SUMMARY: Higher coffee consumption was associated with greater likelihood of response to hepatitis C treatment, according to data reported at the recent American Association for the Study of Liver Diseases "Liver Meeting" (AASLD 2010) in Boston. In the HALT-C trial, which looked at prior non-responders with advanced liver disease, people who drank more coffee were more likely to achieve early and sustained virological response to pegyalted interferon plus ribavirin.

By Liz Highleyman

Previous research has shown that drinking more coffee is associated with better liver health and slower liver disease progress, but its relationship to hepatitis C virus (HCV) treatment response is not fully understood.

Neal Freedman from the National Cancer Institute and colleagues looked at the relationship between coffee consumption and treatment response in the HALT-C (Hepatitis C Antiviral Long-Term Treatment against Cirrhosis) trial, which was designed to show whether long-term pegylated interferon maintenance therapy would reduce the risk of liver disease progression in non-responders.

The researchers previously reported that coffee consumption was associated with slower disease progression in this trial. The same effect, however, was not seen for black or green tea.

The present analysis included 885 participants with HCV-related bridging fibrosis or cirrhosis (Ishak stage F3-F6) who did not achieve sustained response to prior antiviral therapy. In the HALT-C lead-in phase, they were treated with 180 mcg/week pegylated interferon alfa-2a (Pegasys) plus 1000-1200 mg/day weight-adjusted ribavirin; some participants using pegylated interferon alfa-2b (PegIntron) were later added. At week 24, non-responders were randomly assigned to either discontinue treatment or continue on low dose (90 mcg/week) pegylated interferon monotherapy.

At the start of the study, HALT-C participants completed food questionnaires and were asked to report their typical frequency and amount of coffee consumption over the past year, categorized as none (133 patients), < 1 cup per day (253 patients), 1 to < 3 cups per day (367 patients), or 3 or more cups per day (132 patients).

Results

	People who drank 3 or more cups of coffee per day experienced a significantly larger median decrease in HCV viral load from baseline to week 12, compared with those who drank none (3.7 vs 1.7 log, respectively).
	Highly significant trends were seen for proportions of patients with early virological response (EVR, at least a 2 log drop in HCV RNA at week 12 of treatment), 20 week virological response (undetectable HCV RNA at week 20), and sustained virological response (SVR, continued undetectable HCV RNA 24 weeks after completing therapy):
Daily coffee consumption (cups) None <1 1 to <3 3 or more EVR 45.7% 44.7% 57.1% 72.7% Week 20 VR 26.3% 28.9% 39.0% 52.3% SVR 11.3% 12.7% 20.7% 25.8%
	Effects were strongest for consumption of 3 or more cups of coffee per day.
	Coffee consumption at baseline was associated with a number of factors, associated with favorable response including white race, IL28B genotype, less cirrhosis, and ability to tolerate the maximum dose of pegylated interferon, as well as some unfavorable ones, including alcohol use and high baseline HCV RNA.
	However, in a multivariate analysis taking these and other factors into account, the effect of coffee was weaker but still significantly associated with EVR, week 20 response, and SVR.

Based on these findings, the researchers concluded, "Pre-treatment coffee intake was independently associated with improved virologic response during peginterferon alfa-2a and ribavirin in the HALT-C trial."

Investigator affiliations: Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD; New England Research Institutes, Watertown, MA; Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA; Office of the Director, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD; Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD.

12/3/10

Reference
ND Freedman, TM Curto, K Lindsay, and others. Coffee is associated with virologic response in chronic Hepatitis C (CHC): Findings from the Hepatitis C Long-Term Treatment against Cirrhosis Trial (HALT-C). 61st Annual Meeting of the American Association for the Study of Liver Diseases (AASLD 2010). Boston, October 29-November 2, 2010. Abstract 224.