RETROSPECTIVE ANALYSIS OF THE IMPACT OF HIV-INFECTION AND ALCOHOL-USEON CHRONIC HEPATITIS-C IN A LARGE COHORT OF DRUG-USERS

Background/Aim: This retrospective study aimed to better define the re spective biological and pathological impact of human immunodeficiency virus infection and chronic alcohol consumption on the course of hepat itis C virus infection in intravenous drug users. Methods: Tyro hundre d and ten consecutive anti-HCV positive intravenous drug users, among whom 60 were also anti-HIV positive, took part in the study at the Uni versity Hospital, Paris, France. Results: The activity of aspartate am inotransferase and gamma-glutamyl transpeptidase was significantly inc reased in serum from anti-HIV positive patients. The mean hepatitis ac tivity index was significantly higher in anti-HIV positive patients (p <0.05), among whom there was also a higher proportion of patients with cirrhosis as compared to anti-HIV negative patients (30.0 vs 15.3%, p <0.0001). Excessive alcohol drinking (recorded in around 35% of the pa tients, whatever their HIV status), as compared to non-excessive drink ing, was more often associated with cirrhosis in anti-HIV negative (24 .5 vs 11.3%, p<0.05) than in anti-HIV positive patients (30.4 vs 29.7% , not significant). In a multivariate analysis, HIV infection (relativ e risk 2.2, confidence interval 1.1-4.5) and excessive alcohol drinkin g (relative risk 1.9, confidence interval 1.0-3.9) were the variables independently associated with the risk of cirrhosis. Conclusion: Human immunodeficiency virus infection worsens the course of chronic hepati tis C in intravenous drug users. Excessive alcohol drinking also appea rs to be a crucial negative cofactor, and therefore alcohol withdrawal should be proposed as an integral part of the therapy.