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Smoking Cessation Needed for Hep C Population

April 4, 2018

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Smoking cigarettes is an addiction that is notoriously hard to conquer, but for those with Hepatitis C, quitting may actually be more beneficial than successful Hepatitis C treatment.

The habits we engage in have a direct impact on our bodies. Although seemingly obvious, many of us engage in unhealthy habits. Known to increase the risk of heart disease, stroke, and cancer – cigarette smoking typically tops the list of unhealthy habits.

Data from the National Health and Nutrition Examination Survey

Reasons for developing a smoking habit can vary widely. Once started, this addiction is one of the hardest to quit. Analysts are not sure why such a high percentage of people with Hepatitis C smoke cigarettes. In data extracted from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2014, those with Hepatitis C smoked approximately three times more than those without Hepatitis C.

The NHANES survey tallied statistics of over 40,000 people and found the following associations:

  • Smokers with Hepatitis C tended to be older than smokers without Hepatitis C.
  • Smokers with Hepatitis C tended to have less education than smokers without Hepatitis C.
  • Smokers with Hepatitis C were less likely to have health insurance than smokers without Hepatitis C.
  • Smokers with Hepatitis C were more likely to be have an income below the federal poverty level than smokers without Hepatitis C.
  • Smokers with Hepatitis C were more likely to use cocaine and heroin than smokers without Hepatitis C.
  • Smokers with Hepatitis C were more likely to be depressed than smokers without Hepatitis C.

According to this study’s authors, “There is a cigarette smoking epidemic embedded within the Hepatitis C epidemic in the U.S.” Smoking contributes to the risk for heart disease, liver fibrosis, stroke, and cancer. Hepatitis C increases the risk for cardiovascular disease, liver fibrosis, and cancers of the liver, head, neck, lung, pancreas, kidney, and anorectum. As published in the American Journal of Medicine, the authors are concerned, saying: “There is some evidence that these risks may be addictive. Smoking increases the risk of developing liver cancer in people with Hepatitis C.”

The new medications (direct-acting antivirals, or DAA) used to treat Hepatitis C are very effective at eliminating the virus from the bloodstream. Successful Hepatitis C treatment is defined as sustained virologic response, (SVR), meaning that no virus was detected in the blood six months after the treatment’s conclusion. However, achieving SVR might not solve every health problem. A 2017 Cochrane review suggested that DAA treatment might not improve morbidity and mortality in those with Hepatitis C who have attained SVR.

This issue has been encountered in people with HIV. Highly active antiretroviral therapy dramatically changed the prognosis of HIV by decreasing HIV-related deaths. However, highly active antiretroviral therapy was accompanied by an increase in deaths from non-HIV-related causes. Experts believe the increase in deaths not related to HIV in this population is partly because of the high prevalence of HIV smokers. Translating this scenario to a different disease doesn’t bode well for those with Hepatitis C. The prevalence of smokers with Hepatitis C (up to 67 percent) is even higher than smokers with HIV. The primary concern is that the reduction in Hepatitis C-related morbidity and mortality will be offset by tobacco-related morbidity and mortality in smokers with Hepatitis C.

With the information available, it is easy to see the quandary our medical system faces when approaching Hepatitis C prognosis and wellness. The authors of the study described above insinuate that the tens of billions of dollars spent each year on DAAs for eliminating the Hepatitis C virus is downright silly, because more than 60 percent of people with Hepatitis C have an addiction considerably more lethal than Hepatitis C – that is being ignored.

Quitting smoking has been described as a harder feat than ending heroin addiction. Thus, helping people end their cigarette habit is no simple task. Assisting the Hepatitis C population who are most likely to smoke, to quit smoking, could help DAAs actually lower morbidity and mortality rates. That combination holds the potential to be the biggest lifesaver of all.

http://www.aidsmap.com/Smoking-threatens-health-gains-from-hepatitis-C-treatment-US-researchers-warn/page/3217879/, Smoking threatens health gains from hepatitis C treatment, US researchers warn, Keith Alcorn, Retrieved April 1, 2018, NAM Publications, 2018.

https://www.hepmag.com/article/unaddressed-smoking-epidemic-among-people-hep-c?utm_source=phplist644&utm_medium=email&utm_content=HTML&utm_campaign=Preventing+Fatty+Liver+in+Those+With+Hep+C, There Is an Unaddressed Smoking Epidemic Among People With Hep C, Benjamin Ryan, Retrieved April 1, 2018, Smart + Strong, 2018.

https://www.ncbi.nlm.nih.gov/pubmed/29408018, Cigarette Smoking in Persons Living with Hepatitis C: The National Health and Nutrition Examination Survey (NHANES), 1999-2014, Kim RS, et al, Retrieved April 1, 2018, The American Journal of Medicine, January 2018.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32460-1/fulltext, Extending survival for people with hepatitis C using tobacco dependence treatment, C. Gartner, et al, Retrieved April 1, 2018, The Lancet, November 2017.

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