The negative effects of heavy drinking on the liver health and survival of people with hepatitis C are well-documented. Heavy drinking increases damage to the liver, leading to greater risk of cirrhosis and liver cancer (hepatocellular carcinoma).
But research on the effects of light or moderate drinking on hepatitis C disease progression have been less conclusive (download full article as a PDF file here). In the absence of clear answers, many doctors, educators, and people with hepatitis C advise total abstinence from alcohol if you have hepatitis C.
Yet veterans of the War on Drugs are instinctively wary of absolute, "Just Say No" messages. Harm reduction theory and practice originated in part from a recognition that total abstinence from substances was not always possible, necessary, or even perhaps desirable for many people. Is harm reduction an appropriate model for thinking about alcohol and hepatitis C? That depends on how you interpret the research.
A new study published in the March issue of Hepatology examines how different amounts of alcohol affect the progression of hepatitis C liver disease. The study compared the biopsy results of 800 people with hepatitis C to their reported histories of alcohol consumption, measured as average grams/day (with one drink containing 10 grams of alcohol). People were divided into four categories:
Non-drinkers -- no alcohol
Light drinkers -- up to 2 drinks per day
Moderate drinkers -- between 2 and 5 drinks per day
Heavy drinkers -- greater than 5 drinks per day
As expected, heavy drinkers had more fibrosis overall. There was a general trend showing greater fibrosis with increased amounts of alcohol, but these results were only considered statistically significant for heavy drinkers -- specifically, men who consumed on average over eight drinks a day. There was a substantial range of fibrosis within each category of alcohol consumption, and nearly half of heavy drinkers had little or no fibrosis. When all factors were considered, the most significant predictors of fibrosis were age (strongly associated with duration of hepatitis C infection, which averaged over 20 years), liver inflammation (as measured on biopsy), and ALT levels.
So what does this mean for people with hepatitis C? The headlines of two articles discussing the study reflect different interpretations:
from WebMD: "Bad Mix: Alcohol and Hepatitis C -- No Safe Alcohol Levels if You're Infected"
from HIVandHepatitis.com: "Light and Moderate Alcohol Intake May Have Minimal or No Effect on Fibrosis Development in HCV Infection"
Both perspectives are valid, and supported by the research. But they only tell part of the story. It seems that the effects of alcohol on hepatitis C progression can vary considerably, and in some cases other factors may be more important in determining fibrosis.
Coming next: translating research on alcohol into harm reduction.