Alcoholic liver disease and hepatitis C virus infection

Abstract

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.

EASL Clinical Practice Guidelines: Management of alcohol-related liver disease

“…85,112 Histological evaluation also aids in the diagnosis and assessment of liver injury in comorbid conditions. [113][114][115][116][117] Prognostic utility of histology Ballooning, MDBs, lobular polymorphs, canalicular and/or ductular cholestasis, fibrosis and megamitochondria have been described as independent predictors of short-term outcome in patients with AH. In addition, visible bile in canaliculi and/or ductular reaction also predicted bacterial infection and sepsis.…”

Treatment options for alcoholic and non-alcoholic fatty liver disease: A review

“…It has been reported that alcoholic patients with HCV infection have a 30 fold increased risk of getting cirrhosis[ 48 ] and two to eight fold increased risk of all-cause mortality compared with those without the HCV infection[ 49 , 50 ]. Thus, all ALD patients should be screened for HCV before starting treatment and all HCV patients should be advised to stop or reduce alcohol consumption[ 51 ].…”

Environmental Stress Causes Lethal Neuro-Trauma during Asymptomatic Viral Infections

“…This latter idea is unusual, as models of virus-induced disease sensitivity are thought to result from a productive viral infection that induces pathology (Jamieson et al, 2013; Novo-Veleiro et al, 2016). It should therefore be impossible to dissociate VSV infection from sensitivity to CO 2.…”

“…environmental chemicals) can also provoke disease symptoms in an infected individual. An example of this principle can be found from studies of subclinical hepatitis C virus infections, which result in life-threatening liver pathology when combined with alcohol consumption (Novo-Veleiro et al, 2016). While we have an increasing understanding of how virulent pathogens elicit homeostatic disruptions that cause disease directly, our knowledge of how asymptomatic infections poise a host for sensitivities to secondary stress is limited.…”