Alcohol abstinence does not offset the strong negative effect of lifetime alcohol consumption on the outcome of interferon therapy

Abstract

Heavy alcohol consumption has been reported to negatively affect the outcome of interferon therapy. We studied the impact of lifetime alcohol consumption in patients with chronic hepatitis C treated with interferon after 6 months of alcohol withdrawal. Alcohol intake was measured when patients with chronic hepatitis C were referred to us for the first time, and from that moment complete abstinence was recommended. After 6 months of abstinence, 150 patients with persistent elevated serum alanine aminotransferase (ALT) have been treated with interferon (IFN)-alpha, 3 or 6 microU three times per week for 12 months. Univariate and multivariate analysis were performed to identify the predictors of treatment response. Carbohydrate-deficient transferrin was employed to assess alcoholic abstinence. The sustained response rate felt from 33% in nondrinkers to 20% of mild-drinkers and to only 9% in heavy drinkers. Drinker patients showed a relapse rate twice as high as that of nondrinkers. According to the multivariate analysis, the strongest independent predictors of nonresponse were genotype 1b infection, age of the patients and their lifetime alcohol intake. Carbohydrate-deficient transferrin detected at baseline, at 3 months of therapy and at the end of follow-up gave a positive result only in eight determinations (1.77%), confirming the compliance of patients to our recommendation of alcohol abstinence. Lifetime alcohol consumption has a strong negative effect on the outcome of interferon treatment, mainly in heavy drinkers. A 6-month period of abstinence may not be sufficient to offset this negative effect on treatment outcome.

Hepatitis C comorbidities affecting the course and response to therapy

“…It plays a role in resistance to interferon therapy through immunosuppression of CD4+ and NK cells [41] , by increased hepatic iron load, and by inhibiting the IFN-α-activated signals [42,43] . Most studies found that alcohol decreased the response to interferon-based therapy and this effect is alcohol dosedependent [42][43][44] . Median daily alcohol use > 30 g/d is associated with failure to respond to PEG-IFN and RBV for treatment of hepatitis C. Past alcohol use should be evaluated when considering treatment for hepatitis C [42] .…”

Evaluation of standard liver volume formulae for Chinese adults

“…HCV patients with excessive alcohol abuse have a 2-3 fold increased risk of severe liver disease compared with HCV patients without a history of drinking [56] . So far it is still unclear how long a patient has to abstain from alcohol before the negative effect of alcohol is abolished [57] . Alcoholics with HCV infection seem to stop drinking more frequently compared to alcoholics without HCV infection.…”

Alcohol use and hepatitis C

“…A recent study from Italy described 150 consecutive patients with hepatitis C who abstained from alcohol for 6 months, continued to have elevated serum alanine aminotransferase levels, and were treated with interferon alfa thrice weekly. 24 The sustained virological response rate was 33% in nondrinkers, 20% (P = NS) in those who drank 25 to 50 g/day of alcohol, and 9% (P < .02) in those who drank more than 75 g/day. There was no difference in nonresponders but an increase in relapsers (moderate drinkers, 52%; P < .05; heavy drinkers, 59%; P < .01) over nondrinkers (36% was high (>98%) as assessed by carbohydrate-deficient transferrin.…”

“…The effect of interferon therapy on relapse of alcoholism has not been studied prospectively. In the study by Tabone et al, 24 few previously alcoholic patients experienced a relapse while on therapy. However, the depression, irritability, and anxiety that occurs in 20% to 30% of patients treated with interferon-based therapies may be difficult for the patient with a recent history of alcohol dependence and predispose to recidivism.…”