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We read with great interest the article by Wang et al¹ regarding the effects of smoking on the biochemical picture of patients with hepatitis C virus (HCV) infection and its implications for preventing disease progression. In their study, Wang and colleagues clearly showed that smoking in anti-HCV–positive subjects is independently associated with elevated alanine aminotransferase (ALT) levels.

Recently, a European study demonstrated that smoking is definitely associated with more severe hepatic lesions in patients with HCV-related chronic hepatitis.² Therefore, the message that emerges from these studies is that clinicians should inform patients with chronic HCV infection about tobacco hepatotoxicity and advise them to stop smoking. Although further studies are needed to evaluate whether tobacco smoking can be independently associated with poorer response to antiviral therapy, this implication is nevertheless going to lengthen the list of "don'ts" for patients with chronic HCV infection. It is well established that patients chronically infected . . . [Full Text of this Article]

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