Alcoholic liver cirrhosis after the advent of hepatitis C virus: some reflections on its epidemiology and on the concept of attributable risk. Collaborative GESIA and AISF Groups. Gruppo Epidemiologico della Società Italiana di Alcologia and Associazione Italiana per lo Studio del Fegato

The recent availability of hepatitis C virus (HCV) infection markers has led to the hypothesis that the prevalence of alcoholic liver cirrhosis (ALC) may be far lower than has hitherto been believed. On the other hand difficulties in obtaining a reliable patient history of alcohol consumption and of making a differential diagnosis on the basis of histology suggest that the aetiology role of alcohol may be underestimated. Furthermore, epidemiological data strongly suggest that an individual susceptibility of alcoholic liver damage exists. The interaction between alcohol consumption and acquired factors, in particular hepatitis B and C viruses and nutrition, can be studied using an epidemiological approach. The concept of attributable risk, which depends on the strength of the aetiological factors and on their diffusion in the target population, is helpful in this context. Preliminary estimates suggest that alcohol is at least as important as HCV infection in causing liver cirrhosis in Italy. A nationwide study (SIDE-CIR Project) is currently being conducted in order to clarify this issue