Heavy alcohol use, gene variant heighten risk for HCC, mortality in HBV-related cirrhosis
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Patients with cirrhosis who have hepatitis B virus infection and a history of heavy alcohol use are at higher risk for hepatocellular carcinoma and mortality, according to a study published in JAMA Network Open.
As previously reported, heavy consumption of alcohol increases risk for HCC among patients with cirrhosis and HBV. Aldehyde dehydrogenase 2 gene (ALDH2) polymorphism also has been reported to play a role in HCC development, although study results have been mixed.
“However, the roles of heavy alcohol intake, ALDH2 rs671 polymorphism and HBV infection in the development of HCC and mortality remain uncertain and need to be explored,” Ming-Chao Tsai, MD, PhD, of the hepato-gastroenterology division at Kaohsiung Chang Gung Memorial Hospital in Taiwan, and colleagues wrote.
Tsai and colleagues retrospectively enrolled 1,515 patients (mean age, 49.5 years; 84.3% men) with cirrhosis from three tertiary hospitals in Taiwan — 342 with concomitant heavy alcoholism and HBV infection, 796 with only HBV infection and 377 with only heavy alcoholism — from January 2005 to December 2020. Heavy alcohol intake was defined as consuming more than 80 g of ethanol per day for 5 years or longer.
Researchers monitored participants for more than 6 months, through June 2021, and collected blood samples from 746 patients to analyze for ALDH2 rs671 polymorphism.
Newly developed HCC served as the primary endpoint and overall mortality as the secondary endpoint.
Tsai and colleagues reported that patients with concomitant HBV infection and alcoholism had higher 10-year cumulative incidences of HCC and mortality compared with patients with HBV infection or alcoholism alone. Researchers also noted that heavy alcohol intake and ALDH2 rs971 genotype in patients with HBV-related cirrhosis significantly increased the risk for HCC and mortality.
“Our results are consistent with those of previous studies, which demonstrated that the synergistic effect of viral hepatitis infection and heavy alcohol intake aggravated the progression of HCC and mortality,” Tsai and colleagues wrote. “It is important to closely follow-up and aggressively treat these patients with cirrhosis to decrease the incidence of HCC and mortality.”
They added, “To the best of our knowledge, our study is the first to report that heavy alcohol intake combined with ALDH2 rs671 polymorphism is significantly associated with the risk of HCC and mortality in patients with alcoholism and cirrhosis after a 10-year, long-term follow-up.”
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