Hepatitis C infection substantially reduces survival of alcohol-dependent patients
Received 12 January 2018
Accepted for publication 26 March 2018
Published 1 August 2018 Volume 2018:10 Pages 897—905
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Justinn Cochran
Peer reviewer comments 2
Editor who approved publication: Professor Irene Petersen
Roberto Muga,1 Arantza Sanvisens,1 Inmaculada Jarrin,2 Daniel Fuster,1 Ferran Bolao,3 Jordi Tor,1 Alvaro Muñoz4
1Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain; 2National Center of Epidemiology, Institute of Health Carlos III, Madrid, Spain; 3Department of Internal Medicine, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L’Hospitalet de Llobregat, Spain; 4Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
Background: Heavy alcohol use is associated with life-threatening complications including progressive liver disease. We aimed to analyze the impact of hepatitis C virus (HCV) infection on survival and liver-related death in alcohol-dependent patients.
Patients and methods: This is a longitudinal study in patients seeking treatment of alcohol abuse between 2000 and 2010. Information on alcohol use characteristics, alcoholic liver disease, and HCV infection were obtained at entry. Cumulated mortality and causes of death were ascertained through clinical records and death registry.
Results: A total of 819 patients (81.6% men) underwent ethanol detoxification; age was 44 (interquartile range [IQR] 38–51) years; the duration of heavy alcohol use was 14 (IQR 6–24) years; and the alcohol consumption was 190 (IQR 120–250) g/day. The prevalence of HCV infection was 15.8%. There were 129 (16.9%) deaths during 5,117 persons-year (p-y) of follow-up (median follow-up 6.4 [IQR 4.3–9.2] years); 31 (24.6%) deaths were observed among the HCV-positive patients, and 98 (15.4%) deaths were observed among the HCV-negative patients. The mortality rate was significantly (P=0.03) higher among the HCV-positive patients (3.84×100 p-y; 95% confidence interval [CI]: 2.70, 5.46) than among the HCV-negative patients (2.27×100 p-y; 95% CI: 1.86, 2.77). Survival times for the HCV infected patients were 34% shorter (time ratio relative to HCV negative: 0.66; 95% CI: 0.51, 0.86). The main causes of death in the HCV-positive and -negative patients were liver-related mortality (48.4%) and neoplasia (22.4%), respectively. The liver-related mortality was significantly higher among the HCV-positive patients (adjusted sub-distribution hazard ratio [asHR] 3.65; 95% CI: 1.72, 7.78; P=0.001).
Conclusion: HCV infection compromises the survival of patients with alcohol abuse/dependence. The new direct antiviral agents for the treatment of HCV infection may result in better clinical outcomes.
Keywords: hepatitis C virus, alcohol use disorder, survival, liver disease, mortality
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