CHRONIC hepatitis B virus (HBV) infection poses a major global health challenge, with an estimated 296 million individuals affected worldwide. Despite widespread vaccination programmes and strategies to prevent mother-to-child transmission, HBV remains a leading cause of liver disease, accounting for 30% of cirrhosis cases and 45% of hepatocellular carcinoma (HCC) cases globally. In 2016, the World Health Organization set ambitious targets to reduce new HBV infections by 95% and related mortality by 65% by 2030.
HBV significantly increases the risk of cirrhosis and HCC, with 25% of childhood infections progressing to HCC in adulthood without intervention. Alcohol consumption exacerbates these risks, promoting HBV replication and weakening immunity. Approximately 30% of HCC cases globally are linked to alcohol, which also accelerates the progression of liver disease in those with viral hepatitis. However, the quantitative dose-dependent impact of alcohol on HBV-related cirrhosis and HCC has remained unclear.
A recent meta-analysis provided critical insights, establishing that alcohol consumption increases the risk of cirrhosis and HCC in a dose-dependent manner in patients with HBV. For every 12 g of alcohol consumed daily, the risk of cirrhosis rises by 6.2%, and HCC by 11.5%. These findings underscore the importance of monitoring and managing alcohol intake in HBV-infected individuals. High-level drinkers are particularly vulnerable, highlighting the necessity of tailored interventions for this group.
Alcohol-related oxidative stress likely drives these outcomes through pathways such as nuclear factor kappa B activation, which contributes to liver injury. While abstinence can reduce HCC risk in alcohol-related diseases, its role in HBV patients warrants further exploration.
Despite the robust findings, significant heterogeneity across studies limits the precision of dose-dependent models. Issues such as underreporting of alcohol consumption and lack of data on adolescent drinking, abstinence periods, and chronicity of alcohol use highlight the need for comprehensive future research. Public health efforts should focus on reducing alcohol consumption, improving early HBV management, and addressing modifiable risk factors to prevent severe liver disease outcomes.
Katie Wright, EMJ
Reference
Wu YP et al. Dose-dependent relationship between alcohol consumption and the risks of hepatitis B virus-associated cirrhosis and hepatocellular carcinoma: a meta-analysis and systematic review. J Clin Transl Hepatol. 2024;DOI:10.14218/JCTH.2024.00379.
