Hepatitis Living With Heavy Drinking and Chronic Hepatitis C Questioning How Much Alcohol Is Safe By Charles Daniel Charles Daniel, MPH, CHES is an infectious disease epidemiologist, specializing in hepatitis. Learn about our editorial process Charles Daniel Medically reviewed by Medically reviewed by Jay N. Yepuri, MD, MS on September 24, 2020 facebook twitter linkedin Jay Yepuri, MD, MS, is board-certified in gastroenterology. He is a partner with Digestive Health Associates of Texas and a medical director at Texas Health Harris Methodist HEB Hospital. Learn about our Medical Review Board Jay N. Yepuri, MD, MS on September 24, 2020 Print It is well acknowledged that a person with chronic hepatitis C and a history of heavy alcohol abuse has an increased chance of developing advanced liver disease, including cirrhosis and hepatocellular carcinoma (a form of liver cancer). Both of these conditions work together to effectively promote the development, progression, and severity of liver disease. ipopba / Getty Images On its own, heavy alcohol intake can lead to a form of non-viral hepatitis called alcoholic hepatitis. When paired with viral hepatitis (in the form of either hepatitis B or hepatitis C), the impact on the liver can be exponentially increased. Hepatitis C has also been found to be more common in people with a history of alcohol abuse than among non-drinkers. While the reasons for this are not entirely clear, we do know two things: That alcohol and injecting drug use are strongly linked, and;That injecting drug use remains the predominant mode of hepatitis C transmission in the U.S. These associations highlight the need to address alcohol intake in all persons with chronic hepatitis C, whether symptomatic or not, as well as the need to address alcohol use whenever embarking upon a hepatitis C virus (HCV) prevention strategy, particularly among injecting drug users and other high-risk groups. Learn more about the risks associated with alcohol use and hepatitis C below. Increased Risk of Cirrhosis There is little doubt that people with chronic hepatitis C who drink alcohol have a higher chance of developing cirrhosis. From an epidemiological point of view, more than 90% of heavy drinkers (roughly defined as women who have more two drinks per day and men who have more than three drinks per day) will develop fatty liver disease, of which as many as 20% will develop liver cirrhosis within 10 to 20 years. Hepatitis C infection runs a similar course, with 75% of infected persons developing chronic disease, while 15-20% will progress to advanced disease within 10 to 30 years. The combination of these two factors speeds the process dramatically, as well as increasing the severity of liver damage—by some estimates, by as much as 200-300%. Furthermore, heavy alcohol users with HCV have a nearly 11-fold greater risk of developing cirrhosis than non-drinkers with HCV. Increased Risk of Hepatocellular Carcinoma Hepatocellular carcinoma (HCC) is the most common form of liver cancer in the U.S., and one of the more common complications of chronic hepatitis C infection. Even more so than liver cirrhosis, the association between alcoholism and HCC is strong, with 80% of HCC cases being identified as heavy alcohol users. The risk appears to increase with the amount a person drinks. One Italian study showed that the likelihood of HCC doubled when a person drank between 3.4 and 6.7 drinks per day. Similarly, studies have shown that heavy drinking can accelerate the development of HCC by as much as five years, resulting in not only larger tumors but far shorter survival times. Reduced Effectiveness of Peginterferon-Based Therapies While the drug peginterferon is used much less in modern HCV therapy, it is still common in cases where there has been previously failed treatment and/or a diagnosis of advanced liver disease. Ironically, it is often patients with a history of alcohol abuse who require peginterferon-based therapy. Alcohol interferes with the efficacy of peginterferon, resulting in a 300% risk of viral rebound (i.e., the return of virus) after completion of therapy. Surprisingly, the risk of failure was seen to be the same between both light and heavy drinkers when compared to non-drinkers with HCV. How Much Alcohol Is Safe? So far it is unclear how long a patient has to abstain from alcohol before the negative effects of alcohol abuse are reversed. It is for this reason that alcohol cessation (along with an alcohol treatment program, if needed) should be explored as part of a treatment plan for people with chronic HCV infection, particularly those with diagnosed with compensated or decompensated cirrhosis. Furthermore, patients who require peginterferon are recommended to abstain for at least six months before starting treatment and should be advised to abstain from further alcohol consumption for at least six months following completion of therapy. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Mueller, S.; Millonig, G.; and Seitz, H. "Alcoholic liver disease, and hepatitis C: A frequently underestimated combination." World Journal of Gastroenterology. July 28, 2009; 15(28):3462–3471. National Institutes of Health (NIH). "Hepatitis C and Alcohol." Bethesda, Maryland; published September 29, 2004.