Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Pathomechanisms of Alcohol-Induced Damage Dig Dis 2010;28:799–801 DOI: 10.1159/000324288 HCV, HBV and Alcohol – the Dionysos Study S. Bellentani   a F. Scaglioni   a S. Ciccia   a G. Bedogni   b C. Tiribelli   b   a  Centro Studi Fegato, Gastroenterologia, Distretto di Carpi, Azienda USL di Modena, Carpi, and b  Centro Studi Fegato e Dipartimento ACADEM, Università di Trieste, Trieste, Italy ed in secondary care populations, blood donors, or clinical series, and that ethanol intake 130 g/day is the most impor- tant and evitable risk factor for cirrhosis and death in pa- tients with chronic HCV or HBV infection. Copyright © 2011 S. Karger AG, Basel Alcohol is an established risk factor for liver cirrhosis and approximately 15% of alcohol-related global deaths in 2004 were due to liver cirrhosis [1]. However, some cru- cial points remain obscure such as to whether the rela- tionship between alcohol and liver cirrhosis has a dose- response or threshold pattern [2, 3]. Also, the role of sex, ethanol intake, fatty liver (FL) and non-organ-specific autoantibodies (NOSA) in the progression of hepatitis B virus (HBV)/hepatitis C virus (HCV) infection and of other chronic liver diseases (CLD) is incompletely under- stood. The available knowledge on the natural course of CLD is based mainly on studies performed on blood do- nors, military recruits, and secondary or tertiary care se- ries. Population-based studies on the natural history of CLD that consider co-morbidity factors, such as alcohol or metabolic diseases, are lacking. To address these ques- tions, we summarize here recent studies and the results of the Dionysos study [4, 5]. As reported in detail elsewhere [2, 4–6], the Dionysos study was performed in two towns of Northern Italy, started in 1992 with a follow-up in 2002, and allowed us Key Words Hepatitis C virus  Hepatitis B virus  Alcohol  Dionysos study Abstract Population-based studies on the natural history of chronic viral liver disease that consider co-morbidity factors, such as alcohol or metabolic diseases, are lacking. We report here the contribution of ethanol intake and non-organ-specific autoantibodies (NOSA) to the course of chronic viral disease in the Dionysos cohort. As reported elsewhere, the Dionysos study was performed in two towns of Northern Italy, started in 1992 with 10 years of follow-up in 2002, and allowed us to quantify the burden of chronic liver disease in Northern Italy. We followed 139 subjects with chronic hepatitis C virus (HCV) infection and 61 with chronic hepatitis B virus (HBV) infec- tion for a median (IQR) time of 8.4 (1.0) and 8.3 (0.9) years, respectively. The incidence and remission rates of steatosis were 9.0 and 29.7 per 1,000 person-years in the HCV cohort and 4.0 and 30.4 per 1,000 person-years in the HBV cohort. Progression to cirrhosis and hepatocarcinoma was more common in the HCV than in the HBV cohort. In the HCV co- hort, ethanol intake was an independent predictor of liver cirrhosis and of death rate in both cohorts. We found no as- sociation between baseline NOSA and 8.4-year mortality. We conclude that morbidity and mortality rate of HBV and HCV infection in the general population is lower than that report- Stefano Bellentani, MD, PhD Centro Studi Fegato, Azienda USL di Modena Poliambulatori Ospedale ‘Ramazzini’, P.le Donatori di Sangue, 3 IT–41012 Carpi/Modena (Italy) Tel. +39 320 665 8960, E-Mail liversb  @  unimore.it © 2011 S. Karger AG, Basel 0257–2753/10/0286–0799$38.00/0 Accessible online at: www.karger.com/ddi