Innes et al.1 must be congratulated for providing important data on liver-related morbidity and mortality in patients treated for hepatitis C virus (HCV) infection. The authors underlined the importance of comorbidity, particularly in alcohol consumption.
Recently, Backus et al.2 showed a strong decrease in hepatic mortality and, more surprisingly, in nonhepatic and global mortality in cases of sustained virological response (SVR). We hypothesized that patient empowerment prompted by an SVR could lead these patients to consider comorbidities such as alcohol intake, and in this way could decrease hepatic and/or global morbidity or mortality.3
We conducted a pilot study aimed at evaluating the impact of SVR on detoxification in 40 alcoholic heavy drinkers (26 men, 14 women; mean age, 46 years; mean daily quantity, 87 g alcohol) infected with HCV. All patients presented an abuse or dependence according to DSM-IV classification and a CAGE questionnaire score ≥2 at baseline. Thirty-three patients (20 genotypes 1/4, 13 genotypes 2/3) were treatment-naïve. Pegylated interferon-α and ribavirin were initiated simultaneously with a treatment course for alcohol detoxification according to the recommendations (48 weeks for genotypes 1/4, 24 weeks for genotypes 2/3, 72 weeks for nonresponders). The patients were regularly followed up by a team composed of a nurse, a psychiatrist, a psychologist, and a hepatologist.
Six patients discontinued treatment (two for severe anemia, one for hepatocarcinoma, and three for psychiatric side effects [depression, massive alcohol consumption]). For treatment-naïve patients, the SVR observed on intention-to-treat and per-protocol analysis was 40% and 50%, respectively, for genotypes 1/4 and 69% and 82%, respectively, for genotypes 2/3. At the end of the study, 55% of the 40 patients were weaned off alcohol; among these, 71% of the treatment-naïve patients with SVR were also weaned off alcohol, whereas only 37% of nonresponders were weaned off alcohol (P = 0.056). At the end of the study, the Hamilton's score significantly improved in patients with an SVR (P = 0.07).
Treatment of HCV concomitant with a program of alcohol weaning was possible in heavy drinkers when subjected to effective psychiatric evaluation. Therefore, our results and the Innes et al. data fit well with the proposed hypothesis3: that patients achieving an SVR are more prone to change their way of life and to control some pathological factors, such as excessive alcohol consumption.