Hepatitis C infection substantially reduces survival of alcohol-dependent patients
Muga, Roberto (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Sanvisens, Arantza (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Jarrín, Inmaculada (Instituto de Salud Carlos III)
Fuster, Daniel (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Bolao, Ferran (Hospital Universitari de Bellvitge)
Tor Aguilera, Jordi (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Muñoz, Alvaro (Johns Hopkins University)
Universitat Autònoma de Barcelona

Data:	2018
Resum:	Heavy alcohol use is associated with life-threatening complications including progressive liver disease. We aimed to analyze the impact of hepatitis C virus (HCV) infection on survival and liver-related death in alcohol-dependent patients. This is a longitudinal study in patients seeking treatment of alcohol abuse between 2000 and 2010. Information on alcohol use characteristics, alcoholic liver disease, and HCV infection were obtained at entry. Cumulated mortality and causes of death were ascertained through clinical records and death registry. A total of 819 patients (81. 6% men) underwent ethanol detoxification; age was 44 (inter-quartile range [IQR] 38-51) years; the duration of heavy alcohol use was 14 (IQR 6-24) years; and the alcohol consumption was 190 (IQR 120-250) g/day. The prevalence of HCV infection was 15. 8%. There were 129 (16. 9%) deaths during 5,117 persons-year (p-y) of follow-up (median follow-up 6. 4 [IQR 4. 3-9. 2] years); 31 (24. 6%) deaths were observed among the HCV-positive patients, and 98 (15. 4%) deaths were observed among the HCV-negative patients. The mortality rate was significantly (P =0. 03) higher among the HCV-positive patients (3. 84×100 p-y; 95% confidence interval [CI]: 2. 70, 5. 46) than among the HCV-negative patients (2. 27×100 p-y; 95% CI: 1. 86, 2. 77). Survival times for the HCV infected patients were 34% shorter (time ratio relative to HCV negative: 0. 66; 95% CI: 0. 51, 0. 86). The main causes of death in the HCV-positive and -negative patients were liver-related mortality (48. 4%) and neoplasia (22. 4%), respectively. The liver-related mortality was significantly higher among the HCV-positive patients (adjusted sub-distribution hazard ratio [asHR] 3. 65; 95% CI: 1. 72, 7. 78; P =0. 001). HCV infection compromises the survival of patients with alcohol abuse/dependence. The new direct antiviral agents for the treatment of HCV infection may result in better clinical outcomes.
Ajuts:	Ministerio de Economía y Competitividad RD16-0017-0003 Ministerio de Economía y Competitividad PI17-00174
Nota:	Altres ajuts: This study was supported by the Ministry of Economy and Competitiveness, Carlos III Health Institute (ISCIII), European fund for regional development (FEDER) (Network for Cooperative Research in Health [RETICS] RD16/0017/0003 and PI17/00174), Ministry of Health, Social Services and Equality, National Plan on Drugs (PNSD) (2014/042 and 2015/027), Fulbright Visiting Scholar Program, Ministry of Education (PRX16/00147), Spain, and Gilead Fellowship Program, Gilead Science (GLD 17/00187).
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Hepatitis C virus ; Alcohol use disorder ; Survival ; Liver disease ; Mortality
Publicat a:	Clinical Epidemiology, Vol. 10 (august 2018) , p. 897-905, ISSN 1179-1349

DOI: 10.2147/CLEP.S162308
PMID: 30123002

9 p, 883.8 KB

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