Women With Chronic Hepatitis C Virus Infection

Recommendations for Clinical Practice

Mary Jane Burton, MD; James B. Brock, MD; Stephen A. Geraci, MD

Disclosures

South Med J. 2013;106(7):422-426. 

In This Article

Modifiable Risks for Progression of Liver Disease

Excessive alcohol intake accelerates the progression to HCV-related cirrhosis. Studies demonstrate consumption of >30 g/day increases the risk for cirrhosis in hepatitis C threefold.[27] Current guidelines stress the importance of abstinence from alcohol for all patients with HCV.[28] Accumulating evidence suggests that women infected with HCV are more vulnerable than their male counterparts to the effects of alcohol.[20] A prospective study illustrated that women who consumed >20 g/day doubled their risk for increased fibrosis, whereas men required >30 g/day to reach a similar risk increment.[29] Healthcare providers should encourage women with chronic HCV to abstain from alcohol or, alternatively, to limit intake to an equivalent of 12 g/day of ethanol.

Increased body mass index (BMI) also appears to accelerate disease progression, regardless of sex. Multiple studies have illustrated an increased risk for progression of liver disease in patients who are overweight (BMI ≥ 25 kg/m2) or obese (BMI ≥ 30 kg/m2).[30–32] In a small prospective study of patients with chronic hepatitis C, a mean body weight reduction of 5.9 (±3) kg resulted in lower alanine aminotransferase levels and reduced levels of fibrosis on liver biopsy;[33] thus, even modest weight loss may reduce the risk of the progression of liver disease.

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