· The extent of the problem
· The role of alcohol in the progression/severity of viral hepatitis
· The effects of alcohol on the treatment of viral hepatitis
Alcohol and the Liver:
· Alcohol stresses the liver by disorganizing cellular lipids, altering the liver cells ability to deal with other toxins and by leading to the production of a toxic and reactive compound (acetaldehyde)
Alcohol and Viral Hepatitis:
a) Viral Markers in Alcoholics:
· There is an increased incidence of HBV and HCV markers in alcoholics (all HBV markers in up to 49% and HCV up to 41%; by RIBA or RNA)
· HCV strongly associated with IVDA; however, up to 30% deny all risk factors
b) Alcohol and Viral Liver Damage:
? HCV + Ethanol increase the likelihood of elevated ALT more than HCV alone
· Liver Bx:
– HCV + Ethanol (>80 g/d) increases hepatic iron levels
– histology of HCV + Ethanol mainly that of HCV
– HCV + Ethanol increases likelihood of more severe disease on liver Bx
– ? increased level of viremia with ethanol(1)
– One study found a 10-fold decrease in viral load with abstinence(2)
· ? faster rate of progression to cirrhosis
· Daily alcohol consumption of > 50 g/d was one of three independent risk factors in determining progression of HCV to cirrhosis(3)
· Increased risk of HCC in HCV + ethanol vs HCV alone (mainly Japanese studies)
· HCV + ethanol:
– increased rate of HCC recurrence after resection
– decreased post-op survival vs HCV alone(4)
iv) Overall Survival:
· ? decreased overall survival in HCV + ethanol vs HCV alone(5)
c) Alcohol and Response to Antiviral Therapy in HCV:
· HCV + ethanol decrease response to IFN which appears to be related to amount of ethanol intake(6)
· Abstinence appears to restore responsiveness to IFN
Mark Swain, MD
Department of Medicine
University of Calgary
1. Oshita M, Hayashi N, Kasahara A, et al. Increased serum hepatitis C virus RNA levels among alcoholic patients with chronic hepatitis C. Hepatology 1994;20(5):1115-20.
2. Sata M, Fukuizumi K, Uchimura Y, et al. Hepatitis C virus infection in patients with clinically diagnosed alcoholic liver diseases. J Viral Hepat 1996;3(3):143.
3. Poynard T, Bedossa P, Opolon P. Natural history of liver fibrosis progression in patients with chronic hepatitis C. Lancet 1997;349:825-32.
4. Okada S, Ishii H, Nose H, et al. Effect of heavy alcohol intake on long-term results after curative resection of hepatitis C virus-related hepatocellular carcinoma. Jpn J Cancer Res 1996;87(8):867-73.
5. Takase S, Tsutsumi M, Kawahara H, Takada N, Takada A. The alcohol-altered liver membrane antibody and hepatitis C virus infection in the progression of alcoholic liver disease. Hepatology 1993;17(1):9-13.
6. Okazaki T, Yoshihara H, Suzuki K, et al. Efficacy of interferon therapy in patients with chronic hepatitis C. Comparison between non-drinkers and drinkers. Scand J Gastroenterol 1994;29(11):1039-43.