Peginterferon and ribavirin for hepatitis C (letter)

To the Editor: In their review of peginterferon and ribavirin for the treatment of hepatitis C, Hoofnagle and Seeff (Dec. 7 issue) do not include data on the association between the consumption of alcohol and both treatment response and disease progression. Level-one evidence of the deleterious effects of alcohol on hepatitis C virus (HCV) RNA levels, on the response to treatment, and on disease progression led the National Institutes of Health and the American Gastroenterological Association to issue position statements advising that "abstinence should be recommended before and during antiviral treatment ... [since] even moderate alcohol consumption can have a deleterious effect on the progression of liver disease in patients with chronic hepatitis C." Alcohol consumption may explain the marked dichotomy in progression rates that cannot be explained by the HCV genotype. Knowledge of alcohol's effects on disease progression should provide reassurance to patients who want to alter the outcome of their disease, particularly since data for nondrinkers show a more benign course than the authors suggest. At a population level, targeting alcohol consumption may effectively reduce the excess deaths the authors anticipate.