of alcohol consumption in progression of hepatitis C virus (HCV) infection. Alcohol consumption has been found to increase viral load and accelerate hepatic fibrosis in HCV infection.1,2
While studies have reported that a history of alcohol consumption adversely affects treatment outcomes (with some reporting a dose–response relationship),3,4 treatment success has also been reported among patients who continue to consume moderate amounts of alcohol during treatment.5 Although there are biologically plausible mechanisms through which alcohol consumption might negatively affect treatment, low rates of treatment success among drinkers may also be related to lack of adherence to treatment regimen in this population.1 To date, no study has specifically measured the effect of alcohol consumption during treatment while adequately controlling for the effects of compliance, disease progression and baseline viral load.
Until studies are undertaken that measure the direct effect of alcohol consumption on treatment success, while adjusting for compliance, it seems reasonable to advise patients to decrease their level of alcohol consumption before and during HCV treatment. However, given that some patients have successfully completed treatment without abstaining from alcohol consumption, this should not be an automatic exclusion criterion.
References
- Cooper CL. Obstacles to successful HCV treatment in substance addicted patients. J Addict Dis 2008; 27: 61-68.
- Bhattacharya R, Shuhart MC. Hepatitis C and alcohol: interactions, outcomes, and implications. J Clin Gastroenterol 2003; 36: 242-252. 0_i1091862
- Chang A, Skole K, Gautam M, et al. The impact of past alcohol use on treatment response rates in patients with chronic hepatitis C. Aliment Pharmacol Ther 2005; 22: 701-706. 0_i1091864
- Anand BS, Currie S, Dieperink E, et al. Alcohol use and treatment of hepatitis C virus: results of a national multicenter study. Gastroenterology 2006; 130: 1607-1616. 0_i1091866
- Edlin BR. Prevention and treatment of hepatitis C in injection drug users. Hepatology 2002; 36 (5 Suppl 1): S210-S219. 0_CBBJDFFC