Alcohol use disorders and the risk of progression of liver disease in people with hepatitis C virus infection – a systematic review

Abstract

Liver cirrhosis and other chronic liver diseases are usually compartmentalized into separate categories based on etiology (e.g., due to alcohol, virus infection, etc.), but it is important to study the intersection of, and possible interactions between, risk factors. The aim of this study is to summarize evidence on the association between alcohol use disorders (AUDs) and decompensated liver cirrhosis and other complications in patients with chronic Hepatitis C virus (HCV) infection. A systematic search of epidemiological studies was conducted using Ovid Medline databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Relative Risk estimates were combined using random-effects meta-analyses. The proportion of cases with liver disease progression that could be avoided if no person with a chronic HCV infection had an AUD was estimated using an attributable fraction methodology. A total of 11 studies fulfilled the inclusion criteria, providing data from 286,641 people with chronic HCV infections, of whom 63,931 (22.3%) qualified as having an AUD. Using decompensated liver cirrhosis as the outcome for the main meta-analysis (n = 7 unique studies), an AUD diagnosis was associated with a 3.3-fold risk for progression of liver disease among people with a chronic HCV infection (95% Confidence Interval (CI): 1.8-4.8). In terms of population-attributable fractions, slightly less than 4 out of 10 decompensated liver cirrhosis cases were attributable to an AUD: 35.2% (95% CI: 16.2-47.1%). For a secondary analyses, all outcomes related to liver disease progression were pooled (i.e., liver deaths or cirrhosis in addition to decompensated liver cirrhosis), which yielded a similar overall effect (n = 13 estimates; OR = 3.7; 95% CI: 2.2-5.3) and a similar attributable fraction (39.3%; 95% CI: 21.9-50.4%). In conclusion, AUDs were frequent in people with chronic HCV infections and contributed to worsening the course of liver disease. Alcohol use and AUDs should be assessed in patients who have liver disease of any etiology, and interventions should be implemented to achieve abstinence or to reduce consumption to the greatest possible extent.

Severe liver fibrosis in the HCV cure era: Major effects of social vulnerability, diabetes, and unhealthy behaviors

“…Consistent with previous research, we found that unhealthy alcohol use 9 and social condition proxies 35 – expressed in our study by unemployment and a low educational level – were also significant independent predictors of severe fibrosis. This suggests that negative social conditions, as well as current or past unhealthy alcohol use, constitute missed opportunities for prompt HCV screening and referral for HCV care, resulting in more advanced liver disease by the time treatment is initiated.…”

“…Among these, coffee consumption and alcohol abstinence or very low alcohol consumption are known to have anti-inflammatory effects and/or anti-fibrotic properties. 8 Although the effects of unhealthy alcohol use on liver fibrosis are widely documented in people living with HCV, 9 results showing its effect on liver fibrosis after HCV cure in the DAA era are lacking. With regard to coffee, elevated consumption was recently associated with slower liver disease progression (including reduced hepatocellular carcinoma (HCC) incidence in patients with hepatitis C, alcohol-related liver disease, or non-alcoholic fatty liver disease 10 , 11 ) and with reduced mortality (in HIV-HCV co-infected patients).…”

Hepatitis C virus: A critical approach to who really needs treatment

“…Data from 286641 people with chronic HCV infections, of whom 22.3% with AUDs, showed that AUD diagnosis was associated with a 3.3-fold risk for progression of liver disease. Almost 4 out of 10 decompensated liver cirrhosis cases were attributable to an AUD[ 217 ]. Interestingly, similar findings were reported in a very recent study on the effects of alcohol in patients with HBV[ 218 ].…”

Chronic liver disease in homeless individuals and performance of non‐invasive liver fibrosis and injury markers: VALID study

“…40,41 Though studies show that the highest absolute rate of disease in homeless individuals is for hepatitis C, 7,42,43 it is imperative that alcohol use be concurrently addressed. Alcohol acts synergistically with HCV resulting in a more than three-fold higher risk for liver disease progression, 39 maybe by enhancing HCV replication. 44 In our study, alcohol use was an independent predictor Abbreviations: ccCK, caspase-cleaved cytokeratin; HA, Hyaluronic acid; IFNγ, interferon-gamma; IL, interleukin; MMP2, Matrix metalloproteinase-2; PIINP, Procollagen III amino terminal peptide; TIMP-1, Tissue inhibitor of metalloproteinase-1; TNFα, tumour necrosis factor alpha.…”