D. Robert Harris, PhD; René Gonin, PhD; Harvey J. Alter, MD; Elizabeth C. Wright, PhD; Zelma J. Buskell, BS; F. Blaine Hollinger, MD; Leonard B. Seeff, MD; for the National Heart, Lung, and Blood Institute Study Group
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, firstname.lastname@example.org.
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.
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.
To quantify the relationship of transfusion-associated HCV infection and history of heavy alcohol abuse to development of cirrhosis.
Retrospective cohort study.
Liver clinics in university and government hospitals.
Extended follow-up of 1030 patients in prospective investigations of transfusion-associated viral hepatitis conducted in the United States between 1968 and 1980.
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.
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.
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.
Table 1. Characteristics of Included and Excluded Patients
Table 2. Association of Patient Characteristics with Development of Cirrhosis
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Harris DR, Gonin R, Alter HJ, et al, for the National Heart, Lung, and Blood Institute Study Group. The Relationship of Acute Transfusion-Associated Hepatitis to the Development of Cirrhosis in the Presence of Alcohol Abuse. Ann Intern Med. 2001;134:120–124. doi: 10.7326/0003-4819-134-2-200101160-00012
Download citation file:
Published: Ann Intern Med. 2001;134(2):120-124.
Gastroenterology/Hepatology, Infectious Disease, Liver Disease, Tobacco, Alcohol, and Other Substance Abuse, Viral Hepatitis.
Results provided by:
Copyright © 2019 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use