Hepatitis C and alcohol

A close relationship and possible interaction has been noted between alcoho l intake and hepatitis C virus infection, since the discovery of HCV marker s. It is not understood whether these are additive or synergistic effects i n causing liver injury. Interactions between alcohol and HCV may be studied at several levels, including epidemiology, virology (including viral load) , histology (effect on the severity of liver lesions), carcinogenesis (the role of alcohol in the occurrence of hepatocellular carcinoma), and the eff ect on the extrahepatic manifestations or severity of HCV infection. At the epidemiological level, a high prevalence of HCV infection was noted in patients with alcoholic liver diseases (14-37%), also characterized by a high rate of viral replication as detected by PCR, which was present in ov er 90% of patients tested. Moreover, the prevalence of anti-HCV antibodies increased proportionally with the severity of liver lesions. Virological an alysis based on the determination of HCV RNA levels in the serum showed var iations of HCV RNA levels with diet, and a clear relationship between self reported alcohol consumption and the levels of serum HCV RNA (r=.26, p=.001 ). At the histologic level the role of alcohol may be evaluated either thro ugh the development of fibrosis or by determination of the incidence of cir rhosis. A study on the effect of alcohol intake below or over 40 g per day on the histologic progression of liver lesions has confirmed a more rapid i ncrease in fibrosis and a doubling in the incidence of cirrhosis in patient s admitting to alcohol consumption >40 g per day. The role of alcohol in th e occurrence of hepatocellular carcinoma in patients with cirrhosis due to HCV infection has been extensively studied with controversial results. A re cent case control study performed in Italy showed that the relative risk of HCC in patients with HCV infection and heavy alcohol consumption doubled. Finally, alcohol consumption potentially worsens the evolution of dermatolo gical diseases associated with HCV infection such as porphyria cutanea tard a. All of the above are strong arguments which should be used to advise HCV pa tients against alcohol consumption, regardless of the degree of liver injur y. However, the deleterious effect of the occasional intake of small amount s of alcohol has not been demonstrated and therefore an occasional drink ma y be allowed in some cases.