Drinking alcohol when you have hepatitis C can be a dangerous combination, since both negatively affect the liver. The hepatitis C virus, or HCV, causes inflammation that damages and kills liver cells. Over decades, this damage can progress to cirrhosis and liver failure. Not everyone with hepatitis C develops these problems, but drinking alcohol can increase your chances. Alcohol is primarily metabolized by the liver and can cause toxic effects and inflammation. When you have hepatitis C, drinking alcohol -- even in small amounts -- can compound the damaging effects of HCV, increasing the risks for liver scarring, cirrhosis, liver cancer and even death.
Increased Liver Inflammation
Hepatitis C causes inflammation in the liver, triggered by the virus attacking liver cells and the immune system response as it attempts to rid the body of the virus. Alcohol -- especially when consumed in large amounts -- can also inflame liver cells. So drinking alcohol with hepatitis C causes added liver inflammation, which can accelerate hepatitis C-related liver damage and increase the risk for long-term complications.
Increased Liver Scarring
Ongoing inflammation caused by HCV can lead to the formation and accumulation of scar tissue in the liver, a process called fibrosis. This scar tissue replaces healthy liver tissue, which can lead to severe complications over time. Doctors have long known that people with HCV who drink heavily develop more severe liver scarring compared to those who abstain. More recent research shows that even moderate drinking can be risky. A February 2014 study published in "Clinical Infectious Diseases" found a 30 percent increased risk of advanced liver fibrosis among people with hepatitis C who drank occasionally and not to excess. The risk increased with greater alcohol use, with binge and excessive drinkers having a greater than 9-fold risk of advanced fibrosis.
Increased Risk of Cirrhosis
Liver scarring can lead to cirrhosis, a condition wherein heavy scarring distorts the liver and might lead to liver failure. Five to 20 percent of people with hepatitis C eventually develop cirrhosis, according to the Centers for Disease Control and Prevention. Heavy drinking can also cause cirrhosis. Several studies have demonstrated that hepatitis C combined with drinking alcohol increases the likelihood of developing cirrhosis. For example, a study published in September 1998 in "Hepatology" found a 2- to 3-fold greater risk of cirrhosis development in people with HCV who drank heavily. In this study, heavy drinking was defined as 5 or more years of consuming 3 or more drinks per day for women and 4 or more for men. Cirrhosis also developed more quickly in heavy drinkers.
Increased Risk of Liver Cancer
HCV is a known cancer-causing substance, or carcinogen. People who have the virus have an increased risk of developing liver cancer, especially if there is advanced liver fibrosis or cirrhosis. Drinking alcohol also increases the likelihood of developing cirrhosis, which predisposes to liver cancer development and independently raises the risk for liver cancer as well. Therefore, people with hepatitis C have two factors acting together to increase their risk for liver cancer. An Italian study published in the "American Journal of Epidemiology" in February 2002 found that consuming more than 4 alcoholic drinks per day doubled the risk of developing liver cancer in people with hepatitis C, compared to lighter drinking or abstaining.
Increased Risk of Death
Hepatitis C can lead to death, either due to advanced cirrhosis with liver failure or the development of liver cancer. Between 1 and 5 percent of people with hepatitis C will die of the disease, according to CDC. Drinking alcohol can increase this risk. The authors of an April 2013 study published in "Alimentary Pharmacology & Therapeutics" found that moderate drinking -- 1 to 2 drinks per day -- increased the risk of overall and liver-related death in people with hepatitis C. The risk was even higher among heavy drinkers.
Warnings and Next Steps
Given the wide range of risks associated with drinking alcohol, the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America recommend that people with hepatitis C avoid alcohol entirely.
It's not clear if drinking alcohol reduces the effectiveness of hepatitis C treatment with direct-acting antivirals. But ongoing drinking might negatively affect the likelihood of getting a liver transplant, which may be needed if the infection progresses to liver failure or liver cancer develops. If you're having trouble eliminating alcohol or controlling your drinking, talk with your doctor about getting help.
- AASLD/IDSA/IAS–USA: Recommendations for Testing, Managing, and Treating Hepatitis C: HCV Testing and Linkage to Care
- Alcohol Research & Health: Hepatitis C and Alcohol
- National Institute on Alcohol Abuse and Alcoholism: Alcohol and Hepatitis C
- National Institute on Alcohol Abuse and Alcoholism: Overview: How Is Alcohol Metabolized by the Body?
- Journal of Hepatology: Chronic Hepatitis C: Effect of Alcohol on Hepatic Activity and Viral Titre
- Clinical Infectious Diseases: Relationship Between Alcohol Use Categories and Noninvasive Markers of Advanced Hepatic Fibrosis in HIV-Infected, Chronic Hepatitis C Virus–Infected, and Uninfected Patients
- Centers for Disease Control and Prevention: The ABCs of Hepatitis
- Alimentary Pharmacology & Therapeutics: Moderate, Excessive or Heavy Alcohol Consumption: Each Is Significantly Associated With Increased Mortality in Patients With Chronic Hepatitis C
- Hepatology: Impact of Alcohol on the Histological and Clinical Progression of Hepatitis C Infection
- American Journal of Epidemiology: Alcohol and Hepatocellular Carcinoma: The Effect of Lifetime Intake and Hepatitis Virus Infections in Men and Women