Behavioral Intervention Associated with Improved Liver Enzymes in HCV-infected Young People Who Use Injection Drugs

This secondary analysis of data from the Study to Reduce Intravenous Exposures (STRIVE) randomized clinical trial assessed the effect of an educational/behavioral intervention on self-reported drinking and liver enzymes (AST/ALT*) in 355 young (aged 18–35) HCV-infected patients with prior 6-month injection drug use (IDU). The intervention included multiple group sessions about HCV/liver-related health including alcohol, whereas the control arm participated in general discussions about various social issues (family, self-respect, etc.). Data from baseline, 3-, and 6-month follow-up visits were analyzed.

• The intervention was associated with lower AST (odds ratio [OR]=0.91, p=0.06) and ALT (OR=0.94, p=0.05) at 6 months but had no effect on alcohol use or AUDIT† score.

• Patterns of self-reported alcohol use were dynamic, with frequent transitions from use to abstinence and vice versa. Transitions were significantly associated with changes in AST/ALT.

• Subjects who had received a clinical diagnosis of liver disease were more likely to transition to abstinence (relative risk, 1.88).

Comments:

This study showed that an educational/behavioral intervention had a positive effect on AST/ALT in young HCV-infected patients with IDU. It did not report a significant effect on drinking behaviors. Although the study had limitations (short follow-up, secondary analysis, and an intervention not exclusively focused on alcohol), the results are important in that they provide evidence that short-term changes in alcohol use can have significant impact on AST/ALT in young HCV-infected patients with IDU.

Judith Tsui, MD, MPH

Reference:

Drumright LN, Hagan H, Thomas DL, et al. Predictors and effects of alcohol use on liver function among young HCV-infected injection drug users in a behavioral intervention. J Hepatol. 2011;55(1):45–52.