Addiction Recovery Basics

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 (1).

HCV infection is particularly common in alcoholics with liver disease (2–4). 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) (5). 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 cirrhosis and fibrosis (6). 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 (7). There currently is no vaccine for hepatitis C. The standard treatment includes the use of antiviral treatment (interferon-alfa with ribavirin) (7).

Strict abstinence from alcohol is important during treatment, as heavy drinking during treatment has been shown to hinder patients’ responses to therapy (8). 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 (9). 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.

References:

(1) National Institute of Diabetes and Digestive and Kidney Diseases. Chronic Hepatitis C: Current Disease Management. Online at: http: //digestive.niddk.nih.gov/ddiseases/pubs/chronichepc/index.htm. Accessed 2003. (2) Coelho-Little, M.E.; Jeffers, L.J.; Bernstein, D.E.; et al. Hepatitis C virus in alcoholic patients with and without clinically apparent liver disease. Alcoholism: Clinical and Experimental Research 19(5):1173–1176, 1995. (3) Mendenhall, C.L.; Seeff, L.; Diehl, A.M.; et al. Antibodies to hepatitis B virus and hepatitis C virus in alcoholic hepatitis and cirrhosis: Their prevalence and clinical relevance. The VA Cooperative Study Group (No. 119). Hepatology 14:581–589, 1991. (4) Takase, S.; Takada, N.; Sawada, M.; et al. Relationship between alcoholic liver disease and HCV infection. Alcohol and Alcoholism (Suppl. 1A):77–84, 1993. (5) Schiff, E., and Ozden, N. Hepatitis C and alcohol. Alcohol Research & Health 27(3): 232–239, 2003. (6) Hézode, C.; Lonjon, I.; Roudot-Thoraval, F.; et al. Impact of moderate alcohol consumption on histological activity and fibrosis in patients with chronic hepatitis C, and specific influence of steatosis: A prospective study. Alimentary Pharmacology and Therapeutics 17(8):1031–1037, 2003. (7) National Institutes of Health. National Institutes of Health Consensus Development Conference statement: Management of hepatitis C: 2002—June 10–12, 2002. Hepatology 36(5 Suppl. 1):S3–20, 2002. (8) Mochida, S.; Ohnishi, K.; Matsuo, S.; et al. Effect of alcohol intake on the efficacy of interferon therapy in patients with chronic hepatitis C as evaluated by multivariate logistic regression analysis. Alcoholism: Clinical and Experimental Research 20(Suppl. 9):371A–377A, 1996. (9) Zdilar, D.; Franco-Bronson, K.; Buchler, N.; et al. Hepatitis C, interferon alfa, and depression. Hepatology 31(6):1207–1211, 2000.

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