The Role of Alcohol Consumption in the Natural History and Treatment of Chronic Hepatitis C Virus Infection: an Epidemiological Study

Abstract

This thesis used an epidemiological approach to explore the role of alcohol consumption in the natural history and treatment of chronic hepatitis C virus (HCV) infection. The association between alcohol consumption and diagnosed advanced liver disease (ALD) was explored in chronically HCV-infected, treatment-naïve individuals attending specialist services across the UK. While heavy drinking (over 50 units/week) was significantly associated with diagnosed ALD compared to lifetime abstinence from alcohol (former heavy drinkers: OR=1.83, 95% CI: 1.20-2.79; persistent heavy drinkers: OR=2.46, 95% CI: 1.38-4.41), non heavy drinking was not associated with any increased risk (OR=0.88, 95% CI: 0.57-1.36). The association between different levels of alcohol consumption and liver disease progression was explored through a non-invasive measure for detecting ALD: the APRI. There was a significant association between persistent heavy drinking and high APRI scores (OR=3.62, 95% CI: 1.65-7.93), but no significant association was found for non heavy drinking (OR=1.08, 95% CI: 0.61-1.91). Regarding treatment, the role of past alcohol consumption in initiation on, and response to, antiviral HCV therapy was explored among individuals with a diagnosis of cirrhosis by using surveillance data from Scotland, initially in the era of interferon-free antiviral therapies only and, subsequently, over time. Despite improvement over time, past heavy drinking (over 50 units/week) was significantly associated with lower treatment initiation in the interferon-free era, compared to no drinking (OR=0.63, 95% CI: 0.47-0.86); there was a similar, but weaker, association for individuals who reported alcohol consumption between 22 and 50 units per week (OR=0.74, 95% CI: 0.48-1.15). No significant association was found between any level of past alcohol consumption and achieving sustained virological response in this population. These findings suggest that guidelines which advise complete abstinence from alcohol in the course of chronic HCV infection should be reviewed, given that no significant association was established between non heavy drinking (under 50 units/week) and a diagnosis of ALD. Despite considerable progress in Scotland in treatment initiation among cirrhotic individuals, additional effort is still necessary to ensure equity of treatment for people with heavy past alcohol consumption. Access to treatment for people perceived as difficult to treat has key humanitarian benefits in eliminating hepatitis C.

Date of Award	2020
Original language	English
Awarding Institution	Glasgow Caledonian University
Supervisor	Sharon Hutchinson (Supervisor), David Goldberg (Supervisor) & Carol Emslie (Supervisor)