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Implications for Prevention of Hepatitis C Virus Progression

Chong-Shan Wang, MD, MPH; Shan-Tair Wang, PhD; Ting-Tsung Chang, MD; Wei-Jen Yao, MD; Pesus Chou, DrPH

Arch Intern Med. 2002;162:811-815.

Background  Alcohol consumption is a well-known risk factor for elevated ALT levels, but the role of cigarette smoking is unclear.

Methods  We collected a cross-sectional sample of 6095 inhabitants 35 years or older in a community with hyperendemic hepatitis B and C virus infections. We assayed levels of serum alanine aminotransferase (ALT), hepatitis B surface antigen (HBsAg), and anti–hepatitis C virus antibody (anti-HCV). Multivariate logistic regression was performed to determine the factors for elevated ALT levels (40 U/L) among people with different hepatitis infection statuses.

Results  Prevalence of elevated ALT levels in individuals who were seronegative for both infections or seropositive for HBsAg or anti-HCV was 3.9%, 11.1%, and 30.8%, respectively. Subjects with elevated ALT levels were more likely to be seropositive for anti-HCV, male, and seropositive for HBsAg; to drink alcohol; to smoke; and to have undergone blood transfusion (P<.05). An association was found between elevated ALT levels and the consumption of cigarettes and alcohol among anti-HCV–seropositive subjects. In multivariate logistic analyses, alcohol consumption (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.2-4.1) and smoking (OR, 1.8; 95% CI, 1.1-2.7) were significantly associated with elevated ALT levels among anti-HCV–seropositive subjects, but no such association was found among HBsAg-seropositive subjects. The odds of elevated ALT levels were 7 times higher (95% CI, 2.7-18.8) for the anti-HCV–seropositive patients who smoked 1 or more packs of cigarettes per day and frequently drank alcohol than for those who did not.

Conclusions  Smoking and alcohol consumption are independently associated with elevated ALT levels among anti-HCV–seropositive individuals but not among HBsAg-seropositive individuals. Patients who are seropositive for anti-HCV are strongly advised not to smoke and drink alcohol to reduce the possible risk for aggravating the liver dysfunction.

From the A-Lein Community Health Center, Kaohsiung County, Taiwan (Dr C.-S. Wang); the Institute of Public Health, Department of Medicine, Colleges of Medicine (Drs C.-T. Wang and S.-T. Wang), the Institute of Public Health, Division of Gastroenterology, Department of Internal Medicine (Dr Chang), and the Department of Nuclear Medicine, College of Medicine (Dr Yao), National Cheng Kung University, Tainan, Taiwan; and the Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan (Dr Chou).

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