Coffee Consumption is Associated with Response to Peginterferon and Ribavirin Therapy in Patients with Chronic Hepatitis C

Neal D. Freedman; Teresa M. Curto; Karen L. Lindsay; Elizabeth C. Wright,; Rashmi Sinha; James E. Everhart

Disclosures

Gastroenterology. 2011;140(7):1961-1969. 

In This Article

Abstract and Introduction

Abstract

BACKGROUND & AIMS: High-level coffee consumption has been associated with reduced progression of pre-existing liver diseases and lower risk of hepatocellular carcinoma. However, its relationship with therapy for hepatitis C virus infection has not been evaluated.
METHODS: Patients (n = 885) from the lead-in phase of the Hepatitis C Antiviral Long-Term Treatment Against Cirrhosis Trial recorded coffee intake before retreatment with peginterferon α-2a (180 μg/wk) and ribavirin (1000–1200 mg/day). We assessed patients for early virologic response (2 log10 reduction in level of hepatitis C virus RNA at week 12; n = 466), and undetectable hepatitis C virus RNA at weeks 20 (n = 320), 48 (end of treatment, n = 284), and 72 (sustained virologic response; n = 157). RESULTS: Median log10 drop from baseline to week 20 was 2.0 (interquartile range [IQR], 0.6 –3.9) among nondrinkers and 4.0 (IQR, 2.1– 4.7) among patients that drank 3 or more cups/day of coffee (P trend <.0001). After adjustment for age, race/ethnicity, sex, alcohol, cirrhosis, ratio of aspartate aminotransferase to alanine aminotransferase, the IL28B polymorphism rs12979860, dose reduction of peginterferon, and other covariates, odds ratios for drinking 3 or more cups/day vs nondrinking were 2.0 (95% confidence interval [CI]: 1.1–3.6; P trend = .004) for early virologic response, 2.1 (95% CI: 1.1–3.9; P trend = .005) for week 20 virologic response, 2.4 (95% CI: 1.3–4.6; P trend = .001) for end of treatment, and 1.8 (95% CI: 0.8 –3.9; P trend = .034) for sustained virologic response. CONCLUSIONS: Highlevel consumption of coffee (more than 3 cups per day) is an independent predictor of improved virologic response to peginterferon plus ribavirin in patients with hepatitis C.

Introduction

Approximately, 70%–80% of individuals exposed to hepatitis C virus (HCV) become chronically infected.[1] Worldwide these individuals are estimated to number between 130 and 170 million.[2] Treatment with peginterferon and ribavirin resolves chronic hepatitis C in about half of patients.[3,4] However, those who fail or are unable to tolerate treatment have few current treatment options.

A number of factors affect response to therapy,[5] including African-American race,[6–8] presence of cirrhosis,[8] baseline aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio,[8] baseline serum HCV level,[8] insulin resistance,[9,10] particular single nucleotide polymorphisms, including rs12979860 or rs8099917 near IL28B,[11–15] genotype 1 of HCV,[8,16,17] and patients' ability to tolerate full doses of peginterferon during treatment.[18]

Coffee drinking has been associated with several aspects of liver health, including concentrations of the liver enzymes ALT, AST, and γ-glutamyltransferase,[19–24] progression of pre-existing liver disease,[25] and hepatocellular carcinoma.[26,27] It is not known whether coffee affects spontaneous HCV clearance or, among chronically infected individuals, patients' response to HCV therapy.[28]

Therefore, we investigated the association between coffee intake and virologic response to peginterferon plus ribavirin treatment in the lead-in phase of the Hepatitis C Antiviral Long-Term Treatment against Cirrhosis (HALT-C) Trial of patients with baseline fibrosis or cirrhosis who had failed previous interferon therapy.[29]

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