Interaction between alcohol consumption and positivity for antibodies to hepatitis C virus on the risk of liver cirrhosis: A case-control study

Corrao, Giovanni; Carle, Flavia; Lepore, Alberto; Zepponi, Enrico; Galatola, G.; Orio, Ferdinando di

doi:10.1007/bf00145376

Cited by 28 publications

(12 citation statements)

References 20 publications

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“…23 We also found synergism between HCV infection and alcohol drinking in causing HCC, as suggested by computation Concurrent HBV and HCV infection was a rare event in this study, since only 3 cases were observed instead of the of the S. This result is in contrast with the findings of two case-control studies on the risk of liver cirrhosis. 12,30 How-15 expected under the hypothesis of independence (test based on binomial distribution: P õ .001; 95% CI of the 3 ever, these and our studies report imprecise RR estimates, due to the small number of controls with both exposures, cases observed: 0-8). This finding suggests an interference between the two viruses, which is in line with observations which are compatible with both additive and more than additive effects.…”

Section: Laboratory Methodsmentioning

confidence: 53%

“…was similar to that reported among subjects hospitalized for diseases not associated with alcohol consumption in casecontrol studies carried out in Italy on the risk of cirrhosis. 11,12 jects who were anti-HCV positive without HCV RNA were vanced liver diseases have a higher prevalence of HBV markers than alcoholics with less severe forms of liver disease. 8 similar to those features observed in subjects who were anti-HCV negative.…”

Section: Laboratory Methodsmentioning

confidence: 99%

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Hepatitis B and C virus infection, alcohol drinking, and hepatocellular carcinoma: A case-control study in Italy

et al. 1997

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FOR THE BRESCIA HCC STUDY risk (RR) estimates for these factors. The relationships beWe performed a case-control study to assess the association tween HBV and HCV infections, and between these infections of hepatocellular carcinoma (HCC) with hepatitis B virus and alcohol drinking, may be of relevance and may contrib-(HBV) and hepatitis C virus (HCV) infection and alcohol ute to the discrepancies observed. Mutual negative confounddrinking. We recruited as cases 172 subjects with an initial ing interactions between HBV and HCV infections have been diagnosis of HCC, who were admitted to the two major hospifound in most studies, 3-6 whereas positive interactions have tals in the province of Brescia, northern Italy, and 332 subbeen observed in a few. 3,4 Positive interaction between HBV jects, sex-, age-, and hospital-matched, who were admitted to infection and alcohol intake as a cause of liver injury has the Departments of Ophthalmology, Dermatology, Urology, been suggested in some studies but has not been confirmed Cardiology, and Internal Medicine, as controls. Of the HCC by others. 7,8 Few studies have yet documented the joint effect cases, 23.8% were positive for HBsAg and 37.8% for HCV of HCV infection and alcohol drinking: some data suggest RNA; among the controls, 5.4% were positive for HBsAg and synergism between the two, but further research is needed 4.8% for HCV RNA. History of heavy alcohol intake (ú80 g to clarify the relationship. 9 of ethanol per day for at least 5 years) was found amongIn this study, we address the role of HBV, HCV infection 58.1% of the cases and among 36.4% of the controls. The and its genotypes, and alcohol drinking, and their interacrelative risks (RRs) for HBsAg, HCV RNA positivity, and tions in HCC causation, through a case-control study perheavy alcohol intake were, respectively: 11.4 (95% confidence formed in Brescia, North Italy. This locality showed a high interval: 5.7-22.8), 23.2 (95% confidence interval: 11.8-45.7), incidence of liver cancer as compared with the nine Italian and 4.6 (95% confidence interval: 2.7-7.8). Positive interacareas covered by a Cancer Registry, especially in men: the tions (synergisms) between both HBsAg positivity and HCV incidence rate, age-standardized on the Italian population, RNA positivity and heavy alcohol intake were found, sugwas 32.2 per 100,000 in Brescia versus 15 per 100,000 in gesting more than additive effects of viral infections and alcothe provinces of Turin and Varese, North Italy. 10 hol drinking on the risk of HCC. Infection with HCV genotype 1b showed a higher risk than type 2 (RR Å 2.9; 95% confi-PATIENTS AND METHODS dence interval: 0.9-10), suggesting a major role for the former type in causing HCC. On the basis of population attributable Design and Subjects risks (AR), heavy alcohol intake seems to be the single mostThe study base was the population resident in the province of relevant cause of HCC in this area (AR: 45%), followed by Brescia, North Italy. The province includes the city of Brescia (about HCV (AR: 36%), a...

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Section: Laboratory Methodsmentioning

confidence: 53%

Section: Laboratory Methodsmentioning

confidence: 99%

Hepatitis B and C virus infection, alcohol drinking, and hepatocellular carcinoma: A case-control study in Italy

et al. 1997

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“…As compared to ALD patients without HCV infection, those ALD patients with HCV infection have more severe histological features (83), have decreased survival (81), and develop their disease at a younger age (84). The prevalence of HCV also increases proportionally as the liver injury becomes more severe (85-88) with the relative risk for developing cirrhosis estimated at 8.7 in those ALD patients with anti-HCV as compared with those ALD patients without HCV (89). In addition, the presence of HCV is reported to be the major risk factor for the development of hepatocellular cancer (HCC) in patients with alcoholic cirrhosis (90), with a 10-yr absolute cumulative occurrence risk of HCC being reported as high as 81% in anti-HCV-positive alcoholic cirrhotics as compared with 19% in anti-HCVnegative patients (91).…”

Section: Risk Factorsmentioning

confidence: 99%

Alcoholic liver disease: proposed recommendations for the American College of Gastroenterology

McCullough

1998

The American Journal of Gastroenterology

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PREAMBLEGuidelines for clinical practice are intended to suggest preferable approaches to particular medical problems as established by interpretation and collation of scientifically valid research, derived from extensive review of published literature. When data are not available that will withstand objective scrutiny, a recommendation may be made based on a consensus of experts. Guidelines are intended to apply to the clinical situation for all physicians without regard to specialty. Guidelines are intended to be flexible, not necessarily indicating the only acceptable approach, and should be distinguished from standards of care that are inflexible and rarely violated. Given the wide range of choices in any health care problem, the physician should select the course best suited to the individual patient and the clinical situation presented.These guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee. These guidelines are also approved by the governing boards of the American Gastroenterological Association and the American Association for the Study of Liver Disease. Expert opinion is solicited from the outset for the document. Guidelines are reviewed in depth by the Committee, with participation from experienced clinicians and others in related fields. The final recommendations are based on the data available at the time of the production of the document and may be updated with pertinent scientific developments at a later time.Objective: The objective of this work was to develop practice guidelines for the management of alcoholic liver disease. Method: A computerized search using the Medline Data Base from 1966 -July 1997 was performed with the search headings; alcohol, alcoholic hepatitis, alcoholic liver disease, liver transplant, diagnosis, epidemiology, human, and English only. All randomized controlled trials, case-control studies, and meta-analyses were read in depth. A manual search was also done using references from each retrieved report, review articles, editorials, postgraduate course syllabi, and textbooks. In the subsequent review, evidence was evaluated using a hierarchical scale with randomized, controlled trials given the most importance. Abstracts presented at national meetings were included only when unique data were obtained from those studies. (Am J Gastroenterol 1998;93:2022-2036.

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“…[23][24][25][26] Similarly, despite the initial suggestion that chronic infection with hepatitis C virus (HCV) may multiplicatively interact with alcohol intake in determining cirrhosis, 27 recent evidence suggests that these two factors act independently. 28 The aim of the present study was to assess, using a case-control design, the risk of developing liver cirrhosis associated with alcohol intake, HCV infection, and the combined action of these factors. …”

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confidence: 99%

Independent and combined action of hepatitis C virus infection and alcohol consumption on the risk of symptomatic liver cirrhosis

Corrao

Aricò²

1998

Hepatology

301

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Although alcohol intake and hepatitis C virus (HCV) infection are the major determinants of liver cirrhosis (LC) in Western countries, the joint effect of these two factors on LC risk has not yet been adequately studied. We used data from two hospital-based case-control studies performed in Italy. Cases were 285 cirrhotic patients admitted for the first time to district hospitals for liver decompensation. Controls were 417 patients admitted during the same period, and in the same hospitals as the cases, for acute diseases unrelated to alcohol. Alcohol consumption was expressed as lifetime daily alcohol intake (LDAI). Serum HCV antibodies (anti-HCV) were detected using a secondgeneration test and recombinant immunoblotting assay. We found a dose-effect relationship between LDAI and the risk of LC in both anti-HCV-negative and -positive subjects. Considering the extreme LDAI categories (LDAI ‫؍‬ 0 g, lifetime teetotalers, and LDAI ‫؍‬ 175 g), the LC odds ratios increased from 1.0 (reference category) to 15.0 (95% CI, 7.1-31.7) and from 9.2 (95% CI, 2.0-43.2) to 147.2 (95% CI, 42.1-514.3) in anti-HCV-negative and -positive patients respectively. The interaction between LDAI and HCV showed an additive structure for LDAI F50 g/day and a multiplicative structure for consumption G125 g/day. Alcohol intake and HCV infection are independent risk factors for symptomatic liver cirrhosis, each being sufficient to induce the disease. In subjects with high alcohol intake, the coexistence of HCV infection multiplies the alcohol-associated risk of cirrhosis. In subjects with low alcohol intake, other factors could be involved. (HEPATOLOGY 1998;27:914-919.)Alcohol intake represents the main determinant of liver cirrhosis in Italy 1,2 and other Western countries. 3 Evidence in this respect has been given by ecological, 3-5 prevalence, 6-9 case-control, 10-15 and cohort 16,17 studies. However, several observations suggest that other factors should interact with alcohol consumption in causing liver damage. [18][19][20] In alcoholics, liver histology is normal in 5% to 25% of biopsies and 18% of autopsy findings, 21 and cirrhosis develops at a low yearly incidence rate of around 2%. 16 Thus, only 10% to 25% of alcoholics will suffer from cirrhosis during their life. 22 Among these interacting factors, the role of chronic infection with hepatitis B virus is still debated. [23][24][25][26] Similarly, despite the initial suggestion that chronic infection with hepatitis C virus (HCV) may multiplicatively interact with alcohol intake in determining cirrhosis, 27 recent evidence suggests that these two factors act independently. 28 The aim of the present study was to assess, using a case-control design, the risk of developing liver cirrhosis associated with alcohol intake, HCV infection, and the combined action of these factors. PATIENTS AND METHODS Selection of Cases and Controls.We used the data from two hospitalbased case-control studies performed with the same design in two different periods and in two different Italian areas.The desi...

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Interaction between alcohol consumption and positivity for antibodies to hepatitis C virus on the risk of liver cirrhosis: A case-control study

Cited by 28 publications

References 20 publications

Hepatitis B and C virus infection, alcohol drinking, and hepatocellular carcinoma: A case-control study in Italy

Hepatitis B and C virus infection, alcohol drinking, and hepatocellular carcinoma: A case-control study in Italy

Alcoholic liver disease: proposed recommendations for the American College of Gastroenterology

Independent and combined action of hepatitis C virus infection and alcohol consumption on the risk of symptomatic liver cirrhosis

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