Influence of alcohol on the progression of hepatitis C virus infection: A meta-analysis

Background & Aims: A convincing, yet inconsistent, pattern has emerged that demonstrates increased progression of HCV-related liver disease with heavy alcohol use. The aim was to perform a meta-analysis to quantify the effect of alcohol on cirrhosis risk among persons infected with HCV. Methods: A meta-analysis of 20 articles, involving more than 15,000 HCV chronically infected persons, published between 1995 and 2004 was undertaken to explore the relationship between advanced liver disease and the consumption of alcohol. Results: The pooled relative risk of cirrhosis associated with heavy alcohol intake (defined in the range of at least 210-560 g per week) was 2.33 (95% confidence interval, 1.67-3.26) by the random effects model. The risk of HCV-related liver disease associated with heavy alcohol intake increased with severity of the outcome; the lowest (1.63; 95% confidence interval, 1.22-2.17) and highest (3.54; 2.14-5.85) pooled relative risk estimates were obtained for advanced fibrosis and decompensated cirrhosis, respectively. The regression effect of alcohol might, however, be underestimated in studies investigating the risk of HCV-related cirrhosis because they necessarily include patients undergoing liver biopsy and could therefore under-represent heavy alcohol users. Conclusions: The evidence overwhelmingly shows a worsened outcome for those with chronic HCV and concurrent alcohol use. Studies varied widely in their definition of significant alcohol intake, and so the true threshold above which alcohol accelerates HCV disease progression remains uncertain. Alcohol consumption should be minimized as much as possible in those who have chronic HCV until a safe threshold is more definitively determined.