Repercussões do consumo alcoólico em pacientes com infecção crônica pelo vírus da hepatite C

Abstract

Alcohol and hepatitis C virus (HCV) can act synergically increasing the liver disease progression. The aim of this study was to evaluate the impact of alcohol consumption among patients undergoing treatment for HCV. For this, 121 patients were included in this study, of which 78 (64.5%) were men; aged 28-70 years. It was evaluated the relationship of alcohol with pre-treatment viral loads, liver histology, adherence to treatment, early virologic response (EVR), end-of-treatment response (ETR) and sustained virologic response (SVR). For the statistical analysis it was used the X2 test or Fisher\'s exact test and multivariate analysis, calculating odds ratios and 95% confidence intervals. P value ≤0.05 was considered significant. Among patients who consumed >60g/day of alcohol lifetime, the frequencies of viral load ≥106 IU/mL and discontinuation of treatment (50% and 32.4%, respectively) were higher (p <0.05) than among abstainers (27.3% and 9.4%, respectively); treatment discontinuation was more frequent (p<0.05) among those who continued consuming alcohol during treatment (66.7% vs. 21.4%) and more frequent among those who were not abstinent for at least six months prior to treatment (72.7% vs. 15.4%), it was also more frequent among those with CAGE ≥ 2 (19% vs. 2%) or AUDIT diagnosing harmful use or probable alcohol dependence (57.1% vs. 3.3%). Liver fibrosis was more frequent (p<0.05) among men who drank >60g/day of ethanol for over 10 years (87.9%) than among those who drank smaller amounts (60.9%) or were abstinent (61.1%). Through univariate analysis, the SVR rate was similar among patients with different patterns of alcohol consumption. Multivariate analysis showed a positive association between adherence ≥80% and the treatment näive patient with EVR; only HIV coinfection was negatively associated with SVR. The small number of patients did not allow statistical analysis to evaluate predictors of ETR. In conclusion, patients with heavy lifetime alcohol consumption had, more frequently, liver fibrosis, high viral loads and treatment discontinuation; however, among those who have not discontinued, the frequencies of SVR were similar when compared to abstinent or moderate drinkers. Thus, alcoholics should be treated for HCV infection with the accompaniment of a multidisciplinary team, in order to encourage their adherence to treatment and alcohol abstinence.