Higher Hepatic Fibrosis in Chronic Hepatitis B Patients Consuming Locally Brewed Alcohol in North-Central Nigeria

Abstract

Background: Alcohol is a common cause of liver fibrosis and liver failure globally. In Nigeria, many types of alcohol are consumed, including locally brewed and industrially brewed beer and spirits. The common locally brewed alcohol here includes “Burukutu,” “Pito,” “Palm wine,” and “Goskolo.” These local alcoholic drinks impact hepatic fibrosis. Methodology and Objective: His study was carried out on one hundred and thirty-six (136) treatment-naive patients in North Central Nigeria with Chronic Hepatitis B virus-infected (CHBVI) who also consumed locally brewed alcohol. The aim was to determine the effect of various types of alcohol on the degree of liver fibrosis. An interviewer-administered questionnaire was used to obtain biodata and the type of alcohol consumed. Additionally, we also determined the ethanol content of the locally brewed alcohol in North-central Nigeria using Refractometry. Fibroscan was done on all participants after at least 3 hours of fasting, and blood samples for laboratory tests were also drawn. Results: The mean age of participants was 40.8 ± 11.0 years. Seventy-six percent were males, 23% of them also smoked cigarettes. The percentage of Ethanol content in the local brews was 8.7 %, 9.5%, 10.8%, and 30.5% for‘Burukutu’, ‘Palm wine’, ‘Pito’, and ‘Goskolo’. The median HBV DNA (viral load) was 155.0 IU/ml (IQR: 10.0; 12505.3), with the majority (66.2 %) having low viremia (less than 2,000.0 IU). The HBV DNA in the group of patients who do not consume alcohol was even higher (779 IU/ml (IQR: 15.0;7300.0)) and was not significantly different from the group with alcohol consumption, P= 0.794. This shows that the deference in fibrosis is not due to Hepatitis B viraemia. Those who consumed industrially brewed alcohol had a lower level of fibrosis compared to those who consumed locally brewed alcohol (mild fibrosis {TE score of 2.5 to 6.9 kpa} was noticed in 45.9% of those who consumed on industrial alcohol versus 11.1 % in those who consumed both industrial and locally brewed). On the other hand, 29.7% of those who consumed industrial brewed alcohol compared to 66.7% of those who consumed locally brewed had cirrhosis {Transient Elastography (TE) score of 12.5 to 75.0kPa}. 72.7% of participants who consumed both industrial and locally brewed alcohol had liver cirhossis and higher fibrosis scores compared to the 29.7% who consumed only the industrial brew. P-value= 0.004 Conclusion: In treatment-naïve patients with chronic hepatitis B infection, consumption of locally brewed alcohol alone or in combination with industrial brewed alcohol is associated with much higher degrees of liver fibrosis.