QUICK REFERENCE #39: How does alcohol consumption impact the course and treatment of hepatitis C?

Hepatitis C is a liver disease caused by the hepatitis C virus (HCV). People usually become infected after coming in contact with blood from an infected person. Sharing needles or other equipment for injecting drugs is the most common way of spreading HCV. The disease also can be spread by sexual contact. About 4 million people in the United States have HCV, and between 10,000 and 12,000 die each year.

HCV infection is particularly common in alcoholics with liver disease. 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 the connection between alcohol consumption and liver disease progression in HCV patients is very limited.

Treatment Recommendations: Blood tests can diagnose HCV infection, either by detecting antibodies to the virus or by detecting the presence and quantity of the virus’s genetic material itself. There currently is no vaccine for hepatitis C. The standard treatment includes the use of antiviral treatment (interferon-alfa with ribavirin).

Strict abstinence from alcohol is important during treatment, as heavy drinking during treatment has been shown to hinder patients’ responses to therapy. In addition, depression, irritability, and anxiety—side effects that occur in 20 to 30 percent of patients who receive interferon treatment—may be especially difficult to manage in patients with a history of alcoholism, perhaps putting them at greater risk for relapsing to drinking. Thus, for treatment to be most successful, clinicians recommend that alcoholic patients abstain from drinking alcohol at least 6 months prior to beginning interferon therapy. Light-to-moderate drinkers can begin treatment immediately and do not need a period of abstinence before starting therapy.

SOURCE: Excerpted from Alcohol Alert (#64, January 2005), published by the National Institute on Alcohol Abuse and Alcoholism. The original text includes citations. The complete Alcohol Alert issue is available at
http://pubs.niaaa.nih.gov/publications/aa64/AA64.pdf.

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