From the Guidelines
Chronic hepatitis C infection is not an absolute contraindication for steroid treatment in alcoholic hepatitis, but it requires careful consideration. According to the most recent and highest quality study 1, corticosteroids (typically prednisolone 40mg daily for 28 days) can still be used in patients with concurrent hepatitis C when treating severe alcoholic hepatitis, especially in those with discriminant function >32 or MELD score >20. However, steroids should be used cautiously as they may potentially accelerate HCV viral replication and worsen the long-term outcome of the hepatitis C infection.
Key Considerations
- Before initiating steroid therapy, it's advisable to document the patient's hepatitis C viral load and liver function tests as baseline measurements 1.
- Close monitoring of liver function during treatment is essential 1.
- In some cases, hepatology consultation may be beneficial to weigh the immediate benefits of treating severe alcoholic hepatitis against the potential risks to the hepatitis C disease course.
- The development of direct-acting antivirals for hepatitis C has changed this risk-benefit calculation somewhat, as effective HCV treatment can be initiated after the patient recovers from alcoholic hepatitis, potentially mitigating long-term concerns about HCV progression 1.
Treatment Approach
- Corticosteroid therapy (prednisolone 40 mg/day or methylprednisolone 32 mg/day) is recommended in patients with a severe form of alcoholic hepatitis 1.
- Patients with a contraindication to glucocorticoids may be treated with alternative therapies, but the effectiveness of these treatments is still a subject of controversy 1.
- Abstinence from alcohol is the cornerstone of treatment for alcoholic hepatitis, and all patients should be advised to abstain from alcohol use 1.
Monitoring and Follow-up
- Patients with severe alcoholic hepatitis should be closely monitored for signs of liver dysfunction and other complications 1.
- Regular follow-up appointments should be scheduled to assess the patient's response to treatment and adjust the treatment plan as needed 1.
From the Research
Chronic Hepatitis C Infection and Corticosteroids in Alcoholic Hepatitis
- There is no direct evidence in the provided studies to suggest that chronic hepatitis C (HCV) infection is a contraindication for corticosteroids (steroids) in the treatment of alcoholic hepatitis.
- The studies focus on the treatment of severe alcoholic hepatitis with corticosteroids and pentoxifylline, and their effectiveness in reducing mortality 2, 3, 4, 5, 6.
- Corticosteroids are recommended as the first-line treatment for severe alcoholic hepatitis, but their use may be contraindicated in patients with coexistent sepsis, gastrointestinal bleeding, and acute pancreatitis 2.
- The use of corticosteroids in patients with severe alcoholic hepatitis may increase the risk of fungal infections, but does not increase the occurrence of or mortality from bacterial infections 4.
- Pentoxifylline is an alternative treatment option for severe alcoholic hepatitis, and may be considered in patients who are not responsive to corticosteroids or have contraindications to their use 3, 5, 6.