There is no question that alcohol should be off limits for those with HCV. Studies have shown that patients who drink have a higher incidence of cirrhosis. But not only that, patients who drink also have a faster rate of progression to cirrhosis and higher mortality rates. As well, because alcohol interferes with the effect of interferon, those with a history of drinking problems may be denied treatment.
EFFECT OF ALCOHOL ON HCV REPLICATION: A critical question is whether or not alcohol and hepatitis C infection are synergistic in a combined liver injury. In some patients, there are both histologic features of alcoholic liver injury and chronic viral hepatitis, but in most studies the predominant pattern is chronic hepatitis.
Alcohol may enhance the replication of hepatitis C and produce a more severe injury independent of the direct alcohol-induced toxic injury. There is a correlation between HCV RNA levels and amount of alcohol consumed. Alcoholic patients with HCV infection have higher hepatic iron concentrations, which may be germane to increased HCV replication. Clinical evidence of hepatic activity and viral levels is significantly greater in those consuming greater than 10g of alcohol per day.
EFFECT OF ALCOHOL ON PROGRESSION OF CHRONIC VIRAL C HEPATITIS TO CIRRHOSIS AND HEPATOCELLULAR CARCINOMA : There is a more rapid development of cirrhosis and hepatocellular carcinoma in the alcoholic with chronic HCV infection. The period from transfusion to the diagnosis of cirrhosis is shorter in the heavy drinker. As well, recent studies demonstrate that alcohol consumption in cirrhotics can lead to increased bacterial infection (American Journal of Gastroenterology, Editorial, May 2000, Volume 95, Number 5, Pages 1124-1125).
The risk for the development of hepatocellular carcinoma in alcoholic cirrhotics is 8.3 times higher in the HCV(+) patients than HCV(-) patients, and the prevalence of anti-HCV among alcoholics with HCC is 50-70 percent. Therefore, alcohol may modify the replication of HCV as well as the oncogenicity of HCV in hepatocellular carcinoma.
INTERFERON THERAPY IN ALCOHOLIC PATIENTS WITH CHRONIC HEPATITIS C : Among alcoholic patients with chronic hepatitis C who remained abstinent during therapy with interferon, there was a significantly lower rate of HCV RNA clearance in those who consumed 70g/day of ethanol as compared to 70g/day up to the time of interferon therapy. - “Hepatitis C and Alcohol,” by E.R. Schiff, abstract submitted by the author to the National Institute of Health Conference on Hepatitis C, held March 24-26, 1997, in Bethesda, Maryland
An important cofactor of disease severity appears to be alcohol and alcohol should be avoided in those with chronic HCV infection.” - “Natural History and Clinical Aspects of HCV Infection.” H.J. Alter. Department of Transfusion Medicine, National Institutes of Health, Bethesda, Maryland. Cancer Biotechnology Weekly, 01-29-1996, pp 20.