Predictors and effects of alcohol use on liver function among young HCV-infected injection drug users in a behavioral intervention

University of California, San Diego, Department of Medicine, La Jolla, CA, USA.
Journal of Hepatology (Impact Factor: 11.34). 11/2010; 55(1):45-52. DOI: 10.1016/j.jhep.2010.10.028
Source: PubMed


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.
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.
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).
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.

Download full-text


Available from: Steffanie A Strathdee,
13 Reads
  • Source
    • "In addition, the results are, in part, supported by the elevated AST, AST to ALT ratios, and higher proportions of ALT observed in patients on anti-retroviral treatment [10-12]. Since a large number of the injection heroin users in the present study were concomitantly consuming alcohol and khat, it is possible that these non-injection substances synergistically promote the alterations in the ALT levels [10,29]. Importantly, the inverse correlations of absolute ALT levels and the CD4+ T cell counts in the HIV sero-negative injection heroin users, suggests that the CD4+ T cell count can also be utilized as a surrogate marker of liver function in the management of HIV negative heroin users. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Although the co-burden of injection drug use and HIV is increasing in Africa, little is known about the laboratory markers of injection drug use and anti-retroviral treatment (ART) in Kenyan injection drug users. This study, therefore, aimed at determining the clinical chemistry profiles and identifying the key laboratory markers of HIV infection during ART in injection heroin users (IHUs). Methods Clinical chemistry measurements were performed on serum samples collected from HIV-1 infected ART-experienced (n = 22), naive (n = 16) and HIV-1 negative (n = 23) IHUs, and healthy controls (n = 15) from Mombasa, coastal Kenya. Results HIV uninfected IHUs had lower alanine aminotransferase (ALT) levels (P = 0.023) as ART-exposed IHUs exhibited lower albumin (P = 0.014) and higher AST to platelet index (APRI) (P < 0.0001). All IHUs presented with lower aspartate aminotransferase to ALT values (P = 0.001) and higher C-reactive protein (CRP) levels (P = 0.002). ART-naive IHUs had higher globulin levels (P = 0.013) while ART-experienced and naive IHUs had higher albumin to total protein (P < 0.0001) and albumin to globulin (P < 0.0001) values. In addition, CD4+ T cells correlated with ALT (ρ = −0.522, P = 0.011) and CRP (rho, ρ = 0.529, P = 0.011) in HIV negative and ART-experienced IHUs, respectively. HIV-1 viral load correlated with albumin to globulin index in ART-experienced (ρ = −0.468, P = 0.037) and naive (ρ = −0.554, P = 0.040) IHUs; and with albumin to total protein index (ρ = −0.554, P = 0.040) and globulin (ρ = 0.570, P = 0.033) in ART-naive IHUs. Conclusion Absolute ALT, albumin, globulin, and CRP measurements in combination with APRI, AST to ALT, albumin to total protein and albumin to globulin indices may be useful laboratory markers for screening IHUs for initiating and monitoring treatment.
    BMC Clinical Pathology 07/2014; 14(32):1-9. DOI:10.1186/1472-6890-14-32
  • [Show abstract] [Hide abstract]
    ABSTRACT: We investigated the association between actual and self-reported hepatitis C virus (HCV) status and alcohol consumption among injecting drug users (IDUs) to determine whether IDUs who self-report as HCV infected comply with UK guidelines on safe drinking and to determine risk factors for drinking. We conducted a repeat cross-sectional survey of IDUs accessing harm reduction services in Glasgow in 2005 and 2007. We measured self-reported weekly alcohol consumption, excess drinking (defined as exceeding the UK Royal College of Physician's guidelines for safe drinking of 14 units/week for women and 21 units/week for men) and HCV antibodies (anonymously in oral fluid). Among IDUs who tested HCV antibody positive, 65% drank alcohol and 29% drank to excess, compared to 61% (p=0.3) and 18% (p<0.001) of those who tested negative, respectively. IDUs who self-reported as HCV positive were less likely to drink but as likely to drink to excess as self-reported negatives or those with HCV status unknown, both among all IDUs and those who tested HCV antibody positive. Among the antibody positives, excess drinking was associated with incarceration (aOR=2.56; 95% CI: 1.28-5.12), homelessness within six months of interview (aOR=3.60; 95% CI: 2.00-6.48) and homelessness more than six months before interview (aOR=1.93; 95% CI: 1.06-3.53). IDUs who believe they are HCV infected are more likely to abstain from alcohol, but those who drink continue to do so to excess. IDUs diagnosed with HCV need greater support to reduce their alcohol consumption.
    Drug and alcohol dependence 11/2011; 123(1-3):180-9. DOI:10.1016/j.drugalcdep.2011.11.008 · 3.42 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Problem alcohol use is common among illicit drug users and is associated with adverse health outcomes. It is also an important factor in poor prognosis among drug users with hepatitis C virus (HCV) as it impacts on progression to hepatic cirrhosis or opiate overdose in opioid users. OBJECTIVES: To assess the effects of psychosocial interventions for problem alcohol use in illicit drug users (principally problem drug users of opiates and stimulants). SEARCH METHODS: We searched the Cochrane Drugs and Alcohol Group trials register (November 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 11, November 2011), PUBMED (1966 to 2011); EMBASE (1974 to 2011); CINAHL (1982 to 2011); PsycINFO (1872 to 2011) and reference list of articles. We also searched: 1) conference proceedings (online archives only) of the Society for the Study of Addiction (SSA), International Harm Reduction Association (IHRA), International Conference on Alcohol Harm Reduction (ICAHR), and American Association for the Treatment of Opioid Dependence (AATOD); 2) online registers of clinical trials, Current Controlled Trials (CCT), Clinical, Center Watch and International Clinical Trials Registry Platform (ICTRP). SELECTION CRITERIA: Randomised controlled trials comparing psychosocial interventions with another therapy (other psychosocial treatment, including non-pharmacological therapies or placebo) in adult (over the age of 18 years) illicit drug users with concurrent problem alcohol use. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed risk of bias and extracted data from included trials. MAIN RESULTS: Four studies, 594 participants, were included. Half of the trials were rated as having high or unclear risk of bias. They considered six different psychosocial interventions grouped into four comparisons: (1) cognitive-behavioural coping skills training versus 12-step facilitation (N = 41), (2) brief intervention versus treatment as usual (N = 110), (3) hepatitis health promotion versus motivational interviewing (N = 256), and (4) brief motivational intervention versus assessment-only group (N = 187). Differences between studies precluded any pooling of data. Findings are described for each trial individually:comparison 1: no significant difference; comparison 2: higher rates of decreased alcohol use at three months (risk ratio (RR) 0.32; 95% confidence interval (CI) 0.19 to 0.54) and nine months (RR 0.16; 95% CI 0.08 to 0.33) in the treatment as usual group; comparison 3 (group and individual format): no significant difference; comparison 4: more people reduced alcohol use (by seven or more days in the past 30 days at 6 months) in the brief motivational intervention compared to controls (RR 1.67; 95% CI 1.08 to 2.60). AUTHORS' CONCLUSIONS: Very little evidence exists that there is no difference in the effectiveness between different types of interventions and that brief interventions are not superior to assessment only or treatment as usual. No conclusion can be made because of the paucity of the data and the low quality of the retrieved studies.
    Cochrane database of systematic reviews (Online) 11/2012; 11(11):CD009269. DOI:10.1002/14651858.CD009269.pub2 · 6.03 Impact Factor
Show more