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

Abstract:

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

References:

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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