for Veterans and the Public
Alcohol and Hepatitis: Entire Lesson
Alcohol is one of the most widely used and abused substances in the world. It is a potent toxin to the liver, even in people without hepatitis C infection. Excessive alcohol use can lead to cirrhosis of the liver, even liver cancer. Regardless of alcohol use, people with hepatitis C are at risk for cirrhosis of the liver. Hepatitis C impairs the liver's natural function of breaking down alcohol and removing toxic by-products. As a result, the toxins in alcohol are not removed completely and remain within the body, creating a toxic environment.
What happens to people with hepatitis C
For every 100 people infected with hepatitis C:
- 15 people get rid of the virus through their own immune system.
- 85 will develop chronic, or long-term, infection.
Of these 85 people:
- 66 will get only minor liver damage.
- 17 will develop cirrhosis and may have symptoms of advanced liver disease.
- 2 will develop liver cancer.
Which group you end up in (manageable liver disease, cirrhosis, or liver cancer) depends on many things, but it can be related to choices you make about your lifestyle.
Alcohol and fibrosis
Fibrosis is the medical term for scar tissue in the liver. Fibrosis is caused by infection, inflammation, or injury. It prevents the liver from working well.
Alcohol damages the liver, causing more fibrosis. In a person with hepatitis C, the damage caused by alcohol is even greater. Fibrosis eventually can lead to severe scarring (cirrhosis), especially when a person drinks heavily.
Alcohol and cirrhosis
Cirrhosis is severe scarring of the liver and is the end result of damage to liver cells. Cirrhosis can be caused by many things, including viral hepatitis or alcohol, or both.
How does alcohol affect cirrhosis?
Alcohol increases the damage done to the liver and speeds up the development of cirrhosis. Light drinkers or non-drinkers with hepatitis C (on average) have only moderate liver scarring, even up to 40 years after infection. Heavy drinkers--those who drink 5 or more drinks per day--develop scar tissue in their liver much more quickly. After about 25 years of hepatitis C infection, heavy drinkers show more than twice the scarring of light drinkers or non-drinkers. After 40 years of infection and heavy drinking, most heavy drinkers have developed cirrhosis.
What are the chances of getting cirrhosis?
In general, someone with hepatitis C has around a 20% chance of the fibrosis progressing all the way to development of cirrhosis. Alcohol use increases this chance severely. A heavy drinker with hepatitis C has 16 times the risk of cirrhosis that a non-drinker with hepatitis C has. Alcohol and hepatitis C both damage the liver, so together, the risk of serious liver damage (cirrhosis) is much higher than with either alone.
Alcohol use and viral load
The phrase "viral load" refers to the amount of a virus in the bloodstream. In this case, the virus is hepatitis C.
What does alcohol do to your viral load?
The more drinks a person has per week, the more virus he or she will tend to have. Why?
- Heavy alcohol use weakens the immune system, so the more you drink, the fewer resources you have to fight the hepatitis C virus.
- Alcohol is processed and broken down in the liver, so the harder the liver has to work to process alcohol, the more freedom the virus has to do damage.
Alcohol use and response to treatment
Will drinking alcohol change my response to treatment?
People who drink do not do as well on antiviral treatment as non-drinkers. A period of not drinking prior to treatment greatly increases the odds of treatment being effective.
- People who do not drink prior to starting antiviral treatment tend to have better response rates than people who do drink.
- In one study, researchers found that people who drank infrequently or not at all responded to antiviral treatment 3 times more often than heavy drinkers. Of 20 people who drank heavily prior to treatment, only 2 people cleared the virus. Drinkers may be more likely to have trouble sticking with antiviral treatment as prescribed.
What you can do
At present, no one knows if there is a safe level of alcohol for people with hepatitis C. The best advice is to not drink alcohol at all. This may be the hardest thing for you to do. If you drink more than 2 drinks in a day, or regularly drink 6 or 7 days a week, it's important to take steps to reduce how much you drink, until you can give up alcohol altogether.
There are resources to help you stop.
Alcohol Drinking Diary and Change Plan
To keep track of how much you drink, use a drinking diary. Every day record the number of drinks you have. At the end of the month, add up the total number of drinks you had during the week.
One way to make any kind of change in your behavior is to come up with a "Change Plan." This exercise has you list the specific goals you would like to achieve, outline the steps and challenges you will meet in reaching those goals, and figure out ways to overcome those challenges. (A Drinking Diary and Change Plan is included in the resources section.)
Tips for Cutting Back on Drinking
The National Institutes of Health offers the following tips to help people cut back on drinking:
Watch it at home.
Keep only a small amount or no alcohol at home. Don't keep temptations around.
When you drink, sip your drink slowly. Take a break of 1 hour between drinks. Drink soda, water, or juice after a drink with alcohol. Do not drink on an empty stomach! Eat food when you are drinking.
Take a break from alcohol.
Pick a day or two each week when you will not drink at all. Then, try to stop drinking for 1 week. Think about how you feel physically and emotionally on these days. When you succeed and feel better, you may find it easier to cut down for good.
Learn how to say NO.
You do not have to drink when other people drink. You do not have to take a drink that is given to you. Practice ways to say no politely. For example, you can tell people you feel better when you drink less. Stay away from people who give you a hard time about not drinking.
What would you like to do instead of drinking? Use the time and money spent on drinking to do something fun with your family or friends. Go out to eat, see a movie, or play sports or a game.
Cutting down on your drinking may be difficult at times. Ask your family and friends for support to help you reach your goal. Talk to your doctor if you are having trouble cutting down. Get the help you need to reach your goal.
Watch out for temptations.
Watch out for people, places, or times that make you drink, even if you do not want to. Stay away from people who drink a lot and avoid bars where you used to go. Plan ahead of time what you will do to avoid drinking when you are tempted.
Do not drink when you are angry or upset or have a bad day. These are habits you need to break if you want to drink less.
Do not give up!
Most people do not cut down or give up drinking all at once. Just like going on a diet, it is not easy to change. That is OK. If you do not reach your goal the first time, try again. Remember, get support from people who care about you and want to help. Do not give up!
Remember, the best advice is to avoid alcohol altogether.
- Hepatitis C and Alcohol
An easy-to-read color brochure detailing alcohol's effects on the liver and on hepatitis C infection and treatment.
- Drinking Diary Card and Change Plan
The Change Plan is a guide to help you achieve the specific goals you make. The Alcohol Drinking Diary is a chart for tracking how much you drink every day.