Failure to observe a relationship between alcohol consumption GSK-3 inhibitor and advanced fibrosis may reflect the fact that these factors are likely to have influenced entry into HCV treatment. Patients with advanced fibrosis would have been encouraged

to seek treatment, whereas heavy drinkers may have been unwilling or too ill to commit to treatment. Integrated care and aggressive follow-up by phone and in the clinic may have contributed to the high treatment completion rates and SVR achieved in this cohort, but adherence may also have been, in part, the result of the patients’ stable life circumstances and support of the family. In addition to stable insurance coverage, over 60% were married and 80% were either employed or retired. We did not assess the prevalence or severity of alcohol dependence BMN 673 chemical structure in this study, but it seems likely that both are lower in privately insured cohorts with high marriage and employment rates than among the inner-city clinic patients and veterans studied by Chang et al.17 and Anand et al.,9 respectively. Socioeconomic stability and less-severe alcohol dependence may have contributed, in part, to the rapid drop in regular drinking

observed in response to HCV diagnosis and the further decrease once HCV treatment was initiated. We do not believe that these findings were obtained because our cohort was unique. An increasing percentage of the U.S. population is enrolled in integrated health care plans. Except for extremes of income, membership of the Kaiser Sacramento Health Care Plan is representative of the total area’s population,19 and demographics of the Sacramento area are similar to those for the United States as a whole. This is

important, because, although HCV+ rates are relatively low among individuals who are privately insured or on Medicare, this is such a large population that it accounts for 46% of the HCV+ patients in the U.S. household population (Third National Health and Nutrition Survey, National Center for Health Statistics, 1994, unpublished data). Our finding that failure to abstain for find more 6 months before HCV treatment was related to significantly higher risk of treatment failure in moderate, but not heavy, drinkers was also unexpected. This finding is counterintuitive and is based on a relatively small sample. Therefore, it needs to be replicated in a larger sample to determine whether or not it may have occurred by chance. Meanwhile, the fact that pretreatment abstinence was not associated with treatment outcome in the cohort as a whole suggests that requiring 6 months of abstinence before treatment is less critical to outcome than ensuring that patients are committed to treatment and providing close monitoring and ancillary care.