COMMENTARY

Hepatitis C: Let's Get 'Real'

Digestive Disease Week (DDW) 2016

William F. Balistreri, MD

Disclosures

June 24, 2016

In This Article

Can We Improve Outcomes?

Enhanced case recognition is an important first step in improving global outcomes related to HCV. Choosing the optimal drug combination for each patient (see also HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C) and ensuring adherence to the recommended regimen are also important.

What about adjuvant therapies? A growing body of evidence suggests that caffeine might have hepatoprotective properties in a variety of hepatic parenchymal disorders, including nonalcoholic fatty liver disease (NAFLD) and HCV. Increased caffeine consumption has been associated with a decreased risk for liver enzyme elevation, cirrhosis, and HCC.[16]

Setiawan and colleagues[16] evaluated the protective effect of coffee drinking in black, Native Hawaiian, Japanese American, Latino, and white patients with chronic liver diseases. Regular coffee intake was associated with reduced risks for NAFLD-related progression in a dose-dependent manner. For example, compared with non–coffee drinkers, those who reported drinking two to three cups and four or more cups of coffee per day had a 14% and a 34% reduction, respectively, in the risk for NAFLD-related disease. High consumption (four or more cups per day of regular coffee) was associated with a reduced risk for HCV-related chronic liver disease.

Upala and colleagues[17] conducted a systematic review and meta-analysis and demonstrated that caffeine intake was significantly associated with a decreased risk for advanced hepatic fibrosis in patients with chronic hepatitis C.

It is unclear whether caffeine or another component of coffee is the responsible ameliorative agent. However, it is postulated that the presumed hepatoprotective effect may be due to the antioxidant properties of caffeine or to the reduced expression of CYP1A2, which correlates with fibrosis progression.[16,17]

Future studies might assess the optimal dose and preparation of caffeinated beverage for the prevention of hepatic fibrosis in patients with chronic hepatitis C.

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