Substance abuse in many forms increases the risk of hepatitis C virus (HCV) infection. Injecting drugs carries a direct risk of getting infected. But alcohol abuse makes it more difficult for patients with hepatitis infections to live a normal lifespan. Not only does alcohol consumption increase the odds of contracting the virus, it also increases the severity of the disease.
A French team spelled out the risk of alcohol use disorders (AUD) in a study presented April 25 at the International Liver Congress in Vienna, Austria.
Michaël Schwarzinger, director of the Translational Health Economics Network, and Vincent Mallet, a professor of hepatology at the Université Paris Descartes and Assistance Publique — Hôpitaux de Paris in Paris, France, found an epidemiological relationship between chronic HCV infection and AUD.
The study found that chronic HCV infection has a limited impact on mortality, unless the patient also has other severe comorbidities, such as HIV infection, cancer or chronic kidney disease. In contrast, those with AUDs are at significant risk of death with a higher mortality risk observed across all the study subgroups.
The team studied French hospital records and found that from 2008 to 2012, 28,953,755 adults residing in metropolitan France were hospitalized and 1,506,453 died at a hospital. Of these patients, 112,146 (0.39%) had chronic HCV infection with or without AUD. Far more patients were suffering from AUD (705,259 or 2.44%). Of the HCV patients, 23,351 (20.8%) also had AUD.
Analysing the data the team found that in the absence of co-morbidities like HIV or getting a liver transplant, the presence of AUD was the strongest predictor of end-stage liver disease and mortality.
Overall the adjusted hazard ratio of an in-hospital death was 1.90 for HCV infection and 3.13 for AUD.
There was some good news in the findings: alcohol withdrawal or abstinence had a significant positive effect on prognosis. The hazard ratio for these patients dropped to .66, the team concluded.
Commenting on the study, Tom Hemming Karlsen, a member of the European Association for the Study of the Liver’s scientific committee said the results demonstrate that “Alcohol use disorders are a much more accurate indicator of mortality in chronic HCV infection” and that physicians should encourage HCV patients to stop drinking.