title: Natural course of chronic HCV and HBV infection and role of alcohol in the general population: the Dionysos Study.
abstract: BACKGROUND
  Population-based studies of the natural course of chronic viral liver disease that consider comorbidity factors are lacking. Using data from the Dionysos Study, we quantified the burden of chronic viral liver disease and the role of alcohol intake to morbidity and mortality in a representative sample of subjects from the general population of two communities of Northern Italy.
  
  
  RESULTS
  We followed up 139 subjects with chronic hepatitis C virus (HCV) infection and 61 with chronic hepatitis B virus (HBV) infection for a median (IQR) time of 8.4 (1.0) and 8.3 (0.9) yr, respectively. Ethanol intake was evaluated using a food-frequency questionnaire, fatty liver (FL) was diagnosed by ultrasonography, and liver cirrhosis (LC) and hepatocarcinoma (HCC) were diagnosed by liver biopsy. Exact multivariable Poisson regression was performed to identify predictors of death. The incidence and remission rates of FL were 9.0 and 29.7 in the HCV cohort and 4.0 and 30.4 per 1,000 person-years (PY) in the HBV cohort. Progression to LC and HCC was more common in the HCV than in the HBV cohort (4.5 vs 2.0 and 2.7 vs 2.0 per 1,000 PY, respectively). Ethanol intake was an independent predictor of LC in the HCV cohort [rate ratio (RR) = 4.15 (95% CI 1.02-41.2) for every increase of 30 g/day of ethanol intake at baseline] and of death rate in both cohorts [RR = 8.53 (95% CI 1.40-24.61) and 3.56 (1.34 to 26.50) for every increase of 30 g/day of ethanol intake at baseline].
  
  
  CONCLUSIONS
  The morbidity and mortality rate of HBV and HCV infection in the general population is lower than that reported in secondary-care populations, blood donors, or clinical series. Ethanol intake is an independent predictor of LC in subjects with chronic HCV infection and an independent predictor of death in subjects with either HCV or HBV infection.
authors.affiliation: Liver Research Center, AREA Science Park, Basovizza, Trieste, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bedogni
authors.forename: Lucia
authors.initials: L
authors.lastname: Miglioli
authors.forename: Flora
authors.initials: F
authors.lastname: Masutti
authors.forename: Silvia
authors.initials: S
authors.lastname: Ferri
authors.forename: Anna
authors.initials: A
authors.lastname: Castiglione
authors.forename: Marco
authors.initials: M
authors.lastname: Lenzi
authors.forename: Lory Saveria
authors.initials: LS
authors.lastname: Crocè
authors.forename: Alessandro
authors.initials: A
authors.lastname: Granito
authors.forename: Claudio
authors.initials: C
authors.lastname: Tiribelli
authors.forename: Stefano
authors.initials: S
authors.lastname: Bellentani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking; D002423:Cause of Death; D002648:Child; D005260:Female; D006509:Hepatitis B / Q000401:mortality*; D019698:Hepatitis C, Chronic / Q000401:mortality*; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016012:Poisson Distribution; D015995:Prevalence; D012367:RNA, Viral / Q000032:analysis; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires
chemical_list: D012367:RNA, Viral