ALCOHOLIC LIVER-CIRRHOSIS AFTER THE ADVENT OF HEPATITIS-C VIRUS - SOME REFLECTIONS ON ITS EPIDEMIOLOGY AND ON THE CONCEPT OF ATTRIBUTABLE RISK

The recent availability of hepatitis C virus (HCV) infection markers h as led to the hypothesis that the prevalence of alcoholic liver cirrho sis (ALC) may be far lower than has hitherto been believed. On the oth er hand difficulties in obtaining a reliable patient history of alcoho l consumption and of making a differential diagnosis on the basis of h istology suggest that the aetiology role of alcohol may be understimat ed. Furthermore, epidemiological data strongly suggest that an individ ual susceptibility to alcoholic liver damage exists. The interaction b etween alcohol consumption and acquired factors, in particular hepatit is B and C viruses and nutrition, can be studied using an epidemiologi cal approach. The concept of attributable risk, which depends on the s trength of the aetiological factors and on their diffusion in the targ et population, is helpful in this context. Preliminary estimates sugge st that alcohol is at least as important as HCV infection in causing l iver cirrhosis in Italy. A nationwide study (SIDECIR Project) is curre ntly being conducted in order to clarify this issue.