Alcohol and the Viral Hepatitis Patient

To review:
路 The extent of the problem
路 The role of alcohol in the progression/severity of viral hepatitis
路 The effects of alcohol on the treatment of viral hepatitis


Alcohol and the Liver:

路 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:

路 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)
路 HCV strongly associated with IVDA; however, up to 30% deny all risk factors

b) Alcohol and Viral Liver Damage:
i) Severity:
路 Biochemically:
? HCV + Ethanol increase the likelihood of elevated ALT more than HCV alone
路 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
路 Viremia:
– ? increased level of viremia with ethanol(1)
– One study found a 10-fold decrease in viral load with abstinence(2)

ii) Progression:
路 ? faster rate of progression to cirrhosis
路 Daily alcohol consumption of > 50 g/d was one of three independent risk factors in determining progression of HCV to cirrhosis(3)

iii) HCC:
路 Increased risk of HCC in HCV + ethanol vs HCV alone (mainly Japanese studies)
路 HCV + ethanol:
– increased rate of HCC recurrence after resection
– decreased post-op survival vs HCV alone(4)

iv) Overall Survival:
路 ? decreased overall survival in HCV + ethanol vs HCV alone(5)

c) Alcohol and Response to Antiviral Therapy in HCV:

路 HCV + ethanol decrease response to IFN which appears to be related to amount of ethanol intake(6)
路 Abstinence appears to restore responsiveness to IFN

Mark Swain, MD
Assistant Professor
Department of Medicine
University of Calgary
Foothills Hospital


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.

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