Hepatitis C virus (HCV) is spontaneously cleared in 15%to 45%of individuals during primary infection. To define the role of alcohol, race, and HBV or HIV co infections in natural HCV clearance, we examined these parameters in 203 spontan eously HCV-recovered subjects (HCV Ab+/RNA-subjects without prior antiviral t herapy) and 293 chronically HCV-infected patients (HCV Ab+/RNA+). Subjects we re identified from 1,454 HCV antibody-seropositive US veterans tested for HCV R NA between January 2000 and July 2002 at the Philadelphia Veterans Affairs Medic al Center. In univariate analysis, alcohol use disorder (odds ratio > 0.52; 9 5%CI, 0.31-0.85; P = .006) and black race (OR 0.65;95%CI, 0.44-0.96;P = .024 ) were both associated with decreased likelihood of spontaneous HCV clearance. I n multivariate analyses adjusting for race, HIV infection, age, and alcohol use disorder, alcohol remained strongly associatedwith reduced HCV clearance (OR0.49 ;95%CI, 0.30-0.81; P = .005). In contrast, the association between black race and viral clearance was no longer statistically significant (adjusted OR 0.72; 9 5%CI, 0.48-1.09; P = .125). HIV coinfection was negatively associated with HCV clearance (OR 0.37; 95%CI, 0.16-0.83; P = .016), while HBV coinfection was po sitively associated with HCV clearance (unadjusted OR 5.0; 95%CI, 1.26-28.6; P = .008). In conclusion, the likelihood of spontaneous clearance of HCV may be i nfluenced by alcohol and viral coinfections.
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