RESUMEN
BACKGROUND/AIMS: Alcohol and the hepatitis C virus have been postulated to interact to adversely affect the natural history of patients with chronic liver disease. The aim of this study was to examine the effect of alcohol on hepatitic activity and serum HCV RNA levels in patients with chronic hepatitis C. METHODS: Forty-five consecutive patients with chronic hepatitis C were classified according to alcohol intake over the 3-month period preceding study entry: group 1 (n = 23), > 10 g alcohol/day; group 2 (n = 22), < or = 10 g alcohol/day. Hepatitic activity and alcohol intake were assessed at study entry and, following moderation of alcohol intake, after a mean follow-up period of 4.4 +/- 0.2 months. RESULTS: Hepatitic activity was significantly greater in the patients who consumed > 10 g of alcohol/day. Moderation of alcohol consumption in patients consuming > 10 g/day resulted in a significant decrease in both disease activity (p = 0.0002) and viral RNA titre (p = 0.018); there was no change over the study period in patients with a consistently low alcohol intake. CONCLUSION: The results support the hypotheses that, in patients with chronic hepatitis C, alcohol aggravates hepatic injury, increases viral load and adversely affects the natural history of the associated liver disease.
Asunto(s)
Consumo de Bebidas Alcohólicas/sangre , Hepacivirus/genética , Hepatitis C/sangre , ARN Viral/sangre , Alanina Transaminasa/sangre , Alanina Transaminasa/efectos de los fármacos , Consumo de Bebidas Alcohólicas/patología , Aspartato Aminotransferasas/sangre , Aspartato Aminotransferasas/efectos de los fármacos , Biomarcadores/sangre , Biopsia , Enfermedad Crónica , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Hepacivirus/efectos de los fármacos , Hepatitis C/patología , Hepatitis C/virología , Humanos , Masculino , Reacción en Cadena de la Polimerasa , Transaminasas/sangre , Transaminasas/efectos de los fármacos , gamma-Glutamiltransferasa/sangre , gamma-Glutamiltransferasa/efectos de los fármacosRESUMEN
OBJECTIVE: To identify independent patient, disease and viral characteristics that predict a sustained biochemical or viral response to interferon alfa therapy in patients with chronic hepatitis C. DESIGN: Comparison of interferon responders and non-responders by univariate and multivariate analysis. SETTING: The hepatitis clinic of the Alfred Hospital, Melbourne (a tertiary referral hospital), between July 1989 and June 1994. SUBJECTS: All patients with chronic hepatitis C who were treated with interferon alfa (IFN-alpha; 3 million IU, three times a week or more) for at least 12 weeks. OUTCOME MEASURES: Patient demographic and epidemiologic characteristics, pretreatment serum alanine aminotransferase (ALT) and 2-gamma-glutamyl transpeptidase (GGT) levels, histological grading of hepatic steatosis, necroinflammatory activity and fibrosis, serum hepatitis C virus (HCV) RNA titres and genotype and post-treatment serum ALT levels and presence of HCV RNA. RESULTS: Of 58 patients, 13 (22%) had a sustained (six months or longer) biochemical response to IFN-alpha therapy, including 12 (21%) with a sustained viral response. Univariate analysis showed that young patients with a normal serum GGT level, grade 0-1 steatosis and fibrosis, low viral titre and infection with genotypes 3a and 2a were more likely to have a sustained response. Infection with genotypes other than 1a and 1b was the only independent variable associated with both a sustained biochemical and viral response. After adjusting for genotype, a hepatic fibrosis grade of 0-1 was also independently associated with viral response. This logistic regression model accurately predicted the virological response in 80% of cases. CONCLUSION: In Australian patients with chronic hepatitis C, a sustained viral response to IFN-alpha therapy is most likely in those infected with a genotype other than 1a or 1b and with minimal hepatic fibrosis.