for Health Care Providers
Hepatitis C and Alcohol: A Clinician's Perspective
An important perspective on the alcohol and hepatitis C issue is that alcohol intake is the one thing that patients with hepatitis C can alter that may reduce the progression to serious liver disease. Other variables in disease progression, such as gender, age and immunologic response cannot be altered.
Should I tell my patient with chronic hepatitis C that he/she shouldn't drink alcohol?
Answer: Yes. Despite the lack of conclusive information about the exact quantity of alcohol that is harmful to patients with HCV infection, there is substantial evidence that alcohol consumption worsens liver injury associated with HCV disease. Therefore, it remains important to discuss the potential effects alcohol may have on your HCV-infected patient. Every patient with hepatitis C infection needs to be counseled about the value of abstinence from alcohol.
What should I advise my patient who only drinks alcohol once per week or less?
Answer: No amount of alcohol has been shown to be safe for your patient. The evidence is not as clear for the individual who drinks alcohol once per week or less, but variables such as gender, ethnicity, and body frame may influence disease progression even with minimal amounts of alcohol consumption. Insufficient data are available to answer this question conclusively for patients who only drink a few drinks per week. Based on current knowledge, no amount of alcohol ingestion can be considered "safe" for hepatitis C patients.
Should I wait until my actively drinking patient has been abstinent for 6 months or more before performing a liver biopsy or initiating anti-HCV therapies?
Answer: Practitioners disagree on this issue. However, in general, actively drinking patients may have more hepatic inflammation than non-drinkers. Therefore, in order to obtain an accurate assessment of HCV-related fibrosis and inflammation when performing a liver biopsy, it is advisable to wait until the patient has been abstinent for some time. However, the optimal duration of abstinence has not been defined. Liver tests may also improve with alcohol abstinence, leading to reduced urgency for biopsy or treatment in the active alcoholic. In addition, active alcohol use increases HCV RNA levels and may reduce response to therapy, so abstinence prior to therapy seems to be an appropriate recommendation.