Heavy drinking affects the prognosis of women with hepatitis C

Women with hepatitis C virus (HCV) who drink heavily completely lose the survival advantage they have over HCV infected men according to US research published in February edition of Alcoholism: Clinical and Experimental Research.

There is a clear gender difference in the way men and women respond to HCV infection. The disease progresses faster in men than women. Men are also more likely to die from HCV-related liver disease.

Alcohol use speeds up liver damage in people with HCV infection but little research has been done on differences between the sexes. Now researchers at the US National Institute on Alcohol Abuse and Alcoholism have analysed 132,468 deaths where hepatitis C, heavy alcohol use or both were implicated.

Women with hepatitis C who were not heavy drinkers died on average at the age of 61 compared to 55 years for men, supporting earlier findings. But heavy drinking eradicated that advantage. HCV infected women who drank excessively died - on average - at just over 49 years while HCV infection and heavy drinking in men cut the average age of death to 50.

Although heavy drinking is known to be harder on women than men, the researchers say they are surprised the survival advantage HCV-infected women have over men is totally wiped out by alcohol.

Heavy drinking is immunosuppressive, is thought to promote HCV replication, decrease viral clearance and interfere with interferon therapy. It also prompts the liver to produce collagen - as does HCV - leading to cirrhosis. And there are several reasons women generally are at higher risk of alcoholic liver disease. Women process and eliminate alcohol more slowly than men and have higher levels of destructive oxygen free radicals in their blood associated with heavy drinking.

It is not possible to define ‘safe’ and ‘unsafe’ levels of drinking for people with HCV from this study. All the information was gathered from death certificates which do not contain details of alcohol use. Instead deaths which were certainly alcohol-induced were used as a marker of heavy drinking, including alcoholic cirrhosis and mental or behavioural problems due to alcohol use. In fact the authors point out that the data might be underestimating the extent to which alcohol use hastens the deaths of people with hepatitis C as not all heavy drinkers will develop these conditions.

The investigators suggest that this study should prompt further research into whether the alcohol effect on HCV mortality varies across racial and ethnic groups as they also differ in the rate of HCV infections and response to treatment. They add that the interaction between alcohol consumption and co-infection with HIV and HCV should also be studied.