The suggestions by Drs Giannini and Testa are interesting. Our study shows that smoking and drinking alcohol are independently associated with elevated ALT levels among anti-HCV–positive individuals, and we strongly suggest that to reduce the possible risk of aggravating liver dysfunction, anti-HCV–positive patients should not smoke or drink alcohol.1 Cigarette smoking is related not only to elevated ALT levels, but also to increased severity of hepatic fibrosis in anti-HCV–positive patients.2 Treatment for chronic hepatitis C is recommended for patients with persistently elevated ALT levels, but there is no rationale for treating anti-HCV–positive patients with normal ALT levels. It is therefore plausible to suggest to anti-HCV–positive subjects that they abstain from smoking, especially those with elevated ALT levels and those who seek anti-HCV treatment.
Wang C, Wang S, Chang T, Yao W, Chou P. Can Changing Counseling Strategy Change the Picture of the Chronic Hepatitis C Patient Population?—Reply. Arch Intern Med. 2002;162(21):2497. doi: