The Relationship of Acute Transfusion-Associated Hepatitis to the Development of Cirrhosis in the Presence of Alcohol Abuse

  1. D. Robert Harris, PhD;
  2. René Gonin, PhD;
  3. Harvey J. Alter, MD;
  4. Elizabeth C. Wright, PhD;
  5. Zelma J. Buskell, BS;
  6. F. Blaine Hollinger, MD;
  7. Leonard B. Seeff, MD; and
  8. for the National Heart, Lung, and Blood Institute Study Group
  1. From Westat, Rockville, Maryland; National Institute of Diabetes and Digestive and Kidney Diseases and National Institutes of Health, Bethesda, Maryland; New England Research Institutes, Watertown, Massachusetts; Veterans Affairs Medical Center and Georgetown University School of Medicine, Washington, D.C.; and Baylor College of Medicine, Houston, Texas.

    Abstract

    Background: Although concomitant alcoholism is widely believed to enhance liver disease progression in persons with hepatitis C virus (HCV) infection, this relationship has not been well quantified.

    Objective: To quantify the relationship of transfusion-associated HCV infection and history of heavy alcohol abuse to development of cirrhosis.

    Design: Retrospective cohort study.

    Setting: Liver clinics in university and government hospitals.

    Patients: Extended follow-up of 1030 patients in prospective investigations of transfusion-associated viral hepatitis conducted in the United States between 1968 and 1980.

    Measurements: Development of cirrhosis and history of heavy alcohol abuse were determined from review of interviews with patients or their proxies, medical records, death certificates, and autopsy and biopsy reports. Logistic regression was used to estimate the risk for cirrhosis associated with transfusion-associated HCV infection and history of heavy alcohol abuse.

    Results: The absolute risk for cirrhosis was 17% among patients with transfusion-associated HCV; 3.2% among patients with transfusion-associated non-A, non-B, non-C hepatitis; and 2.8% among controls. Patients with transfusion-associated HCV were more likely than controls to develop cirrhosis (odds ratio, 7.8 [95% CI, 4.0 to 15.1]). A history of heavy alcohol abuse was associated with a fourfold increased risk for cirrhosis. Hepatitis C virus infection plus a history of heavy alcohol abuse led to a substantial increase in risk for cirrhosis (odds ratio, 31.1 [CI, 11.4 to 84.5]) compared with controls without such a history.

    Conclusions: Heavy alcohol abuse greatly exacerbates the risk for cirrhosis among patients with HCV infection. This finding emphasizes the need to counsel such patients about their drinking habits.

    Article and Author Information

    • Acknowledgments: The authors thank Song Li and David Chang, Westat, Rockville, Maryland, for data processing and statistical programming support and Jim Korelitz and Stephen Durako for review and comment on earlier drafts of the manuscript.

    • Grant Support: By contracts N01-HB-87047 and N01-HB-37093 from the National Heart, Lung, and Blood Institute.

    • Requests for Single Reprints: Leonard B. Seeff, MD, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Disorders, 31 Center Drive, Room 9A18, Mail Drop MSC2560, Bethesda, MD 20892-2560; e-mail, seeffl{at}extra.niddk.nih.gov.

    • Current Author Addresses: Drs. Harris and Gonin: Westat, 1650 Research Boulevard, Rockville, MD 20850.

    • Dr. Alter: Department of Transfusion Medicine, National Institutes of Health, Building 10, IN307, 9000 Rockville Pike, Rockville, MD 20892.

    • Dr. Wright: New England Research Institute, 9 Galen Street, Watertown, MA 02472.

    • Ms. Buskell: Hepatitis Research, Room 3A-128, Veterans Affairs Medical Center, 50 Irving Street NW, Washington, DC 20422.

    • Dr. Hollinger: Baylor College of Medicine, NS BCM 3B5, One Baylor Plaza, Houston, TX 77030.

    • Dr. Seeff: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Disorders, 31 Center Drive, Room 9A18, Mail Drop MSC2560, Bethesda, MD 20892-2560.

    • Author Contributions: Conception and design: D.R. Harris, R. Gonin, E.C. Wright, Z.J. Buskell, F.B. Hollinger, L.B. Seeff.

    • Analysis and interpretation of the data: D.R. Harris, R. Gonin, Z.J. Buskell, F.B. Hollinger, L.B. Seeff.

    • Drafting of the article: D.R. Harris, R. Gonin, H.J. Alter, L.B. Seeff.

    • Critical revision of the article for important intellectual content: D.R. Harris, R. Gonin, H.J. Alter, E.C. Wright, Z.J. Buskell, F.B. Hollinger, L.B. Seeff.

    • Final approval of the article: D.R. Harris, R. Gonin, H.J. Alter, E.C. Wright, Z.J. Buskell, F.B. Hollinger, L.B. Seeff.

    • Provision of study materials or patients: H.J. Alter, F.B. Hollinger, L.B. Seeff.

    • Statistical expertise: D.R. Harris, R. Gonin, E.C. Wright.

    • Administrative, technical, or logistic support: D.R. Harris, Z.J. Buskell, L.B. Seeff.

    • Collection and assembly of data: D.R. Harris, R. Gonin, H.J. Alter, Z.J. Buskell, F.B. Hollinger, L.B. Seeff.

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    1. Ann Intern Med January 16, 2001 vol. 134 no. 2 120-124
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