An Empirical Study of Alcohol Consumption By Patients Considering HCV Treatment

Background and purpose.  Alcohol use accelerates the course of HCV infection and reduces the effectiveness of interferon-based antiviral therapies; even casual alcohol use accelerates HCV liver damage.  The consensus of multiple professional liver-related medical societies  recommend complete abstinence from alcohol for at least six months prior to treatment. Treatment providers focus on current abstinence among patients with a history of problematic alcohol use, with far less attention to casual alcohol use among other patients.  To date, research on alcohol use patterns among HCV-infected populations has been limited and also generally focused on addiction, rather than on consumption—even though consumption is of far greater importance in HCV treatment.  This study addresses this gap by examining alcohol consumption patterns among patients with HCV, describing and comparing groups of patients with and without alcohol use disorders and current and lifetime alcohol use histories.

Method.  Male and female HCV patients considering antiviral treatment (N=309) recruited from university-affiliated and VA liver and infectious disease clinics were assessed for lifetime and current-year psychiatric disorders and alcohol-use patterns.  Dichotomous variables were compared using chi-squared analysis, substituting Fisher’s exact tests when expected cell sizes were <5.  Numerical variables were compared using Student’s t-tests, using Satterthwaite comparisons in cases of unequal variances.

Results.  More than one-half reported use of alcohol in the last year.  Patients without past year alcohol use largely resembled those with no lifetime alcohol use, regardless of diagnostic status.  Compared to patients still using alcohol, those no longer using alcohol in the last year were less likely to have current substance use disorder or drug use, and had fewer current risky behaviors.  Among patients using alcohol in the last year, those with a past alcohol use disorder differed from those without only by greater drug use disorder and drug use history.

Conclusions and implications.  Continuing use of alcohol by HCV patients, regardless of alcohol history, has the potential to worsen liver damage with potential progression to end-stage liver disease and death.  Assessment and monitoring of all HCV patients for alcohol consumption by their treating physicians is important, regardless of previous diagnostic history.