Drinking 3 cups of coffee a day helps patients with hepatitis C respond to treatment, report Neal Freedman et al. in the June issue of Gastroenterology.
Coffee reduces risks of progression of liver diseases and risk for hepatocellular carcinoma, so Freedman et al. investigated whether it also had benefits for patients undergoing therapy for hepatitis C virus (HCV) infection.
The authors recorded coffee intake among 885 patients in the Hepatitis C Antiviral Long-Term Treatment Against Cirrhosis Trial who were being treated with peginterferon α-2a and ribavirin. They found that after 20 weeks of therapy, patients that drank 3 or more cups of coffee per day had half the level of HCV RNA of patients that did not drink coffee, and were about twice as likely to have early and sustained virologic responses. This response was independent of other risk factors, including a high tolerance to peginterferon treatment. No effect was observed for drinkers of black or green tea.Coffee contains more than 1000 different compounds—it is not clear which of these promote an antiviral response. The study did not compare effects of caffeinated and decaffeinated coffee or how the coffee was brewed. However, Freedman et al. do not think that coffee and its constituents have a direct antiviral effect, because they would have observed lower baseline levels of HCV RNA among coffee drinkers. The authors propose that coffee somehow improves response to the drugs peginterferon and ribavirin.
How could drinking coffee improve the efficacy of certain drugs? Response to peginterferon and ribavirin has been associated with polymorphisms in IL28 that affect the JAK-STAT signaling pathway; this pathway is also activated by kahweol, a diterpene in coffee. Coffee might facilitate this signal transduction mechanism in patients that take these drugs. Furthermore, high serum levels of total and low-density lipoprotein (LDL) cholesterol have been associated with response to peginterferon and ribavirin. Freedman et al. and other groups found that coffee drinkers have higher serum levels of cholesterol, which could improve drug response.
Freedman et al. state that more studies are needed to resolve these mechanisms and determine if coffee intake affects response to other antiviral agents or patients with other stages or types of liver diseases.
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Freedman ND, Curto TM, Lindsay KL, et al. Coffee consumption is associated with response to peginterferon and ribavirin therapy in patients with chronic hepatitis C. Gastroenterology 2011;140:1961–1969.
Read a related Clinical Gastroenterology and Hepatology article.
Yasui K, Hashimoto E, Komorizono Y, et al. Characteristics of patients with nonalcoholic steatohepatitis who develop hepatocellular carcinoma. Clin Gastroenterol and Hepatol 2011;9:428–433.