Hepatitis C and Alcohol

By Schiff, Eugene R.; Ozden, Nuri | Alcohol Research, July 1, 2003 | Go to article overview

Hepatitis C and Alcohol


Schiff, Eugene R., Ozden, Nuri, Alcohol Research


Patients infected with the hepatitis C virus (HCV) who drink heavily are likely to suffer more severe liver injury, promoting disease progression to cirrhosis and increasing their risk for liver cancer. Some research, although not conclusive, suggests that even moderate drinking may spur liver damage in HCV-infected patients. Research areas that have the greatest potential for developing more effective treatment options include HCV virology, immunology, animal models, and the mechanisms of liver injury.

KEY WORDS: hepatitis C virus; alcoholic beverage; chronic AODE (alcohol and other drug effects); amount of AOD use; epidemiology; risk factors; disease course; alcoholic liver cirrhosis; gender differences; biochemical mechanism; RNA; mutation; apoptosis; inflammation; hepatocellular carcinoma; regulatory proteins; immune response; alcoholic fatty liver; treatment issues; treatment outcome; interferon

Hepatitis C is an infectious liver disease caused by the hepatitis C virus (HCV). The virus, which causes inflammation in the liver and can lead to more serious illness, primarily is spread by intravenous contact with the blood of an infected person. About 4 million people in the United States have been infected, making it the Nation's most common blood-borne disease, resulting in the deaths of between 10,000 and 12,000 people each year (National Institute of Diabetes and Digestive and Kidney Diseases 2003). Those at heightened risk for HCV infection include intravenous drug users, people who received blood transfusions or organ transplants before 1992 or clotting factors made before 1 987, health care workers who suffer needle-stick accidents, and infants born to mothers who are infected with HCV (Centers for Disease Control and Prevention 1998). Several factors may accelerate the progression of hepatitis C, including older age at the time of infection, male gender, obesity, abnormal accumulation of fat in the liver (a condition known as fatty liver, or steatosis), and excessive alcohol consumption (Poynard et al. 2001).

This article discusses the mechanisms by which alcohol may exacerbate HCV-infected patients' risk of disease progression, reviews issues in the treatment of alcoholic patients with HCV infection, and addresses important areas of future research.

EPIDEMIOLOGY OF HEPATITIS C AMONG ALCOHOLICS

Almost one-third of alcoholics with clinical symptoms of liver disease have been infected with HCV, which is four times the rate of HCV infection found in alcoholics who do not have liver disease (Coelho-Little et al. 1995; Mendenhall et al. 1991; Takase et al. 1993). As shown in figure I, people with more severe liver disease are considerably more likely to test positive for HCV infection than those with less severe liver disease (Takase et al. 1993).

LEVELS OF ALCOHOL CONSUMPTION IN HCV PATIENTS AND THE RISK OF FURTHER LIVER DISEASE

Several studies have indicated that heavy alcohol consumption accelerates patients' progression from chronic HCV to cirrhosis (a condition in which fibrous scar tissue replaces healthy liver tissue), and liver cancer (specifically, hepatocellular carcinoma, the most common form of liver cancer). Although fewer studies have examined the effects of moderate drinking on the course of liver disease in HCV patients, there is some indication that alcohol consumption in the moderate-to-heavy range may increase HCV-infected patients' risk of developing liver fibrosis and cirrhosis. Research on whether gender has any effect on alcohol consumption and liver disease progression in HCV patients is very limited.

Cirrhosis

In a study of 2,235 HCV-infected patients, Poynard and colleagues (1997) observed that patients who drank heavily (more than 50 grams [g] of alcohol, or 4.2 drinks, per day') tended to show much more advanced liver scarring (i.e., fibrosis, a defining feature of cirrhosis) than those who did not drink as heavily. In addition, the researchers identified a group of "rapid fibrosers," who were more likely to be male, heavy drinkers, and infected with HCV after age 40. …

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