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THE IMPACT OF ALCOHOL AND INTERFERON TREATMENT ON
THE CLINICAL OUTCOME OF HEPATITIS C (HCV)-RELATED CIRRHOSIS



M Mazen Jamal, Kenneth J. Vega, Ehab Rabaa,
David E. Johnston, Long Beach, CA; Jacksonville, FL; Rockville, MD; Everett, WA

This study discusses whether interferon can slow
HCV disease progression with or without a viral response. And the effects of
continued alcohol use on disease progression are discussed. Here is yet another
study showing interferon slows disease progression. Aside from its antiviral
effect, interferon is said slow disease progression. 226 patients with HCV
cirrhosis were looked at between June 1992 and June 2000. Patients with HIV were
excluded but HIV appears to accelerate HCV progression. Some patients received
HCV therapy & some did not. They found that 33% developed decompensation
(ascites, GI bleed, encepholopathy, jaundice). And 67% remained compensated. 65%
were men, 50% white. follow-up was 52 months. 102 patients received interferon
and 124 did not. The treated patients had higher platelet counts.

The study found that patients who received
interferon therapy were 2.3 times less likely to experience HCV disease
progression to decompensation. Patients that continued to drink alcohol heavily
were 5.6 times more likely to develop decompensation. Perhaps the most important
point the author stressed was that patients in the study experienced slowing of
HCV disease progression whether or not they were viral responders. Not receiving
interferon therapy increased risk for death by 3.8 times. So refusing to take
interferon increased death in this study. Continuing heavy alcohol use increased
risk for death by 11 times.

After 72 months the probability for developing
decompensated cirhosis was 50% in the interferon untreated patients and 14% in
the treated patients. After 72 months patients who were abstinent from alcohol
had a 14% risk for decompensated disease compared to 67% for those who continued
heavy alcohol use. After 72 months patients who received interferon had a 95%
probaility of survival vs 68% for patients who did not receive interferon. Heavy
drinkers also had decreased survival at 72 months (55%) vs those who were
abstinent (98%).

There are numerous studies showing interferon can
slow disease progression. But the study findings are not conclusive. The
potential benefit to maintenance therapy or interferon is controversial. The
data indicates that interferon slows disease progression. A large NIH study
called HALT-C is looking at this question but results will not be ready for
several years. A few investigators are trying to start a smalled study to get
answers more quickly.

abstract:

Background:The long-term prognosis of chronic
liver disease secondary to hepatitis C is not clearly defined. This study
examines predictive factors of decompensation and the effects of treatment and
alcohol consumption on time to decompensation and death in patients with
hepatitis C-related compensated cirrhosis.

Methods: A cohort of 226 patients with compensated
cirrhosis was enrolled and followed up for a mean period of 52.9 months.
Inclusion criteria were biopsy proven liver cirrhosis, positive hepatitis C RNA,
absence of decompensation, and no evidence of hepatitis B, HIV and metabolic, or
autoimmune liver diseases. Age, sex, ethnicity, age at infection, duration of
infection, alcohol consumption, continuing heavy alcohol consumption, LFT's,
interferon treatment, platelets, HCV RNA and genotype were evaluated as
potential predictive factors for time to decompensation and death.

Results: One hundred and two patients were treated
with interferon or rebetron for a mean duration of 10.2 months. During
follow-up, 35 patients (15.5%) died and decompensation occurred in 74 patients
(32.7%). In multivariate analysis lack of treatment and continuing heavy alcohol
consumption were predictive factors of decompensation. Predictors of survival
included interferon treatment and no history of heavy alcohol consumption
(Table). The probability of decompensation was 0% at 2 years, 6.8% at 4 years
and 14% at 6 years for treated patients and 9.2%, 18% and 50.2% for untreated
patients.The probability of decompensation for patients with no heavy alcohol
consumption was 0%, 4.6% and 13.8% at 2, 4 and 6 years and 15.4%, 29.8% and 67%
for continuing heavy alcohol consumption patients. Death was highest among
non-treated patients and patients with continuing heavy alcohol consumption.

Conclusions: 1- Continuing heavy alcohol
consumption and lack of interferon therapy are independent predictors of poor
outcome. 2- Survival probability is better in interferon treated patients and in
patients with no heavy alcohol consumption. 3- Interferon therapy and abstinence
increase the time to decompensation and death.









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