Alcoholic hepatitis linked to hepatitis C risk

Hepatitis C virus (HCV) is more common in patients with alcoholic hepatitis than the general population, but infections may be going undetected, US data show.

Figures from the Nationwide Inpatient Sample (NIS) dataset show that while the frequency of hospital admissions with an AH diagnosis on discharge remained stable between 1998 and 2007, the number of admissions for AH with concomitant HCV infection more than doubled from 3.6% to 7.7%.

With a concurrent overall increase in HCV diagnoses from 0.4% to 1.2% over the period, the researchers say these figures contrast with the estimated HCV prevalence of 1.6% in the general population.

The authors believe that these increases in recorded HCV infection come from changes in detection rather than an actual increase in prevalence. "Given the paucity of data currently available, the present study provides useful information on the epidemiology of AH in general and the epidemiological trends in HCV in AH patients in particular," say Ashwani Singal (Mayo Clinic, Minnesota, USA) and colleagues.

The NIS dataset provides information on a total of 76,957,719 admissions, of which 111,726 were for AH. Of all admissions with a discharge diagnosis of AH, 7240 (6.5%) had concomitant HCV infection.

Several of the findings point toward inadequate levels of testing in patients with alcoholism, the researchers say. For example, the rate of HCV among AH patients is lower than previously reported prevalences of up to 17%. There was also a higher frequency of HCV-positivity at teaching hospitals compared with nonteaching hospitals, which the authors suggest could be partly due to differences in testing rates.

The study also found that while in-hospital mortality for HCV infections had declined over the decade, AH patients with HCV infection were 29% more likely to die in hospital than HCV-negative patients. In fact, concomitant HCV infection was found to be an independent predictor of in-hospital mortality among AH patients.

Reasons for the increased prevalence in HCV among AH patients, the authors suggest, include the concurrent use of intravenous drugs among alcoholics. Furthermore, alcohol abuse lowers the immune system, making users more susceptible to infection.

The authors therefore recommend that awareness should be raised among healthcare workers to increase HCV testing in alcoholic patients.

They conclude: "Studies are required to understand the mechanisms for these findings and develop better treatment modalities to further improve the outcome of patients with AH with an HCV infection."

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