Even with the high cure rates of new HCV drugs (DAAs), there might be liver damage that means alcohol is important to think about. Heavy drinking is known to be harmful to the liver, whether or not a person has HCV.
Alcohol intake in amounts over 50 grams per day for men and over 30 grams per day for women accelerates HCV progression.
Fifty grams is equivalent to four or five glasses of wine, 2-3 pints of beer or mixed drinks. Binge drinking is more harmful for your liver than moderate daily drinking.
Alcohol harms the liver by increasing both inflammation and scarring. Generally, the less you drink, the better for your liver, but no one has determined a safe amount for people with chronic HCV. Drinking less – or not at all – may be more important than treating HCV.
Alcohol increases hepatitis C viral load, which makes with peginterferon and ribavirin less effective.
This may be why studies using interferon (since replaced by a combination of peginterferon and ribavirin) reported that HCV treatment was not very effective for people who drink alcohol.
A few more recent studies have not reported much difference in HCV treatment outcomes among drinkers vs. non-drinkers with similar adherence. Nonetheless, many doctors will not treat people who consume alcohol.
Alcohol and liver damage
Alcohol is mainly broken down by the liver, but during this process by-products are produced that damage the liver more than the alcohol itself.
Prolonged inflammation from long-term alcohol use results in the over production of molecules called free radicals. These can destroy healthy liver tissue and subsequently impair liver function.
Alcohol can also disrupt the production of antioxidants, which defend the body against free radical damage. The combination of over-production of free radicals and loss of antioxidants can lead to liver damage.
Women may be more vulnerable to the damaging effect of alcohol than men.
Drinking less – or not at all – can be very difficult. Some people cut down or quit on their own, others find that support groups, counselling, and/or pharmacotherapy works best for them.
A list of resources to help with reducing alcohol is included below.
Tips for reducing alcohol
The following suggestions may help, whether you decide to drink less or quit drinking altogether
If you decide to stop completely:
- Don’t keep any alcohol at home.
- Avoid people, places or circumstances that trigger alcohol use, or develop a plan so that you are prepared and able to deal with the situation without alcohol.
- Remind yourself regularly about why you are giving up alcohol and the benefits it will bring.
- Try to keep your mind off alcohol, by involving yourself in other things, particularly at times when you usually have a drink.
If you decide to cut down:
- Monitor how much alcohol you drink. Be honest, even if the total seems unreasonable. Once you know where you are starting from it will be easier to measure or monitor improvements.
- If you are drinking alcohol, drink slowly and drink plenty of water or juice as well. Grapefruit juice is not recommended because of potential drug interactions, and citrus juices are not good if you have stomach acid problems.
- Drink with or after food as this slows down the absorption rate.
- Spread your alcohol intake over the whole week, rather than drinking heavily in one session.
Antidote is a drug and alcohol service for lesbian, gay, transgender and bisexual people, based in London with a national phoneline. 020 7833 1674 (10am-6pm, Monday to Friday). London Friend website. Antidote on FaceBook.
Alcoholics Anonymous (AA) has over 3,000 regional meeting places. The AA phoneline is 0845 769 7555 (10am-10pm, everyday) and their website is: www.alcoholics-anonymous.org.uk
Alcohol Concern can provide a wide range of information and advice. Contact details are 0207 395 4000 – www.alcoholconcern.org.uk
Drinkline is a national helpline that also provides information and advice on 0800 917 8282 (24 hour service).
Your doctor may also be able to refer you for help and support in giving up drinking.
Last updated: 17 August 2017.