Management of Alcoholic Hepatitis in the Presence of Concomitant Hepatitis C Virus Infection: A Survey of Practising Gastroenterologists and Hepatologists

Abstract

Purpose: We found previously in a retrospective study of 76 patients with alcoholic hepatitis (AH) that those with concomitant hepatitis C virus (HCV) were treated for AH less often than those without HCV(28% vs. 57%; P=0.014, Hepatology; 50: 613A and Eur J Gastroenterol Hepatol 2011; 23: 204-9), perhaps reflecting absence of guidelines for treating such patients. To further understand current practice, we conducted survey of gastroenterologists (GE) and hepatologists (HP) regarding their current views on treating HCV +ve AH patients. Methods: A 16 item questionnaire was electronically mailed to GE and HP, with a reminder after 2 months. Accessing the secured web site and responding to the survey was considered informed consent, as approved by the Institutional Review Board. Participation was confidential and responses provided no identifiable information. Results: There were 416 responses to 1556 (response rate: 27%) validated emails. Respondents were 56% GE and 48% were ≤ 45 years of age. Sixty four % of respondents reported seeing >10 AH patients per year, 68% admitted >50% of AH patients, 78% admitted > 50% of these patients through the emergency room, only 14% reported a need for liver biopsy for diagnosis in >25% cases, and 57% reported HCV prevalence of >20% amongst their AH patients. Sixty nine % often treated AH patients, and 46% preferred corticosteroids (CS). Proportion of respondents with consensus on specific questions for management of HCV +ve AH patients were: 94% favored routine HCV testing of AH patients, 48% felt that HCV worsened patient outcome, 79 and 91% felt that HCV does not change response to CS or pentoxifylline respectively. Seventy five % felt that HCV should not change treatment for AH, but only 4% would choose CS. Logistic regression model showed that none of respondent variables: age (≤45 vs. >45 yrs), specialty (GE vs. HP), number of patients seen per year (≤30 vs. > 30 patients per year), and HCV prevalence (≤20 % vs. > 20%) could predict the respondent to be in consensus on 3 questions (where the consensus amongst respondent was <80%) on management of HCV +ve AH patients. On the contrary, a higher proportion of respondents were in consensus if they were seeing ≤30 patients per year compared to respondents seeing >30 patients per year [21% vs. 9%; Likelihood ratio chi-square 4.34; P=0.037]. Conclusion: Gastroenterologists and hepatologists believe that alcoholic hepatitis patients be routinely checked for HCV. However, there is little consensus on treatment, choice of drug, and outcome of HCV positive alcoholic hepatitis patients. Studies are needed as a basis for guidelines for management of AH patients with concomitant HCV.