The contribution of alcohol use disorder to decompensated cirrhosis among people with hepatitis C: An international study
The contribution of alcohol use disorder to decompensated cirrhosis among people with hepatitis C: An international study
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DOI：
10.1016/j.jhep.2017.10.019
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发表时间：
2018-03-01
影响因子：
25.7
通讯作者：
Dore, Gregory J.
中科院分区：
文献类型：
--
作者：
Alavi, Maryam;Janjua, Naveed Z.;Dore, Gregory J.
背景与目的：直接作用抗病毒药物（DAAs）的出现使丙型肝炎病毒（HCV）消除有了宏伟目标。然而，在酒精使用障碍的情况下，DAAs实现这些目标的能力可能会受到影响。本研究旨在评估酒精使用障碍在三种情况下对丙型肝炎病毒相关失代偿性肝硬化的影响。
方法：加拿大不列颠哥伦比亚省、澳大利亚新南威尔士州和苏格兰（分别为1995 - 2011/2012/2013年）的丙型肝炎病毒通报与住院情况（分别为2001 - 2012/2013/2014年）相关联。酒精使用障碍定义为因酒精使用导致的非肝脏相关住院。绘制年龄标准化失代偿性肝硬化发病率，使用考克斯回归评估相关因素，并计算与酒精使用障碍相关的人群归因分数（PAFs）。
结果：在不列颠哥伦比亚省、新南威尔士州和苏格兰的58487、84529和31924名丙型肝炎病毒感染者中，分别有2689人（4.6%）、3169人（3.7%）和1375人（4.3%）被诊断为失代偿性肝硬化，在这些失代偿性肝硬化患者中，分别有28%、32%和50%患有酒精使用障碍。在新南威尔士州和苏格兰，酒精使用障碍患者的年龄标准化失代偿性肝硬化发病率明显更高。在不列颠哥伦比亚省（风险比[aHR]1.92；95%置信区间[CI]1.76 - 2.10）、新南威尔士州（aHR 3.68；95% CI 3.38 - 4.00）和苏格兰（aHR 3.88；95% CI 3.42 - 4.40），失代偿性肝硬化与酒精使用障碍独立相关。在不列颠哥伦比亚省、新南威尔士州和苏格兰，与酒精使用障碍相关的失代偿性肝硬化的人群归因分数分别为13%、25%和40%。
结论：在所有情况下，酒精使用障碍都是丙型肝炎病毒肝脏疾病负担的主要因素，在苏格兰更为明显。酒精使用在多大程度上会损害DAAs治疗在个体和人群层面的益处需要密切监测。如果要实现世界卫生组织2030年丙型肝炎病毒死亡率降低的目标，各国应在适当情况下制定策略，将促进DAAs治疗的采用与酒精使用障碍的管理相结合。
通俗总结：全球丙型肝炎患者的肝脏疾病负担一直在上升。最近针对丙型肝炎推出的高效药物（称为直接作用抗病毒药物或DAAs）给该领域带来了新的希望。DAAs的推广可能在未来几十年内消除丙型肝炎作为一种公共卫生威胁。然而，我们的研究结果表明，大量饮酒是丙型肝炎患者患肝脏疾病的一个主要风险因素。如果持续大量饮酒，可能会损害新的抗病毒治疗在个体和人群层面的益处。为了应对丙型肝炎作为一种公共卫生威胁，在需要的情况下，DAAs治疗应与大量饮酒的管理相结合。（C）2017欧洲肝脏研究协会。由爱思唯尔出版有限公司出版。保留所有权利。
Background & Aims: The advent of direct-acting antivirals (DAAs) has led to ambitious targets for hepatitis C virus (HCV) elimination. However, in the context of alcohol use disorder the ability of DAAs to achieve these targets may be compromised. The aim of this study was to evaluate the contribution of alcohol use disorder to HCV-related decompensated cirrhosis in three settings.Methods: HCV notifications from British Columbia, Canada; New South Wales, Australia, and Scotland (19952011/2012/2013, respectively) were linked to hospital admissions (2001-2012/2013/2014, respectively). Alcohol use disorder was defined as non-liver-related hospitalisation due to alcohol use. Age-standardised decompensated cirrhosis incidence rates were plotted, associated factors were assessed using Cox regression, and alcohol use disorder-associated population attributable fractions (PAFs) were computed.Results: Among 58,487, 84,529, and 31,924 people with HCV in British Columbia, New South Wales, and Scotland, 2,689 (4.6%), 3,169 (3.7%), and 1,375 (4.3%) had a decompensated cirrhosis diagnosis, and 28%, 32%, and 50% of those with decompensated cirrhosis had an alcohol use disorder, respectively. Age-standardised decompensated cirrhosis incidence rates were considerably higher in people with alcohol use disorder in New South Wales and Scotland. Decompensated cirrhosis was independently associated with alcohol use disorder in British Columbia (aHR 1.92; 95% CI 1.76-2.10), New South Wales (aHR 3.68; 95% CI 3.38-4.00) and Scotland (aHR 3.88; 95% CI 3.42-4.40). The PAFs of decompensated cirrhosis-related to alcohol use disorder were 13%, 25%, and 40% in British Columbia, New South Wales and Scotland, respectively.Conclusions: Alcohol use disorder was a major contributor to HCV liver disease burden in all settings, more distinctly in Scotland. The extent to which alcohol use would compromise the individual and population-level benefits of DAA therapy needs to be closely monitored. Countries, where appropriate, must develop strategies combining promotion of DAA treatment uptake with management of alcohol use disorders, if World Health Organization 2030 HCV mortality reduction targets are going to be achieved.Lay summary: The burden of liver disease has been rising among people with hepatitis C globally. The recent introduction of highly effective medicines against hepatitis C (called directacting antivirals or DAAs) has brought renewed optimism to the sector. DAA scale-up could eliminate hepatitis C as a public health threat in the coming decades. However, our findings show heavy alcohol use is a major risk factor for liver disease among people with hepatitis C. If continued, heavy alcohol use could compromise the benefits of new antiviral treatments at the individual-and population-level. To tackle hepatitis C as a public health threat, where needed, DAA therapy should be combined with management of heavy alcohol use. (C) 2017 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.