Published online Jan 28, 2016. doi: 10.3748/wjg.v22.i4.1411
Peer-review started: May 6, 2015
First decision: August 31, 2015
Revised: October 1, 2015
Accepted: November 30, 2015
Article in press: December 1, 2015
Published online: January 28, 2016
Alcohol consumption and hepatitis C virus (HCV) infection have a synergic hepatotoxic effect, and the coexistence of these factors increases the risk of advanced liver disease. The main mechanisms of this effect are increased viral replication and altered immune response, although genetic predisposition may also play an important role. Traditionally, HCV prevalence has been considered to be higher (up to 50%) in alcoholic patients than in the general population. However, the presence of advanced alcoholic liver disease (ALD) or intravenous drug use (IDU) may have confounded the results of previous studies, and the real prevalence of HCV infection in alcoholic patients without ALD or prior IDU has been shown to be lower. Due to the toxic combined effect of HCV and alcohol, patients with HCV infection should be screened for excessive ethanol intake. Patients starting treatment for HCV infection should be specifically advised to stop or reduce alcohol consumption because of its potential impact on treatment efficacy and adherence and may benefit from additional support during antiviral therapy. This recommendation might be extended to all currently recommended drugs for HCV treatment. Patients with alcohol dependence and HCV infection, can be treated with acamprosate, nalmefene, topiramate, and disulfiram, although baclofen is the only drug specifically tested for this purpose in patients with ALD and/or HCV infection.
Core tip: Alcohol favors hepatitis C virus (HCV) replication and diminishes immune response against it, increasing the risk of advanced liver disease. HCV infection prevalence among alcoholics, initially thought to be much higher (up to 50%) than in the general population, has been reported to be lower in recent studies. Intravenous drug use and advanced alcoholic liver disease may confound the prevalence of HCV infection among alcoholics. Before starting HCV infection treatment, patients should be screened for alcohol use disorder and abstinence should be achieved. Baclofen may be the drug of choice for patients with alcohol dependence and advanced liver disease.