Hepatitis C infection substantially reduces survival of alcohol-dependent patients

Roberto Muga; Arantza Sanvisens; Inmaculada Jarrin; Daniel Fuster; Ferran Bolao; Jordi Tor; Alvaro Muñoz

doi:10.2147/CLEP.S162308

Hepatitis C infection substantially reduces survival of alcohol-dependent patients

Clin Epidemiol. 2018 Aug 1:10:897-905. doi: 10.2147/CLEP.S162308. eCollection 2018.

Authors

Roberto Muga¹, Arantza Sanvisens¹, Inmaculada Jarrin², Daniel Fuster¹, Ferran Bolao³, Jordi Tor¹, Alvaro Muñoz⁴

Affiliations

¹ Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain, rmuga.germanstrias@gencat.cat.
² National Center of Epidemiology, Institute of Health Carlos III, Madrid, Spain.
³ Department of Internal Medicine, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain.
⁴ Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA.

Abstract

Background: 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.

Patients and methods: 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.

Results: 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).

Conclusion: 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.

Keywords: alcohol use disorder; hepatitis C virus; liver disease; mortality; survival.