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Relationship among Transfusion-Related Hepatitis C, Alcohol Abuse, and Cirrhosis

What is the problem and what is known about it so far? Hepatitis C virus (HCV) infection causes inflammation of the liver, a condition known as hepatitis. Before the blood supply in the United States was routinely tested, people commonly became infected by receiving blood transfusions that contained HCV. (Giving blood does not carry a risk for getting hepatitis.) Some people with HCV infection develop damage and scarring of the liver (cirrhosis) many years after becoming infected. Studies suggest that people with HCV infection who drink alcohol are more likely than those who do not drink alcohol to develop cirrhosis, but the strength of that relationship is unclear. Why did the researchers do this particular study? To find out how strongly alcohol abuse is associated with development of cirrhosis in people with HCV infection. Who was studied? The study included 836 patients who had blood samples collected and stored after blood transfusions between 1968 and 1980, during a study of hepatitis that develops after blood transfusion. How was the study done? The researchers tested stored blood to determine whether patients had HCV infection, as well as hepatitis caused by the hepatitis A and B viruses. They also collected information on study participants from death registries, interviews with patients and family members, medical records, and autopsy reports. Patients were classified as alcohol abusers if they met at least one of the following conditions: they reported losing friends, family, or a job because of drinking; they admitted to ever having alcoholism; their medical records indicated heavy drinking; or they reported drinking more than 80 grams of alcohol daily. What did the researchers find? Of the 836 patients in the study, 206 had HCV; 95 had transfusion-associated hepatitis but tested negative for hepatitis A, B, and C viruses; and 535 were controls (transfused patients who had not developed hepatitis). Of patients with HCV, 17% developed cirrhosis, compared with only about 3% of patients in the other groups. Patients who abused alcohol were 4 times more likely to develop cirrhosis than were patients who did not abuse alcohol. Patients with both HCV infection and alcohol abuse were more than 30 times more likely to develop cirrhosis than persons who had neither HCV infection nor alcohol abuse. What were the limitations of the study? The researchers based the diagnosis of alcohol abuse on reports from patients and medical records; the exact amount of alcohol that patients drank is unknown. The study does not prove that patients with HCV infection who stop drinking alcohol will lower their chances of developing cirrhosis. What are the implications of the study? The combination of HCV infection and alcohol abuse appears to put people at high risk for developing cirrhosis.