title: The impact of lifetime alcohol use on hepatitis C treatment outcomes in privately insured members of an integrated health care plan.
abstract: Treatment of chronic hepatitis C infection (HCV(+) ) has historically been shown to be less effective in patients with a heavy drinking history. The effect of moderate and heavy alcohol use on treatment with pegylated interferon-alpha and ribavirin (P/R) in an insured household population has not been previously reported. We investigated the effect of alcohol on treatment outcome in a cohort of 421 treatment-naïve HCV(+) patients, members of an integrated health care plan treated with P/R between January 2002 and June 2008. A detailed drinking history was obtained for 259 (61.5%) eligible patients. Regular drinking was reported by 93.1% of patients before HCV diagnosis, by 30.9% between HCV diagnosis and treatment, by 1.9% during treatment, and 11.6% after the end of treatment. Heavy drinking patterns were reported by 67.9%, 63.5% of patients drank more than 100 kg of ethanol before initiating HCV treatment, and 29.3% reported abstaining less than the required 6 months before treatment. Despite these reports of heavy drinking, sustained virological responses (SVRs) were obtained in 80.2% of patients with HCV genotypes 2 or 3 and 45.1% of patients with genotypes 1, 4, or 6. Pretreatment drinking patterns and total alcohol intake were both unrelated to SVR rates. Abstaining less than 6 months before treatment was related to lower SVR rates in moderate, but not heavy, drinkers. HCV treatment relapse was unrelated to drinking after treatment ended.
  
  
  CONCLUSIONS
  The amount of alcohol consumed before HCV treatment did not have a negative effect on treatment outcomes in our population. A history of heavy drinking should not be considered a deterrent to HCV treatment in members of an integrated health care plan who are closely monitored.
authors.affiliation: Pacific Institute for Research and Evaluation, Prevention Research Center, Berkeley, CA 94704, USA. russell@prev.org
authors.forename: Marcia
authors.initials: M
authors.lastname: Russell
authors.forename: Mary Patricia
authors.initials: MP
authors.lastname: Pauly
authors.forename: Charles Denton
authors.initials: CD
authors.lastname: Moore
authors.forename: Constance
authors.initials: C
authors.lastname: Chia
authors.forename: Jennifer
authors.initials: J
authors.lastname: Dorrell
authors.forename: Renee J
authors.initials: RJ
authors.lastname: Cunanan
authors.forename: Gayle
authors.initials: G
authors.lastname: Witt
authors.forename: Scott
authors.initials: S
authors.lastname: Martin
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects* / Q000191:economics; D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use; D002140:California; D015331:Cohort Studies; D016001:Confidence Intervals; D019033:Delivery of Health Care, Integrated / Q000191:economics*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006526:Hepatitis C / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D016898:Interferon-alpha / Q000191:economics / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011092:Polyethylene Glycols / Q000191:economics / Q000627:therapeutic use*; D017149:Private Sector / Q000191:economics; D011994:Recombinant Proteins / Q000191:economics / Q000627:therapeutic use; D012189:Retrospective Studies; D012254:Ribavirin / Q000191:economics / Q000627:therapeutic use*; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a