In this study, a research team from France examined the association between smoking and histological liver lesions in chronic hepatitis C.
The team studied 244 consecutive patients (152 men, 92 women; mean age 45.9 years) with histologically proven chronic hepatitis C.
They recorded daily tobacco consumption (number of cigarettes smoked daily) during the 6 months preceding liver biopsy.
While lifetime tobacco consumption was recorded as the number of cigarette packs smoked per year.
In addition, the researchers graded liver biopsy specimens for histological activity and fibrosis using the METAVIR scoring system.
The research team found that the proportion of patients with moderate (A2) or marked (A3) activity increased gradually from 62% in non-smokers, to 82% in patients who smoked more than 15 cigarettes per day.
Furthermore, a similar relationship was observed for total lifetime tobacco consumption.
|Patients with moderate to marked histological activity:|
- Non-smokers = 62%
- Smokers = 82%
The team found that 59% of patients who had never smoked had grade A2 or A3 disease activity, compared with 85% of patients who smoked more than 20 packs per year.
Multivariate analysis showed that age over 50 years (odds ratio (OR) 5.4), alcohol intake exceeding 20 g/day (OR 2.75), and tobacco consumption of more than 15 cigarettes/day (OR 3.6) were independently related to the histological activity score.
The researchers found no relationship between the severity of fibrosis, and either daily tobacco consumption, or total lifetime tobacco consumption.
Multivariate analysis showed that only age over 50 years (OR 8.8), daily alcohol intake exceeding 30 g/day (OR 3.4), and histological activity score (OR 7.9) were independently related to the fibrosis score.
Dr Hézode's team concluded, "This study suggests that smoking, independent of alcohol, could aggravate the histological activity of chronic hepatitis C".
"Patients with chronic hepatitis C virus infection should be advised to reduce or stop smoking."