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Heavy Alcohol Use Increases Liver Cancer Risk for People with Hepatitis B

Hepatitis B patients with liver cirrhosis who consumed large amounts of alcohol were more likely to develop hepatocellular carcinoma (HCC) than people who drank less, according to a report in the December 6, 2012, online edition of the Journal of Hepatology. However, antiviral treatment can help prevent liver cancer.

Over years or decades chronic hepatitis B virus (HBV) infection can lead to serious liver disease including cirrhosis (scarring) and HCC, a form of primary liver cancer. Other things that injure the liver, including exposure to toxins, also increase HCC risk, and together they may have an additive effect.

Chih-Wen Lin from Kaohsiung Medical University in Taiwan and colleagues looked at the impact of heavy alcohol consumption and HBV infection on HCC among people with cirrhosis.

The analysis included 966 cirrhotic patients in Taiwan, where HBV is endemic in the population. Within this group 132 were alcoholics with HBV infection, 632 had HBV but were not alcoholics, and 202 were alcoholics without HBV.

Heavy alcohol consumption was defined as more than 80 g daily for at least 5 years, based on self-report. Participants were enrolled during 2000-2009 and followed until 2011. The primary endpoint was development of new HCC.

Results

• Over 6 months of follow-up, people with both hepatitis B and alcoholism were most likely to develop liver cancer:

o   Alcoholic with HBV: 38 patients (28.8%);

o   HBV but not alcoholic: 100 patients (15.8%);

o   Alcoholic without HBV: 21 patients (10.4%).

• The risk of developing HCC was significantly higher among cirrhotic patients with HBV and alcoholism than among those with HBV alone or alcoholism alone:

o   Annual HCC incidence: 9.9%, 4.1%, and 2.1%, respectively;

o   10-year cumulative incidence: 52.8%, 39.8%, and 25.6%, respectively.

• In a multivariate analysis of participants with both HBV infection and alcoholism, other significant predictors of HCC were higher baseline HBV DNA viral load (odds ratio [OR] 16.8, or about 17 times higher risk) and higher serum alfa-fetoprotein (OR 1.18).
• Treatment withnucleoside/nucleotide analog antiviral drugs was protective against liver cancer (OR 0.01).

Based on these findings, the study authors concluded, "Heavy alcohol consumption significantly increased the risk of HCC in HBV-related cirrhotic patients."

"Elevated baseline serum HBV DNA was a strong risk predictor of HCC and antiviral [nucleoside/nucleotide analog] therapy reduced the incidence of HCC in cirrhotic patients with HBV infection and alcoholism," they added, recommending that, "Aggressive [nucleoside/nucleotide therapy]should be considered in alcoholic cirrhosis with detectable serum HBV DNA in order to reduce the incidence of HCC.”

1/24/13

Reference

C-W Lin, C-C Lin, L-R Mo, et al. Heavy alcohol consumption increases the incidence of hepatocellular carcinoma in hepatitis B virus-related cirrhosis. Journal of Hepatology S0168-8278(12)00916-6, December 6, 2012 (Epub ahead of print).