title: Predictors and effects of alcohol use on liver function among young HCV-infected injection drug users in a behavioral intervention.
abstract: OBJECTIVE
  Hepatitis C virus (HCV) screening can provide opportunities to reduce disease progression through counseling against alcohol use, but empirical data on this issue are sparse. We determined the efficacy of a behavioral intervention in reducing alcohol use among young, HCV-infected injection drug users (IDUs) (n=355) and assessed whether changes in liver enzymes were associated with changes in alcohol consumption.
  
  
  METHODS
  Both the intervention and attention-control groups were counseled to avoid alcohol use, but the intervention group received enhanced counseling. Logistic regression, ANOVA, and continuous time Markov models were used to identify factors associated with alcohol use, changes in mean ALT and AST levels, and change in alcohol use post-intervention.
  
  
  RESULTS
  Six months post-intervention, alcohol abstinence increased 22.7% in both groups, with no difference by intervention arm. Transition from alcohol use to abstinence was associated with a decrease in liver enzymes, with a marginally greater decrease in the intervention group (p=0.05 for ALT; p=0.06 for AST). In multivariate Markov models, those who used marijuana transitioned from alcohol abstinence to consumption more rapidly than non-users (RR=3.11); those who were homeless transitioned more slowly to alcohol abstinence (RR=0.47); and those who had ever received a clinical diagnosis of liver disease transitioned more rapidly to abstinence (RR=1.88).
  
  
  CONCLUSIONS
  Although, behavioral counseling to reduce alcohol consumption among HCV-infected IDUs had a modest effect, reductions in alcohol consumption were associated with marked improvements in liver function. Interventions to reduce alcohol use among HCV-infected IDUs may benefit from being integrated into clinical care and monitoring of HCV infection.
authors.affiliation: University of California, San Diego, Department of Medicine, La Jolla, CA, USA.
authors.forename: Lydia N
authors.initials: LN
authors.lastname: Drumright
authors.forename: Holly
authors.initials: H
authors.lastname: Hagan
authors.forename: David L
authors.initials: DL
authors.lastname: Thomas
authors.forename: Mary H
authors.initials: MH
authors.lastname: Latka
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Golub
authors.forename: Richard S
authors.initials: RS
authors.lastname: Garfein
authors.forename: John D
authors.initials: JD
authors.lastname: Clapp
authors.forename: Jennifer V
authors.initials: JV
authors.lastname: Campbell
authors.forename: Sebastian
authors.initials: S
authors.lastname: Bonner
authors.forename: Farzana
authors.initials: F
authors.lastname: Kapadia
authors.forename: Thelma King
authors.initials: TK
authors.lastname: Thiel
authors.forename: Steffanie A
authors.initials: SA
authors.lastname: Strathdee
mesh_terms: D000293:Adolescent; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000428:Alcohol Drinking / Q000009:adverse effects / Q000503:physiopathology / Q000628:therapy*; D001219:Aspartate Aminotransferases / Q000097:blood; D001521:Behavior Therapy; D005260:Female; D019698:Hepatitis C, Chronic / Q000503:physiopathology / Q000628:therapy* / Q000635:transmission; D006801:Humans; D008111:Liver Function Tests; D016015:Logistic Models; D008297:Male; D008390:Markov Chains; D015819:Substance Abuse, Intravenous / Q000150:complications; D013695:Temperance; D055815:Young Adult
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase