University of California, San Diego, Department of Medicine, La Jolla, CA, USA.
J Hepatol. 2011 Jul;55(1):45-52. doi: 10.1016/j.jhep.2010.10.028. Epub 2010 Nov 24.
BACKGROUND & AIMS: 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.
丙型肝炎病毒（HCV）筛查可通过劝阻饮酒为患者提供疾病进展的机会，但针对该问题的经验数据仍很缺乏。本研究旨在确定一种行为干预措施在减少年轻 HCV 感染的注射吸毒者（IDU）饮酒方面的效果，并评估肝酶变化与饮酒量变化之间的关系。
对干预组和对照组 IDU 均进行了避免饮酒的咨询，但干预组接受了强化咨询。采用逻辑回归、方差分析和连续时间马尔可夫模型来确定与饮酒相关的因素、ALT 和 AST 平均水平的变化以及干预后的饮酒变化。
干预后 6 个月，两组的戒酒率均增加了 22.7%，且干预组与对照组之间无差异。从饮酒转为戒酒与肝酶水平下降相关，且干预组的下降幅度更大（ALT：p=0.05；AST：p=0.06）。在多变量马尔可夫模型中，与非使用者相比，使用大麻的 IDU 从戒酒转为饮酒的速度更快（RR=3.11）；无家可归的 IDU 转为戒酒的速度较慢（RR=0.47）；曾经接受过肝脏疾病临床诊断的 IDU 转为戒酒的速度较快（RR=1.88）。
尽管针对 HCV 感染 IDU 减少饮酒的行为咨询具有一定效果，但饮酒量的减少与肝功能的显著改善相关。将减少 HCV 感染 IDU 饮酒的干预措施整合到临床护理和 HCV 感染监测中可能会从中受益。
