Journal Article Annotations
2017, 4th Quarter
Annotation by Aum A. Pathare, MD
Type of study: Retrospective population-based cohort study
The finding: Generally, the predictors of disease advancement in patients with HCV infection appear to be older age, coupled with more recent notification of HCV status, male gender, and co-infection with HBV/HIV. Alcohol use disorder contributes to increased rates of decompensated cirrhosis in patients with HCV infection, and liver disease progressing at a younger age.
Strength and weaknesses: The large sample size of this study, along with its inclusivity, are major strengths of this study. The general data collection spans more than 16 years, and age-standardized measures have been derived from at least 7 years of information. These findings, albeit from high income economies, show similar trends at all three sites of the study.
Weaknesses include definitions of decompensated cirrhosis, which were not validated with this diagnosis, and the determination of infection status being made with antibodies without RNA confirmation. There also appears to be potential for underestimation of alcohol use and overestimation of the impact of more severe forms of alcohol use disorder, whereas the effects of antiviral treatment were not evaluated.
Relevance: Psychosocial factors play a significant role in liver disease progression after HCV infection. Patients with HCV have an increased likelihood of problematic alcohol use, which could also limit the potential utility of antiviral medications, increase risk of decompensated cirrhosis, and mortality from liver disease, at a younger age. The benefits of screening, in cases with HCV infection/cirrhosis and its complications, with even a suspicion of alcohol use based on history, laboratory studies, or prior records, need to be considered. Consultation liaison psychiatrists in hospital, or integrated care settings, can lead and direct efforts for early detection and treatment.