HCV Increases Mortality Among Patients with Alcohol Dependence

Patients who are heavily dependent on alcohol face substantially higher rates of mortality if they are also infected with the hepatitis C virus (HCV), according to the findings of a new study based on 10 years of data spanning 2000 through 2010.

A team of investigators from Spain, working alongside scientists at Johns Hopkins University, pulled records for 817 individuals who had checked in to 2 Spanish hospitals for the treatment of alcohol dependence. Of those, 15.8% were also infected with HCV. Using clinical records and a governmental death registry, the investigators reviewed rates of death among patients during the 5117 person-years included in the study. Overall, 129 patients died; 31 of those patients were HCV-positive, while the other 98 were HCV-negative. That translated into a death rate of 15.4% among HCV-negative patients, and 24.6% among those with HCV infection.

Moreover, survival times for HCV-positive patients were 34% shorter than their HCV-negative peers. Liver-related mortality was the leading cause of death in the group overall, with slightly less than half (48.4%) of the patients dying from liver-related conditions.

The authors argue these findings are important because there is significant overlap between patients with HCV infection and patients with alcohol dependence.

“A recent study reported that up to 30% of patients with HCV infection may experience excessive alcohol consumption, and when both diseases occur concurrently, the liver-related mortality is 6 times higher than that of HCV-negative patients with liver-related complications,” Roberto Muga, MD, of the Autonomous University of Barcelona, Spain, and colleagues wrote.

They suggest that early detection and treatment, of both alcohol dependence and HCV, could lead to a significant reduction in liver-related mortality.

The authors also highlight a potential mitigating factor not available at the time of the study—direct-acting antivirals (DAAs), which have shown the ability to dramatically improve the lives of patients with HCV. Furthermore, DAAs have the potential to significantly improve the survival rates of alcohol-dependent people with HCV, after detoxification from alcohol, they said.

“Studies have shown that excessive alcohol consumption and other substance use disorders do not usually compromise adherence to HCV treatment,” Muga and colleagues wrote, “and that persons engaged in treatment who have achieved sobriety have HCV treatment outcomes similar to those without histories of associated substance use.”

Some limitations to the study include that individuals who struggle with alcohol dependence may have changes to their consumption levels over time and the study authors did not include data on relapse and readmissions, which might have allowed for a more nuanced understanding of how alcohol detoxification rates affect survival.

In addition, because only those patients with the most severe cases were admitted to the hospital, the results do not enable a clear understanding of how less severe alcohol abuse might affect patients with HCV.

Still, the authors say it is clear that for this particular cohort of patients—those admitted to the hospital for alcohol abuse—hepatitis C infection leads to a clear increase in the risk of death.

The study, entitled, “Hepatitis C infection substantially reduces survival of alcohol-dependent patients,” was published in the journal Clinical Epidemiology.