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

Drumright, Lydia N.; Hagan, Holly; Thomas, David L.; Latka, Mary H.; Golub, Elizabeth T.; Garfein, Richard S.; Clapp, John D.; Campbell, Jennifer V.; Bonner, Sebastian; Kapadia, Farzana; Thiel, Thelma King; Strathdee, Steffanie A.

doi:10.1016/j.jhep.2010.10.028

« Previous Next »Journal of Hepatology
Volume 55, Issue 1 , Pages 45-52, July 2011

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

Lydia N. Drumright
- University of California, San Diego, Department of Medicine, Division of Global Public Health, La Jolla, CA, USA
- Present address: Centre for Infection Prevention and Management, Division of Infectious Diseases and Immunity, Department of Medicine, Imperial College London, London, United Kingdom.
Holly Hagan
- National Development and Research Institute, Center for Drug Use and HIV Research, New York, NY, USA
David L. Thomas
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA
Mary H. Latka
- Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY, USA
- Present address: The Aurum Institute, Johannesburg, South Africa.
Elizabeth T. Golub
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA
Richard S. Garfein
- University of California, San Diego, Department of Medicine, Division of Global Public Health, La Jolla, CA, USA
John D. Clapp
- Center for Alcohol and Drug Studies, School of Social Work, San Diego State University, San Diego, CA, USA
Jennifer V. Campbell
- Seattle-King County Department of Public Health, HIV/AIDS Prevention Program, Seattle, WA, USA
Sebastian Bonner
- Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY, USA
Farzana Kapadia
- Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY, USA
- Present address: New York University, Community Public Health Program New York, NY, USA.
Thelma King Thiel
- Hepatitis Foundation International, Silver Springs, MD, USA
Steffanie A. Strathdee
- University of California, San Diego, Department of Medicine, Division of Global Public Health, La Jolla, CA, USA
- Corresponding author. Address: University of California, San Diego School of Medicine, Institute of the Americas, 10111 N. Torrey Pines Rd., La Jolla, CA 92093-0507, USA. Tel.: +1 858 822 1952; fax: +1 858 534 7566.

Received 28 May 2010; received in revised form 6 October 2010; accepted 7 October 2010. published online 09 December 2010.

Clinical trials registration number: NCT00391482

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.

Methods

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.

Results

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).

Conclusions

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.

Abbreviations: HCV, hepatitis C virus, IDUs, injection drug users, ALT, alanine aminotransferase, AST, aspartate aminotransferase, US, United States, RNA, ribonucleic acid, STRIVE, Study to Reduce Intravenous Exposures, A-CASI, audio-computer assisted self interview, AUDIT, alcohol use disorders identification test, PCR, polmerase chain reaction, ANOVA, analysis of variance