Literature Review on Alcohol and Hepatitis

Hepatitis C Virus Testing of Persons Born During 1945–1965: Recommendations From the Centers for Disease Control and Prevention. CDC. Anals of Internal Medicine. The CDC  recommends that all infected persons receive alcohol screening and counseling as indicated. Brief alcohol screenings are effective in reducing alcohol use and maintaining that reduction for 1 year or more. Because alcohol is known to accelerate progression of HCVassociated liver disease (27), screening to evaluate the level of alcohol consumption followed by counseling to reduce or cease alcohol use can avoid this acceleration. Screening tools shown to be effective in eliciting history of alcohol use from patients include the Alcohol Use Disorders Identification Test and are available from the National Institute on Alcohol Abuse and Alcoholism (http://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/clinicians_guide.htm). The World Health Organization has published intervention tools to help patients reduce alcohol use (www.who.int/substance_abuse/activities/sbi /en/index.html). Although the screening and intervention may be uncomfortable or cause anxiety, the benefits of alcohol reduction for persons with HCV infection outweigh those harms. Finally, the CDC recommends that all infected persons receive medical care (for example, hepatitis A and B virus vaccinations as needed and medical monitoring of disease progression), but detailed care and treatment recommendations are beyond the scope of these guidelines. The patient and provider should make treatment decisions considering such factors as disease stage, genotype, comorbid conditions, and adverse events of therapy.

Moderate, excessive or heavy alcohol consumption: each is significantly associated with increased mortality in patients with chronic hepatitis C.  Z. M. Younossi.  Alimentary Pharmacology & Therapeutics. Volume 37, Issue 7, pages 703–709, April 2013.
The impact of moderate alcohol consumption on long-term outcomes of CH-C patients using population-based data was assessed. Although chronic hepatitis C is associated with increased risks for overall and liver-related mortality, these risks are even higher for patients consuming moderate and excessive amounts of alcohol.

Alcohol and viral hepatitis: a mini-review.  S. Gitto. Digestive and Liver Disease. Volume 41, Issue 1, January 2009, Pages 67–70.
Alcohol use and abuse can be associated with hepatitis B and C virus infections and it has been demonstrated that alcohol plays a role as a co-morbid factor in the development of liver disease. There is evidence that alcohol accelerates the progression of liver fibrosis and affects the survival of patients with chronic hepatitis C. Abstinence could reverse some of these deleterious effects.

Management of alcoholic hepatitis: Current concepts.  Hetal A Karsan. World J Hepatol. 2012 December 27; 4(12): 335–341.
The primary and most effective intervention for alcoholic hepatitis is complete abstinence from alcohol consumption. Abstinence is the single most important factor in the prevention of disease progression and can improve survival.

High prevalence of alcohol use among hepatitis C virus antibody positive injection drug users in three US cities. Jennifer V. Campbell. Drug Alcohol Depend. 2006 February 28; 81(3): 259–265.
Approaches to eliminate drinking in this population need to address underlying reasons for continued alcohol use and not simply increase awareness of its consequences, as there is a clear disconnect between knowledge and drinking behavior.

Hepatitis B and C virus and alcohol-induced liver injury. Jack R. Wands M.D. Hepatology. Volume 14, Issue 4, pages 730–733, October 1991.
Alcohol when consumed in large quantities is associated with acute and chronic liver injury.  With cessation of alcohol intake hepatic disorders are reversible.

Liver transplantation for alcoholic liver disease.  Vibha Varma. World J Gastroenterol. 2010 September 21; 16(35): 4377–4393.
Alcoholic liver disease (ALD) is the second most common indication for liver transplantation after viral hepatitis in the United States and Europe.

Natural history of liver fibrosis progression in patients with chronic hepatitis C. The OBSVIRC, METAVIR, CLINIVIR, and DOSVIRC groups. Poynard T. Lancet. 1997 Mar 22;349(9055):825-32.
The host factors of ageing, alcohol consumption, and male sex have a stronger association with fibrosis progression than virological factors in HCV infection.

Hepatitis C and alcohol. Schiff ER. Hepatology. 1997 Sep;26(3 Suppl 1):39S-42S.
Chronic alcoholism in patients with chronic hepatitis C appears to cause more severe and rapidly progressive liver disease leading more frequently to cirrhosis of the liver and hepatocellular carcinoma.

Liver disease in alcohol and hepatitis C. Jamal MM. Best Pract Res Clin Gastroenterol. 2003 Aug;17(4):649-62.
The prevalence of hepatitis C is 7-10-fold higher in alcoholics than it is in the general population. Among alcoholics, the prevalence of hepatitis C is higher in alcoholics with advanced liver disease.  Recent alcohol use decreases the response rate to interferon treatment.

Symptoms and signs of acute alcoholic hepatitis.Gurjot Basra.  World J Hepatol. 2011 May 27; 3(5): 118–120.
Although there is not one specific sign or symptom related to alcoholic hepatitis (AH), a constellation of symptoms and signs can help make the diagnosis of AH with reasonable accuracy. Documentation of chronic and active alcohol abuse is paramount in making a diagnosis of AH. Clinical presentation after abstinence for more than 3 m should raise doubts about the diagnosis of AH and dictate the need for considering other causes of liver disease, decompensation of alcoholic cirrhosis, sepsis and malignancy as the cause of patient’s clinical profile.