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Research Summary

A Multidisciplinary Approach to Hepatitis-C Treatment Reduced Viral Load and Increased Abstinence in Patients with Co-Occurring Alcohol Dependence

Current guidelines recommend that alcohol-dependent patients with hepatitis C virus (HCV) should abstain from drinking for 6 months prior to HCV treatment (interferon and ribavirin). Yet patients who drink heavily have the highest risk for developing HCV-associated disease and, therefore, most strongly stand to benefit from treatment. This prospective observational study examined HCV treatment outcomes in 73 alcohol-dependent patients with ongoing consumption or abstinence of <6 months. Participants were enrolled in a 24–48 week multidisciplinary program that included care by hepatologists and addiction specialists. Moderation of drinking was strongly encouraged but not required.

  • At the start of treatment, 62% of participants reported “high-risk” consumption,* with a median consumption of 50 drinks per week (interquartile range, 30–98 drinks per week).
  • During treatment, 30% of participants continuously abstained, 34% consumed “low-risk” amounts, and 36% consumed high-risk amounts. Fifty-three percent of patients abstained for at least 3 months.
  • Sustained viral response (SVR) was achieved in 48% of patients, which did not differ significantly from matched controls with low-risk alcohol use. Among patients who drank high-risk amounts during the study, 33% achieved SVR.
  • Drug use severity and duration of abstinence during treatment significantly predicted SVR in multivariable models.
*High-risk consumption was that which exceeded “low-risk” amounts, defined as ≤21 standard (10 g ethanol) drinks per week for men, ≤14 drinks per week for women, and ≤4 drinks per occasion in this study.

Comments:

This study demonstrated that patients with alcohol dependence can be successfully treated for HCV in a multidisciplinary program. Although abstinence during treatment was associated with better outcomes, one-third of patients who continued to drink heavily during treatment achieved SVR. Judith Tsui, MD, MPH

Reference:

Le Lan C, Guillygomarc'h A, Danielou H, et al. A multi-disciplinary approach to treating hepatitis C with interferon and ribavirin in alcohol-dependent patients with ongoing abuse. J Hepatol. 2012;56(2):334–340.

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