Heavy drinking greatly increases the risk of cirrhosis in patients with HCV hepatitis

Aims To quantify the relationship between heavy alcohol intake in conjuncti on with transfusion associated hepatitis and the subsequent development of cirrhosis. Design Retrospective cohort study of subjects found to have transfusion ass ociated hepatitis. Setting Liver clinics in US university and government hospitals. Methods Retrospective cohort study of 1030 patients with transfusion associ ated hepatitis in the USA between 1968 and 1980. Included patients from thr ee prospective studies of cases of transfusion related hepatitis C infectio n with matched controls with similar transfusion histories but who had not developed hepatitis. Data were obtained from case notes, death registries, and personal interview. History of excessive alcohol consumption was obtain ed from personal interview of patient or proxy. Criteria for heavy consumpt ion were well defined although absolute quantities of alcohol could not be determined. Results A total of 836 (81%) of the original cohort of 1030 were included. Baseline characteristics of included and excluded patients were similar. Co mparisons between cases developing cirrhosis (n=53) and those who did not ( n=783) found no association with tattooing, occupational exposure, travel t o areas where hepatitis C was endemic, or intravenous drug use. Development of cirrhosis was associated with ethnicity, number of units transfused, an d history of heavy alcohol consumption. Patients with transfusion associate d hepatitis C were 7.8 times (confidence interval (CI) 4.0-15.1) more likel y to develop cirrhosis than controls. A history of heavy alcohol consumptio n was strongly associated with an increased risk of developing cirrhosis (o dds ratio 4.0 (CI 2.1-7.7)). Patients with both transfusion related hepatit is C and a history of heavy alcohol use were 31.1 times (CI 11.4-84.5) more likely to develop cirrhosis than controls with no history of alcohol abuse or hepatitis C. Conclusion Heavy alcohol abuse greatly exacerbates the risk of cirrhosis am ong patients with hepatitis C virus infection. This finding emphasises the need to counsel such patients about their drinking habits.